Falls in the Aging Population

  • Kareeann S.F. Khow
    Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network and Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Level 8B, Woodville Road, Woodville South, South Australia 5011, Australia
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  • Renuka Visvanathan
    Corresponding author.
    Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network and Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Level 8B, Woodville Road, Woodville South, South Australia 5011, Australia
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Published:April 27, 2017DOI:


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        • United Nations
        • Department of Economics and Social Affairs
        World population ageing 2015.
        United Nations, New York2015
        • World Health Organization
        WHO global report on falls prevention in older age.
        World Health Organization, Geneva2007
        • Tromp A.M.
        • Pluijm S.M.
        • Smit J.H.
        • et al.
        Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly.
        J Clin Epidemiol. 2001; 54: 837-844
        • Tinetti M.E.
        • Williams C.S.
        The effect of falls and fall injuries on functioning in community-dwelling older persons.
        J Gerontol A Biol Sci Med Sci. 1998; 53: M112-M119
        • Vassallo M.
        • Azeem T.
        • Pirwani M.F.
        • et al.
        An epidemiological study of falls on integrated general medical wards.
        Int J Clin Pract. 2000; 54: 654-657
        • Campbell A.J.
        • Borrie M.J.
        • Spears G.F.
        • et al.
        Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study.
        Age Ageing. 1990; 19: 136-141
        • Rosen T.
        • Mack K.A.
        • Noonan R.K.
        Slipping and tripping: fall injuries in adults associated with rugs and carpets.
        J Inj Violence Res. 2013; 5: 61-69
        • Dellinger A.M.
        • Boyd R.M.
        • Haileyesus T.
        Fall injuries in older adults from an unusual source: entering and exiting a vehicle.
        J Am Geriatr Soc. 2008; 56: 609-614
        • Masud T.
        • Morris R.O.
        Epidemiology of falls.
        Age Ageing. 2001; 30: 3-7
        • Fleming J.
        • Brayne C.
        Inability to get up after falling, subsequent time on floor, and summoning help: prospective cohort study in people over 90.
        BMJ. 2008; 337: a2227
        • Melton 3rd, L.J.
        • Amin S.
        Is there a specific fracture ‘cascade’?.
        Bonekey Rep. 2013; 2: 367
        • Cummings S.R.
        • Melton L.J.
        Epidemiology and outcomes of osteoporotic fractures.
        Lancet. 2002; 359: 1761-1767
        • Sattui S.E.
        • Saag K.G.
        Fracture mortality: associations with epidemiology and osteoporosis treatment.
        Nat Rev Endocrinol. 2014; 10: 592-602
        • Vochteloo A.J.
        • van Vliet-Koppert S.T.
        • Maier A.B.
        • et al.
        Risk factors for failure to return to the pre-fracture place of residence after hip fracture: a prospective longitudinal study of 444 patients.
        Arch Orthop Trauma Surg. 2012; 132: 823-830
        • Scheffer A.C.
        • Schuurmans M.J.
        • van Dijk N.
        • et al.
        Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons.
        Age Ageing. 2008; 37: 19-24
      1. Center for Disease Control and Prevention. Cost of falls among older adults. Available at: Accessed August 30, 2016.

        • Close J.
        • Ellis M.
        • Hooper R.
        • et al.
        Prevention of falls in the elderly trial (PROFET): a randomised controlled trial.
        Lancet. 1999; 353: 93-97
        • Thomas S.L.
        • Muscatello D.J.
        • Middleton P.M.
        • et al.
        Characteristics of fall-related injuries attended by an ambulance in Sydney, Australia: a surveillance summary.
        N S W Public Health Bull. 2011; 22: 49-54
        • Ambrose A.F.
        • Paul G.
        • Hausdorff J.M.
        Risk factors for falls among older adults: a review of the literature.
        Maturitas. 2013; 75: 51-61
        • Salonen L.
        • Kivela S.L.
        Eye diseases and impaired vision as possible risk factors for recurrent falls in the aged: a systematic review.
        Curr Gerontol Geriatr Res. 2012; 2012: 271481
        • Harwood R.H.
        • Foss A.J.
        • Osborn F.
        • et al.
        Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial.
        Br J Ophthalmol. 2005; 89: 53-59
        • Lord S.R.
        • Dayhew J.
        • Howland A.
