journal article·2022-08-08Open access

Falls among Older Adults: Screening, Identification, Rehabilitation, and Management

Silvia Giovannini, Fabrizio Brau, Vincenzo Galluzzo, Domenico Alessandro Santagada, Claudia Loreti, Lorenzo Biscotti, Alice Laudisio, Giuseppe Zuccalà, Roberto Bernabei

Applied Sciences· Volume 12· Issue 15

Abstract

A fall is an event where a person unintentionally and traumatically finds themselves on the floor or a lower level. Falls are very common, especially in the older adult population. One in four people falls at least once a year after age 65. Because of falls, there can be injuries, whereby there can be an impairment of health status. Fractures, reduced mobility, disability, and the need for institutionalization are potential consequences after falls. In older adult patients, especially frail ones, these types of complications are more common. There are several risk factors for falls. Falls generally result from a combination of factors operating simultaneously. Sarcopenia, cognitive impairment, or poly-pharmacotherapy are just a few examples of risk factors that are common in the older people. Through careful clinical evaluation, it is possible to identify risk factors and conditions predisposing to falls. In some cases, it is possible to correct these factors. Several types of treatment are available to restore the health status before the fall and prevent subsequent falls. Using multi-component interventions, the risk of falls can be effectively reduced. Aware that this review will not be exhaustive of such a broad topic, the purpose of this narrative review is to summarize relevant and recent evidence in the current literature to encapsulate fall-related risk factors, risk identification, fall prevention, and management, including various rehabilitation techniques. This article conforms to the Scale for Assessment of Narrative Review Articles (SANRA) guidelines.
Source: crossref · Quality: baseline

Research context

OpenAlex topics: Balance, Gait, and Falls Prevention · Cerebral Palsy and Movement Disorders · Stroke Rehabilitation and Recovery

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy

UOS Riabilitazione Post-Acuzie, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy

UOC Chirurgia Vertebrale, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy

Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy

Presiding Officer of Geriatric Care Promotion and Development Centre (C.E.P.S.A.G), Università Cattolica del Sacro Cuore, 00168 Rome, Italy

Unit of Geriatrics, Department of Medicine, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 200, 00128 Rome, Italy

References (100+)

