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.
Barbara Amdur says
Thank you for your terrific information .Unfortunately, I just had my 2nd big fall 1 week ago–and I am suffering ( enormous back pain.) I had to call 911-and went to the ER–but since the x-rays & C-Scan showed no broken bones, I was sent home. Since I am 90 and live alone ( with part-time Home Health Aides, ) I thought they should have put me in the hospital to better deal with the pain–and to have Physical Therapy there ( at the world-class RUSK INSTITUTE in N.Y.C. In 2018 I fell and broke my Femur Bone—-in 2017 I developed this very rare disease MYASTHENIA GRAVIS—-Then CLL–a form of slow-growing Leukemia. But I just became a GREAT-GRANDMOTHER–AND that will keep me alive!
Leslie Kernisan, MD MPH says
Wow! You have been through a lot! I am very sorry about your fall and your pain. I hope the pain is better now and that you’ve been able to arrange for some help and support. It is sometimes possible to get physical therapy at home through home health care; you could ask your health provider if you might qualify. (Generally, a person has to be homebound.)
You clearly have a lot of spirit! As you know, a positive and determined attitude can make a huge difference. Good luck and take care!
DANI MASSIE says
hello my grandmother fell in 2012 that the time she was 64 years old and she was getting off as a shuttle to do jury duty if she missed judge how far the step was from the curb and sell on both knees and the table top position she said she fell so hard that she was shaking and her whole body felt like a wet noodle and she got assisted to stand by some of the guys that were on the shuttle she went to the doctor but she didn’t go to physical therapy fast forward to 2019 she can no longer lift her legs higher than two inches she needs a walker and it’s getting harder for her to move she has high blood pressure so she takes medication for that but she’s been experiencing inflammation swelling pain muscle aches she seen numerous specialist neurologist they pumped her up with ink to make sure she has no clot look like they run pretty much every test you can think of and no one can tell her what’s wrong with her she’s losing weight and I feel like it’s because she’s losing muscle mass because she can’t move or workout without fear falling because she can hardly lift her legs she keeps going to the doctor’s and we keep getting no answers please help me
Leslie Kernisan, MD MPH says
Sorry to hear of your grandmother’s problems. Hard to say if her current difficulties are related to the fall in 2012 or not, but certainly sounds worrisome if she can no longer lift her legs and is having difficulty walking at age 70.
Honestly, her situation sounds unusual, so I would recommend specialty consultation with neurology. If the neurologist you’ve seen so far hasn’t been helpful, consider getting a second opinion with another neurologist, at an academic medical center if possible. You may also want to consider a “second opinion” type of service from a major medical center, such as this UCSF service: https://www.ucsfhealth.org/secondopinion/#
Good luck!
Ananth says
Hello doctor,
My mom aged 53, had foot drop for past 5 years and she could balance and walk and she will have back pain as well. When we diagnosed after MRI and Nerve conduction tests, our neurologist said it would be CIDP and this can only be cured slowly. However she is taking regular tablets now like Omnocortil etc.
Few day back she hot severe headache and when we take MRI for brain, observations were mutilple tiny bright signals noticed in both Corona radiata and centrum (ischema related changes).
Will this affect the brain? And Dr said, this is reason that blood circulation is lost to foot which caused the drop and lost balancing. Are these related and how to proceed with the treatment ? I am afraid if this would be life threatening. Kindly advice
Leslie Kernisan, MD MPH says
Hm, your mother’s situation sounds more complicated than most. I would recommend asking her doctors to explain what the MRI findings mean. It is possible that they are white matter lesions (which I explain in more depth here: Cerebral Small Vessel Disease: What to Know & What to Do) but you will need to check with her doctors.
You will also need to ask the doctors to clarify whether they think the MRI findings are related to her foot drop and balance problems. Good luck!
Rosie says
I’m so glad I found this blog! I was looking around for information. My neighbor in the complex, 85, took a fall and fell on her head face first, it was slippery, and not due to most of the reasons described. Her entire face was black for weeks. They took her in an ambulance when she fell, and then was sent home. She is normally cranky, but she’s been having angry tirades, irritable, etc. I was wondering if she had a concussion, and if the doctor checked for it. I didn’t have a chance to ask her, b/c she’s been yelling when she sees me. I don’t have the name or number of her son who comes to see her. Anyway, I am now bookmarking the blog, have to keep seeing this GREAT information!