        Multifocal glasses impair edge-contrast sensitivity and depth perception and increase the risk of falls in older people.
        J Am Geriatr Soc. 2002; 50: 1760-1766
        • Jiam N.T.
        • Li C.
        • Agrawal Y.
        Hearing loss and falls: a systematic review and meta-analysis.
        Laryngoscope. 2016; 126: 2587-2596
        • Gopinath B.
        • McMahon C.M.
        • Burlutsky G.
        • et al.
        Hearing and vision impairment and the 5-year incidence of falls in older adults.
        Age Ageing. 2016; 45: 409-414
        • Pate R.R.
        • O'Neill J.R.
        • Lobelo F.
        The evolving definition of “sedentary”..
        Exerc Sport Sci Rev. 2008; 36: 173-178
        • van der Ploeg H.P.
        • Chey T.
        • Korda R.J.
        • et al.
        Sitting time and all-cause mortality risk in 222 497 Australian adults.
        Arch Intern Med. 2012; 172: 494-500
        • Cauley J.A.
        • Harrison S.L.
        • Cawthon P.M.
        • et al.
        Objective measures of physical activity, fractures and falls: the osteoporotic fractures in men study.
        J Am Geriatr Soc. 2013; 61: 1080-1088
        • Thibaud M.
        • Bloch F.
        • Tournoux-Facon C.
        • et al.
        Impact of physical activity and sedentary behaviour on fall risks in older people: a systematic review and meta-analysis of observational studies.
        Eur Rev Aging Phys Act. 2012; 9: 5-15
        • Visvanathan R.
        • Chapman I.
        Preventing sarcopaenia in older people.
        Maturitas. 2010; 66: 383-388
        • Landi F.
        • Liperoti R.
        • Russo A.
        • et al.
        Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study.
        Clin Nutr. 2012; 31: 652-658
        • Poisson P.
        • Laffond T.
        • Campos S.
        • et al.
        Relationships between oral health, dysphagia and undernutrition in hospitalised elderly patients.
        Gerodontology. 2016; 33: 161-168
        • Kojima G.
        Frailty as a predictor of future falls among community-dwelling older people: a systematic review and meta-analysis.
        J Am Med Dir Assoc. 2015; 16: 1027-1033
        • Clegg A.
        • Young J.
        • Iliffe S.
        • et al.
        Frailty in elderly people.
        Lancet. 2013; 381: 752-762
        • Muir S.W.
        • Gopaul K.
        • Montero Odasso M.M.
        The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis.
        Age Ageing. 2012; 41: 299-308
        • Gleason C.E.
        • Gangnon R.E.
        • Fischer B.L.
        • et al.
        Increased risk for falling associated with subtle cognitive impairment: secondary analysis of a randomized clinical trial.
        Dement Geriatr Cogn Disord. 2009; 27: 557-563
        • Mirelman A.
        • Herman T.
        • Brozgol M.
        • et al.
        Executive function and falls in older adults: new findings from a five-year prospective study link fall risk to cognition.
        PLoS One. 2012; 7: e40297
        • Stubbs B.
        • Stubbs J.
        • Gnanaraj S.D.
        • et al.
        Falls in older adults with major depressive disorder (MDD): a systematic review and exploratory meta-analysis of prospective studies.
        Int Psychogeriatr. 2016; 28: 23-29
        • Paleacu D.
        • Shutzman A.
        • Giladi N.
        • et al.
        Effects of pharmacological therapy on gait and cognitive function in depressed patients.
        Clin Neuropharmacol. 2007; 30: 63-71
        • Deandrea S.
        • Lucenteforte E.
        • Bravi F.
        • et al.
        Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis.
        Epidemiology. 2010; 21: 658-668
        • Barak Y.
        • Wagenaar R.C.
        • Holt K.G.
        Gait characteristics of elderly people with a history of falls: a dynamic approach.
        Phys Ther. 2006; 86: 1501-1510
        • Jensen J.L.
        • Brown L.A.
        • Woollacott M.H.
        Compensatory stepping: the biomechanics of a preferred response among older adults.
        Exp Aging Res. 2001; 27: 361-376
        • Verghese J.
        • Holtzer R.
        • Lipton R.B.
        • et al.
        Quantitative gait markers and incident fall risk in older adults.
        J Gerontol A Biol Sci Med Sci. 2009; 64: 896-901
        • Verghese J.
        • Ambrose A.F.
