Not only does a poor or impaired physical condition increase the risk of falls, but it also affects how people respond to hazards and hazardous situations. Use of drugs that affect attention for example, opioid analgesics, antianxiety drugs, and some antidepressant drugs or lower blood pressure for example, antihypertensive, diuretic, and some heart drugs can also increase the risk of falling.
Hazards in the environment are involved in many falls. Falls may occur when people do not notice a hazard or do not respond quickly enough after a hazard is noticed. Most falls occur indoors. Some happen while people are standing still. But most occur while people are moving—getting in or out of bed or a chair, getting on or off a toilet seat, walking, or going up or down stairs.
While moving, people may stumble or trip, or balance may be lost. Any movement can be hazardous. But if people are rushing or if their attention is divided, movement becomes even more hazardous. For example, rushing to the bathroom especially at night when not fully awake or when lighting may be poor or to answer the telephone or talking on a cordless phone can make walking more hazardous.
Often before falling, people have no symptoms. When an environmental hazard or a hazardous situation results in a fall, there is little or no warning. Symptoms may include. After a fall, injuries are common and tend to be more severe as people age. Over half of all falls result in at least a slight injury, such as a bruise, sprained ligament, or strained muscle.
More serious injuries include broken bones, torn ligaments, deep cuts, and damage to organs such as a kidney or the liver. Some falls result in loss of consciousness or a head injury. Falls can cause even more problems if people cannot get up right away or summon help. Such a situation may be frightening and may make people feel helpless. Remaining on the floor, even for a few hours, can lead to problems such as. Dehydration Dehydration Dehydration is a deficiency of water in the body.
Vomiting, diarrhea, excessive sweating, burns, kidney failure, and use of diuretics may cause dehydration. People feel thirsty, and as dehydration Low body temperature hypothermia Hypothermia Hypothermia is a dangerously low body temperature.
Hypothermia is often regarded as a cold injury, because it can be caused or made worse by exposure to cold surroundings. Being in an environment Pneumonia Overview of Pneumonia Pneumonia is an infection of the small air sacs of the lungs alveoli and the tissues around them. Pneumonia is one of the most common causes of death worldwide. Often, pneumonia is the final Pressure sores Pressure Sores Pressure sores are areas of skin damage resulting from a lack of blood flow due to prolonged pressure.
Pressure sores often result from pressure combined with pulling on the skin, friction, The effects of a fall may last a long time. About half of people who could walk before they fell and broke a hip cannot walk as well afterward, even after treatment and rehabilitation. People who have fallen may develop a fear of falling that robs them of their self-confidence.
As a result, they may stay at home and give up activities, such as shopping, visiting friends, and cleaning. When people become less active, joints can become stiff and muscles can become weak.
Stiff joints and weak muscles can further increase the risk of falling and make remaining active and independent more difficult. For many people, falls seem to be an important factor in the decision to move to a nursing home Nursing Homes Nursing homes are for people who need help with health care for chronic conditions but do not need to be hospitalized.
The decision to move to a nursing home may be triggered by a change in These communities can For all these reasons, falls can greatly reduce quality of life. Some falls can be serious and result in death.
Death may occur immediately—for example, when the head hits a hard surface and causes uncontrolled bleeding in or around the brain. Thank you for having worked in this important area! And of course a very big thank you for appreciating the site and sharing it with others!
These are definitely things that the elderly should have checked. My mom is getting pretty old, and I have noticed that she walks slower than you used to. She should probably get her gait and balance checked, like you said. My 82 year old mother is passing out. Those are her words, for an hour or 2 at a time. She wakes up and does not know what has happened or what she was doing before she passed out. She has fallen a number of times over the past few years and usually hits her face and has bruises.
What questions should we be asking or what kinds of tests might she need? Generally, you should consider asking the doctor about all 8 things mentioned in the post. Usually doctors start by checking an ECG in the office, and they might also consider monitoring over a several days, using a Zio patch or other ambulatory monitor.
