The older person who has fallen: a case-based approach

The case: found on the floor

An 82-year-old woman is helped up by a neighbour after slipping in her kitchen. She feels shaken and has a sore hip but can stand. She has had a couple of near-falls recently and takes several medicines, including one for blood pressure and a water tablet. This is a familiar situation. Rather than treating the fall as a one-off accident, a clinician sees it as a clue. Older people fall for many reasons at once — weak muscles, poor balance, medicines, low blood pressure on standing, poor vision, foot problems and hazards around the home. The two immediate questions are always the same: what caused this fall, and has it caused an injury that needs treating now?

Why older people fall

Falls in later life usually have several causes acting together rather than a single one. Common contributors include reduced muscle strength and balance, problems with vision or the feet, and conditions such as arthritis or Parkinson's disease. Medicines matter a great deal: some lower blood pressure, some cause drowsiness, and taking many medicines together raises the risk. A drop in blood pressure on standing up, called postural hypotension, can cause dizziness and a fall. So can irregular heart rhythms, infections, dehydration and simply the hazards of a home — loose rugs, poor lighting, trailing wires and no rails. Because the causes stack up, the value of a proper assessment is that several small improvements together can make a real difference to whether someone falls again.

The red flags that mean urgent care

Some features after a fall need urgent attention. Call 999 if the person cannot get up, is in severe pain, or a limb looks bent, shortened or twisted, which may mean a broken bone such as a hip. Urgent assessment is also needed for any blow to the head — especially loss of consciousness, repeated vomiting, drowsiness, confusion or a person on blood-thinning medicines — because of the risk of bleeding inside the skull. Other warning signs include chest pain, breathlessness, palpitations or blacking out before the fall, which may point to a heart or circulation cause, and signs of stroke such as face drooping or weakness. A fall with any of these needs same-day medical help rather than watchful waiting.

How doctors assess after a fall

A good assessment covers both the injury and the cause. The clinician checks for fractures and head injury, then explores why the fall happened: what the person was doing, whether they felt dizzy, faint or had palpitations, and whether they blacked out. Blood pressure is often measured lying and standing to look for a drop, the heart rhythm is checked, and medicines are reviewed to see if any could be lowering blood pressure or causing drowsiness. Strength, balance and walking are observed, and eyesight, feet and footwear considered. Blood tests may look for infection, anaemia or dehydration. This broad look, sometimes called a falls assessment, aims to find the handful of things that, if changed, will most reduce the chance of another fall.

Preventing the next fall

Much can be done to prevent future falls. Strength and balance exercises, such as those offered by physiotherapists or community falls programmes, are among the most effective steps. Reviewing medicines to reduce or adjust those that cause dizziness or drowsiness helps, as does treating low blood pressure on standing, sorting out vision and foot problems, and checking bone health, since preventing fractures matters as much as preventing falls. Simple changes at home — removing loose rugs, improving lighting, adding grab rails and keeping walkways clear — reduce hazards. Keeping active, staying hydrated and wearing well-fitting shoes all help. The key message from this case is that a fall is worth taking seriously: it is both a chance to prevent the next one and, sometimes, a sign of injury needing urgent care.