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! 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.
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 post, I’ll list eight key items that you can make sure the doctors check on, after a fall. 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 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 Medications to Review if You’re Concerned About Falling.”
5. Gait and balance. At a minimum, a gait assessment means that the doctor carefully watches the way the older person is walking. There are also some simple ways to check balance.
Simple things to do, if gait and balance 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.
- Consider a physical therapy referral for gait and balance assessment. A physical therapist can often recommend suitable strengthening exercises, 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. Vitamin D level. Studies suggest that treating low vitamin D levels (e.g. less than 20ng/mL) might help reduce falls in older adults. Low vitamin D levels can also contribute to fragile bones.
If your older loved one spends a lot of time indoors and doesn’t take a daily vitamin D supplement, there is a fairly high chance of having a low vitamin D level. Taking a daily supplement of 800-1000 IU will eventually maintain vitamin D at a normal level in most people, but if you are very concerned about falls or vitamin D, talk to your doctor about getting a level checked. When vitamin D levels are very low, doctors sometimes treat with higher doses of vitamin D for a few months.
Note: I generally recommend my patients take 800-1000 IU of Vitamin D per day, unless we have documented a severe deficiency that would warrant temporary high-dose treatment. I don’t recommend people take high doses of Vitamin D (e.g. 2000 IU/day or more) without medical supervision. For more on vitamin D, see my post “Vitamin D: The Healthy Aging Dose & FAQs”
7. 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.
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.
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. 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 are some ideas 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.
- Post your questions or comments below. I’d love to know more about how this list can help you make sure your loved one gets the right care after a fall.
For more practical advice on preventing falls, see our Falls Topic Page. You can also learn more about clinically proven exercises that reduce falls here.
I love your focus Leslie and am looking forward to the call today.
One thing I also teach is the impact of nutrition and malnutrition in the elderly. I have seen such amazing improvement when good nutrition was restored to them. One area I find that is often lacking is adequate protein intake.
Thank you Victoria!
Malnutrition is a very important topic. As with falls, I find that it helps to first do a good assessment to identify the factors leading to weight loss or malnutrition. For instance, it could be dental pain, or inability to get out to the store, or depression, or belly pain, or an underlying medical illness, etc.
I wrote about evaluating weight loss here: Q&A: What to Do About Unintentional Weight Loss
The number one thing I wish caregivers would do is weigh an older person regularly. Tracking weight, along with energy and functional abilities, is a great way to help the doctors notice when something starts to go wrong.
Agree that many older adults benefit once they get a better diet that fits with their life needs and health situation. Great that you are helping people with this!
Look foward to meeting you today and thanks again for this comment.
I am a caregiver for my 86 year old Grandma. She collapsed slowly this evening and couldn’t get up on her own. She has bedsores and is bedridden, except she takes the stairs up and down morning and night for bed. With my help of course…
She has has a decrease in appetite and won’t eat anything solid anymore… She barely drinks 5 cups of fluid per day… and is sleeping most of the time.
is 5 cups of milk/juice… with banana or cheese snacks, puddings or apple sauce. And a multivitamin enough to stave off malnutrition?
Because I am at my wits end at what to do or feed her.
Yikes. You are describing a lot of red flags for serious illness so you should get your grandmother medically evaluated as soon as possible.
The medically safest course is to call 911 if a person has collapsed and can’t get up. If she has a primary care doctor then you can also call and ask for advice; since they know her past history they can ask questions and determine whether you should go to the emergency room versus consider an urgent care visit. Primary care offices usually have an answering service 24/7, and often can connect you to an advice nurse or doctor.
Malnutrition is indeed common in older adults but before figuring out what/how to feed her, you must get help understanding what is the cause of her symptoms and decline.
My colon is completly covered with polops and my food goes strait through. I have lost 100 pounds in 6 months. I eat and have a loose or liquid bowel movement within half an hour even if I lay down right after I eat. I eat meat and vegetables or meat and eggs but nothing stays with me. I have no pain but I am hungary all of the time. I slipped on the back steps and fell only two steps but I am very sore. I have lost 50 pounds. What can I eat or drink or do?
This sounds like a serious situation, I would recommend contacting your health providers as soon as possible and asking them for help. It is impossible to say what you should eat or do without a better understanding of what is going on in your gastrointestinal tract. You may need to see a specialist in gastroenterology or in digestion. Food and nutrients are generally absorbed in the small bowel and then the colon removes extra liquid. I do have an article addressing unintended weight loss here: Q&A: What to Do About Unintentional Weight Loss.
You should also tell your health providers about your fall, so that they can check you for injury and determine what may have caused it. Good luck!
Hi my mum has alzimers and has falls I feed her salmon , fish , vegetables and all good things but she has just got over covid 19 and had had a small fall and broken her collarbone I don’t know how els to keep her from falling . And get her to strengthen her legs she’s just had physio and was doing really well now this set back ..
I’m sorry to hear about your mom’s fall and that is often a setback for a frailer older person. What you describe sounds like a great approach for someone in your mom’s situation, and remember that falls are usually related to many factors. Here’s a video about that.
Something I suggest when a person has had a fall is getting a home assessment by an Occupational Therapist. These professionals will look for common tripping hazards and things like lighting and layout, as well as make suggestions about any equipment or modifications that can reduce fall risk.
And as Dr. Kernisan mentions in the article, mediation review is also absolutely critical to do after a fall.
Hi my name is Debra. I am 68yrs old. I take care of my grandson who just turned 6. I had just gotten him off his school bus & I slipped on a skate board. I fell right on my back & hit the back of my head pretty hard yesterday & it’s not the first time. I have had a bad headache since that fall & I don’t get headaches , but I also don’t like going to hospital’s is there anything I can do at home to help it. Ty & God Bless
If you want to try pain relievers for your headache, we recommend starting with acetaminophen, which has fewer side effects than NSAIDs (like ibuprofen) or narcotics (like morphine). Here’s an article about pain relievers that might be of interest: https://betterhealthwhileaging.net/safest-otc-painkiller-aging-risks-of-nsaids/
It sounds like your fall could have happened to anyone, but if you’ve fallen before, it might be a good idea to see your doctor about it. I understand not wanting to go to a hospital, but if someone is having persistent headaches after a head injury, it’s a good idea to get a CT scan or MRI, just to make sure there isn’t bleeding or some other issue.
Hi Victoria and Leslie,
Leslie. Thanks for the article. It was very useful and i could tell written with love and care. That makes a difference.
My dad is finding it more and more difficult to walk and recently has been falling too often: once or twice daily these past two days.
I will do the blood test and visit a doctor.
I would be grateful if you elaborate a bit on the nutrition side.
Thanks
Yes, if your father has been falling, then I would certainly recommend having him evaluated by a clinician as soon as you can.
In terms of nutrition: many older people are low on protein (this can be seen on certain blood tests, for albumin and pre-albumin), and also have weak muscles that contribute to falls. Some experts believe that older adults need a higher protein intake than current guidelines recommend. Muscle strength can also be improved with resistance training and special exercise programs.
Another nutrition-related issue that can contribute to falls is low levels of vitamin B12, which is necessary for good nerve function (which relates to balance and reflexes). I have information on vitamin B12 here: How to Avoid Harm from Vitamin B12 Deficiency.
Lastly, a healthier diet can help address cardiovascular risk factors, and sometimes very small strokes in the brain (cerebral small vessel disease) are one of the reasons that older adults may be at higher fall risk. I cover a healthier diet here: How to Address Cardiovascular Risk Factors for Better Brain Health: 12 Risks to Know & 5 Things to Do.
Good luck!
Thanks for your prompt reply. I am taking him to what we call here a “brain and nerve” doctor who will only be available on Thursday. Someone has been coming every other day to give him exercise since last June, and she says his muscles are good and that she believes it is a matter of “brain and nerves”. He has an enlarged prostate for which he has been taking medication for about a year now. His blood pressure was 138 over 66 yesterday with a heart rate of 66 and today, after having taken a coffee then had a massage and walked a bit, his blood pressure was 168 over 77 with a heart rate of 80.
What blood or other tests do you recommend? He forgets things he used to do in the past, like how to cook stuff which he hasn’t cooked in a year, for example.
Which blood tests really depends on his situation and past history, the doctor will have to decide.
I explain the most common blood tests that are often ordered for older adults here: Understanding Laboratory Tests: 10 Commonly Used Blood Tests for Older Adults.
If he seems more forgetful or if you’re starting to notice changes in memory or thinking, you can learn more about how we often evaluate that issue in these articles:
How to Diagnose & Treat Mild Cognitive Impairment
8 Behaviors to Take Note of if You Think Someone Might Have Alzheimer’s
Good luck, I hope the neurologist is helpful!
