Does experiencing multiple falls per year increase the risk of death in an elderly person?

Multiple Falls Per Year Significantly Increase Mortality Risk in Elderly Persons

Yes, experiencing multiple falls per year substantially increases the risk of death in elderly persons, with falls being the leading cause of injury-related death among adults aged 65 and older. 1, 2

Mortality and Morbidity Impact

Falls are directly associated with considerable mortality in the elderly population. 1 The American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons explicitly state that falling is associated with considerable mortality, morbidity, reduced functioning, and premature nursing home admissions. 1

Key Mortality Statistics:

• Falls resulted in approximately 32,000 deaths among older adults in 2018 in the United States alone. 3
• Deaths from falls are increasing, with the largest increases occurring among persons aged ≥85 years. 3
• Falls are the leading cause of injury-related death in persons aged 65 years or older. 2
• In the USA, falls are the leading cause of injury-related death among persons aged 65 and over. 1

The Critical Distinction: Multiple Falls vs. Single Falls

With two or more falls per year, the risk of complications—including death—increases significantly. 4 This is a crucial clinical threshold that demands immediate comprehensive assessment and intervention. 4

Why Multiple Falls Are More Dangerous:

• Among elderly persons who have suffered a fall episode, 20-30% develop complications in the form of injuries, which further increase the risk of premature death. 4
• A history of falls is itself one of the strongest risk factors for future falls, with a relative risk of 3.0 (range 1.7-7.0). 1
• The risk of falling increases dramatically as the number of risk factors increases, demonstrating synergistic effects. 1

Mechanisms of Increased Mortality Risk

The combination of high fall incidence and high susceptibility to injury creates the mortality risk, not simply the falls themselves. 1 This propensity for fall-related injury stems from:

• High prevalence of comorbid diseases (e.g., osteoporosis) 1
• Age-related physiological decline (e.g., slower reflexes) that makes even relatively mild falls potentially dangerous 1
• Approximately 5% of older people who fall require hospitalization 1

Serious Injury Patterns:

• 10% to 25% of institutional falls result in fracture, laceration, or need for hospital care 1
• More than 950,000 hospitalizations or transfers to another facility resulted from fall-related injuries in 2018 3
• An estimated 3 million emergency department visits occurred due to falls in 2018 3

Clinical Implications and Risk Stratification

Every fourth elderly person faces a fall annually, with about half seeking medical help. 4 However, the presence of multiple falls per year signals a patient at substantially elevated risk who requires immediate multifactorial intervention. 4

High-Risk Indicators Requiring Urgent Assessment:

• Two or more falls in the past year 1, 4
• One injurious fall 1
• Unsteady gait or balance 1
• Gait speed less than 0.8 to 1 m/s 2

Prevention Reduces Mortality

Multifactorial interventions can reduce fall rates by 23% (Rate Ratio 0.77,95% CI 0.67-0.87), directly impacting mortality risk. 1 Exercise interventions reduce falls with a rate ratio of 0.77 (95% CI 0.71-0.83). 2

Evidence-Based Interventions That Reduce Death Risk:

• Supervised exercise programs including balance, functional training, and resistance training 5, 2
• Comprehensive multifactorial risk assessment addressing modifiable factors 1, 5, 2
• Medication review and deprescribing when appropriate 1, 5, 2
• Environmental modifications for high-risk individuals 5, 2

Common Pitfalls to Avoid

Do not dismiss multiple falls as "normal aging"—this represents a medical emergency requiring comprehensive evaluation. 1 Older people are frequently not aware of their fall risks and do not report these issues to physicians, resulting in missed prevention opportunities that become evident only after injury and disability have occurred. 1

Do not wait for an injurious fall to initiate assessment—the presence of two or more falls per year alone warrants immediate comprehensive multifactorial falls risk assessment. 1, 4