With a rapidly ageing population, doctors in all specialties are likely to encounter older people with falls. Falls in the elderly are common and associated with major morbidity and mortality. Falls cause injuries, fractures, loss of confidence and independence, depression and death. Recurrent falls and fear of falling are the most common reasons for an older person to require nursing home care. An initial fall may be a manifestation of an acute illness and may be the only presenting feature. However, it is known that an index fall is a risk for future falls and approximately half of those who fall once are likely to do so again. There is good evidence to support a multidisciplinary risk factor assessment and approach to the prevention of falls. Up to 30% of falls in community-dwelling older adults may be prevented if this standardised approach is applied. In addition, falls of hospital inpatients are difficult for patients and staff. Carers in environments where specialist medicine for the elderly services are not routinely available often struggle to minimise and manage falls. While arguably more problematic to manage, a simple structured approach to these falls can also reduce risk. This article will cover the recommended approach to the management of older people presenting with a fall and give some guidance about managing falls of hospital inpatients.