I will be seeing my primary Dr soon and will talk to her. I saw a neurologist yesterday and he said he didn’t know anything. My first visit with home – so disappointing. When I fell backwards I was feeling,fine!! Both times. Is scary where this might happen again. I don’t have the tendency to fall
Hm. That does sound disappointing, if your fall risk factors weren’t carefully evaluated. You can learn more about how doctors are supposed to evaluate falls at the CDC Steadi site: CDC Stopping Falls.
I also offer a fall prevention mini-course that helps people create a list of things to ask the doctor about, for better fall assessment and prevention.
Be sure to tell your primary doctor that you have fallen twice and that you’re concerned. Good luck!
Difficulty Walking with gate problems, memory, and falling can also be a sign of hydrocephalus, which is treatable. Hydrocephalus is under diagnosed 15% of the time as demensia or Parkinsons. Hydrocephalus Foundation has a great website for information. Hydroassoc.Org
Thank you for your informational posts and comments, your list is very helpful. My step mom has hydrocephalus, but also was having 1 second seizures called “Atonic” seizures, which caused her to fall to the floor without warning. 1 second! Impossible to diagnose until she had “Tonic” seizures and I was able to identify the earlier falls as the “ATonic”, from intensive research . Good luck to everyone. Thanks again for your posts.
Hi Sheri, and sorry to hear about your stepmother’s difficulties. You are correct that NPH (normal pressure hydrocephalus) is something that should be considered when an older adult has had a fall and other causes have been ruled out. This article uses some medical jargon, but provides a good review. Usually NPH is diagnosed when there is a cluster of symptoms (urinary incontinence, gait problems, and memory problems) and a characteristic appearance on a brain scan (CT or MRI). NPH does resemble other conditions like Alzheimer’s disease and Parkinson’s, so it can be hard to diagnoses, even for an expert.
In addition, when an older adult is having a seizure or other unusual symptom, most Geriatricians would be very thorough in their work up to rule out unusual causes of falls. See this article on dementia diagnosis, and thanks for checking out the site!
My elderly sister has had two recent falls. Both times she describes seeing coloured lights flashing in front of her prior to falling.. both have been in the morning. She is on meds for blood pressure, nerve pain thyroid and overactive bladder. What could causes the coloured lights.
Hm, I’m not sure what is causing the colored lights. A neurologist or ophthalmologist might know. In general, flashes in just one eye are more likely to be related to something happening in that eye, and flashes in both eyes are more likely to be related to something happening in the brain. I would recommend consulting with a eye specialist especially if she otherwise is experiencing changes to her vision or vision symptoms.
If she is feeling light-headed or losing consciousness right before she falls, I think it’s plausible that the lights could be related to that…either low blood pressure or something else causing her to pass out. Good luck!
Ahh. wish I had come to this informative post earlier. My mom passed away a month back due to a severe fall. She was 75 and was having falls since last year. Every three month she would fall and had many fractures due to this like wrist fracture, ribs and shoulder. Everytime I took her to the best of hospitals here in India, docs did all the tests heart brain, blood but never said that she was lacking something or had any disease. They only said she was old so this was elderly problem but never went deep into the cause. I had changed three hospitals and all docs said the same. Her reports showed she had mild heart problem, and also had edema in foot but docs never bothered to give some treatment. When she fell last month she had complete heart block and then again doc said that only 2% chance of survival if a pace maker is put. I am completely devastated and I feel so much pain in me losing her without any treatment. But now reading this article I remember she had difficulty in walking, walked with a stick also she was having ear machine as was now not able to hear properly and maybe she had other symptoms which docs never bothered to thoroughly examine…Wish I had taken her to some other city and showed there to some other doctors…I couldn’t save her that is my guilt…
I’m so sorry to hear about your mom’s passing and I can understand your feelings of guilt about how things went. It sounds like you did everything you could think of to help and that her problems were dismissed as “old age”. I’m sure that you did the best you could.
That is why Dr. K and I are so dedicated to sharing medical education about getting older. Geriatrics is all about digging in and trying to sort out an older person’s medical issues and give advice that can help them with what matters most in their lives. Thanks for reading the article and for sharing your story.
Thanks Nicole..I am sharing this post to many so that people get to know right things in time and care for their elder.
I am going through it now with my mom she fall the other night and now she hurts so bad . I can help her any more ?
I’m sorry to hear that your mother is in pain. Persistent pain after a fall makes me wonder if there’s an injury that might need attention from a doctor. I would advise seeking help as soon as you can if you haven’t already.
After a fall are blood clots common?
I’m not sure what you mean by blood clots. I’ve seen patients that fall and hit their heads, producing blood clot under the dura, or membrane covering the brain (also called a subdural hematoma, or SDH).
There are probably about 50 per 100 000 older individuals with a subdural hematoma and about half of those have had a fall. This is based on a recent study in the UK, which you can read here: https://journals-scholarsportal-info.libaccess.lib.mcmaster.ca/details/14602725/v110i0006/375_iiocshite.xml
Risk factors for getting a subdural would include trauma (like falls), being on a blood thinner, and having brain atrophy, or shrinkage (which can be normal with advanced age, or with certain conditions).
my 81 year wife has parkinsons plus history utis what causes her bp ck in morning to be low 99/50 latter on it goes 185/89 her dr has taken her of metoprolol she also takes metformin she also is dizzyearly the bp is my concern
It’s pretty common for older adults with medical problems to have blood pressure that varies a lot. Part of it is that BP varies based on time of day, position of the arm, position of the body, and emotional state. It can also vary a lot depending on what medications are being taken, and how soon before/after medication the BP was checked.
Parkinson’s tends to give people low blood pressure, especially when they stand.
To help the doctor figure out just what is happening to your wife, it might help if you check twice a day for a week or two. It would be a little unusual to have Parkinson’s and every day be so low in the morning and so high in the afternoon, unless medications or body position is a factor. The more detailed information you bring to the doctor, the better.
Your article contains vital information, very important! I am copying it to share with my nursing students, who will be instructing patients on balance exercises in their homes (part of Meals on Wheels Fall Prevention community outreach.)
Thank you for your focus on the geriatric population, particularly those living home alone, who may be our most vulnerable in the community.
Linda Meneken, Physical Therapist for In Home Exercise Program, MOWSOS, Walnut Creek, CA
Thank you, I’m glad you are finding the information useful. Nurses and nursing students have a very important role to play, when it comes to caring for an aging population. Love collaborating with physical therapy as well, thank YOU for helping seniors who are at home.
You never mentioned checking for any internal injury or any broken bones
Actually, I note in the first part of the post that a visit after a fall is usually mainly about checking for injuries, and that this is important.
I do find that usually the injury check is adequate, but that clinicians often don’t do as much to identify and mitigate fall risk factors as they could.
That said, important injuries are occasionally missed. I wrote about how caregivers can help prevent this from happening in the post “How to Help Doctors Notice What’s Wrong: The story of the missed pelvic fracture.”
My 74-year-old mother has had nearly two dozen falls in the past year, but she refuses to use a cane or a walker. Her internist has offered physical therapy and home health aides, both of which my mother refused. Her last fall left her with a bruised face that caused the E.R. doctor to insinuate that my father had hit her, which is not the case at all. She has managed not to break any bones or fracture her skull or cause a brain bleed with these events. Doctors can’t pinpoint what’s causing the falls, and her internist has informed us that she’s no longer able to care for my mother because she won’t follow medical advice. What can we do to help her understand that she needs help to prevent future falls?
Yikes, this sounds tough. Frustration because an older parent won’t follow recommendations is fairly common, although the underlying reasons the parent isn’t following suggestions is variable. I describe my top 4 tips to help with this situation here:
4 Things to Do When an Older Person Resists Help.
Briefly: I always recommend people consider the possibility of cognitive impairment (problems w memory or thinking), because if the person might be impaired then that changes a lot of things.
Otherwise, to get a person to understand something, you need to start by first trying to understand them. Sometimes this leads to framing recommendations such that the older person feels this helps them reach an important goal (i.e. continuing to live independently).
If you are feeling stuck then consider a hiring a good geriatric care manager to help you discuss this issue with your mother. Look for someone with a family therapy or social work background; this often helps parents and their adult children communicate better about a difficult issue.
Last but not least: your mother has refused PT but you might still want to see if she’d be willing to consider a special exercise program to reduce falls, such as the Otago program.
Good luck!
My mum of 84 fell and broke herwrist and finger and has a black eye. She was sent home last night at midnight from a and e with the canula still in her arm?
They scanned her tummy but not sure why…any idea?
Oh, your poor mom. I hope she recovers ok from the fall.
I can’t say why they scanned her tummy and would encourage you to ask your doctors for more information.
