If you want to prevent dangerous falls in an aging adult, here’s one of the very best things you can do: be proactive about getting the right kind of medical assessment after a fall.
Why? There are three major reasons for this:
- A fall can be a sign of a new and serious medical problem that needs treatment. For instance, an older person can be weakened and fall because of illnesses such as dehydration, or a serious urinary tract infection.
- Older adults who have fallen are at higher risk for a future fall. Although it’s a good idea for any older person to be proactive about identifying and reducing fall risk factors, it’s vital to do this well after a fall.
- Busy doctors may not be thorough unless caregivers are proactive about asking questions. Most doctors have the best intentions, but studies have shown that older patients often don’t get recommended care. By being politely proactive, you can make sure that certain things aren’t overlooked (such as medications that worsen balance).
All too often, a medical visit after a fall is mainly about addressing any injuries that the older person may have suffered.
Obviously, this is very important; one doesn’t want to miss a fracture or other serious injury in an older person.
However, if you want to help prevent future falls, it’s also important to make sure the doctors have checked on all the things that could have contributed to the fall.
This is really key to preventing falls in an aging adult. Even if you’re pretty sure your loved one just tripped and stumbled, a good evaluation can uncover issues that made those trips and stumbles more likely.
In this article, I’ll list eight key items that you can make sure the doctors check on, after an older person falls. This will help you make sure your loved one has had a thorough work-up, and can reduce the chance of future serious falls.
This list is partly based on the American Geriatrics Society’s Clinical Practice Guidelines on Preventing Falls.
8 Things the Doctors Should Check After a Fall
1. An assessment for an underlying new illness. Doctors almost always do this if an older person has been having generalized weakness, delirium, or other signs of feeling unwell. Be sure to bring up any symptoms you’ve noticed, and let the doctor know how quickly the changes came on.
Just about any new health problem that makes an older person weak can bring on a fall. Some common ones include:
- Urinary tract infection
- Dehydration
- Anemia (low red blood cell count), which can be brought on by bleeding in the bowel or by other causes
- Pneumonia
- Heart problems such as atrial fibrillation
- Strokes, including mini-strokes that don’t cause weakness on one side
2. A blood pressure and pulse reading when sitting, and when standing. This is especially important if you’ve been worried about falls — or near falls — that are associated with light-headedness, or fainting.
If your older relative takes blood pressure medication, you should make sure the doctor confirms that he or she isn’t experiencing a drop in blood pressure with standing. (Note that tamsulosin — brand name Flomax — is a popular prostate medication that also causes drops in blood pressure.)
A 2009 study of Medicare patients coming to the emergency room after fainting found that checking sitting and standing blood pressure was the most useful test. However, it was only done by doctors 1/3 of the time.
For more information, see 6 Steps to Better High Blood Pressure Treatment for Older Adults.
3. Blood tests. Checking an older person’s blood tests is often a good idea after a fall. Falls can be worsened by problems with an older person’s blood count, or by things like blood sodium getting too high or too low.
Generally, a complete blood cell count (CBC) and a check of electrolytes and kidney function (metabolic panel, or “chem-7”) are a good place to start.
For more on blood tests that are often useful, see Understanding Laboratory Tests: 10 Commonly Used Blood Tests for Older Adults.
Be sure to ask the doctor to explain any abnormalities found in the blood work, whether they might be related to falls, and how the doctor plans to address them.
If your loved one has diabetes and takes insulin or other medications to lower blood sugar, be sure to bring in the glucometer or a blood sugar log. Episodes of low blood sugar (hypoglycemia) are an important risk factor for falls, but a laboratory blood test generally doesn’t show moments of low blood sugar.
4. Medications review. Many older adults are taking medications that increase fall risk. These medications can often be reduced, or even eliminated. Be sure to ask the doctor to address the following types of medications:
- Any sedatives, tranquilizers, or sleeping medications. Common examples include zolpidem (Ambien) for sleep, or lorazepam (Ativan) for anxiety. Antipsychotic medications for restless dementia behaviors, such as risperidone or quetiapine, can also increase sedation and fall risk.
- Blood pressure and diabetes medications. As noted above, it’s not unusual for older adults to be “over-treated” for these conditions, meaning they are taking a level of medication that causes the blood pressure (or blood sugar) be lower than is really necessary for ideal health.
