Falls are a common health concern facing older people. An estimated one-third of older people aged ˃65 years who live in the community, half of older people aged ˃65 years who live in residential aged care facilities (RACFs), and half of older people aged ˃80 years in both the community and RACFs will fall each year.2 Falls are more prevalent in people with dementia, especially those with Parkinson’s dementia (refer to Part A. Dementia). Almost half of those who experience a fall will have a repeat fall within the next year. Injuries are higher due to the prevalence of underlying disease and reduced physiological reserve in older people. It is important to ask patients if they have experienced ‘near falls’ as well as falls.
A significant proportion of falls (40–60%) leads to injury, and a further 10–15% leads to serious injury, which may include hip fracture. Hip fracture has a significantly associated mortality rate – 10% die within a month, 20% within six months and 33% within a year.2 Only a small number of older patients (~20%) regain full mobility after a fall.
Older people who fall are at risk of a ‘long lie’ because of the inability to get up from the fall without assistance, which can result in hypothermia, bronchopneumonia, dehydration, pressure injuries, rhabdomyolysis and, in some instances, death.
Falls are associated with a loss of confidence, functional decline, social withdrawal, anxiety and depression (refer to Part A. Mental health), increased use of medical services, and a fear of falling. An older person is at greater risk of institutionalisation following a fall.
Most falls are due to multiple interactions between an individual with a propensity to fall and other mediating factors.3,4 A recent Cochrane Review has found that a multi-component intervention may not be better than exercise alone for older people living in the community.5 However, it is widely acknowledged that there is a wide range of contributing factors to prevent falls, and a multi-component intervention may be necessary when appropriate.
- Advanced age
- Central processing problems
- Cognitive impairment
- Vascular dementia and Lewy body dementia (greater risk due to gait disturbance)
- Gait and balance disturbance
- Parkinson’s disease
- Parkinson-like syndromes (eg progressive supranuclear palsy, multiple system atrophy, Lewy body dementia)
- Muscle weakness
- Chronic pain (refer to Part A. Pain)
- Proximal myopathy (eg hypothyroidism)
- Vision impairment
- Poor visual acuity
- Poor depth perception
- Poor contrast sensitivity
- Need for rapid adjustment to vision, bifocal or multifocal lenses
- Orthostatic hypotension
- Neurocardiogenic syncope
- Valvular heart disease
- History of falls
- Age – ≥80 years are particularly at risk
- Female sex
- Urinary incontinence (refer to Part A. Urinary incontinence)
- Fear of falling
- Inappropriate footwear
- Inappropriate clothing
- Physical and/or chemical restraint (refer to Part A. Behavioural and psychological symptoms of dementia)
- Cluttered environment
- Poorly lit environment
- Alcohol use
- Household pets
- Taking more than three medications (refer to Part A. Medication management), particularly
- Class 1A antiarrhythmic medications