Falls Prevention

A fall is an event, not a diagnosis. It may be the visible result of impaired balance, medication effect, orthostatic hypotension, delirium, syncope, visual impairment, environmental hazard, or a combination of these. The experienced clinician does not stop at “the patient fell”; they ask what changed, what the patient was trying to do, and whether the event represents a reversible medical problem. The consequences extend beyond the immediate injury. A painful fracture can reduce mobility, immobility causes deconditioning, and deconditioning makes the next fall more likely. Fear of falling can produce the same cycle even when no fracture occurred. Prevention therefore aims to preserve safe function, not to keep an older adult inactive or confined to bed. Risk is context-dependent. In community practice, a fall history and gait or balance function help determine who needs a comprehensive assessment. In hospital and long-term-care settings, acute illness, unfamiliar surroundings, medication changes, toileting needs, cognitive impairment, and fluctuating function make every older patient high risk. Selective screening is not an adequate substitute for universal assessment and individualized prevention in these settings. For community-dwelling...