        • Lipton R.B.
        • et al.
        Neurological gait abnormalities and risk of falls in older adults.
        J Neurol. 2010; 257: 392-398
        • Sanders K.M.
        • Scott D.
        • Ebeling P.R.
        Vitamin D deficiency and its role in muscle-bone interactions in the elderly.
        Curr Osteoporos Rep. 2014; 12: 74-81
        • Bischoff-Ferrari H.A.
        • Dawson-Hughes B.
        • Staehelin H.B.
        • et al.
        Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials.
        BMJ. 2009; 339: b3692
        • Latham N.K.
        • Anderson C.S.
        • Reid I.R.
        Effects of vitamin D supplementation on strength, physical performance, and falls in older persons: a systematic review.
        J Am Geriatr Soc. 2003; 51: 1219-1226
        • Mukai S.
        • Lipsitz L.A.
        Orthostatic hypotension.
        Clin Geriatr Med. 2002; 18: 253-268
        • Gangavati A.
        • Hajjar I.
        • Quach L.
        • et al.
        Hypertension, orthostatic hypotension, and the risk of falls in a community-dwelling elderly population: the maintenance of balance, independent living, intellect, and zest in the elderly of Boston study.
        J Am Geriatr Soc. 2011; 59: 383-389
        • Trahair L.G.
        • Horowitz M.
        • Jones K.L.
        Postprandial hypotension: a systematic review.
        J Am Med Dir Assoc. 2014; 15: 394-409
        • Kenny R.A.
        • Richardson D.A.
        Carotid sinus syndrome and falls in older adults.
        Am J Geriatr Cardiol. 2001; 10: 97-99
        • Seifer C.
        • Kenny R.A.
        The prevalence of falls in older persons paced for atrioventricular block and sick sinus syndrome.
        Am J Geriatr Cardiol. 2003; 12: 298-301
        • Bowling C.B.
        • Muntner P.
        • Bradbury B.D.
        • et al.
        Low hemoglobin levels and recurrent falls in U.S. men and women: prospective findings from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort.
        Am J Med Sci. 2013; 345: 446-454
        • Duh M.S.
        • Mody S.H.
        • Lefebvre P.
        • et al.
        Anaemia and the risk of injurious falls in a community-dwelling elderly population.
        Drugs Aging. 2008; 25: 325-334
        • Bjorkelund K.B.
        • Hommel A.
        • Thorngren K.G.
        • et al.
        The influence of perioperative care and treatment on the 4-month outcome in elderly patients with hip fracture.
        AANA J. 2011; 79: 51-61
        • Australian Commission on Safety and Quality in Health Care
        Safety and quality improvement guide standard 10: preventing falls and harm from falls (October 2012).
        ACSQHC, Sydney (Australia)2012
        • Stevens J.A.
        • Phelan E.A.
        Development of STEADI: a fall prevention resource for health care providers.
        Health Promot Pract. 2013; 14: 706-714
        • Shumway-Cook A.
        • Brauer S.
        • Woollacott M.
        Predicting the probability for falls in community-dwelling older adults using the Timed up & Go Test.
        Phys Ther. 2000; 80: 896-903
        • Rubenstein L.Z.
        • Vivrette R.
        • Harker J.O.
        • et al.
        Validating an evidence-based, self-rated fall risk questionnaire (FRQ) for older adults.
        J Safety Res. 2011; 42: 493-499
        • Katz S.
        • Ford A.B.
        • Moskowitz R.W.
        • et al.
        Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychological function.
        JAMA. 1963; 185: 914-919
        • Lawton M.P.
        • Brody E.M.
        Assessment of older people: self-maintaining and instrumental activities of daily living.
        Gerontologist. 1969; 9: 179-186
        • Washburn R.A.
        • McAuley E.
        • Katula J.
        • et al.
        The physical activity scale for the elderly (PASE): evidence for validity.
        J Clin Epidemiol. 1999; 52: 643-651
        • Dent E.
        • Visvanathan R.
        • Piantadosi C.
        • et al.
        Nutritional screening tools as predictors of mortality, functional decline, and move to higher level care in older people: a systematic review.
        J Nutr Gerontol Geriatr. 2012; 31: 97-145
        • Kruizenga H.M.
        • Seidell J.C.
        • de Vet H.C.
        • et al.
