Why? There are three major reasons for this:
- A fall can be a sign of a new and serious medical problem that needs treatment. For instance, an older person can be weakened and fall because of illnesses such as dehydration, or a serious urinary tract infection.
- Older adults who have fallen are at higher risk for a future fall. Although it’s a good idea for any older person to be proactive about identifying and reducing fall risk factors, it’s vital to do this well after a fall.
- Busy doctors may not be thorough unless caregivers are proactive about asking questions. Most doctors have the best intentions, but studies have shown that older patients often don’t get recommended care. By being politely proactive, you can make sure that certain things aren’t overlooked (such as medications that worsen balance).
All too often, a medical visit after a fall is mainly about addressing any injuries that the older person may have suffered.
Obviously, this is very important! However, if you want to help prevent future falls, it’s also important to make sure the doctors have checked on all the things that could have contributed to the fall.
Even if you’re pretty sure your loved one just tripped and stumbled, a good evaluation can uncover issues that made those trips and stumbles more likely.
In this post, I’ll list eight key items that you can make sure the doctors check on, after a fall. This will help you make sure your loved one has had a thorough work-up, and can reduce the chance of future serious falls.
This list is partly based on the American Geriatrics Society’s Clinical Practice Guidelines on Preventing Falls.
8 Things the Doctors Should Check After a Fall
Free Fall Assessment Cheatsheet: The 8 things doctors should check after an aging person falls, in a handy PDF checklist that you can print or save. Click here.
1. An assessment for underlying new illness. Doctors almost always do this if an older person has been having generalized weakness, delirium, or other signs of feeling unwell. Be sure to bring up any symptoms you’ve noticed, and let the doctor know how quickly the changes came on.
Just about any new health problem that makes an older person weak can bring on a fall. Some common ones include:
- Urinary tract infection
- Anemia (low red blood cell count), which can be brought on by bleeding in the bowel or by other causes
- Heart problems such as atrial fibrillation
- Strokes, including mini-strokes that don’t cause weakness on one side
2. A blood pressure and pulse reading when sitting, and when standing.This is especially important if you’ve been worried about falls — or near falls — that are associated with light-headedness, or fainting.
If your older relative takes blood pressure medication, you should make sure the doctor confirms that he or she isn’t experiencing a drop in blood pressure with standing. (Note that tamsulosin — brand name Flomax — is a popular prostate medication that also causes drops in blood pressure.)
A 2009 study of Medicare patients coming to the emergency room after fainting found that checking sitting and standing blood pressure was the most useful test. However, it was only done by doctors 1/3 of the time.
For more information, see “6 Steps to Better High Blood Pressure Treatment for Older Adults”.
3. Blood tests.Checking an older person’s blood tests is often a good idea after a fall. Falls can be worsened by problems with an older person’s blood count, or by things like blood sodium getting too high or too low.
Generally, a complete blood cell count (CBC) and a check of electrolytes and kidney function (metabolic panel, or “chem-7”) are a good place to start.
For more on blood tests that are often useful, see Understanding Laboratory Tests: 10 Commonly Used Blood Tests for Older Adults.
Be sure to ask the doctor to explain any abnormalities found in the blood work, whether they might be related to falls, and how the doctor plans to address them.
If your loved one has diabetes and takes insulin or other medications to lower blood sugar, be sure to bring in the glucometer or a blood sugar log. Episodes of low blood sugar (hypoglycemia) are an important risk factor for falls, but a laboratory blood test generally doesn’t show moments of low blood sugar.
4. Medications review.Many older adults are taking medications that increase fall risk. These medications can often be reduced, or even eliminated. Be sure to ask the doctor to address the following types of medications:
- Any sedatives, tranquilizers, or sleeping medications. Common examples include zolpidem (Ambien) for sleep, or lorazepam (Ativan) for anxiety. Antipsychotic medications for restless dementia behaviors, such as risperidone or quetiapine, can also increase sedation and fall risk.
- Blood pressure and diabetes medications. As noted above, it’s not unusual for older adults to be “over-treated” for these conditions, meaning they are taking a level of medication that causes the blood pressure (or blood sugar) be lower than is really necessary for ideal health.
- “Anticholinergic” medications. These medications are commonly taken by older adults, who often have no idea that these medications worsen balance and thinking! They include medications for allergies, overactive bladder, vertigo, nausea, and certain types of antidepressants which may also be given for nerve pain. For more on identifying and avoiding anticholinergics, see here.
- Opiate pain medications,especially if they are new.
The Centers for Disease Control recommends that older adults concerned about falls request a medication review. To learn more about which medications should be reviewed, and what should be done about risky drugs, see this article:
“10 Types of Medication to Medications to Review if You’re Concerned About Falling.”
5. Gait and balance.At a minimum, a gait assessment means that the doctor carefully watches the way the older person is walking. There are also some simple ways to check balance.
Simple things to do, if gait and balance don’t seem completely fine, are:
- Address any pain or discomfort, if that seems to be a cause of problems. Many older people are reacting to pain in their feet, joints, or back.
