If you want to prevent dangerous falls in an aging adult, here’s one of the very best things you can do: be proactive about getting the right kind of medical assessment after a fall.
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; one doesn’t want to miss a fracture or other serious injury in an older person.
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.
This is really key to preventing falls in an aging adult. 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 article, I’ll list eight key items that you can make sure the doctors check on, after an older person falls. 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
1. An assessment for an 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
- Dehydration
- Anemia (low red blood cell count), which can be brought on by bleeding in the bowel or by other causes
- Pneumonia
- 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 Review if You’re Concerned About Falling.”
5. Gait, balance, and leg strength. At a minimum, a gait assessment means that the doctor carefully watches the way the older person is walking. Asking the older person to stand up from a chair (without using the arms) can help assess leg strength. There are also some simple ways to check balance.
Simple things to do, if gait, balance, or leg strength 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.
- Refer to physical therapy for gait and balance assessment. These assessments will usually include checking the older person’s leg strength. A physical therapist can often recommend suitable strengthening and balance exercises for seniors, 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. 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, or sick sinus syndrome, which can cause the heart to beat too slowly.
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.
7. Evaluation for osteoporosis and fracture risk. Many older adults, especially women, develop thinner bones in later life. Osteoporosis isn’t technically a risk factor for falls, but it’s certainly a major risk factor for injury from a fall. In particular, people with osteoporosis are at much higher risk of having a hip fracture or other type of fracture when they fall.
For this reason, after an older person falls, it’s important to check and make sure they’ve been assessed for osteoporosis.
The US Preventive Services Task Force recommends that all women aged 65 or older be screened for osteoporosis., however many older women end up not getting screened.
If they do have osteoporosis, then it should be treated. Treatment with bisphosphonate medications has been proven to reduce fracture risk.
Experts also recommend promptly starting osteoporosis treatment after a fracture, as the research shows this doesn’t interfere with fracture healing and can reduce the risk of a subsequent fracture.
Calcium and vitamin D supplementation may also help, especially in older adults who have low levels of vitamin D. Other lifestyle changes can also help treat osteoporosis; for more on this, see here.
Note: The United States Preventive Services Task Force and other expert groups used to recommend vitamin D supplementation to help prevent falls, because research had initially identified an association between low vitamin D levels and falls. However, randomized trials were not able to show that vitamin D supplementation decreases falls, so vitamin D is no longer recommended for fall prevention.
8. Vision, podiatry, and home safety referrals. Could your loved one be in need of a vision 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. Even something as simple as installing grab bars can make a difference, and home safety evaluations often uncover other simple changes that can prevent falls. 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’s an idea 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.
For more practical information on why older adults fall and how you can prevent falls, see my article Why Older People Fall & How to Reduce Fall Risk . You can also learn more about clinically proven exercises that reduce falls here.
Maria says
Good morning,
My 70 year old active mother slipped & fell at work 3 weeks ago and got a head laceration that ended with 5 staples. She is going down hill since then. A CT scan was not performed because she didn’t go unconscious. Now she has a fear of walking and I don’t know if its anxiety or something worse. I took her to the WorkMed doctor yesterday they ordered a CT scan but he didn’t seem to know what to look for or concerned like I am. Her job is a very fast pace, 40+ hour work week. I’m having her quit and slow down but the thought has her depressed because she went from strong and active to weak and slow (she holds on to walls and furniture to walk). Any suggestions on how I can help her?
Leslie Kernisan, MD MPH says
Sorry to not reply sooner, this one slipped past me somehow. Did she get the CT scan eventually? In some cases, older adults can develop something called a chronic subdural hematoma after hitting their head, and this can cause symptoms.
Otherwise, I would say she needs a comprehensive evaluation to evaluate her current symptoms. For instance, they should check to see if she has any neurological symptoms, or any new confusion, etc. These might provide clues as to what might be contributing to her weakness and poor balance. It’s also possible that a comprehensive evaluation would not turn up much, in which case it might be reasonable to give her a few more weeks to recover and then reassess. You could also consider physical therapy exercises for balance, as these might help her recover her confidence. good luck!
Terry Brady says
I’m a 76-yr old female in generally excellent health. My husband and I live independently and require no caregiving. I do yoga twice a week and see a chiropractor twice a month for spinal adjustments. Have a fairly active social and church life. About three weeks ago I tripped over a potted plant while watering my garden and hit my head on the patio. No blood, and I was careful to observe my behavior for the rest of the day – no unusual sleepiness and nothing strange with vision or eyes. Yesterday and last night I had a severe headache (I rarely get headaches.) I hit the back of my head left of center and the headache has been mostly on the top of my head. I’m not one to go to doctors at the least little symptom, although I do have regular checkups. Do you think the headache could be related to the 3-week old fall? Thank you.