Leslie Kernisan, MD MPH says
Kudos to you for being concerned about your older neighbor, she’s very lucky to have you thinking of her.
Yes, it’s possible that her fall might have caused some kind of internal injury to her brain, or there could be another reason for her to be behaving differently. Unfortunately, if you aren’t related to her, you might find it harder to intervene or otherwise help. If you ever do see her seeming very confused or out of it, or if she falls again, you could consider calling emergency services. good luck!
Evelyn Dove says
Have had Meniere’s Disease for years and have fallen several times; however, this last fall fractured my hip bursa. Trying to heal for a long time now. Need to shed weight. Wish you could help me.
Leslie Kernisan, MD MPH says
Sorry to hear of your falls. Meniere’s disease can certainly affect balance but it’s also possible that there are other factors contributing to your falls. I would recommend a comprehensive evaluation to assess for various fall risks. good luck!
Ruth says
Hi Ffrstly thanks for this opportunity to ask questions.
My mother who us 88 sometimes “sees stars” and has to immediately lie down. If she doesn’t bet yo abec or chair she can black out. It is usually when she overdoes it. She has early stage 1 to 2 CHF and Atrial fib which caued a stroke 10 years ago. She has been on warfarin since. She was seen at the hospital yesterday but no obvious cause found for her blackouts. Blood pressure checked standing and sitting. Dr thought not TIA or epilepsy as no fitting but sending her for brain scan. Not sure why. I thought her heart problems would be more likely cause. No signs of Parkinson’ so what else would they be looking for with a Brain MRI? Thank you.
Leslie Kernisan, MD MPH says
I can’t really say what they were looking for. It’s true that the types of symptoms you describe can be caused by issues related to blood flow through the brain (which is affected by heart function, among other things). But it’s also possible to them to be related to other things happening within the brain. So I’m not surprised that they ordered an MRI, especially if she hadn’t had one recently. good luck!
Heather says
My grandma recently fell, she’s in her 70’s. Never fell before and always is up to date on appointments. She was due for a blood work appointment. Which she had to fast the night before, that early morning around 530 am she got up and tripped over her own feet and fell. She hit her head and hurt her arm, she told the nurse (thankfully at her appointment) she was given the ok, just take it easy….. I did not find this out til 2 days later. Was this possible fall due to fasting for blood work, do I need to wait on the results of her blood work, or do I need to start watching for more signs of possible falling issues?
Leslie Kernisan, MD MPH says
Sorry to hear of your grandma’s fall. Generally, I wouldn’t expect fasting to cause a fall. If an older person has fallen, especially if it was bad enough to cause an injury, we would normally pursue more of an evaluation. Bloodwork is usually part of that, and will help the health care team check to see if anemia or another blood work abnormality might be related to the fall. good luck!
Terry Lasek says
My dad fell last night, laid on the dining room floor all night. (8:30pm-11:45am) He wasn’t answering the phone so I came down to check on him and found him laying there. ? He said he fell around 8:30 ish. He was very weak and thirsty. He wet himself while laying there. Luckily my husband was home, it was snowing and sleeping, I was home b/c schools were closed. He got him showered b/c he wet himself. Small black eye abrasions on his chin and bad ones on elbow and knee from trying to get up. He doesn’t want to go to get checked out. He said he tripped over the roll of carpet from the floor renovation. We did take him to the doctor on Friday. Doctor did examine, I questioned whether he a a mini stroke. He said no. He drew some blood, no results yet. He ordered in home PT, they will be coming Tuesday. My question is, why after the fall did he loose complete loss of leg function. He can’t get up, stand, or walk without a great amount of help. He needs round the clock care. He’s 79, his brain is still sharp as a tack! Sounds great! Able to recall memories from childhood to present. Loves telling stories.
Leslie Kernisan, MD MPH says
Sorry to hear of your father’s fall, that must have been awful for him to lay on the floor for such a long time.