If you try to ask extra questions and the doctor is still not very helpful, you might consider getting a second opinion. We are having problems with my mother shaking to the point of falling. She is on three blood pressure medications — Metaprolol, Losartan and Amilopidine and is also taking Mitrazapine to help her gain weight. She has already fell two times — ended up in ER the other week.
She has neuropathy and dementia. Was taken off blood thinners due to falling. Would any medicines be causing this?
Her walking has gotten much worse and she has foot pain — was taken off Gapabentin about two years ago. We changed doctors because the previous one seemed to not want to deal with someone in nineties, and new doctor said she could take Ativan but afraid it might make her worse. She seems sleepy all of the time, anyway.
Thank you. Sorry to hear about this. I list several common contributors to falls in the slideshow. Keep researching as you are doing, and then keep communicating with her doctors. You want to keep letting them know of the falls, and it often helps to keep asking questions. Thank you for your response — was considering asking doctor if the beta blocker could be both affecting her weight loss and the weakness?
This problem seems to be getting worse really quickly — having problems even getting her out of bed these days — and her leg muscles are very weak. The Mitrazapine has helped her appetite some, but she has lost thirty pounds and gained about seven back. I think I may hold off on the Ativan for the time being. That amount of weight loss is pretty concerning. Beta-blockers make some people feel lousy, but it would be unusual for it to cause that much weight loss or that much weakness.
It could well be the same thing that is making her weak and causing weight loss, and that weakness may well be the main driving factor with her falls. Good luck and take care! Kenison, I am an 83 year old male. Bad nausea and severe constipation. I also get very little physical exercise. I believe I am dying but my cardiologist refuses to give me a time table. Please help me. Thank you! So sorry to hear of your difficulties and your symptoms. I cannot say whether you are gravely ill and likely to die within the next few months or not, but you certainly sound distressed and you must be feeling quite unwell.
It sounds like you are trying to learn more about your prognosis and what to expect. It also sounds like you feel things are pretty dire. Ask your cardiologist to help you understand what to plan for. You can also say you want to discuss goals of care. That said, hospice is GREAT at helping people with distressing symptoms and also emotional fears at the end of life.
Another option for you would be to ask to speak with a palliative care provider; they are trained to discuss prognosis and life expectancy. See here: Get Palliative Care. It is always a great idea to find a top doctor that will truly care about you. A great doctor who uses the leading-edge technology is another factor.
I also encourage people to consider health clinics that are specially designed for older adults, because they often have trained their staff and clinicians to help people with falls. Thanks for all your wonderful advice. I just came across this while searching for what could be causing the kind of pain my mother is experiencing following her fall.
My mother is 81 years old and fell more than a month ago while taking a walk in park. She fell on the concrete because she was dragging her feet and was not wearing tennis shoes. She has been to the emergency room twice because of the pain and X-rays and CT scans do not show any broken bones yet she continues to have excruciating pains. She has arthritis and it looks like this fall has exaggerated it immensely. Do you know what can help with this?
What do you advise? Hm…hard to say what might be causing her continued pain. Other possibilities would be a nerve being pinched or aggravated somewhere, or even worsened arthritis.
Some older adults also get relief from topical therapies on the painful area, and this can be safer since there are often fewer side effects. It will also help if you can keep pushing to have her pain carefully assessed and diagnosed. Last but not least, once you have made progress addressing the pain issues, you could consider askign the doctors for help assessing her gait why is she dragging her feet?
HI my dad fell nobody saw him and when he came inside the house he had a memory loss which came back later.
My step mother said he looked as if he had been running and he was sweating. Coukd this have been signs of his heart? The dr. Did not do ekg but ordered blood work and a scan of t h e brain.
Can they tell by these type of exams? Obviously, falling or experiencing pain can do this to people. My father is 86 and lives with my husband and I in our finished basement. I work at home so can check on him throughout the day. Yesterday dad fell getting out of the shower.
I did not see him fall, but heard the shower curtain rod fall so ran down to see if he was OK. I am use to his strange sleep patterns, however, last night he went to bed at pm, woke up at am and at some point went back to bed because he is still sleeping at pm cst. Should I be concerned? Men are so stubborn. This sounds like an urgent concern.