Leslie Kernisan, MD MPH says
It is possible to develop something called a “chronic subdural hematoma”, it is a collection of blood under the skull that can get bigger over a few weeks after hitting one’s head.
See here:
For Older Adults, a Rising Risk of Subdural Hematoma
Chronic Subdural Hematomas.
If your headaches or if other worrisome symptoms persist, I would recommend consulting with your usual health provider. good luck and take care!
James Oswaldson says
Thank you.
From my experience, members of the family very often don’t realize that their relatives become “elderly”. They see them often and see them as DAD or MOM, but not the ELDERLY. We have to be conscious of the time passing by and get ourselves prepared for the upcoming challenges.
Leslie Kernisan, MD MPH says
Perceiving age-related vulnerability — whether in ourselves or in our older parents — is a tricky business. My experience is that most older adults are dismayed by their family treating them as if they are frail, or vulnerable, or “elderly.” Research also shows that older adults develop a “positivity bias” in their brains, which is part of why people often become happier as they get older, but also makes it more challenging for them to take action to prevent falls.
I would say it’s important to be diplomatic, positive, and respectful when encouraging older adults to address fall prevention. Attention to their dignity and autonomy is essential.
lj says
I’m 50 and suffer from intractable, difficult to treat migraines. (No opioids involved but Botox, anti-seizure medication, anti-emetics, and triptans and occasional ER visits for DHE-45).
Often after a migraine, I still feel exhausted and a little ‘out of it’. Today I tripped over a curb and was unable to recover my balance. I went down and scraped some skin and pride.
I’ve found that as I’m getting older, this is happening more and more. I trip over something or twist my ankle and instead of doing the quick recover, I fall. I also notice that I tend to ‘trip’ more after a migraine.
I’ve marked down on my check in forms with the neurologist that I’ve had falls but I’m not sure they’ve noticed. Is this worth bringing up? Or is this just ‘migraine brain’ and being clumsy as I get older?
Leslie Kernisan, MD MPH says
If you have had repeated falls, or otherwise are at high risk for falls, generally it’s worth bringing up with your usual doctors.
It does sound like your post-migraine state makes you more vulnerable to falls. But that doesn’t mean that they shouldn’t evaluate you comprehensively to identify all your fall risk factors and then address those that can be improved. For instance, it’s often possible to improve one’s strength and balance through a focused program of physical therapy or related exercises. This can help with your recovery when you lose balance.
We have more articles on fall prevention on the site, or if you want something that is more structured, I also have a mini-course designed to help people identify issues and potential fall reduction approaches to discuss with their doctors.
Self-Study Course: How to Personalize Your Fall Prevention Plan
Do keep bringing up the falls with your doctors. They should evaluate you further, but you might have to insist to make sure it happens. Good luck and take care.
Mark Vincent Mendoza says
Hello, I hope I cam also ask advice. My Grandfather had suffered a very strong fever that sapped all his energy. He said that he was very cold and he was shivering. Although he felt hot, his chill last for several minutes until it ended with him very weak, having shortness of breath, and sweating. He started talking about strange things and it is probably a delirium from high fever so we have called an ambulance. Now, my grandfather had gone out of the hospital and he was suffering from low fever almost everyday however at some time, it would fade away. He always complained that he feel weak and tired however, he said that there’s no any pain from any of his body.
Most of the time he always feel cold and it is something that makes me nervous because we would have to cover him especially his feet with thich clothes. This gives me nervous because I hope not to see him chill from a very high fever anymore.
Beside from feeling weak and tired, he always complained about his feet that seemed to swell. He couldn’t sit for much time because he said that his buttocks always started to give pain. Because of that, he always lays on bed.
I was thinking he was a strong man and a healthy one. Just two months earlier, he could even lift and carry more than half a sack of vegetables to the market. He was sixty seven years old and he had just stopped smoking in the month of December last year. Seeing him like this now pains me very much. I wish there’s something I should do.
Leslie Kernisan, MD MPH says
Sorry to hear of your grandfather’s illness. It does sound like he has developed some kind of significant condition that’s making him really unwell and weak, and that might be the main reason for any falls he’s having now. He needs a comprehensive medical evaluation. Wasn’t that done in the hospital? Your family may need to ask extra questions so that they explain what they checked for, and what they think is causing his symptoms. Good luck!
Chris Eager says
My 78 year old Mother had a fall in Jan 18 and bruised her ribs, she wouldn’t go to a doctor, but after a month or so she felt better, but then after a couple of months started talking slower and has to think to get the words out. I can’t get her to go to a doctor, is there anything I can do to help her
Leslie Kernisan, MD MPH says
Sorry to hear of your mother’s difficulties.