Generally, any diagnostic imaging after a fall is done because the doctors are checking for further injury.
1.An old lady fell down and having bleeding .
2.Unfortunately Medication error occurred.
3.You are not informed abou the pressure ulcer and taken over a client.
Kindly let me know the answers.
Generally if an older person is bleeding after a fall, it’s best to have them seen in person by a doctor. I would also recommend medical attention if there has been a blow to the head during the fall, if the person seems physically or mentally different after the fall, or if there is a lot of pain.
I like this it helped me a lot to understand the 7 things to have the doctor check after an aging person falls & it helped me with my paper for nursing assistant
Thanks for this great article. I like you mention that it is important to be proactive about asking questions instead of just assuming the older person will receive care. I can see why making sure everything is addressed would be important. I would think that knowing the background of the person would be something to keep in mind as you visit the doctor. There may be something that happened in the past that would affect the present situation.
Glad you found this helpful.
My 84 yr old Mom has dementia and has suddenly fallen (not tripped or lost balance, just finds herself on ground) she does have history of two heart attacks (last one in 2001 we almost lost her) and has low blood pressure (but they say it’s not so low she needs meds). I am going to make her an appt as someone told me possibly her heart is stopping that’s why she falls so suddenly. Her 82 brother has dementia and Parkinson’s, maybe now she has that too?
Sorry to hear of these falls. Yes, you should absolutely have her evaluated.
The “heart stopping” problem a person mentioned may be sick sinus syndrome, a condition that becomes more common as people get older. However, there are several other reasons an older person may pass out or find themselves on the ground, so it’s important that the doctors be thorough and not jump to conclusions too quickly.
Parkinson’s does cause falls, but if that is part of the problem, the doctor should be able to detect other signs of Parkinson’s, such as a resting tremor or stiffness of the limbs.
Good luck!
This sounds exactly like my step moms symptoms, she’s 76 and was having “Atonic” Seizures. Which caused sudden falls without warning.
She also had mini strokes brought on by untreated extremely high triglycerides and dementia like symptoms from hydrocephalus (NPH). If not for extremely pro active help from family , she would not be able to live independently at this point. Many doctors do miss these subtle signs.
Hi Sheri and thanks for sharing your stepmom’s story. You describe a complex situation, and I’m glad that it sounds like you have been able to advocate as a family to get her the resources she needs. See this reply about NPH, to another question on the forum.
What about an assessment for stroke? A month ago, my 81-year old mother fell, seemingly for no reason. She arrived at the hospital within an hour, with slurred speech, face drooping on one side, and weakness on one side, and inability to walk. She had been completely independent before.
She was not evaluated for stroke (incredibly!). She was therefore not given TPA during the “golden” 3-4 hour window. She is now completely bed-ridden, can not walk or take care of herself. She is having physical therapy and rehab, but because of the ER’s failure to recognize her stroke until the next day, she will never be independent again.
Wow, what a tragic story. You are describing pretty classic stroke symptoms (weakness on one side, facial droop on one side, slurred speech), so that is very surprising if the emergency room didn’t think to evaluate and treat her for stroke. (What DID they think she had??)
I’m sorry to hear that she’s lost so much function. Hopefully she will regain some of her abilities with time and rehab.
Regarding this article, I do list stroke under item 1, “An assessment for underlying new illness.”
You are providing such a wonderful service, Dr. Kernisan. Seniors, people who love them and professionals who work with them can learn so much from your blog, articles and podcasts. I headed up a falls prevention coalition for 10 years (it’s still going, but with a new coordinator; I’ve turned her on to your website) and have always been looking for info to use. Our focus is educational…getting the word out in as many ways as are possible…about risk factors, reducing risk and behavior change.
Our challenges? Denial in seniors, frustration in loved ones, a medical community that does not see falls as a priority, given all they have to address in so little time. We have been working on empowering seniors to request an annual wellness visit, but that’s also a challenge, both in getting physicians to offer them and seniors to ask for them.
Keep up your important work!! And PS: Both my husband and I have MPHs and doctorates in health ed. (his from Berkeley). So happy to see that MPH after your name!
Thank you for so much commenting and for sharing these fascinating insights regarding your experience in fall prevention. I completely agree, denial among older adults is often a hurdle, and yes, it can be hard to get clinicians to devote enough attention to falls. Education and empowerment of seniors and families is necessary, but probably not sufficient…we also need to change the health system so that it becomes easier for seniors and clinicians to do the right things to prevent falls and otherwise improve the wellbeing of aging adults. Thank you for having worked in this important area! And of course a very big thank you for appreciating the site and sharing it with others!
My Mom is 82, she’s been falling against things that actually catch her fall, she’s been tired lately she gets around with her cane, she had a stroke in 2013, her doctor said it might has something to do with her nerves
It might be something with her nerves, but generally it’s best to ask the doctor to do a comprehensive evaluation because often there are multiple causes for falls. For more about this, see:
Why Older People Fall & How to Reduce Fall Risk
10 Types of Medications to Review if You’re Concerned About Falling
If no particular cause for falling is found, then she might still benefit from a structured program to improve strength and balance, such as Otago
Interview: Otago & Proven Exercises for Fall Prevention.
Good luck!
Thank you
These are definitely things that the elderly should have checked. My mom is getting pretty old, and I have noticed that she walks slower than you used to. She should probably get her gait and balance checked, like you said.
My 82 year old mother is passing out. Those are her words, for an hour or 2 at a time. She wakes up and does not know what has happened or what she was doing before she passed out. She is not big on doctors or medication or therapy but feels she’ll know when she needs help. She has fallen a number of times over the past few years and usually hits her face and has bruises. We question her doctor but he says let her do what she wants, she won’t listen to any advice I have. What questions should we be asking or what kinds of tests might she need?
Yikes, this sounds scary for your mom and for your family.
Generally, you should consider asking the doctor about all 8 things mentioned in the post. That said, if an older person complained of “passing out” and it had been going on for weeks-to-months, I would be especially considering the possibility of underlying cardiac and/or neurological problems. I would also want to check blood pressure sitting/standing and it can help to review several home BP readings.
Occasionally problems with heart rhythm can cause passing out and/or falls. Usually doctors start by checking an ECG in the office, and they might also consider monitoring over a several days, using a Zio patch or other ambulatory monitor.
As for the doctor, it might help for you to ask more questions about what he thinks is causing your mother’s falls. Even if she has refused to follow his advice in the past, for such a potentially significant problem, she might be willing to follow medical advice, especially if it’s framed as a way to help her attain her goals (e.g. a way for her to be able to live independently for longer; a severe fall can force a move, which most older people don’t want). Also, whether or not your mother wants to follow the doctor’s advice, it’s usually reasonable to push for evaluation and better understanding of what is causing such “passing out” falls.
If you try to ask extra questions and the doctor is still not very helpful, you might consider getting a second opinion. Good luck!
We are having problems with my mother shaking to the point of falling. She is on three blood pressure medications – Metaprolol, Losartan and Amilopidine and is also taking Mitrazapine to help her gain weight. She has already fell two times – ended up in ER the other week. She has neuropathy and dementia.
When she first gets up, it’s worse, but she also fell outside when she said she started shaking and went over with her walker. Her BP is normally 145/ 79. Was taken off blood thinners due to falling.
Would any medicines be causing this? Her walking has gotten much worse and she has foot pain – was taken off Gapabentin about two years ago.
We changed doctors because the previous one seemed to not want to deal with someone in nineties, and new doctor said she could take Ativan but afraid it might make her worse. She seems sleepy all of the time, anyway. Thank you
Sorry to hear about this. If your mom is in her 90s and taking mirtazapine “to gain weight,” then I’m guessing she might be kind of frail.
Usually, in people like her, the falls are “multifactorial,” meaning there are several factors contributing to her falls.
I would recommend you read this article, which goes into more details: Why Older People Fall & How to Reduce Fall Risk. I list several common contributors to falls in the slideshow.
I also list specific medications associated with falls here: 10 Types of Medication to Review if You’re Concerned About Falling.
If she’s on Ativan now, you should know that this is a medication that associated with increased fall risk. But again, she’s probably experiencing several other problems that are increasing her fall risk.
Re her blood pressure, it’s important to check it sitting and then standing.
Keep researching as you are doing, and then keep communicating with her doctors. You want to keep letting them know of the falls, and it often helps to keep asking questions. Good luck!
Thank you for your response – was considering asking doctor if the beta blocker could be both affecting her weight loss and the weakness? This problem seems to be getting worse really quickly – having problems even getting her out of bed these days – and her leg muscles are very weak. The Mitrazapine has helped her appetite some, but she has lost thirty pounds and gained about seven back.