As a matter of principle, if you ever have an urgent concern regarding possible illness or injury, you must contact your usual doctors, or even consider the emergency room. Urgency aside, you are raising a couple of important issues.
Another is that your dad fell recently, and what would warrant further evaluation. If after a fall an older person seems sleepier or more tired: — Could an illness or physical abnormality have caused or contributed to his fall? Older adults sometimes fall because they are feeling weak due to some new or worsened health issue. This could be an infection, anemia, basically the things I mention under item 1 in the article.
So, you basically need to watch after a fall and see whether you notice any other signs that something may be amiss. If you do, you need an urgent evaluation.
There often are ways to at least improve their thinking, if not reverse an underlying disease, plus some of them are actually suffering from a treatable non-dementia problem that scrambles thinking. Lastly: yes, lots of older adults seem quite stubborn, and will resist or decline further evaluation. Does any of this make sense. Thank you for your comments. Yes, as people age, all kinds of reflexes and physical abilities can slow down.
If you have noticed this for yourself, I would recommend bringing it up to your doctor, so that you can be evaluated for treatable issues that might be making it harder for your feet to keep up.
The right kinds of exercises can also help improve mobility and balance. She did say she had a some pain when breathing but she has had this for a while as she has a cute COPD. I can never advise online as to what someone should do. If she has recently fallen and you are concerned, you need to seek medical advice from someone close to you. What is most worrisome, in terms of acute injury, is worsening pain, worsening shortness of breath or chest pain, or the person becoming very weak or very confused.
If any doubt, try to get her to a medical professional. Try to reassure her and speak to her fears. Perhaps she might agree if you remind her that this is not a hospitalization, it is just an urgent care check up. Also point out how this can help her reach some of her goals, like continuing to live at home.
Hi Dr. My Mom 72, fell and fractured 2 vertebrae in her back T8 and T9. She lived with the pain for 2 weeks until the pain became too much to handle. We rushed her to the hospital. Due to the pain meds, no bowel program, and a host of other pre-existing issues, we have now been here for 16 days. She has 10 specialist treating their specific area, but her health is deteriorating daily.
Her primary care physician does not have privileges at the hospital, so we are assigned a hospitalist, who changes daily. I need to find a doctor to take over and coordinate all of the specialists, but I have no idea who I am looking for.
Am I looking for a Geriatric Specialist? An Internist? Any help would be greatly appreciated. You could see if there is a geriatric consult service available. A palliative care service might be able to advise re managing her pain, bowels, or other uncomfortable symptoms.
She does have a lot of internal medicine problems and internists are used to taking care of people like your mom. But if they are busy or just not attuned to the geriatric angle on things…well, I have described many hospitalists there they are usually internists.
If you need help getting things coordinated and back on track, you could look into hiring a professional patient advocate. Some of them are even medical doctors, but I think most are nurses or have other healthcare backgrounds. A good one will have experience navigating the usual hospital mayhem.
My mom had a fall last May. We rushed her to the hospital and lucky nothing broken. She recovered well from her head wound but her arm wound it was deep became infected and took a long time to heal.
She has since had continuous pain in her arm that is now starting at her shoulder and shoots down her arm to the point that it wakes her! What type of doctor should she see for this pain?
Sorry that your mother has developed frequent pain in her arm. Hard to say just what might be causing it. Pain that shoots down a limb can be caused by damage or pressure to a nerve. Sometimes people get shoulder or arm pain due to a nerve in the neck being squeezed, but nerves can also be injured or squeezed in the shoulder or upper arm. Generally, the experts in nerves are neurologists. The Mayo Clinic has a page on pain due to pinched nerves here: Pinched nerve.
Good luck, I hope your mother finds some relief soon! I fell yesterday and got a cut on my wrist while I got up to go to the bathroom. My wife yelled for my sons and they put me back in bed, and I went to sleep. I would recommend bringing up the fall with your doctor and considering further evaluation to identify and address fall risk factors. I do have a fall prevention mini-course designed to help older adults figure out what to discuss with their doctor, you can learn more here: How to Personalize Your Fall Prevention Plan.