Unfortunately, if you’ve noticed a change or decline in your mother’s thinking, speech, or any other abilities, she really does need a medical evaluation. These changes may or may not be related to her prior fall. In truth, both thinking problems and falls tend to be due to multiple causes at the same time, some of which overlap.
You can help your mother by continuing to encourage a medical visit. You can also report your concerns to her usual doctor and see if that clinician might be able to call your mom and encourage her to come in. I have information on how thinking concerns should be evaluated here:
Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check
I have suggestions on getting a reluctant parent to see the doctor in last part of this article
6 causes of paranoia (see the section “Tips on following up on safety issues and memory problems”)
Good luck!
Millie Hue says
Thanks for pointing out that it is important to check the blood pressure during sitting and standing because it can be related to lightheadedness. My sister had a fall yesterday on the stairs because she got out of balance without any reason at all. I think it might have to do with her blood pressure. I will make sure that the doctor will do this procedure once I take my sister to an expert tomorrow. Thanks!
Leslie Kernisan, MD MPH says
A fall on the stairs can be scary, I hope she wasn’t injured. Good luck getting her evaluated and reducing the risk of future falls.
marilyn says
Great info. Thanks!
Believe your article covers what I need to check on given 3 falls in the past 10 months. First was due to freshly washed bathroom floor and no cone warning of that. Others because sidewalks and pavements in MY and LI where I live are disaster areas and I walk 7 to 10 miles a day weather permitting. Going to check re B12 which had allergic reaction to many yrs ago but 2.4 mcg seems what is recommended and might be worth trying. I am 73 btw steady on feet take no drugs and bloods are always excellent. Thinking of exploring OTHER things re strengthening lower body to give me ability to keep from falling. Anything you could add would be greatly appreciated. Thx Marilyn
Leslie Kernisan, MD MPH says
Sorry to hear of your recent falls. Certainly reasonable to check on vitamin B12. In most older adults, falls are multifactorial and due to several causes and risk factors, so reducing risk means identifying as many as possible and chipping away at them.
Vision assessment has a mixed track record in reducing falls, it seems to depend on what type of vision problem there is and how they attempt to correct it. One randomized trial did find a reduction in falls with the substitution of single lens glasses for multifocal glasses during outdoor and walking activities.
Walking is great exercise but often additional exercises (e.g. resistance exercises) are needed to build up more strength, and still other exercises are needed to challenge and improve balance. You can see examples of such exercises here: Videos Illustrating Otago Exercises for Fall Prevention.
Good luck!
Georgia B says
Thanks for giving such a detailed list of things to have a doctor check for after an elderly person falls! My parents are both advancing in age, and I’m getting worried about their health. It’s good to know that you should make sure to get an assessment for any other illnesses if they ever take a fall.
Leslie Kernisan, MD MPH says
Glad you found this helpful.
Nikki Reed says
I am 73 & have a hip & knee replacement on left side. Rt. Side needs to be done too, but for now I have been getting cortisone shots in hip & knee on rt. Side. Also have arthritis in my back & have had cortisone shots there several times & I’ve had a nerve ablation on rt. Side of backe & the Dr. Wants me to get one on the left side next. Last week I had a cortisone shot deep in my rt. Hip & right now I have the least pain that I’ve had in 2years. (It’s still not all gone). My problem now is that I keep falling out of bed! In 2weeks I fell 3 times. We got a special bar to put under the mattress that blocks me from falling out of bed. A week ago I fell out of bed (because I forgot to put the bar up) & hit the side of my head on my nightstand on my way to the floor & just missed hitting my eye. Since then I have used the bar faithfully! This AM I fell again & pulled the bar out onto the floor with me! I bruised & cut my rt. Arm in several places & got a bump on my cheek bone. My question is; why do I keep falling out of bed??? I rarely fell out of bed until about a year ago.
Leslie Kernisan, MD MPH says
Yikes, this falling out of bed does sound concerning. I can’t say why it’s happening, would recommend you talk with your usual health providers about it. They will probably want to know what is happening when you fall out of bed. Are you asleep, or awake? Does it tend to happen at the same time? Has anyone noticed whether you are experiencing restlessness or unusual movements while in bed? Have any medications changed? Figuring out the patterns, triggers, and related symptoms is often very helpful when evaluating falls.
For those older adults who do fall out of bed, one approach that can help is to use a “low bed,” such as a mattress placed on the floor. This can reduce falls, but the downside is that an older person often needs help to stand up from such a low position.
Good luck, I hope you find a way to reduce your falls soon!