Show source-provided references
1. Prevalence of Falls in Patients Presenting to an Ophthalmic Outpatients Department—A Surveillance Study10.22599/bioj.178 ↗
2. WHO Falls (2022, July 22). World Health Organization. Available online: https://www.who.int/news-room/fact-sheets/detail/falls#:~:text=Falls%20are%20the%20second%20leading,greatest%20number%20of%20fatal%20falls.
3. Falls in the Elderly: Spectrum and Prevention
4. Interactions between Drugs and Geriatric Syndromes in Nursing Home and Home Care: Results from Shelter and IBenC Projects10.1007/s40520-018-0893-1 ↗
5. Selenium Concentrations and Mortality Among Community-Dwelling Older Adults: Results from IlSIRENTE Study10.1007/s12603-018-1021-9 ↗
6. Myeloperoxidase Levels and Mortality in Frail Community-Living Elderly Individuals10.1093/gerona/glp183 ↗
7. Substrates for Normal Gait and Pathophysiology of Gait Disturbances with Respect to the Basal Ganglia Dysfunction10.1007/s00415-008-4004-7 ↗
8. The Fall in Older Adults: Physical and Cognitive Problems10.2174/1874609809666160630124552 ↗
9. A Review of Telomere Length in Sarcopenia and Frailty10.1007/s10522-018-9749-5 ↗
10. Prevention of Falls Network Europe: A Thematic Network Aimed at Introducing Good Practice in Effective Falls Prevention across Europe10.1007/s10433-004-0008-z ↗
11. Falls and Their Prevention in Elderly People: What Does the Evidence Show?10.1016/j.mcna.2006.05.013 ↗
12. SANRA-a scale for the quality assessment of narrative review articles10.1186/s41073-019-0064-8 ↗
13. (2022, February 14). NSC Older Adult Falls-Injury Facts. National Safety Council Tabulations of National Center for Health Statistics Data. Available online: https://injuryfacts.nsc.org/home-and-community/safety-topics/older-adult-falls/data-details/.
14. Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years-United States, 2012–201810.15585/mmwr.mm6927a5 ↗
15. Predicting Falls in Nursing Homes: A Prospective Multicenter Cohort Study Comparing Fall History, Staff Clinical Judgment, the Care Home Falls Screen, and the Fall Risk Classification Algorithm10.1016/j.jamda.2020.06.037 ↗
16. Choi, N.G., Choi, B.Y., Dinitto, D.M., Marti, C.N., and Kunik, M.E. (2019). Fall-Related Emergency Department Visits and Hospitalizations among Community-Dwelling Older Adults: Examination of Health Problems and Injury Characteristics. BMC Geriatr., 19.10.1186/s12877-019-1329-2 ↗
17. (2022, July 22). Self-Reported Falls and Fall-Related Injuries Among Persons Aged ≥ 65 Years. United States. 2006, Available online: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5709a1.htm.
18. Falls and Fractures: A Systematic Approach to Screening and Prevention10.1016/j.maturitas.2015.06.035 ↗
19. Incidence of Injury-Causing Falls Among Older Adults by Place of Residence: A Population-Based Study10.1111/j.1532-5415.1995.tb05529.x ↗
20. Risk Factors for Injurious Falls: A Prospective Study10.1093/geronj/46.5.M164 ↗
21. The Cost and Frequency of Hospitalization for Fall-Related Injuries in Older Adults10.2105/AJPH.82.7.1020 ↗
22. Predictors of falls and hospitalization outcomes in elderly patients admitted to an acute geriatric unit10.1016/j.archger.2008.06.004 ↗
23. Medical Costs of Fatal and Nonfatal Falls in Older Adults10.1111/jgs.15304 ↗
24. Costs and Benefits of Multifactorial Falls Prevention in Nursing Homes in the Netherlands10.1016/j.exger.2020.111173 ↗
25. Falls in Older People: Epidemiology, Risk Factors and Strategies for Prevention10.1093/ageing/afl084 ↗
26. Risk Factors for Falls in Community-Dwelling Older People: A Systematic Review and Meta-Analysis10.1097/EDE.0b013e3181e89905 ↗
27. Preventing Falls in the Geriatric Population10.7812/TPP/12-119 ↗
28. Psychoactive Medication Use among Older Community-Dwelling Americans10.1016/j.japh.2019.05.001 ↗
29. Chronic Pain in the Elderly: The Case for New Therapeutic Strategies
30. Giovannini, S., Coraci, D., Brau, F., Galluzzo, V., Loreti, C., Caliandro, P., Padua, L., Maccauro, G., Biscotti, L., and Bernabei, R. (2021). Neuropathic Pain in the Elderly. Diagnostics, 11.10.3390/diagnostics11040613 ↗
31. Chronic Musculoskeletal Pain and the Occurrence of Falls in an Older Population10.1001/jama.2009.1738 ↗
32. Occupational Therapy Fall Prevention Interventions for Community-Dwelling Older Adults: A Systematic Review10.5014/ajot.2018.030494 ↗
33. Prevention of Falls in Parkinson’s Disease: A Review of Fall Risk Factors and the Role of Physical Interventions10.2217/nmt.14.22 ↗
34. Impact of Depression on Gait Variability in Parkinson’s Disease10.1016/j.clineuro.2020.106324 ↗
35. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC) (2022, July 22). National Center for Injury Prevention and Control (NCIPC), Available online: https://www.cdc.gov/about/organization/cio-orgcharts/ncipc.html.
