Falls and their resulting injuries are a serious public health issue among older adults. Falls are associated with a considerable number of deaths, a considerable number of complications, reduced functioning and premature nursing-home admission.

Both the incidence of falls and the severity of fall-related complications rise steadily after age 60. In the United States, 1 in 3 people aged 65 years and older falls each year. After age 75, the rates are even higher.

A key concern for older people is not simply the high incidence of falls but their high susceptibility to injury. Of those who fall, 20% to 30% suffer moderate to severe injuries that reduce mobility and independence and increase the risk of premature death. Approximately 5% of older people who fall must be hospitalized.

In addition to physical injury, falls can also have psychological and social consequences. It has been well described that people who fall lose their self-confidence. This leads to further reduction in their mobility, their level of activity and, eventually, their ability to socialize.

As the number of older adults in the population grows, the number of falls will increase, and the burden on financial resources will grow. At present, it is estimated that falls cost $20 billion per year in the U.S. Other consequences include pain, disability, deterioration in general well-being and extra burdens on other family members.

Here are some of the most frequently asked questions — and their answers — about falls among the elderly:

Factors that contribute to falls in older people include:

Age-related changes. Aging is associated with several important changes that predispose an older person to falls. For example, age-related changes in blood-pressure regulation may cause an older person's blood pressure to drop when he or she stands. This may cause the person to pass out (a condition called syncope).

Disease-related factors. Older people are also more likely to fall because they often have several co-existing diseases. Studies have shown that falls in older people more likely result from a combination of multiple disorders than from a single disease. For example, a person with low blood pressure that causes dizziness on standing, cataracts that cause poor vision, and arthritis that causes unstable knee joints is more likely to fall than someone with only one of these conditions.

Polypharmacy (the use of multiple medications). Medications are a significant contributing factor to falls in older adults. This is because older adults are more likely to be taking multiple medications for longer periods, which increases the risk of side effects and medication interactions. The medication-related mechanisms that may lead to falls include:

Specifically, there appears to be an increased risk of falls among patients taking four or more medications. Medications that have been shown to increase the risk of falls include sleeping pills, blood pressure medication, diuretics (water tablets) and antidepressants.

Environmental factors. Older people are less able than younger people to compensate for common environmental hazards such as loose rugs and poorly fitting shoes. Such hazards can lead to accidental falls, which account for 50% of all falls among the elderly.

Most falls in older adults are the result of a combination of several factors rather than a single event. The proportion of older adults who fall increases with the number of risk factors present. The risk factors for falls are best described as internal or external.

Syncope (pronounced SINK-o-pee) is the medical term for fainting. It is a sudden, brief loss of consciousness caused by inadequate blood supply to the brain. It is usually preceded by lightheadedness. The individual recovers spontaneously (that is, the individual does not need to be resuscitated).

Similar to a fall, syncope is a symptom, not a disease. It is a common problem with a lot of causes. These include:

Syncope can cause falls, fractures, brain hemorrhage and loss of independent function.

You should always call your doctor if you have had an episode of syncope. Your doctor will need to determine:

The treatment of syncope will be directed at the cause.

A fall is a symptom, not a diagnosis. Although falls are more common in older people, they should not be accepted as a normal part of aging. There is no acceptable number of falls. A single fall can cause serious injuries. It is therefore important that you consult a health care professional if you have had even a single fall.

It is also important that you continue to see your doctor for regular follow-up. This will allow early identification and management of any new risk factors for falls that may develop. It is also necessary to keep track of any deterioration in your health that may require changes to your environment.

Many times, falls can be prevented by relatively simple interventions, such as adjusting the dose of your medication or getting new eyeglasses. Your doctor can determine your risk of falls and help you avoid falls in the future.

Your doctor may do one or more of the following:

Certain older people require a full fall evaluation:

It's important that the health care professional has the appropriate skills and experience in managing falls. You may need a referral to a geriatrician, a doctor who specializes in the care of older adults.

During the evaluation, the health care professional will:

It may also be necessary to have a nurse come to your home to identify your needs more accurately.

The information obtained from your medical history and physical examination will guide which diagnostic tests you may need. Medical tests are needed only if your history and physical examination do not reveal the cause of your fall or if they point to a particular abnormality that requires more-detailed evaluation.

These tests may include:

Your doctor may refer you to a specialist such as a bone doctor if you have joint problems or an ear specialist for specific balance problems.

It is a common misconception that people in nursing homes have fewer falls. In fact, the opposite is true. Falls occur more often among people in nursing homes than among those in the community, and the injuries sustained are far greater. This may be because nursing-home residents tend to be frailer than older adults living in the community are. They also tend to be older and have more memory trouble, and they have greater limitations in their activities of daily living (such as eating, bathing and going to the bathroom). These are some of the key factors associated with falls.

The high rate of falls among nursing-home residents may also reflect better reporting of falls because of closer observation.

Older people who have recurrent falls should participate in regular exercise and balance training. Your health care professional can help you develop a program or provide you with information on where you can find one. The optimal type, duration and intensity of exercise are unclear. However, the following facts have been proven: