What are the causes of falls in the geriatric population?

From the Guidelines

Falls in the elderly are primarily caused by a combination of age-related physical changes, medical conditions, medications, and environmental hazards, with the most recent evidence suggesting that multifactorial falls prevention interventions can reduce the rate of falls by 23%. According to the study published in 2023 1, falls are a major problem in community-dwelling older persons, with one-third of older persons living at home falling annually. The study highlights that falling is complex and many factors contribute to its risk, including mobility impairment, medication use, and home hazards.

Key Factors Contributing to Falls

• Age-related physical changes, such as muscle weakness, balance problems, vision impairment, and gait disturbances
• Medical conditions, including Parkinson's disease, arthritis, dementia, cardiovascular disorders, and diabetes with peripheral neuropathy
• Medications, particularly psychoactive drugs, antidepressants, antipsychotics, antihypertensives, diuretics, and polypharmacy
• Environmental hazards, such as poor lighting, loose rugs, clutter, lack of grab bars in bathrooms, and uneven surfaces
• Behavioral factors, including rushing, improper footwear, and not using assistive devices when needed

Prevention Strategies

A multifaceted approach is necessary to prevent falls, including medication review, vision checks, strength and balance exercises, home safety modifications, and proper footwear. The study published in 2020 1 found that exercise interventions, particularly those that target strength and balance, can be effective in preventing falls. Additionally, the study published in 2023 1 highlights the importance of implementing multifactorial falls prevention interventions in the community setting, which can include a combination of exercise, medication advice, and home safety modifications.

Importance of Implementation

The implementation of effective falls prevention interventions is crucial to reduce the economic burden of society and improve the quality of life of older adults. The study published in 2023 1 emphasizes the need to address important implementation issues, such as barriers and facilitators, and to select suitable strategies at different levels of the context to implement multifactorial falls prevention interventions in the community setting.

From the Research

Causes of Falls in the Elderly

The causes of falls in the elderly are multifactorial, involving both intrinsic and extrinsic factors.

• Intrinsic factors include:
  • Impaired balance and gait 2
  • Polypharmacy 2
  • History of previous falls 2, 3
  • Advancing age 2, 3
  • Female gender 2
  • Visual impairments 2
  • Cognitive decline, especially attention and executive dysfunction 2, 4
• Extrinsic factors include:
  • Environmental factors 2, 5
  • Treatment with certain medications, such as neuroleptics, oral bronchodilators, digitalins, and antidepressants 3

Risk Factors

The risk factors for falls in the elderly can be classified into two categories: intrinsic and extrinsic.

• Intrinsic risk factors are those that are related to the individual, such as age, gender, and medical conditions.
• Extrinsic risk factors are those that are related to the environment, such as poor lighting, slippery floors, and lack of handrails.

Prevention and Management

Prevention and management of falls in the elderly require a comprehensive approach that takes into account both intrinsic and extrinsic factors.

• This can include:
  • Identifying and addressing underlying medical conditions, such as cognitive impairment and dependence to perform instrumental activities of daily living 4
  • Reviewing and adjusting medications to minimize the risk of falls 3
  • Implementing environmental modifications, such as installing handrails and improving lighting 5
  • Providing education and support to caregivers and patients to prevent falls and promote safe mobility 5