Falls in Older Adults

Falls are the leading cause of injury-related death in US adults aged 65 years and older. About one in four older adults—more than 14 million people—reports a fall each year, and falls generate roughly 3 million emergency department visits annually [14]. The age-adjusted death rate from unintentional falls rose from 64.7 per 100,000 older adults in 2018 to 78.4 per 100,000 in 2024 [15]. A fall is an event, not a diagnosis. A trip over a rug, orthostatic hypotension after a medication change, a hypoglycemic episode, a seizure, and syncope may all end with the patient on the floor. Older adults may not remember a brief loss of consciousness, so an unwitnessed or unexplained fall deserves a syncope assessment rather than automatic classification as a mechanical accident. The clinical goal is to find the interaction among intrinsic vulnerability, medication effects, acute illness, and environmental hazards—and to identify the finding that changes urgency.