Falls


Updated April 2008

Falls are a major cause of disability and the leading cause of mortality due to injury in older people aged over 75 years in the UK. The incidence of falls rises with age, and can be linked to conditions such as osteoporosis. Over the age of 74 years, falls are twice as common in women as men. Approximately 30 per cent of people over 65 years of age and living in the community fall each year; the number is higher in institutions. Although less than one fall in 10 results in a fracture, a fifth of fall incidents require medical attention.

There are many causes of falls, including the following:
  • drugs and alcohol, eg sedatives, diuretics, hypotensive agents (which lower blood pressure)
  • age-related physiological changes, eg balance/gait abnormalities; frailty; poor vision; poor mobility
  • medical, eg arthritis, Parkinson’s disease, foot problems, depression; dementia
  • environmental factors, eg hazards at home (rugs, poor lighting), weather conditions (high wind, ice).
Falls can contribute significantly to life changes for older people, leading to loss of independence and confidence. Many falls are preventable. A Cochrane review of interventions for preventing falls in older people [see reference 1] found that the following interventions were likely to be beneficial:
  • a programme of muscle strengthening and balance retraining, individually prescribed at home by a trained health professional.
  • a 15 week Tai Chi group exercise intervention
  • home hazard assessment and modification that is professionally prescribed for older people with a history of falling. A reduction in falls was seen both inside and outside the home
  • withdrawal of psychotropic medication
  • risk factor screening/intervention programmes in the community and in residential care facilities.
Exercise programmes alone do not reduce the incidence of falls.[see reference 2] Multifaceted interventions are more effective, such as those including medical assessment, home safety assessment, changes in prescribed drugs, environmental changes, tailored exercise programmes, training in transfer skills (eg getting up from a chair), balance and gait, and referral to relevant healthcare professionals according to need. Exercise has other health benefits, such as improving cardiovascular fitness. Those in residential homes benefit from a programme of risk assessment for residents who have had at least one fall, the use of hip protectors, and referral to their primary physician for specific preventive measures if necessary.

The government sets out its strategy for tackling falls in the National Service Framework for Older People. The key interventions proposed include public health strategies to reduce the incidence of falls in the population and the identification, assessment and prevention measures taken for those most at risk of falling. A New Ambition for Old Age details how these services for older people and their families will be improved.[see reference 3]

The National Institute for Health and Clinical Excellence (NICE) has prepared guidelines for the NHS in England and Wales for the assessment and prevention of falls including recurrent falls in older people.[see reference 4]

The 2001 BMA Board of Science report Injury prevention provides a comprehensive overview of injury surveillance and prevention in the UK, focusing on people in all age groups.

References:
  1. Gillespie LD, Gillespie WJ, Robertson MC et al (2003) Interventions for preventing falls in elderly people (Cochrane Review). Cochrane Database of Systematic Reviews 4: CD000340.
  2. Feder G, Cryer C, Donovan S et al (2000) Guidelines for the prevention of falls in people over 65. British Medical Journal 321: 1007-11.
  3. National Director for Older People (2006) A new ambition for old age: Next steps in implementing the National Service Framework for Older People. London: Department of Health.
  4. National Institute for Health and Clinical Excelence (1999) Physical activity and the prevention and management of falls and accidents among older people. London: National Institute for Health and Clinical Excelence (Access the report here)
Further information:

© British Medical Association 2008

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