Have already hurt my back one time trying to get her up, so I really hope there’s a way to get her steady on her feet again. I think I may hold off on the Ativan for the time being. I’m definitely printing the article on falling, to keep.
That amount of weight loss is pretty concerning. Beta-blockers make some people feel lousy, but it would be unusual for it to cause that much weight loss or that much weakness.
I would encourage you to ask the doctor to explain what he/she thinks is causing the weight loss. It could well be the same thing that is making her weak and causing weight loss, and that weakness may well be the main driving factor with her falls. I have an article on this topic here, which lists common causes
Q&A: What to Do About Unintentional Weight Loss.
Re Ativan, in people who take it daily, it’s important to be very careful about stopping or reducing the dose too quickly. See How You Can Help Someone Stop Ativan. Good luck and take care!
Dr. Kenison, I am an 83 year old male. I am suffering aftereffects from a fall 1 1/2 years ago. Bad nausea and severe constipation. I also get very little physical exercise. I have three blocked (80%) coronary arteries treated with metropolal,isosorbide, amlodiipine. Also type 2 diabetes and take insulin/metformin. I believe I am dying but my cardiologist refuses to give me a time table. Please help me. Thank you!
So sorry to hear of your difficulties and your symptoms. I cannot say whether you are gravely ill and likely to die within the next few months or not, but you certainly sound distressed and you must be feeling quite unwell.
It sounds like you are trying to learn more about your prognosis and what to expect. It also sounds like you feel things are pretty dire. To get advice regarding this, you’ll need to work with a health provider who is able to interview you, examine you, and review your medical records.
Rather than ask your cardiologist for a time table, you might want to try saying that you feel really unwell and are worried that you might continue to decline and/or have a serious health crisis. Ask your cardiologist to help you understand what to plan for. You can also say you want to discuss goals of care.
You can even ask your health providers if they think you are now within the “six month life expectancy” window that makes people eligible for hospice. (You don’t have to want to sign up for hospice, to want to understand what they think your prognosis is. That said, hospice is GREAT at helping people with distressing symptoms and also emotional fears at the end of life.)
Another option for you would be to ask to speak with a palliative care provider; they are trained to discuss prognosis and life expectancy. See here: Get Palliative Care.
Last but not least, I have an article about constipation here, it should be possible to relieve your constipation: How to Evaluate, Prevent & Manage Constipation in Aging. Good luck and take care!
I like what you’ve mentioned about “make sure the doctors have checked on all the things that could have contributed to the fall”. It is always a great idea to find a top doctor that will truly care about you. A great doctor who uses the leading-edge technology is another factor.
Everyone wants a “top doctor” but if you can’t find one, learning to work well with the doctors that are available is the next best thing. I also encourage people to consider health clinics that are specially designed for older adults, because they often have trained their staff and clinicians to help people with falls.
Hi Leslie,
Thanks for all your wonderful advice. I just came across this while searching for what could be causing the kind of pain my mother is experiencing following her fall. My mother is 81 years old and fell more than a month ago while taking a walk in park. She fell on the concrete because she was dragging her feet and was not wearing tennis shoes. She has been to the emergency room twice because of the pain and X-rays and CT scans do not show any broken bones yet she continues to have excruciating pains. She has arthritis and it looks like this fall has exaggerated it immensely. Do you know what can help with this? What do you advise?
Greatly appreciate your response.
Sorry to hear that your mother has been having all this pain since her fall.
Hm…hard to say what might be causing her continued pain. Sometimes people have hairline fractures that don’t show up on xray, but I would expect those to show up on a follow-up CT. Other possibilities would be a nerve being pinched or aggravated somewhere, or even worsened arthritis.
Pain often gets better with time, but it’s important to keep moving, and the right type of physical therapy can also help. The trouble is that people in pain often don’t want to move…so sometimes judicious use of pain medicine 30 minutes before can make it possible for the person to participate in their therapy and otherwise keep the painful area moving at least a bit. Some older adults also get relief from topical therapies on the painful area, and this can be safer since there are often fewer side effects.
It will also help if you can keep pushing to have her pain carefully assessed and diagnosed. I can’t do that online, but generally, the doctors need to ask detailed questions about where your mom feels it, what brings it on, whether it feels like an ache or a sharper burning feeling, and so forth. These types of questions are supposed to help a doctor figure out where the pain is coming from, and whether it’s more likely to be coming from a pinched nerve versus arthritis inflammation within a joint or the spine.
If you aren’t satisfied with the efforts the doctors are making, consider a second opinion.
Last but not least, once you have made progress addressing the pain issues, you could consider askign the doctors for help assessing her gait (why is she dragging her feet?). Good luck!
HI my dad fell (nobody saw him) and when he came inside the house he had a memory loss which came back later. My step mother said he looked as if he had been running and he was sweating. Coukd this have been signs of his heart? The dr. Did not do ekg but ordered blood work and a scan of t h e brain. Can they tell by these type of exams? Thank you
Hm. The tricky thing is that looking sweaty and out of breath could be cardiac (which means “heart-related” but it can also easily be caused by the “fight or flight” stress response, which comes on whenever one is scared or angry or experiencing any kind of situation that provokes a strong emotion. Obviously, falling or experiencing pain can do this to people.
To evaluate an older person after a fall, it’s important to consider their age, their medical history, and also to ask questions about what symptoms the person experienced before the fall, or has been experiencing lately. This helps to determine whether an EKG — or any other test — is likely to be helpful or not, and also helps determine what the doctors can “tell” from the various test results.
I would recommend talking to your father’s doctor about your questions. You can ask if they think it’s possible that your father’s fall could be related to his heart, or if an EKG might help sort things out. Good luck!
My father is 86 and lives with my husband and I in our finished basement. I work at home so can check on him throughout the day. He has shown signs of severe memory loss and other symptoms of what I think could be dementia, but when I shared this with his doctor, he didn’t seem concerned or prescribe any testing. Yesterday dad fell getting out of the shower. I did not see him fall, but heard the shower curtain rod fall so ran down to see if he was OK. He said he was ok, got up on his own, got dressed and even walked up & down the basement steps a couple of times. I am use to his strange sleep patterns, however, last night he went to bed at 8:15 pm, woke up at 5:30 am and at some point went back to bed because he is still sleeping at 3:15 pm (cst). Should I be concerned? If he wakes up and still says he’s fine, shouldn’t I get him checked out even though he will probably resist? Men are so stubborn.
This sounds like an urgent concern. As a matter of principle, if you ever have an urgent concern regarding possible illness or injury, you must contact your usual doctors, or even consider the emergency room. Primary care doctors in the US have answering services, and should be able to let you know fairly quickly whether they’d recommend urgent care, the ER, or an ambulance.
Urgency aside, you are raising a couple of important issues. One is that you’ve noticed worrisome symptoms, but it’s not clear that your father’s doctor has done much of an evaluation or proposed a diagnosis. Another is that your dad fell recently, and what would warrant further evaluation.
In terms of the fall, it’s reassuring that he was able to get up afterwards and walk the stairs. If after a fall an older person seems sleepier or more tired:
– Could an illness or physical abnormality have caused or contributed to his fall? Older adults sometimes fall because they are feeling weak due to some new or worsened health issue. This could be an infection, anemia, basically the things I mention under item 1 in the article. If an older person continues to seem weaker or sleepier after a fall, it’s certainly best to get them evaluated.
– In terms of injuries caused by falls, it is possible for older adults to hit their head and develop bleeding in the brain over the next few hours, especially if the older adult has been taking a blood-thinner such as warfarin. For this reason, if an older person falls and you think he may have hit his head, you’ll want to monitor over the next 12-24 hours, and if they develop worrisome symptoms or just seem weaker or more confused than usual, it’s best to get further evaluation.
So, you basically need to watch after a fall and see whether you notice any other signs that something may be amiss. If you do, you need an urgent evaluation. If not, then you should still consider an evaluation to assess the fall and address fall prevention, but it’s a little less urgent.
In terms of your father’s memory symptoms: it’s common for doctors to not address this, often because they are busy and sometimes because they may not be entirely sure how to go about the assessment. Some doctors also believe there’s not much point in assessing memory symptoms, because many forms of dementia — such as Alzheimer’s disease — can’t technically be cured or reversed.
But in fact, older adults with signs of memory or thinking problems SHOULD be evaluated. There often are ways to at least improve their thinking, if not reverse an underlying disease, plus some of them are actually suffering from a treatable non-dementia problem that scrambles thinking. These two articles explain why it’s important to push for evaluation, and what the evaluation should include:
Q&A: What to do if your aging parent becomes rude & resistant
How We Diagnose Dementia: The Practical Basics to Know
Lastly: yes, lots of older adults seem quite stubborn, and will resist or decline further evaluation. Using better communication strategies sometimes helps, but generally it’s a tough situation.