36. Prevention of Falls in Community-Dwelling Older Adults10.1056/NEJMcp1903252 ↗
37. AGS Releases Guideline for Prevention of Falls in Older Persons
38. Will My Patient Fall?10.1001/jama.297.1.77 ↗
39. Is a Fall Just a Fall: Correlates of Falling in Healthy Older Persons. The Health, Aging and Body Composition Study10.1046/j.1365-2389.2003.51267.x ↗
40. Lower Extremity Function and Subsequent Disability: Consistency across Studies, Predictive Models, and Value of Gait Speed Alone Compared with the Short Physical Performance Battery10.1093/gerona/55.4.M221 ↗
41. Lower-Extremity Function in Persons over the Age of 70 Years as a Predictor of Subsequent Disability10.1056/NEJM199503023320902 ↗
42. Comparison of Fallers and Nonfallers on Four Physical Performance Tests: A Prospective Cohort Study of Community-Dwelling Older Indigenous Taiwanese Women10.1016/j.ijge.2017.04.006 ↗
43. Relationship among Fear of Falling, Physical Performance, and Physical Characteristics of the Rural Elderly10.1097/PHM.0000000000000009 ↗
44. Short-Physical Performance Battery (SPPB) Score Is Associated with Falls in Older Outpatients10.1007/s40520-018-1082-y ↗
45. Association Between Short Physical Performance Battery and Falls in Older People: The Progetto Veneto Anziani Study10.1089/rej.2013.1491 ↗
46. The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons10.1111/j.1532-5415.1991.tb01616.x ↗
47. Tools for Assessing Fall Risk in the Elderly: A Systematic Review and Meta-Analysis10.1007/s40520-017-0749-0 ↗
48. Performance-oriented assessment of mobility problems in elderly patients10.1111/j.1532-5415.1986.tb05480.x ↗
49. Goldberg, A., and Alexander, N.B. (2007). Gait and Mobility. Prim. Care Geriatr. A Case-Based Approach, 253–262.10.1016/B978-032303930-7.50026-2 ↗
50. Determining Risk of Falls in Community Dwelling Older Adults: A Systematic Review and Meta-Analysis Using Posttest Probability10.1519/JPT.0000000000000099 ↗
51. Validity of Divided Attention Tasks in Predicting Falls in Older Individuals: A Preliminary Study10.1046/j.1532-5415.2002.50415.x ↗
52. Orthostatic Hypotension and Falls in Older Adults: A Systematic Review and Meta-Analysis10.1016/j.jamda.2018.11.003 ↗
53. Low Vitamin D and High Parathyroid Hormone Levels as Determinants of Loss of Muscle Strength and Muscle Mass (Sarcopenia): The Longitudinal Aging Study Amsterdam10.1210/jc.2003-030604 ↗
54. Serum 25-Hydroxyvitamin D Concentrations and Risk for Hip Fractures10.7326/0003-4819-149-4-200808190-00005 ↗
55. Screening and Intervention to Prevent Falls and Fractures in Older People10.1056/NEJMoa2001500 ↗
56. Interventions to Prevent Falls in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force10.1001/jama.2017.21962 ↗
57. Use of antidepressant medications among older adults in European long-term care facilities: A cross-sectional analysis from the SHELTER study
58. New Cochrane Review Assesses the Benefits and Harms of Exercise for Preventing Fall s in Older People Living in the Community
59. Exercise to Prevent Falls in Older Adults: An Updated Systematic Review and Meta-Analysis10.1136/bjsports-2016-096547 ↗
60. Age-Related Decrease in Physical Activity and Functional Fitness among Elderly Men and Women
61. Integration of Balance and Strength Training into Daily Life Activity to Reduce Rate of Falls in Older People (the LiFE Study): Randomised Parallel Trial
62. Physical Activity Programs for Balance and Fall Prevention in Elderly: A Systematic Review10.1097/MD.0000000000016218 ↗
63. Preventing Injuries in Older People by Preventing Falls: A Meta-Analysis of Individual-Level Data10.1046/j.1532-5415.2002.50218.x ↗
64. Effects of Physical Exercise in Older Adults with Reduced Physical Capacity: Meta-Analysis of Resistance Exercise and Multimodal Exercise10.1097/MRR.0000000000000249 ↗
65. Combined Exercise Is More Effective than Aerobic Exercise in the Improvement of Fall Risk Factors: A Randomized Controlled Trial in Community-Dwelling Older Men10.1177/0269215516655857 ↗
66. Effects of Two Physical Exercise Protocols on Physical Performance Related to Falls in the Oldest Old: A Randomized Controlled Trial10.1111/ggi.12497 ↗
67. Exercise Interventions for Older Adults: A Systematic Review of Meta-Analyses10.1016/j.jshs.2020.06.003 ↗
68. Potential Health-Related Benefits of Resistance Training10.1006/pmed.2001.0909 ↗
69. Association of Body Fat With Health-Related Quality of Life and Depression in Nonagenarians: The Mugello Study10.1016/j.jamda.2019.01.128 ↗
70. Muscle strength is related to mental and physical quality of life in the oldest old10.1016/j.archger.2020.104109 ↗
71. Use of proton-pump inhibitors is associated with depression: A population-based study10.1017/S1041610217001715 ↗
72. Endurance and Strength Training Outcomes on Cognitively Impaired and Cognitively Intact Older Adults: A Meta-Analysis10.1007/BF02982674 ↗