It’s not uncommon for older adults to have problems getting up, standing, or walking after a fall, especially if they were down a long time. Being on the floor for hours can lead to muscle damage. People also may have bruises or sprains that affect their mobility. It’s also possible that something neurological happened before the fall and that this contributed to the fall. Sorting this out is complicated and requires a careful history and exam, and also sometimes seeing what happens during the days after the fall.
Physical therapy is generally a good idea, as most older adults will benefit from exercises that improve strength and balance. Hope he feels better soon. If he continues to fall or look wobbly, I would recommend asking his health providers for further evaluation. Good luck!
Barbara VandeVenter says
My 81 year old husband has been falling a lot. He says if he gets his left foot at wrong angle, he falls and can’t get up. At that point, he has no strength in his legs or feet and even has difficulty pulling himself up with his arms. Once he is up, he can get around normally, but his walking has become extremely slow. He had a knee replacement 2 years ago and complains that it, as well as the other knee, are painful. He has peripheral neuropathy in his feet plus a number of other health issues to deal with. The falls are becoming more and more often and I can’t pull him up, he has to get to something he can hang onto and eventually get enough strength back in his limbs to pull himself up. He sees our primary doctor at least every 2 weeks for blood tests (on Warfarin). He takes 12 different prescribed medicines including 3 for blood pressure, one for pain, one for breathing issues, A Fib, cholesterol, etc. I am feeling totally helpless. Asked doc if we could cut back on some of meds but doc commented that they are keeping him alive. Any suggestions?
Leslie Kernisan, MD MPH says
Hm. So, someone like him usually benefits from a comprehensive evaluation to determine why he’s falling (it’s often many things at the same time), followed by a tailored program to address those problems.
For many older adults, decreased leg strength and balance are an issue, and in most cases, these can improve through physical therapy. The key is to do exercises that specifically focus on balance and strength, such as the Otago program.
Re medications keeping him alive: in most cases medications are reducing the risk of some later event. It is often possible to cut back the medications at least a little bit. For every medication, the likely benefit needs to outweigh the burdens and risk of harm. Reducing medication doses often results in only a small decrease in benefit, but can sometimes improve quality of life.
I have more on blood pressure medication here:
New Blood Pressure Study: What to Know About SPRINT-Senior & Other Research
6 Steps to Better High Blood Pressure Treatment for Older Adults
The problem is that it can be very tiring to have to advocate for oneself or one’s spouse with the doctor. Sorry if you are in this position. You could consider a visit with a different doctor, or perhaps getting another family member to accompany you and advocate. You could also see if it’s possible to get a consultation for medications or falls at a geriatrics clinic; they are sometimes available at academic medical centers.
How to find geriatric care — or a medication review — near you
Good luck!
sameer says
Hi Leslie,
My mother is Age 70 and it all happened in December 2017, she was tensed about something and suddenly she got a severe headache and her blood pressure went up to 200/120. this was the first incident and she was shivering. we really had no clue took her to emergency clinic . Doctors kept her under observation for 3 days. gave her few pain killers . Her Blood pressure went normal in few hours they did few tests and recommended us to follow up with Neurologist and a cardiologist. they had done some Brain MRI, ECO and several tests. but none of them prescribed and medication. but last few times she has a similar issue, she don’t have headaches but her BP shoots and she starts shivering, her hand and feet are cold, only once the doctors said she is dehydrated. but now it happens very oftenly and she is feeling very weak. please help and pls guide as what all test or what type of medical is required.
Leslie Kernisan, MD MPH says
Sorry to hear of your mother’s health challenges, I can see how this would be very worrisome to her and your family. Unfortunately I can’t advise as to what tests or treatment would be advised. There is no general information about falls follow-up that I can share to be helpful.
If you are concerned about what is going on, I would recommend asking the doctors many more questions about what they think is going on, what their plan is, what you should expect. Some patients truly are medical mysteries, others just need a higher level of evaluation at a specialty center, and in other cases, the medical team just hasn’t communicated well enough with the patient and family. I hope you get some answers soon, good luck!