4 Things to Do When an Older Person Resists Help
If his memory is really bad, I recommend learning more about decision-making capacity, because it’s possible that he has lost the capacity to correctly decide whether or not he needs evaluation.
Incompetence & Losing Capacity: Answers to 7 FAQs
Hope he is feeling ok, and good luck with your next steps!
I am presently 84 yrs old and don’t have any health problems except for COPD. I’ve never fallen – so far- but I am very careful when walking in the house or outside. It appears to me that the feet don’t get the message from the
brain fast enough to move in concert with the upper body. E.G. if you are
walking and decide to turn around, the feet don’t ‘keep up’ so you have to slow the body down till they do. Does any of this make sense.
Thank you for your comments.
Chris
Terrific that you haven’t fallen and that you are being careful and attentive regarding your fall risk.
Yes, as people age, all kinds of reflexes and physical abilities can slow down. There are many possible reasons for this; in most older people, it’s due to a combination of factors.
If you have noticed this for yourself, I would recommend bringing it up to your doctor, so that you can be evaluated for treatable issues that might be making it harder for your feet to keep up. The right kinds of exercises can also help improve mobility and balance. Good luck!
Hi, my 80 year old mum lost her balance today, I was kneeling on the floor & she somehow lost her balance falling onto me, her side hitting my side, I managed to grab her braking her fall before she landed on the floor. I checked her ribs/ stomach which showed no sign of bruising or pain when gently pressed & again 1 hr later. She did say she had a some pain when breathing but she has had this for a while as she has a cute COPD.
I have advised her to take some pain relief can you please advise as she refuses to go to the Dr’s as my father went into hospital 2 years ago & never came out
I can never advise online as to what someone should do. If she has recently fallen and you are concerned, you need to seek medical advice from someone close to you. In the US, most primary care doctors’ offices have advice lines, I would recommend calling something similar.
What is most worrisome, in terms of acute injury, is worsening pain, worsening shortness of breath or chest pain, or the person becoming very weak or very confused. If any doubt, try to get her to a medical professional.
In terms of her refusing to go to a doctor: she’s perhaps feeling scared and emotional, and it’s hard to reason with people at a time like this. Try to reassure her and speak to her fears. Perhaps she might agree if you remind her that this is not a hospitalization, it is just an urgent care check up. Also point out how this can help her reach some of her goals, like continuing to live at home. I have tips on talking to resistant parents here: 4 Things to Do When an Older Person Resists Help.
Good luck!
Hi Dr. My Mom 72, fell and fractured 2 vertebrae in her back T8 and T9. She lived with the pain for 2 weeks until the pain became too much to handle. We rushed her to the hospital. Due to the pain meds, no bowel program, and a host of other pre-existing issues, we have now been here for 16 days. She has 10 specialist treating their specific area, but her health is deteriorating daily. Her primary care physician does not have privileges at the hospital, so we are assigned a hospitalist, who changes daily. I need to find a doctor to take over and coordinate all of the specialists, but I have no idea who I am looking for. She has diabetes, COPD, low functioning 1 kidney, High Blood Pressure. Am I looking for a Geriatric Specialist? An Internist? Any help would be greatly appreciated.
So sorry to hear of your situation, sounds very difficult.
16 days is a long time to be in the hospital. It’s hard to say what kind of doctor would be best without knowing more about why she is still requiring hospital care. You could see if there is a geriatric consult service available. A palliative care service might be able to advise re managing her pain, bowels, or other uncomfortable symptoms. Palliative care specialists are also good at grasping the “big picture,” which might be very helpful in your mom’s situation.
She does have a lot of internal medicine problems and internists are used to taking care of people like your mom. But if they are busy or just not attuned to the geriatric angle on things…well, I have described many hospitalists there (they are usually internists).
If you need help getting things coordinated and back on track, you could look into hiring a professional patient advocate. Some of them are even medical doctors, but I think most are nurses or have other healthcare backgrounds. A good one will have experience navigating the usual hospital mayhem.
Good luck, I hope you find a way to make progress soon.
My mom had a fall last May. She fell against her dining room china cabinet (handle) and punctured her arm ( about 1/2 way between her elbow and wrist) and head. We rushed her to the hospital and lucky nothing broken. She recovered well from her head wound but her arm wound(it was deep) became infected and took a long time to heal. She has since had continuous pain in her arm that is now starting at her shoulder and shoots down her arm to the point that it wakes her ! she has gone to her GP and he sent her to a dermatologist?! What type of doctor should she see for this pain ? they have taken xrays and ultrasounds and there is nothing broken and the infection did not penetrate further than the top layer of her skin. Thank you !
Sorry that your mother has developed frequent pain in her arm. Hard to say just what might be causing it. Pain that shoots down a limb can be caused by damage or pressure to a nerve. Sometimes people get shoulder or arm pain due to a nerve in the neck being squeezed, but nerves can also be injured or squeezed in the shoulder or upper arm. I’m not an expert on upper extremity nerves, so I’m not sure if the injury she experienced would be likely to cause this or not.
Generally, the experts in nerves are neurologists. Xrays and ultrasounds can be reasonable tests to make sure there’s no fracture or fluid collection pressing on things in her arm, but they don’t particularly test nerves or nerve function. The Mayo Clinic has a page on pain due to pinched nerves here: Pinched nerve.
Many medications to treat nerve pain can affect an older person’s balance, or sometimes their thinking. If this is the cause of your mother’s pain, you may want to ask about non-drug methods to manage the pain, or perhaps something like physical therapy might be able to relieve the pressure on the nerve. Good luck, I hope your mother finds some relief soon!
I fell yesterday and got a cut on my wrist while I got up to go to the bathroom. I fell right in front of my bed, but didn’t blackout. My wife yelled for my sons and they put me back in bed, and I went to sleep. I felt better today, so I may not ever fall again, but if I do than I’ll go visit my doctor for sure.
Yikes. You don’t say how old you are, but in general, an older person who falls is at fairly high risk of falling again. I would recommend bringing up the fall with your doctor and considering further evaluation to identify and address fall risk factors.
I do have a fall prevention mini-course designed to help older adults figure out what to discuss with their doctor, you can learn more here: How to Personalize Your Fall Prevention Plan.
Good luck and take care!
Hi Dr. Kernisan,
My Mom is 70 years old and has been diagnosed with Dementia and has had a few “mini strokes” that even she wasn’t aware of. Over the last 2 years she has had a rapid decline. 2 years ago she was “normall” and now she can’t walk without a walker, is unable to get up from the couch on her own, she’s unable to get in and out of the tub without assistance, I have to wash her hair, she no longer uses the shower because she falls constantly. We’ve had numerous trips to the ER for various falls that resulted in stitches, loss of consciousness, various strains and sprains. We’ve been going to PT 3 times a week with no improvement. I guess I’m trying to understand why this is happening? Is this because of Alzheimer’s? Or is this something else entirely? We’ve seen her PCP, neuro, cardio but no one has told me WHY the falls and physical decline is happening? She doesn’t talk much which I can understand, it’s the physical part I’m totally confused about? At this rate I feel like she will be in a wheelchair soon. I worry I’m missing something and I have no idea how to help her.
She does have a history of alcoholism and stopped completely about 6-7 years ago. Could that be a contributing factor? I’m not sure if her Dr’s even know that?
Oh, I’m sorry to hear of your mom’s decline, it must be very hard for both her and you.
Falls in older adults are almost always due to multiple factors at the same time. Her dementia (having both vascular dementia and Alzheimer’s is not uncommon) is almost certainly contributing to falls, but she may well have other issues as well.
A good PT evaluation should be able to tell a person’s doctor — as well as the patient and family — if an older person is showing signs of decreased strength and/or poor balance. Exercises and physical therapy can help counter these problems, but they have to be the right kind of exercises, and generally getting someone with dementia to cooperate with the exercises takes effort, persistence, and perhaps a little extra skill.
It absolutely is important for healthcare providers to assess an older person for fall risks beyond a PT eval. I cover some of the most common causes of falls in this article: Why Older People Fall & How to Reduce Fall Risk.
I also explain how falls should be evaluated in this mini-course: How to Personalize Your Fall Prevention Plan.
Regarding past alcoholism, it is associated with chronic damage to the brain (thought to be mainly due to associated poor nutrition) and part of the brain’s balance system. It can also affect the peripheral nerves. So it’s quite possible that her past alcoholism is a contributor to her current difficulties. You may want to mention it to her doctors, but as she has been sober for a few years, this is probably not a modifiable contributor to her falls (meaning, there’s not something the doctors or you can do differently regarding past alcohol abuse as a contributor to current falls).