73. Effect of Exercise on Physical Function, Daily Living Activities, and Quality of Life in the Frail Older Adults: A Meta-Analysis10.1016/j.apmr.2011.08.042 ↗
74. Efficacy of Physical Exercise in Preventing Falls in Older Adults with Cognitive Impairment: A Systematic Review and Meta-Analysis10.1016/j.jamda.2014.08.007 ↗
75. Association of Long-Term Exercise Training With Risk of Falls, Fractures, Hospitalizations, and Mortality in Older Adults: A Systematic Review and Meta-Analysis10.1001/jamainternmed.2018.5406 ↗
76. The Effect of Physical Rehabilitation on Activities of Daily Living in Older Residents of Long-Term Care Facilities: Systematic Review with Meta-Analysis10.1093/ageing/aft133 ↗
77. Oral Nutritional Support with or without Exercise in the Management of Malnutrition in Nutritionally Vulnerable Older People: A Systematic Review and Meta-Analysis10.1016/j.clnu.2017.09.004 ↗
78. The Effect of Combined Resistance Exercise Training and Vitamin D 3 Supplementation on Musculoskeletal Health and Function in Older Adults: A Systematic Review and Meta-Analysis10.1136/bmjopen-2016-014619 ↗
79. Effects of Protein Supplementation Combined with Resistance Exercise on Body Composition and Physical Function in Older Adults: A Systematic Review and Meta-Analysis10.3945/ajcn.116.143594 ↗
80. Liao, C.D., Chen, H.C., Huang, S.W., and Liou, T.H. (2019). The Role of Muscle Mass Gain Following Protein Supplementation Plus Exercise Therapy in Older Adults with Sarcopenia and Frailty Risks: A Systematic Review and Meta-Regression Analysis of Randomized Trials. Nutrients, 11.10.3390/nu11081713 ↗
81. A Meta-Analysis of Fall Prevention Programs for the Elderly: How Effective Are They?10.1097/00006199-200201000-00002 ↗
82. Long-Term Follow-up of Exercise Interventions Aimed at Preventing Falls in Older People Living in the Community: A Systematic Review and Meta-Analysis10.1016/j.physio.2018.09.002 ↗
83. Interventions to Reduce the Number of Falls among Older Adults with/without Cognitive Impairment: An Exploratory Meta-Analysis10.1002/gps.4056 ↗
84. Improvement of Balance Control Ability and Flexibility in the Elderly Tai Chi Chuan (TCC) Practitioners: A Systematic Review and Meta-Analysis10.1016/j.archger.2014.10.016 ↗
85. Tai Chi for Risk of Falls. A Meta-Analysis10.1111/jgs.15008 ↗
86. Impact of Tai Chi Chu’an Practice on Balance and Mobility in Older Adults: An Integrative Review of 20 Years of Research10.1519/JPT.0b013e3182abe784 ↗
87. Tai Chi for Improving Balance and Reducing Falls: An Overview of 14 Systematic Reviews10.1016/j.rehab.2019.12.008 ↗
88. A Meta-Analysis of Fear of Falling Treatment Programs for the Elderly10.1177/0193945908320466 ↗
89. Intervention Characteristics Associated With a Reduction in Fear of Falling Among Community-Dwelling Older People: A Systematic Review and Meta-Analysis of Randomized Controlled Trials10.1093/geront/gnaa021 ↗
90. An Interactive Physical-Cognitive Game-Based Training System Using Kinect for Older Adults: Development and Usability Study10.2196/27848 ↗
91. Phirom, K., Kamnardsiri, T., and Sungkarat, S. (2020). Beneficial Effects of Interactive Physical-Cognitive Game-Based Training on Fall Risk and Cognitive Performance of Older Adults. Int. J. Environ. Res. Public Health, 17.10.3390/ijerph17176079 ↗
92. Guimarães, V., Oliveira, E., Carvalho, A., Cardoso, N., Emerich, J., Dumoulin, C., Swinnen, N., de Jong, J., and de Bruin, E.D. (2021). An Exergame Solution for Personalized Multicomponent Training in Older Adults. Appl. Sci., 11.10.3390/app11177986 ↗
93. Exergaming for Balance Training of Elderly: State of the Art and Future Developments10.1186/1743-0003-10-101 ↗
94. Balance and visual reliance in post-COVID syndrome patients assessed with a robotic system: A multi-sensory integration deficit10.1007/s10072-021-05647-8 ↗
95. Global approaches for global challenges: The possible support of rehabilitation in the management of COVID-1910.1002/jmv.25829 ↗
96. Giovannini, S. (2022, July 22). Technological Balance and Gait Rehabilitation in Patients With Stroke Sequelae: Functional, Motor and Cognitive Outcomes (ROAR-S), Available online: https://clinicaltrials.gov/ct2/show/NCT05280587.
97. Giovannini, S. (2022, July 22). Robotic Assisted Rehabilitation for Balance and Gait in Orthopedic Patients. (ROAR-O), Available online: https://clinicaltrials.gov/ct2/show/NCT05459584.
98. The Role of Assistive Technology in Alternative Models of Care for Older People
99. Home Modifications to Reduce Injuries from Falls in the Home Injury Prevention Intervention (HIPI) Study: A Cluster-Randomised Controlled Trial10.1016/S0140-6736(14)61006-0 ↗
100. Effectiveness of Assistive Technology in Improving the Safety of People with Dementia: A Systematic Review and Meta-Analysis10.1080/13607863.2018.1455805 ↗