Over the last 2 years she has had a rapid decline. Or is this something else entirely? At this rate I feel like she will be in a wheelchair soon. She does have a history of alcoholism and stopped completely about years ago. Could that be a contributing factor? Falls in older adults are almost always due to multiple factors at the same time. Exercises and physical therapy can help counter these problems, but they have to be the right kind of exercises, and generally getting someone with dementia to cooperate with the exercises takes effort, persistence, and perhaps a little extra skill.
It absolutely is important for healthcare providers to assess an older person for fall risks beyond a PT eval. It can also affect the peripheral nerves. Her overall physical decline does sound worrisome. Whether or not it can be stabilized or reversed, the doctors should be able to do a better job of explaining the likely causes. Some people are able to get a geriatric consultation at an academic medical center near them.
My mom fell last October, she refused to be rushed in the hospital. She had bruises on her arm and was complaining how painful her left shoulder was. She was able to bear with it for a week but after then she was already trembling when she walks and lost her appetite. We rushed her to the hospital and underwent few testings. The doctor told us that there was no dislocated bone are breaks on her shoulder or head. We were discharged after a week. Her condition improved to say the least.
However, after 3 months, she can hardly walk again and she is shaking uncontrollably. She also gets fever everyday and would subside either at night or early morning. She seems to be having hard time breathing as well. Any idea what she might be the problem? You cannot solve a problem like this online, she needs to be seen by a health provider and you need to ask what they think might be going on.
Good luck and please get her to see a health provider soon. Prior to mu intervention, she was only taking the Metoprolol. That has been doubled, and she also started taking diltiazem, famatodine, eliquis, and pravastatin.
Since then her cognition has been declining. Then she fell and hurt her head 6 weeks ago. CtScan fine. The past three weeks she has been hallucinating nearly daily. In her mind, the people. Could one of the meds that shes now taking regularly cause this, or more likely the fall?
Prior to around October she did very well on her own. Its been a steady decline, but more so the last several weeks. Medications do sometimes cause psychosis symptoms which include hallucinations or cognitive decline, but there are many other potential causes, so you really have to work with a clinician in person and get her evaluated. In general in geriatrics, we try to use the least amount of medication necessary.
Occasionally people who fall and hit their head initially have a negative head CT but later develop a bruise in or on the brain.
This is insulting to older adults most of whom are quite able to speak for themselves. I have balance issues so I use a wheeled walker and I am very careful. I do NOT need a caregiver to attend every doctor visit and speak for me. I have had my sister with me at times because I want another perspective on the doc;s statements and because she is younger I have had to tell the doctor that I am able to speak for myself.
I have many friends who are also quite able to handle their own lives even after seventy. I will not allow myself to be treated like a child.
This is one of my older articles, written a few years ago when the site was called Geriatrics for Caregivers and all articles were quite explicitly addressed to people who were caring for an aging parent, or otherwise helping an older person with health concerns. Wants me to get one on the left side next. Last week I had a cortisone shot deep in my rt. My problem now is that I keep falling out of bed! In 2weeks I fell 3 times. We got a special bar to put under the mattress that blocks me from falling out of bed.
Since then I have used the bar faithfully! My question is; why do I keep falling out of bed??? I rarely fell out of bed until about a year ago. Yikes, this falling out of bed does sound concerning. If you have a fall, it's important to keep calm. If you're not hurt and you feel strong enough to get up, do not get up quickly.
Roll onto your hands and knees and look for a stable piece of furniture, such as a chair or bed. Hold on to the furniture with both hands to support yourself and, when you feel ready, slowly get up. Sit down and rest for a while before carrying on with your daily activities. If you're hurt or unable to get up, try to get someone's attention by calling out for help, banging on the wall or floor, or using your personal alarm or security system if you have one.
If possible, crawl to a telephone and dial to ask for an ambulance. Try to reach something warm, such as a blanket or dressing gown, to put over you, particularly your legs and feet. Stay as comfortable as possible and try to change your position at least once every half an hour or so.
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