Her overall physical decline does sound worrisome. Whether or not it can be stabilized or reversed, the doctors should be able to do a better job of explaining the likely causes. I would encourage you to keep asking them questions, and they aren’t helpful, consider a second opinion. Some people are able to get a geriatric consultation at an academic medical center near them.
You can also learn more about cerebral small vessel disease (which is closely related to “mini-strokes” that people aren’t aware of) here: Cerebral Small Vessel Disease: What to Know & What to Do.
good luck, I hope you get some better answers soon!
Hi!
My mom fell last October, she refused to be rushed in the hospital. She hit her head but she didn’t go unconscious nor did it bleed. She had bruises on her arm and was complaining how painful her left shoulder was. She was able to bear with it for a week but after then she was already trembling when she walks and lost her appetite. We rushed her to the hospital and underwent few testings. The doctor told us that there was no dislocated bone are breaks on her shoulder or head. We were discharged after a week. Her condition improved to say the least. However, after 3 months, she can hardly walk again and she is shaking uncontrollably. She also gets fever everyday and would subside either at night or early morning . She seems to be having hard time breathing as well.We haven’t seen a doctor though. Any idea what she might be the problem? She’s 68.
I can’t say what might be the program, but I will say that it all sounds extremely concerning. Especially if someone is having difficulty breathing, it’s essential to contact a health provider right away to get help.
You cannot solve a problem like this online, she needs to be seen by a health provider and you need to ask what they think might be going on. Good luck and please get her to see a health provider soon. If she doesn’t have a regular doctor, you can still take her to an urgent care center or even to an emergency room.
I’ve been left to be the caregiver for my 92 yr old MIL. She’s had congestive heart failure and AFib dx 8 years. In Sept ’17, medications were adjusted and added. Prior to mu intervention, she was only taking the Metoprolol. That has been doubled, and she also started taking diltiazem, famatodine, eliquis, and pravastatin. Since then her cognition has been declining. Then she fell and hurt her head 6 weeks ago. CtScan fine. The past three weeks she has been hallucinating nearly daily. In her mind, the people.she sees are real. Could one of the meds that shes now taking regularly cause this, or more likely the fall? Prior to around October she did very well on her own. Its been a steady decline, but more so the last several weeks.
Sorry to hear of your situation, I can see why you are concerned.
Medications do sometimes cause psychosis symptoms (which include hallucinations) or cognitive decline, but there are many other potential causes, so you really have to work with a clinician in person and get her evaluated. I cover the most common causes of psychosis symptoms here: 6 Causes of Paranoia in Aging & What to Do
I will say that it seems unusual to me that she’s on both metoprolol and diltiazem, as those both slow the heart rate down, sometimes excessively. I wouldn’t expect this to cause hallucinations, but it could contribute to falls. In general in geriatrics, we try to use the least amount of medication necessary. You may want to ask her doctors if it’s possible to reduce her medications or at least the doses. This is called deprescribing, you can learn more here: Deprescribing: How to Be on Less Medication for Healthier Aging
Occasionally people who fall and hit their head initially have a negative head CT but later develop a bruise in or on the brain. One study I saw found that this happened in 6% of cases, so again, not likely but a possibility.
Good luck, I hope you can get a careful evaluation and some answers from her health providers.
This is insulting to older adults most of whom are quite able to speak for themselves. I have balance issues so I use a wheeled walker and I am very careful. I do NOT need a caregiver to attend every doctor visit and speak for me. I have had my sister with me at times because I want another perspective on the doc;s statements and because she is younger I have had to tell the doctor that I am able to speak for myself. I have many friends who are also quite able to handle their own lives even after seventy. I will not allow myself to be treated like a child.
Sorry if you found the article “insulting,” it was certainly not meant to offend. This is one of my older articles, written a few years ago when the site was called Geriatrics for Caregivers and all articles were quite explicitly addressed to people who were caring for an aging parent, or otherwise helping an older person with health concerns.
Now speaking of “showing some respect” (part of your words which I am removing): I am willing to approve your comment complaining about the article but I am removing one of your sentences, because it felt discourteous to me and unhelpful to the audience.
I agree it’s important to point out that many older adults can manage their health and affairs just fine. Also very useful to remind everyone that even if an older person is accompanied to a visit by a family member or friend, that doesn’t mean the older person can’t speak for himself/herself.
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.
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!
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.
Glad you found this helpful.
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
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!
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!
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.
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
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!
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.
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!
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?
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.
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.
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.
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.
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!
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?
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!
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.
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!
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?
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!
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.
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!
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?
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!
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.
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!
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.
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!
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!
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!
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
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!
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
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!
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!
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!
Dr. Kernisan, i am in awe at your dedication on this. I am looking after my mom, now aged 82, since the last 4 years, and after she had a prosthetic implant owing to a fracture of the femor collar of her left leg, this was not caused by a fall. She also has osteoporosis. Things are certainly not easy in managing things about and around her. She fell on 20th Oct 2019, and her assessment on the 21st had nothing in line with your directives, they only focused on her previous operated area, which was fine, but she did have a hairline fracture in the hip bone on the same side . Complications just seem to be popping up one after the other since then, like loss of urine and more recently stool control, inability to stand up on her own, almost none.
After reading your article, i feel it would be great if there is any way i could have a skype session for some directions, whereby i can make things easy for her. Unfortunately i do not have access to such detail oriented medical care. I have shared my email address in the box below, any help will be huge for me.
Sorry to hear of your mother’s fall and difficulties. That is great that you are being proactive and taking a close look at the care she is getting.
I see from your IP address that you are located outside the US. I must say that many families within the US are also having difficulty accessing good geriatric care. Unfortunately, I don’t do remote consultations by Skype or by phone.
For families that would like extra support in learning how to support an aging parent, including how to advocate for the next step in medical evaluation, we provide education and support through the Helping Older Parents Membership program. You can learn more here.
Good luck!
I observed an elderly woman fall on Parnassus Avenue today after I got off of the Grey shuttle whereas I made the right choice to calmly tell the doctor who works at Parnassus Heights that she fell down on the street. Luckily, her grandson was there to help her out even though she wasn’t alone. He told me that he sees it, rushed to the medical center and I managed to walk to the elevator after the situation was resolved quickly. Did you experience it before?
Thankfully I have not had this experience recently, although I have witnessed falls in the past and it can be alarming. I’m so glad that a family member was there to help and that the lady was not left lying on the ground for a long period. We all have a responsibility to keep each other safe, so it’s good that you were able to seek additional help.
I am 71 fell in my behind. I heard a crunch but felt no pain. My feet started tingling about a week later. Still no pain. When lifting my leg I feel me lower vertebrae pop. No pain.
Now I am having difficulty walking. Feeling a odd sensation in my body between my waist and knees. Like I am heavy and hard to walk.
Still no pain.
The fall was a,month ago. Today the tingling is all over my legs.
My hubby thinks it’s all in my head. But it’s not.
Do you know what could cause this.
Hi Mary. I can’t give you any medical advice. When I hear about tingling symptoms, I think about pressure or irritation to a nerve. A doctor could help to determine if the pattern of a person’s nerve symptoms are in keeping with a problem in the spine or the limb.
My father fell twice, hit his head pretty hard. Then things started to change for him, weird personality was kicking in, then shortage of memory loss how to fix or that was gone out the window. Then lack of diet was happening as well. Last year he was confirmed not competent and was dealing with Dementia. His falls had something to do with that. He passed on in December from Aspiration pneumonia. I would say lack of diet after his two bad falls. My fathers siblings blame lack of diet. I told them his falls would do that. What’s your take on that? Before that he was doing fine he ate healthy and spunky.
I’m sorry to hear about your father, Krystal. A fall is often the beginning of a cascade of challenges for older adults and sometimes it can be difficult to tell if the person fell because they were getting ill or got ill as a result of the fall. Nonetheless, fall prevention is very important.
I am trying to find answers for my mother who is 76 years old but fairly healthy and has had multiple falls and they are becoming more frequent. She has seen a neurologist a cardiologist and I referred her to a gerontologist to see if it’s a possible issue with medications she has arthritis and asthma so when she falls after years of steroid use She breaks something most of the time. Thankfully not a hip yet but bilateral humerus, clavicle and hands most recently. This week she fell and hit her face thankfully nothing is broken. When I’m around her she seems to be off-balance frequently and we thought it was due to knee pain so we discussed a replacement but she is not ready for that. She has had a recent Cortizone shot which takes care of the pain but I don’t know if the knee instability is contributing to these falls. She is seeing a physical therapist as she did after she broke both arms to work on balance. she seems to be OK for a little while and then starts falling again. She denies any dizziness. she is overweight at this time and that is probably contributing to some of this with her poor muscle tone as she has not been exercising. She had begun to do water aerobics and was planning to do more when she broke the clavicle this past fall. Apparently this has been going on for years but since I don’t live near Her I didn’t realize how frequently she was falling. She lives alone. She seems to be careful when I’m with her but other times she doesn’t seem to be paying attention and she loses her balance and falls. we are at a loss as to what to do next. She is so depressed from this because it keeps happening in spite of her being careful. I amLooking for an answer as to what might be the root cause of these frequent falls. She is not frail. I appreciate any feedback. Thank you so much.
