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Falls in older adults
A fall in an older adult almost always results from several factors acting together — balance, strength, medications, blood pressure, vision and the environment — so a person at high risk receives a multifactorial assessment and a plan that addresses each factor, centred on exercise for balance and strength.
Why it matters in the exam
The exam presents an older adult who fell and asks for the next step: measure lying and standing blood pressure, review fall-risk-increasing drugs, perform a gait test, or refer for balance training. Candidates need to know who is high risk (a fall with injury, two or more falls in a year, inability to get up from the floor, frailty, suspected syncope) and which interventions are proven.
Recurring points: balanced exercise (balance and strength, such as Tai Chi or the Otago programme) is the most effective intervention; vitamin D reduces falls only in people who are deficient and is not given routinely; first-eye cataract surgery and a home assessment by an occupational therapist both reduce falls; and benzodiazepines, sedatives and antihypertensives are common culprits.
Falls are a leading cause of fractures, head injuries, admission and moving into an institution, and about a third of people aged 65 and over in the community fall every year. The exam also asks about a fall of a hospitalised patient: the first step (examination for injury, including head injury in a patient on anticoagulants), and how to prevent the next fall — supervised walking, suitable shoes, night lighting, help to the toilet and fewer sedatives. A "long lie on the floor" after a fall is dangerous in itself: dehydration, muscle breakdown and pressure injuries.
Key points
- Screening: a fall in the past year, fear or unsteadiness.
- High risk → multifactorial assessment and an individual plan.
- Balance and strength exercise is the central intervention.
- Review medications; check orthostatic blood pressure; cataract surgery and home assessment.
- Vitamin D only when deficient; after a fall — assess for osteoporosis.
Summary table
| Step | What is checked or done | Exam point |
|---|---|---|
| Screening | A fall in the past year, fear of falling, feeling unsteady | One question at every routine visit |
| High risk | Fall with injury, 2 or more falls in a year, a long lie on the floor, frailty, suspected syncope | Multifactorial assessment |
| Assessment | Gait (TUG), orthostatic blood pressure, medications, vision, feet and footwear, cognition, home | Orthostatic hypotension = systolic fall ≥20 mmHg or diastolic fall ≥10 mmHg by 3 minutes of standing |
| Proven interventions | Balance and strength training, medication reduction, cataract surgery, home assessment | Exercise is the foundation |
| Not recommended routinely | Vitamin D for everyone, restricting movement, restraints | Restraints increase injuries |
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Sources
- World guidelines for falls prevention and management for older adults (World Falls Task Force), 2022 — Risk stratification, assessment and interventions
- Geriatrics Review Syllabus (American Geriatrics Society), 11th edition (2022) — Falls
- NICE guideline — Falls in older people: assessing risk and prevention, CG161 (2013) — Multifactorial assessment and intervention
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.