Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention.

BACKGROUND AND SIGNIFICANCE Falls are among the most common and serious problems facing elderly persons. Falling is associated with considerable mortality, morbidity, reduced functioning, and premature nursing home admissions. 1–5 Falls generally result from an interaction of multiple and diverse risk factors and situations, many of which can be corrected. This interaction is modified by age, disease, and the presence of hazards in the environment. 6 Frequently, older people are not aware of their risks of falling, and neither recognize risk factors nor report these issues to their physicians. Consequently opportunities for prevention of falling are often overlooked with risks becoming evident only after injury and disability have already occurred. 7–9 Both the incidence of falls and the severity of fallrelated complications rise steadily after age 60. In the age 65-and-over population as a whole, approximately 35% to 40% of community-dwelling, generally healthy older persons fall annually. After age 75, the rates are higher. 10,11 Incidence rates of falls in nursing homes and hospitals are almost three times the rates for community-dwelling persons age $ 65 (1.5 falls per bed annually). Injury rates are also considerably higher with 10% to 25% of institutional falls resulting in fracture, laceration, or the need for hospital care. 12 Fall-related injuries recently accounted for 6% of all medical expenditures for persons age 65 and older in the United States. 12,13 A key concern is not simply the high incidence of falls in older persons (young children and athletes have an even higher incidence of falls) but rather the combination of high incidence and a high susceptibility to injury. This propensity for fall-related injury in elderly persons stems from a high prevalence of comorbid diseases (e.g., osteoporosis) and age-related physiological decline (e.g., slower reflexes) that make even a relatively mild fall potentially dangerous. Approximately 5% of older people who fall require hospitalization. 14 Unintentional injuries are the fifth leading cause of death in older adults (after cardiovascular, neoplastic, cerebrovascular, and pulmonary causes), and falls are responsible for two-thirds of the deaths resulting from unintentional injuries. More pointedly, 75% of deaths due to falls in the United States occur in the 13% of the population age 65 and over. 15 In addition to physical injury, falls can also have psychological and social consequences. Recurrent falls are a common reason for admission of previously independent elderly persons to long-term care institutions. 16,17 One study found that falls were a major reason for 40% of nursing home admissions. 14 Fear of falling and the post-fall anxiety syndrome are also well recognized as negative consequences of falls. The loss of self-confidence to ambulate safely can result in self-imposed functional limitations. 1,18