Patient handout

Falls and fall risk (older adult)

PRODUCTION

1. Your condition

This handout is for falls and fall risk (older adult). Your care team identified this based on: ≥1 fall in last 12 months — steadi screen positive (cdc steadi 2017; uspstf 2024 pmid 38833246).

Other reasons your team may use this plan: gait or balance complaint, fear of falling (ags/bgs 2010 pmid 21226685); post-fall ed visit (with or without injury) — canadian ct head rule applies if anticoag / ams (ags 2024); recurrent unexplained falls — full multifactor evaluation (uspstf 2024; ags/bgs 2010 pmid 21226685).

3. When to call your provider

Contact your care team if any of the following happen:

New syncope → cardio.neurally-mediated-reflex-syncope.v1 / cardio.afib.core.v1
New focal deficit → neuro.ischaemic-stroke.v1
Fracture → ortho + admission
New positional vertigo → symptom.vertigo.v1 (Dix-Hallpike workup)
New cognitive decline → symptom.dementia.v1
Refractory OH despite midodrine + fludrocortisone → autonomic neurology referral

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Fall with head impact in patient on anticoagulation (warfarin / DOAC) — Canadian CT Head Rule elderly indication; ICH must be ruled out (AGS/BGS 2010 PMID 21226685; CCHR; AHA 2022 ICH)(life-threatening)
Loss of consciousness with fall and unexplained etiology — cardiogenic vs reflex vs orthostatic; route to symptom.syncope pathway (AGS/BGS 2010 PMID 21226685)
≥2 falls in past 12 months OR injurious fall in past 6 months — high-risk tier triggering full multifactor evaluation (USPSTF 2024 PMID 38833246; CDC STEADI 2017; AGS/BGS 2010 PMID 21226685)
Fall resulting in fracture, head injury, laceration requiring repair, or hospitalization (AGS/BGS 2010 PMID 21226685; USPSTF 2024)
Post-fall evaluation in patient on anticoag (even without head impact) — low threshold for CT head; reassess anticoag benefit vs falls with HAS-BLED (AGS 2024)
Fall temporally associated with STOPP-listed or Beers-listed medication — psychoactives (benzo, z-drug, opioid, anticholinergic), hypoglycemics (sulfonylurea, insulin tight control), antihypertensives (overshoot), alpha-blockers, first-gen antihistamine (O'Mahony 2023 PMID 37256475; AGS Beers 2023 PMID 37139824)
Severe hypoglycemia (level 3 — requiring 3rd-party assistance) precipitating fall in patient with DM on sulfonylurea or insulin (ADA 2026; AGS Beers 2023)
Hip / vertebral / wrist / proximal humerus fracture after fall from standing height (USPSTF 2018; AACE/ACE 2020)
Pattern of injury inconsistent with mechanism, fearful patient, isolated, neglect signs (poor hygiene, malnutrition, untreated pressure ulcer, missed meds) (AGS 2024)

5. Follow-up

Multifactorial intervention review at 3 mo; caregiver education; advance care planning if frail; geriatrics co-management if available (AGS/BGS 2010 PMID 21226685; USPSTF 2024)

6. Sources

Guideline: USPSTF Falls Prevention 2024 update + CDC STEADI 2017 + AGS/BGS Falls Guideline 2010 update (with 2024 update incorporated) + AGS BEERS 2023 + STOPP/START v3 (O'Mahony 2023) + Sherrington Cochrane Exercise 2019 + Campbell Otago 1997 + Bischoff-Ferrari vit D 2009