        Development and validation of a hospital screening tool for malnutrition: the short nutritional assessment questionnaire (SNAQ).
        Clin Nutr. 2005; 24: 75-82
        • Malmstrom T.K.
        • Miller D.K.
        • Simonsick E.M.
        • et al.
        SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes.
        J Cachexia Sarcopenia Muscle. 2016; 7: 28-36
        • Hodkinson H.M.
        Evaluation of a mental test score for assessment of mental impairment in the elderly.
        Age Ageing. 1972; 1: 233-238
        • Borson S.
        • Scanlan J.M.
        • Chen P.
        • et al.
        The Mini-Cog as a screen for dementia: validation in a population-based sample.
        J Am Geriatr Soc. 2003; 51: 1451-1454
        • Malmstrom T.K.
        • Voss V.B.
        • Cruz-Oliver D.M.
        • et al.
        The rapid cognitive screen (RCS): a point-of-care screening for dementia and mild cognitive impairment.
        J Nutr Health Aging. 2015; 19: 741-744
        • Song H.J.
        • Meade K.
        • Akobundu U.
        • et al.
        Depression as a correlate of functional status of community-dwelling older adults: utilizing a short-version of 5-item Geriatric Depression Scale as a screening tool.
        J Nutr Health Aging. 2014; 18: 765-770
        • Wetherell J.L.
        • Birchler G.D.
        • Ramsdell J.
        • et al.
        Screening for generalized anxiety disorder in geriatric primary care patients.
        Int J Geriatr Psychiatry. 2007; 22: 115-123
        • Kanis J.A.
        • Harvey N.C.
        • Cooper C.
        • et al.
        A systematic review of intervention thresholds based on FRAX: a report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation.
        Arch Osteoporos. 2016; 11: 25
        • Gadam R.K.
        • Schlauch K.
        • Izuora K.E.
        Frax prediction without BMD for assessment of osteoporotic fracture risk.
        Endocr Pract. 2013; 19: 780-784
        • Nguyen N.D.
        • Frost S.A.
        • Center J.R.
        • et al.
        Development of prognostic nomograms for individualizing 5-year and 10-year fracture risks.
        Osteoporos Int. 2008; 19: 1431-1444
        • O'Mahony D.
        • O'Sullivan D.
        • Byrne S.
        • et al.
        STOPP/START criteria for potentially inappropriate prescribing in older people: version 2.
        Age Ageing. 2015; 44: 213-218
        • Glab K.L.
        • Wooding F.G.
        • Tuiskula K.A.
        Medication-related falls in the elderly: mechanisms and prevention strategies.
        Consult Pharm. 2014; 29: 413-417
        • Woo J.
        • Yu R.
        • Wong M.
        • et al.
        Frailty screening in the community using the FRAIL scale.
        J Am Med Dir Assoc. 2015; 16: 412-419
        • Jones D.M.
        • Song X.
        • Rockwood K.
        Operationalizing a frailty index from a standardized comprehensive geriatric assessment.
        J Am Geriatr Soc. 2004; 52: 1929-1933
        • Gillespie L.D.
        • Robertson M.C.
        • Gillespie W.J.
        • et al.
        Interventions for preventing falls in older people living in the community.
        Cochrane Database Syst Rev. 2012; (CD007146)
        • Clemson L.
        • Mackenzie L.
        • Ballinger C.
        • et al.
        Environmental interventions to prevent falls in community-dwelling older people: a meta-analysis of randomized trials.
        J Aging Health. 2008; 20: 954-971
        • Cakar E.
        • Durmus O.
        • Tekin L.
        • et al.
        The ankle-foot orthosis improves balance and reduces fall risk of chronic spastic hemiparetic patients.
        Eur J Phys Rehabil Med. 2010; 46: 363-368
        • Menant J.C.
        • Steele J.R.
        • Menz H.B.
        • et al.
        Optimizing footwear for older people at risk of falls.
        J Rehabil Res Dev. 2008; 45: 1167-1181
        • El-Khoury F.
        • Cassou B.
        • Charles M.A.
        • et al.
        The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials.
        BMJ. 2013; 347: f6234
        • Voukelatos A.
        • Cumming R.G.
        • Lord S.R.
        • et al.
        A randomized, controlled trial of tai chi for the prevention of falls: the Central Sydney tai chi trial.
        J Am Geriatr Soc. 2007; 55: 1185-1191