Falls in Older Adults

A fall is not a diagnosis; it is a signal that the patient’s physiologic reserve, environment, or both no longer reliably support safe mobility. Falls are the leading cause of injury-related death among US adults aged 65 years and older, and both fall-related deaths and emergency department visits have increased markedly over the past decade. The event deserves a clinical evaluation even when the patient describes it as a simple trip. The useful model is interaction, not a single culprit. Gait and balance impairment, lower-extremity weakness, sarcopenia, sensory loss, cognitive change, delirium, orthostatic hypotension, arrhythmia, neuropathy, foot pain, depression, fear of falling, and malnutrition can combine with sedating medications, poor footwear, an incorrectly fitted device, or a loose rug. A modest environmental challenge can become dangerous when several small intrinsic deficits converge. The immediate task is to find injury or a dangerous medical trigger. The next task is to classify recurrence risk and reduce modifiable contributors while preserving activity and independence.