What is the cause of recurrent falls?

From the Guidelines

Frequent falls in older adults require a comprehensive approach to prevent injuries and address underlying causes, starting with a thorough evaluation by a healthcare provider, including medication review, vision and hearing tests, and assessment of balance and gait, as recommended by the US Preventive Services Task Force 1, 2, 3.

Key Interventions

• Home modifications are essential to reduce fall risk, including removing tripping hazards, installing grab bars, and ensuring adequate lighting 1.
• Regular exercise focusing on strength and balance, such as tai chi or physical therapy-guided programs, can significantly reduce fall risk 2.
• Medications that may contribute to falls, such as sedatives, antidepressants, and blood pressure medications, should be reviewed and adjusted as necessary 3.
• Proper footwear with non-slip soles and standing up slowly to prevent orthostatic hypotension are also important considerations.

Underlying Conditions

• Medical conditions that increase fall risk, including Parkinson's disease, arthritis, neuropathy, and vitamin D deficiency, should be properly managed 1, 2, 3.
• The American Geriatrics Society (AGS) recommends multifactorial risk assessment with multicomponent intervention in older adults who have had 2 falls in the past year or have gait or balance problems 1.

Additional Considerations

• Personal emergency response systems may be considered for individuals who continue to experience falls despite interventions 2.
• The burden of falls on patients and the healthcare system is significant, and decreasing the incidence of falls can improve socialization and functioning in older adults who have previously fallen and fear falling again 3.

From the FDA Drug Label

Falling asleep while engaged in activities of daily living usually occurs in patients experiencing preexisting somnolence, although some patients may not give such a history For this reason, prescribers should reassess patients for drowsiness or sleepiness especially since some of the events occur well after the start of treatment. Consider discontinuing carbidopa and levodopa orally disintegrating tablets in patients who report significant daytime sleepiness or episodes of falling asleep during activities that require active participation (e.g., conversations, eating, etc.)

Frequent falls may be related to sudden onset of sleep or somnolence associated with levodopa treatment. Patients should be advised to exercise caution while driving or operating machines during treatment. If a patient experiences significant daytime sleepiness or episodes of falling asleep, consideration should be given to discontinuing levodopa treatment 4.

From the Research

Frequent Falls in Older Adults

• Frequent falls are a major public health problem, occurring in more than 27% of adults 65 years and older, and costing the U.S. health care system tens of billions of dollars each year 5.
• The most common risk factors for frequent falls are prior falls, balance disorders, fear of falling, and dementia 5.
• Regular physical activity reduces fall risk, and identifying injuries is the first step in evaluating older adults who have fallen 5.

Interventions to Prevent Falls

• Multifactorial interventions, which include evaluating environmental and home safety factors and optimizing care of chronic medical conditions, have been associated with a reduction in falls 6, 7.
• Exercise interventions have also been shown to reduce falls, and have been associated with statistically significant reductions in people experiencing a fall and injurious falls 6, 7.
• Vitamin D supplementation has had mixed results, with some studies showing a reduction in falls and others showing no significant difference 6, 7.

Fall Risk in Parkinson's Disease

• Fall risk has been associated with vitamin D in Parkinson's disease, but more study is needed to determine if supplementation decreases falls 8.
• Levodopa usage and cumulative levodopa exposure have been implicated in the neuropathy of Parkinson's disease, and may contribute to fall risk 9.
• Age and lower folate levels have also been independently associated with neuropathy in Parkinson's disease, and may contribute to fall risk 9.