Falls in Older Adults

A fall is an event, not a diagnosis. In an older adult, it may reflect the interaction of sarcopenia, slowed postural reflexes, impaired gait or balance, visual or vestibular decline, neuropathy, cognitive impairment, orthostatic blood-pressure dysregulation, urgency, medications, footwear, assistive devices, and the home environment. Several modest vulnerabilities can combine to produce a major event even when no single abnormality seems dramatic. Risk behaves less like one broken component and more like a system with little reserve: a sedating sleep medication, a small postural blood-pressure drop, and a poorly lit bathroom may each be tolerated alone but become hazardous together. This is why correcting only one factor often underperforms a coordinated intervention in a high-risk patient. The immediate task is twofold: identify injury or an acute medical cause, then reduce the probability of a second fall. Approximately one in four community-dwelling adults aged 65 and older reports a fall each year, and falls are the leading cause of injury-related death in this age group in the United States. An 82-year-old who falls after rising at night may have urgency, zolpidem...