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INTRODUCTION

Falls are a major cause of morbidity and mortality in the geriatric population. Close to one-third of those aged 65 years and older living at home suffer a fall each year. Among nursing home residents, as many as half suffer a fall each year; 10% to 25% cause serious injuries. Accidents are the fourth leading cause of death in persons older than age 65, and falls account for two-thirds of these accidental deaths. Of deaths from falls in the United States, more than 70% occur in those older than age 65. Fear of falling can adversely affect older persons’ functional status and overall quality of life. An injurious fall sets off a chain of events including emergency department care, hospitalization, surgical intervention, and prolonged immobility. Repeated falls and consequent injuries can be important factors in the decision to institutionalize an older person.

Table 9-1 lists potential complications of falls. Fractures of the hip, femur, humerus, wrist, and ribs and painful soft tissue injuries are the most frequent physical complications. Many of these injuries will result in hospitalization, with the attendant risks of immobilization and iatrogenic illnesses (see Chapter 10). Fractures of the hip and lower extremities often lead to prolonged disability because of impaired mobility. A less common, but important, injury is subdural hematoma. Neurological symptoms and signs that develop days to weeks after a fall should prompt consideration of this treatable problem.

TABLE 9-1.Complications of Falls in Older Patients

Even when the fall does not result in serious injury, substantial disability may result from fear of falling, loss of self-confidence, and restricted ambulation (either self-imposed or imposed by caregivers).

Many studies suggest that some falls can be prevented. The potential for prevention, together with the use of falling as an indicator of underlying risk for disability make understanding the causes of falls and a practical approach to the evaluation and management of gait instability and fall risk important components of geriatric care. Like many other conditions in the geriatric population, multiple factors can contribute to or cause falls, and very often more than one of these factors play an important role in an individual fall (Fig. 9-1). Some of these factors are intrinsic to the individual, such as medical and neurological conditions, sensory impairment, and age-related changes in neuromuscular function, reflexes, and gait. Others are extrinsic to the individual, such as medications, improper footwear or use of assistive devices, ...

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