Hi Terrie. As you seem to be aware, a fall in an older adult is usually the result of multiple issues, or what we would in Geriatrics call “multifactorial”. As such, it often takes a multi-pronged approach to reduce fall risk. As Dr. K points out, we usually recommend reviewing medications and trying to reduce or stop anything that can contribute to fall risk, among other interventions described in the article.
Getting your mom a referral to a Geriatrician is a great idea.
Finally, revisit the idea of your mom being “frail”. It’s not important to label people, but frailty doesn’t always look like we expect. Recognizing frailty and keeping up on nutrition, exercise, and social connectedness might take on a new meaning if considered int he context of frailty.
Hello my grandmother is 74 years old and had 3 falls in the last month and all of them are on the same side of her head she was okay untill friday my grandfather pasted away next to her in the bed and she had a fall on thursday night aswell she is very confused and she cant pee at all since Friday she only poops water and she complains about headaches and dizziness and she sleeps all day and night and still complains she is so tired she has heart problems her to part of her heart only wobbles and the bottom part is the side thats beating she is short of breath she had a heart attack 3 months ago and her body started fulling up with water like crazy and the docter gave us things to inject her with to help with the water to bring it off and also gave her tablets when she has had her injection and finish drinking her water tablets not long after she must run then she would pee alot and a few times a day but after the last fall nothing so i dont know is it from the fall or the shock that she cant pee but poops water
Hello Michelle and I’m so sorry to hear about the difficulties that your grandmother is having. From your IP address it looks like you’re in South Africa so I can’t advise the best thing to do. The sudden loss of a spouse would affect a person with chronic health conditions, although it would be hard to say whether it would fully account for all of the changes you describe.
i fell down my stairs of my rented apartment (stairs would not pass on code inspection) almost two years ago. i am 58 years old. i started having back pain about a month later and it worsened to the point that i saw a doctor for sciatic nerve. i had gradual changes in gait and balance, both hands and feet were numb. on christmas eve i was alone and was in horrible pain and was unable to walk. i was admitted to a hospital and given many tests. i was released to get appointment with primary care doctor who could refer me to neurologist. tests showed spinal cord damage and compression of discs. i went home but my walking became worse so i went to ER at a different hospital. i was seen by a neurologist who ordered a spinal tap and prednisone but other doctors nixed that and i was to go to snf for 30 days for pre-surgery. the second day there, my numbness spread and i went back to ER. i was released with a five day supply of prednisone which helped like magic. i ran out of pills and my condition deteriorated. my primary doctor refused to prescribe prednisone and referred me to a spine specialist. my doctor appointment was in february and my referred appointment is at the end of april. i am worse every day. i am in pain and can not walk as of yesterday.
could this have been caused by my fall?
why should i have to suffer so long waiting for referral appointment? what should i do? i am on medi-cal in sacramento, ca
Hi Tracy and I’m so sorry to hear about your pain. I can’t say whether your situation is related to your fall, and unfortunately it’s getting increasingly difficult to predict the timing of appointments and procedures with the current coronavirus pandemic.
I hope that you don’t need to return to an emergency department and that your primary care provider can give you some information about where to go next. Best of luck.
why are my 90 year old mother’s cold internally to her and very painful. They get so bad that she can’t even walk. We have been told that it is poor circulation, but she walks everyday. She also has been taking meds for high blood pressure for quite sometime. We thought she was being over medicated so with the doctors approval she went off one that was possibly causing the leg issue. She seemed better for about a week but then her leg pain and coldness feeling internally came back.
Appreciate any help, thanks.
This sounds like a very uncomfortable feeling for your mom. Medications can sometimes contribute to changes in sensation in the legs, but other causes can include nerve damage (also called peripheral neuropathy) related to Diabetes or blood vessel disease, or arthritis in the spine that affects nerves in the legs. Thyroid disease can also cause feelings of cold.
Feeling cold in the hands or feet is a common complaint but we often do not find a clear answer about cause. Often, warm clothing is the best way to treat the symptom.
I am a 92 and female. I fell 4 weeks ago on my left side I was seeing an emergency and have been back there again. I have severe pain in my leg that is getting worse each week. The doctors can’t seem to find the reason.
I’m so sorry to hear about your fall and injury. When I see someone with worsening pain after a fall, I first want to make sure to rule out a broken bone, or something else that could require surgery, especially if the person can’t walk or bear weight on the limb. This can usually be done with an x-ray. If that doesn’t show any fracture, and the pain is worsening, then other imaging is sometimes required – like a CT scan or MRI, or even a bone scan.
Unfortunately, even when there is nothing broken, there can still be injury, which we refer to as “soft tissue” related. The soft tissues are things like muscle, tendons, cartilage and skin, and when their integrity is disrupted, it can be painful and take weeks to improve.
Dr Kernisan has a good article about how to select a pain reliever, here., and I often find that recovery from an injury needs a team approach, with physiotherapy, massage, and other professionals to help.
My practice is in Canada, but universally, persistence is important if a person is suffering and needs answers. I hope you are feeling better soon.
I’ve had multiple x-rays and they can’t find anything. What could they be missing. What is causing my pain to get wor se. I cannot continue to live this way.
Please give me some answers as to why you think my pain is not getting better after 4 weeks It’s getting worse I cannot take care of myself. I need help.
Hi my mom is 90 years old she had a stroke 14 months ago , last September of 2019. She lives w me I am her caregiver and we moved her down to my floor no stairs etc she recovered about 80% her speech is still not back to normal and she has to walk w a walker or cane she needs help w stairs. 10 days ago she fell outside I helped her down the 2 stairs outside she had her cane w the big base four prongs she was fine and she wanted to go out front to sit in the sun she couldn’t reach the latch on the gate I was in the house I thought she was fine between the gate cane and I guess her instability she fell she says she did not hit her head she was outside for 10 min when my husband came home and found her in the driveway. He Got her up on her feet and she walked w her cane into the house. She was embarrassed. She ate dinner and walked ok at night I noticed a big lump and bruise on her arm (she is on elequis) I iced it and drew a circle around it and it did not get any bigger it is getting better and she has a bruise on her thigh too she said she fell right on her behind. I called her PCP her said as long as she did not hit her head she would be fine. We got to PT he checked her out knees, hips shoulder back everything was fine. My only concern is she seems to be very very tired weak walking ALOT slower and moving ALOT slower I am going to her neurologist in 2 days w her for a check up oh and she has a fib and got a pacemaker last year too. What do u think the slowness could be from and she said she feels it as well. Sorry for the long e mail thank you.
I’m so sorry that your mom had a fall. It’s good to hear that your mom is seeing her neurologist and also has a primary care provider.
Sometimes, a person seems to be “different” after having fallen, and there’s often a concern about bleeding in the brain or a concussion, especially if there’s been a head injury. A person could also move more slowly if they have pain or stiffness from their other injuries.
When we hear about “slowing” we often think about Parkinson’s disease, which usually also causes tremor, trouble walking, and stiffness. Parkinson’s disease can increase the risk for falls as well.
I hope you get some answers from your doctors soon and thanks for visiting the site.
Hi,
I’m taking care of my 77 year old aunt. She has had an aortic valve replacement and she has a pace maker. She Is iron deficient anemia and has had it all her life. She has recently lost 47 pounds and I had her removed from 3 different blood pressure meds, her diabetes meds, potassium, and fluid pills. She has no appetite and has started falling. She has absolutely no strength in her legs. She still walks but she is very wobbly and I’ve noticed that she is beginning to have one foot drag some. She also has spells where her speech is slurred and she is very weak. I have taken her to her primary care physician. He did notice an abnormality in her blood. She was very anemic. She has received two iron transfusions. Her PCP tells me that it is all just old age symptoms. That there really isn’t anything I can do. I have been giving her protein shakes and letting her eat anything she wants. I am at my wits end as to how to help her. Oh and she is forgetting to take her meds. She might take 4 out of 7 days.
Whew! I’m sorry to hear about all of the difficulties your aunt is having.
Falling, weakness, memory loss and dragging one foot do not sound like “just old age symptoms” to me, and sorting all of this out requires a careful and comprehensive approach – the essence of Geriatrics! Severe anemia could cause some of those symptoms, but I wouldn’t expect them to be in “spells”, but rather a slow, gradual progression.