- Consider a physical therapy referral for gait and balance assessment. A physical therapist can often recommend suitable strengthening exercises, and also can help fit the older person for an assistive device (e.g. a walker) if appropriate. For more on the proven Otago physical therapy program to reduce falls — including videos demonstrating the exercises — see “Otago and Proven Exercises for Fall Prevention.”
6. Vitamin D level.Studies suggest that treating low vitamin D levels (e.g. less than 20ng/mL) might help reduce falls in older adults. Low vitamin D levels can also contribute to fragile bones.
If your older loved one spends a lot of time indoors and doesn’t take a daily vitamin D supplement,there is a fairly high chance of having a low vitamin D level. Taking a daily supplement of 800-1000 IU will eventually maintain vitamin D at a normal level in most people, but if you are very concerned about falls or vitamin D, talk to your doctor about getting a level checked. When vitamin D levels are very low, doctors sometimes treat with higher doses of vitamin D for a few months.
Note: I generally recommend my patients take 800-1000 IU of Vitamin D per day, unless we have documented a severe deficiency that would warrant temporary high-dose treatment. I don’t recommend people take high doses of Vitamin D (e.g. 2000 IU/day or more) without medical supervision. For more on vitamin D, see my post ““
7. Evaluation for underlying heart conditions or neurological conditions.These chronic conditions are different from the “acute” types of illnesses that we usually look for right after a fall.
In a minority of cases, an older person may be falling because he or she has developed a chronic problem with the heart or blood pressure system. An example of this would be paroxysmal rapid atrial fibrillation, which causes the heart to sometimes race.
It’s also possible for older people to develop a new chronic neurological condition, such as Parkinson’s disease.
If you’re worried about these possibilities, ask the doctor “Do you think a heart condition might have caused this fall? Or do you think an underlying neurological condition could have caused this fall?”
It’s particularly useful for you to ask about these kinds of problems if the falls or near-falls keep happening, especially if you’ve already minimized risky medications and over-treatment of high blood pressure.
8. Vision, podiatry, and home safety referrals. Could your loved one be in need of avision check, podiatry care, or a home safety evaluation? If you’ve brought an older person in after a fall, it’s a good idea to talk to the doctor about whether these services might help.
I especially recommend home safety evaluations, if they are available in your area. Vision checks are also an excellent idea if the older person hasn’t had one recently.
How to use this information
Overwhelmed by this list? Here are some ideas for you:
- Print out this post — or download our free cheat sheet — and bring it along next time you take an older person to see the doctor after a fall. If the doctor overlooks certain points, don’t be shy about asking why.
Free Fall Assessment Cheatsheet: The 8 things doctors should check after an aging person falls, in a handy PDF checklist that you can print or save. Click here.
- Post your questions or comments below. I’d love to know more about how this list can help you make sure your loved one gets the right care after a fall.
For more practical advice on preventing falls, see our Falls Topic Page. You can also learn more about clinically proven exercises that reduce falls here.
Check for injuries, indicated by bruising, skin discoloration, or evidence of a break. If the person grimaces or cries out when they try to move or when you touch their limbs, call for an ambulance. Keep them calm and lying down until help arrives.Why is it important to monitor falls in the elderly? ›
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.What can falls lead to in elderly? ›
Falls can cause broken bones, like wrist, arm, ankle, and hip fractures. Falls can cause head injuries. These can be very serious, especially if the person is taking certain medicines (like blood thinners).What are the 4 P's of fall prevention? ›
Falls Prevention Strategies
The 4P's stand for: Pain, Position, Placement, and Personal Needs. This approach may be used by various caregivers and members of the care team to help prevent falls, and to develop a culture that checks in with the resident and addresses their needs at different times of the day.
Stay with the patient and call for help. Check the patient's breathing, pulse, and blood pressure. If the patient is unconscious, not breathing, or does not have a pulse, call a hospital emergency code and start CPR. Check for injury, such as cuts, scrapes, bruises, and broken bones.How do you know if you should go to the doctor after a fall? ›
Symptoms of a Potential Fall Injury
- Severe or lingering pain.
- Obvious swelling.
- Ringing in the ears.
- Loss of balance.
- Back pain.
Any fall that results in an injury is cause for concern, no matter how minor, and should receive treatment immediately. Injuries can appear small at first, but gradual or sudden changes in health or behavior are significant signs that an injury is worth a closer look.What should a falls assessment include? ›
identification of falls history. assessment of gait, balance and mobility, and muscle weakness. assessment of osteoporosis risk. assessment of the older person's perceived functional ability and fear relating to falling.Why do elderly not recover from falls? ›
Advanced age, frailty and pre-existing medical conditions decrease the likelihood that older individuals will recover from fall-related injuries. A team of researchers from the University of Rochester Medical Center set out to study how the effects of ground-level falls differ between elderly and non-elderly adults.How long does it take for an elderly person to recover from a fall? ›
Recovering after an injury is often a very long and time-consuming process, which is particularly true for adults ages 65+. It can often take months until they fully recover, but there are ways to speed up this process and recover a bit faster.
