Recurrent Falls in Older Adults: Assessment, Prevention and Team Management

Repeated falls, meaning two or more falls within 12 months, are a simple clinical marker that a patient has entered a major geriatric syndrome with a very high risk of further falls. In this lecture, Prof. Jean Belmin of Sorbonne Université and Hôpital Charles Foix explains how to recognise high-risk older adults, what to look for during assessment, and how to build a personalised, multidimensional prevention plan with the care team.

Falls are among the leading causes of injury and injury-related death in older adults. About one in three people aged 65 and over fall each year, and around half of those over 80. In France alone, falls lead to some 500,000 emergency visits a year, a third of them followed by hospitalisation, at an estimated cost of €2.5 billion. Beyond fractures, falls trigger fear of falling, post-fall syndrome, reduced mobility, loss of independence and worsening sarcopenia, a vicious circle that care must break.

What the lecture covers

• Fall-risk stratification in line with the World Falls Guidelines (2022), the French HAS guidelines and NICE: who needs a full geriatric assessment, and the role of the Timed Up and Go and one-leg stance tests
• Predisposing (chronic) and precipitating (acute) factors, and why several are usually present in the same patient
• A focused work-up: clinical and medication review, geriatric assessment, blood tests, ECG and creatine kinase after a long lie, and which investigations add cost without benefit
• Fall prevention clinics and day-care rehabilitation programmes
• Evidence-based interventions: footwear, technical aids, home environment, exercise, vitamin D and calcium, osteoporosis treatment, patient and caregiver education, and personal alarms
• Fall-risk-increasing drugs (FRIDs) and deprescribing
• Resistance and balance training, tele-rehabilitation and exergames, including a meta-analysis of 27 randomised trials
• Why physical restraints increase, rather than reduce, the risk of injury

Questions and answers

What counts as repeated falls?

Two or more falls within 12 months. These patients should be treated as high risk for recurrence and offered a geriatric assessment and a tailored, multidimensional intervention.

How should a patient with one fall or no falls be screened?

With simple tests such as Timed Up and Go and one-leg stance. Fear of falling, frailty or sarcopenia help decide whom to test. An abnormal result places the person in the high-risk group. Normal results call for general advice with exercise and balance training.

Does stopping fall-risk-increasing drugs prevent falls on its own?

Medication review remains part of the assessment, but a recent meta-analysis found that deprescribing alone did not reduce falls. It works as part of a multidimensional programme.

What exercise works?

Lower-limb resistance and balance training at least twice a week for 30 minutes or more. Tele-rehabilitation and exergames can add to conventional physiotherapy.

Learn more about related topics in our geriatrics collection: link

*Provided by International Association of Gerontology & Geriatrics (IAGG) & Federation of Geriatric Education (FGE)

Speakers

• Prof. Jean Belmin

Learning objectives

• Define repeated falls and explain why they signal a geriatric syndrome with a high risk of recurrence.
• Stratify fall risk using the World Falls Guidelines criteria and simple tests such as Timed Up and Go and one-leg stance.
• Identify predisposing and precipitating factors through clinical assessment, medication review and targeted investigations.
• Plan a personalised, multidimensional prevention programme, including exercise, osteoporosis care and review of fall-risk-increasing drugs.
• Assess the place of tele-rehabilitation and exergames, and explain why physical restraints should be avoided.