Unexplained falls in the elderly

Falls are a geriatric syndrome affecting mortality, morbidity, and institutionalization. Falls are also the leading cause of unintentional injury and a common emergency department presentation. Physical and psychological issues may develop idler falling, leading to increase in dependency and disability and their relative costs. The pathogenesis of falls is multifactorial, being indeed the result of the interaction between increased individual susceptibility, high risk activities and environmental hazards. The patient should be evaluated for gait, standing balance, mobility, muscle weakness, cognitive status, osteoporosis risk, sensorial impairment, urinary incontinence, functional status, and for possible residential environmental hazards. It is also mandatory to obtain a full report of the circumstances and a careful therapeutic recognition. However not all falls are explainable. Indeed, retrograde amnesia and the frequent absence of a witness complicate history collection of falls in older adults. In this case, the management of unexplained falls should be the same as that for unexplained syncope as stated by the latest version of the European Society of Cardiology guidelines on syncope. In this context, the investigation of the cardiovascular autonomic nervous system and the use of implantable loop recorder have an increasing role. The present paper addresses the diagnostic approach to falls in older adults through a comprehensive multifactorial risk assessment and examines evidence and gaps on fall prevention strategies.

Automated summary

Falls in older adults are a complex issue that can lead to increased mortality, morbidity, and institutionalization. They are the leading cause of unintentional injury and are commonly seen in emergency departments. The causes of falls are multifactorial, involving individual susceptibility, high-risk activities, and environmental hazards. Evaluating the patient for various factors such as gait, balance, muscle weakness, and cognitive status is important, as well as assessing the residential environment for potential hazards. Not all falls can be explained, but the approach to managing unexplained falls is similar to that of unexplained syncope. Increasingly, the cardiovascular autonomic nervous system and implantable loop recorders are being used to investigate and diagnose falls.