Falls can cause adverse psychological impact on carees, increased fear of falling again, decreased self-efficacy, and confidence in balance .What is the most common injury among elder due to fall? ›
Each year, 36 million falls occur among older adults age 65 and older. One out of five falls cause serious injury such as broken bones or a head injury. Over 950,000 older adults are hospitalized because of a fall injury every year,5 most often due to a head injury or hip fracture.What is Post fall syndrome? ›
Post Fall Syndrome or Psychomotor Regression Syndrome (PRS) is defined as: “Decompensation of the systems and mechanisms implicated in postural and walking automatisms (Mourey, 2009)” It appears either insidiously due to an increase of frailty or either brutally after a trauma (fall) or an operation.What are 3 standard fall precautions? ›
Follow the following safety interventions:
Secure locks on beds, stretcher, & wheel chair. Keep floors clutter/obstacle free (especially the path between bed and bathroom/commode). Place call light & frequently needed objects within patient reach.
- Make an appointment with your health care provider. Start by making an appointment with your health care provider. ...
- Keep moving. Physical activity can go a long way toward fall prevention. ...
- Wear sensible shoes. ...
- Remove home hazards. ...
- Light up your living space. ...
- Use assistive devices.
The 5 P's acronym is used systematically in a neurovascular assessment to assess compartment syndrome's presence. The P's refer to pain, pallor, pulse, paresthesia, and paralysis.What are 5 nursing interventions used to address a client with a risk for falls? ›
- Familiarize the patient with the environment.
- Have the patient demonstrate call light use.
- Maintain the call light within reach. ...
- Keep the patient's personal possessions within safe reach.
- Have sturdy handrails in patient bathrooms, rooms, and hallways.
- Signs of internal abdominal bleeding include:
- Vomiting bright red blood.
- Vomit that looks like coffee grounds.
- Black or tarry stool.
- Shortness of breath.
Depending on how quickly your fall occurs, your body releases a surge of adrenaline when you first start to lose control and you begin to panic. Once the fall is underway, your body braces for impact by tensing your muscles and extending your arms or legs.What are the 5 key steps in a falls risk assessment? ›
- Identify hazards.
- Assess the risks.
- Control the risks.
- Record your findings.
- Review the controls.
A fall risk assessment checks to see how likely it is that you will fall. It is mostly done for older adults. The assessment usually includes: An initial screening. This includes a series of questions about your overall health and if you've had previous falls or problems with balance, standing, and/or walking.Why do doctors ask about falls? ›
Doctors can help older adults reduce their risk of falling, so be sure you let your doctor know if you've fallen, or if you have a fear of falling.” Many patients who've fallen worry they'll be fast-tracked to losing their independence.Should an elderly person go to hospital after a fall? ›
It is especially important for your senior to see a doctor if they are experiencing any of the following: They lost consciousness during their recent fall. They could not explain how or why they fell, or they realized they were on the floor and couldn't explain how it happened.What do seniors do after a fall? ›
- Assess the Situation.
- Help the Senior Get Up.
- Evaluate for 24 Hours.
- Notify Family Members.
- See Primary Care Doctor.
- Prevent Future Falls.
Delayed responses to trauma can include persistent fatigue, sleep disorders, nightmares, fear of recurrence, anxiety focused on flashbacks, depression, and avoidance of emotions, sensations, or activities that are associated with the trauma, even remotely.What are the 3 types of falls? ›
- Physiological (anticipated). Most in-hospital falls belong to this category. ...
- Physiological (unanticipated). ...
It can take a few minutes to feel pain from injuries. If someone else falls it's important to reassure them, and assess the situation together, before you act. Find out more about what to do when someone falls in this leaflet (PDF, 1 MB).Why do I feel unwell after a fall? ›
This can be a sign of a concussion. Nausea. Feeling sick to your stomach or throwing up after a fall can be a sign of brain injury, and should be taken seriously.What neurological conditions cause falling? ›
Parkinson disease (PD), multiple sclerosis (MS) and stroke carry high risk of falls. Among people with PD, 45–68% are reported to be fallers each year and two-thirds of them fall repeatedly (1).Should elderly go to ER after a fall? ›
Obvious injuries resulting from a fall, such as fractures (a broken bone), open wounds or head injuries that may or may not be associated with loss of consciousness, can require an Emergency Room visit.
It is recommended to seek emergency medical help within 72 hours of a slip and fall accident, but the sooner the better. If you cannot see a family doctor within 72 hours of your slip and fall you must go to an emergency room or walk-in clinic. The most important reason to seek medical help is your health.Why do elderly deteriorate after fall? ›
"People can die after a fall for many reasons, which may include head trauma, internal bleeding and complications of a bone fracture," he said. "Fractures can lead to hospitalization, immobility in bed and respiratory or other infections, which can be fatal."