I often hear from patients that it takes a lot of advocacy to get a thorough workup or a referral to a specialist, but it’s usually worthwhile, so don’t give up.
You might also be interested in the Helping Older Parents Membership. The membership provides ongoing guidance from Dr. Kernisan and her team of professional geriatric care managers, to help you more easily get through your journey helping your aging parents. It also includes access to her popular Helping Older Parents Course and live QA calls with her. You can join the waitlist here if you’re interested.
I’m 69 and had 3 back and neck surgeries. I had scoliosis as a child and I know this has something to do with my 3 back surgeries. I had two surgeries in Atlanta and knocked where I live now. The first surgery was very bad stenosis in 2004. The stenosis came back in different places. In 2013 I had another surgery for stenosis. I thought I was fun until 2017 when I started falling down our stairs every day. No one could find anything wrong. I got an appointment with Mayo Clinic. The first doctor looked at my x-rays and said that it was complicated. I saw a team of 10 doctors. They came to the conclusion that I needed another spinal surgery. I came to Mayo in a wheelchair and left walking very good until a year later. I’m falling again and I think there’s something wrong with me. I have very bad memory and just don’t feel right. I went to a neurologist and she told me that if I fell again I could get paralyzed. I’m sorry this has been so long. But I just thought about my numb toes. Thank you.
Hi Pamela and thanks for sharing your story – what a journey you’ve had! Most falls in older adults are related to multiple issues, and certainly, if a person has had spinal stenosis or back surgery, that could affect balance and stability.
There are some conditions that cause memory problems as well as falls, for example Normal Pressure Hydrocephalus. A neurologist should be able to explore this diagnosis. Thanks for reading!
My mother is 75 she fell back in January and was ok for a couple months then she started having real bad hip pain. The doctors at the er took xrays could not find anything wrong and sent her home. Then her family doctor sent her to a specialist and he said her sciatic nerves were [inched so she had surgery for pinched nerves and was sent home. She was feeling better but the pain in her hip still continues as well as her tail bone hurts because she continues to fall and recently she has fallen at least 6 times. Her left foot hurts as well as it is very swollen. She is barely able to walk. I cannot get her out of her house by myself because she falls every time. All the doctor wants her to do is get more xrays. I think there is more going on. She has no usage of her legs anymore. Any information on what could cause this would be grateful.
I would be very concerned if someone suddenly became unable to walk and was falling frequently.
When a Geriatrician is trying to sort out why a person is falling frequently, they would do a head to toe physical examination, and review all medications, other illnesses, and lifestyle practices. We also refer frequently to other professionals like physiotherapists and occupational therapists, to see if a cane or walker or other equipment is needed.
I would advise someone in your position to continue to advocate for more assessment and help. Best of luck.
My mom passed away recently. She was 72. History of CHF, CKD was having dialysis. LUPUS. CHRONIC LUMBAR FRACTURES FROM YEARS AGO.. I found her on the floor one day and noticed her chest protruding a little. Complaining of chest pain. took her to er. She had pneumonia and her oxygen levels were low in 40s. They put her on a ventilator And attempted to take her off but when they tried her levels dropped Her pulmonologist stated she had multiple organ failure. Was on ventilator for 3 weeks. Cxr was negative for fracture. My question is can the fall have caused her lung damage that resulted in the pneumonia ? Thank you in advance.
I’m so sorry for your loss, Jennifer.
It’s hard to say if a fall is the cause of an infection like that or if the person was already “brewing” a pneumonia and that is why they fell. It’s not uncommon for older adults, especially those living with chronic illnesses like kidney disease and congestive heart failure to have an atypical course, so a pneumonia symptom might be a fall, rather than a cough or fever.
It’s very hard to prevent all falls in frail older persons, and sometimes they’re unavoidable. I hope your family finds some comfort in your grief.
hi my 88 year old gmother keeps having these turns she calls them when she cant remeber a thing she blacks out cant hold a speach falls asleep when talking and also really gittery with her words and couldnt walk properly and couldnt walk to toilet fell down and she wet her pants she didnt hurt herself just didnt get to toilet in time luckly i helped her when she fell down whats wrong i called ambo all test were fine except her chest xray was inconclusive
That sounds like a very frightening situation and the symptoms you describe are worrisome. I’m glad that you mention that all of her tests are fine. Blacking out, having trouble speaking, weakness, and shaking could be due to a lot of serious thigs, like a stroke, infection, delirium, or something else. An abnormal chest x-ray in an older person could be related to a pneumonia or fluid on the lungs from a heart issue (congestive heart failure).
I can’t give specific medical advice, but I would tell someone in a situation similar to yours to keep advocating for a full assessment. If there’s a Geriatrician in your region, that would be a helpful person to see to get everything ironed out.
Your grandmother is fortunate to have such a caring grandchild.
My mother, 69 years old fell down suddenly on floor without knowing to her. Only medical conditions that time was indigestion. After that, the doctor checked her random blood sugar, and it was 200 and BP 140/80. Next day we went to other doctor for sugar test before 110 and after breakfast is 176. BP is 140/80. So for she is not taking any sugar or BP medicines. Doctor suggesting for CT scan for further investigation. What to do – is CT scan is really required? What will be the cause for her fall?
A fall like you describe can be alarming, but I can’t give specific medical advice over the internet.
Often, a CT scan of the head is done after a fall to rule out any bleeding or other signs of trauma. I would consider doing one if a person had neurological signs or symptoms, like a headache, excessive drowsiness, or changes in strength or speech.
Falls can have a multitude of causes, from an infection to a medication side effect, and everything in-between. It’s good that your family member is being seen by a doctor and I hope you get some answers soon.
Dear Dr Lesley. I am 54 years old. When I was 27 I received electric convulsion shocks by my Psychiatrist for depression.
I have been standing up, get dizzy and my arms and legs will shake like mad. I normally fall backwards or forwards and by unconscious for a short while and then stand get ill. This has happened for the last 6 years. This few days was quite bad because I am full of blue marks and bounce my head against head pedestals. Do you think I should go for an MRI or scans or just get my blood tested. My brother passed away from very low hemoglobin 4 years ago and I am very worried about the falling.
Those falls sound very concerning, especially if you’re losing consciousness, hitting your head, and are experiencing shaking.
I would suggest a complete medical evaluation, to rule out seizures, a heart issue, or something else that’s serious.
On the other hand, if you’ve been having these spells for 6 years and they haven’t progressed, they may be part of a benign process.
My 89yo dad broke his hip and had a pinning about 5 weeks ago. He has a-fib and a history of triple bypass at age 54 and a revision of one of those grafts about five years ago. He has bronchiectasis that appears to be controlled. He has balance issues, ergo fall, but overall in decent shape and enjoys life.
Doing well with the hip, but while in rehab he got a norovirus, vomiting and diarrhea. Appeared to get over that, got home fairly quickly and first week did well. He’s not on pain meds anymore. Then, little by little getting nausea that comes and goes everyday. Lack of appetite. Went to doc and he prescribed blood work and a flat abdomen that showed a lot of stool. I expected the doctor to order a chest X-ray for possible pneumonia considering the history of being sedentary but since his lungs sounded clear, he didn’t. I know you can still have lung problems even if you don’t hear anything. Four days of citrate, then miralax and he’s feeling no better.
Also he had a negative urinalysis.And has lost 18 lbs during this time.
Any help? My mom won’t listen to anyone but the doctor. Thanks for your consideration.
I’m so sorry to hear about your dad and it sounds like the gastrointestinal virus threw him off his rehab track, which can happen.
Dr. K has a good article about constipation management that you might be interested in: https://betterhealthwhileaging.net/how-to-prevent-and-treat-constipation-aging/
Constipation can contribute to a feeling of abdominal fullness and affect appetite, so I would hope that his picks up when that is fixed. In general, if symptoms aren’t getting better with a treatment plan, that’s a good reason to go back to the doctor for more advice. If you can go to the appointment and advocate for your dad, that would be very valuable. Many times, health providers need to be reminded that 89 year olds can get better and should not be “written off” after a setback like a fall or an infection. Best of luck!
My dad’s dotor said he was going to change my dad’s blood pressure medicine because the last doctor gave him the BP medicine and HTC in the same pill and that was the issue for most. It’s a double pill in one so he would only prescribe the one BP medicine as he said its enough already in the pill. You don’t need the water part for old people.
well see what happens
Many pills contain more than one compound, for example a diuretic and an angiotensin receptor blocker. Both are blood pressure pills, and many people find it more convenient to take a 2-in-1, as long as both medications are at the correct dose for them.
I believe the comments given are very helpful, but perhaps as important is the loving manner n which they are given. Thanks