- “Anticholinergic” medications. These medications are commonly taken by older adults, who often have no idea that these medications worsen balance and thinking! They include medications for allergies, overactive bladder, vertigo, nausea, and certain types of antidepressants which may also be given for nerve pain. For more on identifying and avoiding anticholinergics, see here.
- Opiate pain medications, especially if they are new.
The Centers for Disease Control recommends that older adults concerned about falls request a medication review. To learn more about which medications should be reviewed, and what should be done about risky drugs, see this article:
10 Types of Medication to Review if You’re Concerned About Falling.
5. Gait, balance, and leg strength. At a minimum, a gait assessment means that the doctor carefully watches the way the older person is walking. Asking the older person to stand up from a chair (without using the arms) can help assess leg strength. There are also some simple ways to check balance.
Simple things to do, if gait, balance, or leg strength don’t seem completely fine, are:
- Address any pain or discomfort, if that seems to be a cause of problems. Many older people are reacting to pain in their feet, joints, or back.
- Refer to physical therapy for gait and balance assessment. These assessments will usually include checking the older person’s leg strength. A physical therapist can often recommend suitable strengthening and balance exercises for seniors, and also can help fit the older person for an assistive device (e.g. a walker) if appropriate. For more on the proven Otago physical therapy program to reduce falls — including videos demonstrating the exercises — see here: Otago and Proven Exercises for Fall Prevention.
6. Evaluation for underlying heart conditions or neurological conditions. These chronic conditions are different from the “acute” types of illnesses that we usually look for right after a fall.
In a minority of cases, an older person may be falling because he or she has developed a chronic problem with the heart or blood pressure system. An example of this would be paroxysmal rapid atrial fibrillation, which causes the heart to sometimes race, or sick sinus syndrome, which can cause the heart to beat too slowly.
It’s also possible for older people to develop a new chronic neurological condition, such as Parkinson’s disease.
If you’re worried about these possibilities, ask the doctor “Do you think a heart condition might have caused this fall? Or do you think an underlying neurological condition could have caused this fall?”
It’s particularly useful for you to ask about these kinds of problems if the falls or near-falls keep happening, especially if you’ve already minimized risky medications and over-treatment of high blood pressure.
7. Evaluation for osteoporosis and fracture risk. Many older adults, especially women, develop thinner bones in later life. Osteoporosis isn’t technically a risk factor for falls, but it’s certainly a major risk factor for injury from a fall. In particular, people with osteoporosis are at much higher risk of having a hip fracture or other type of fracture when they fall.
For this reason, after an older person falls, it’s important to check and make sure they’ve been assessed for osteoporosis.
The US Preventive Services Task Force recommends that all women aged 65 or older be screened for osteoporosis., however many older women end up not getting screened.
If they do have osteoporosis, then it should be treated. Treatment with bisphosphonate medications has been proven to reduce fracture risk.
Experts also recommend promptly starting osteoporosis treatment after a fracture, as the research shows this doesn’t interfere with fracture healing and can reduce the risk of a subsequent fracture.
Calcium and vitamin D supplementation may also help, especially in older adults who have low levels of vitamin D. Other lifestyle changes can also help treat osteoporosis; for more on this, see here.
Note: The United States Preventive Services Task Force and other expert groups used to recommend vitamin D supplementation to help prevent falls, because research had initially identified an association between low vitamin D levels and falls. However, randomized trials were not able to show that vitamin D supplementation decreases falls, so vitamin D is no longer recommended for fall prevention.
8. Vision, podiatry, and home safety referrals. Could your loved one be in need of a vision check, podiatry care, or a home safety evaluation? If you’ve brought an older person in after a fall, it’s a good idea to talk to the doctor about whether these services might help.
I especially recommend home safety evaluations, if they are available in your area. Even something as simple as installing grab bars can make a difference, and home safety evaluations often uncover other simple changes that can prevent falls. Vision checks are also an excellent idea if the older person hasn’t had one recently.
Next steps to prevent future falls
Overwhelmed by this list? Here’s a suggestion:
Print out this post — or download my free cheat sheet — and bring it along next time you take an older person to see the doctor after a fall. If the doctor overlooks certain points, don’t be shy about asking why.
For more practical information on why older adults fall and how you can prevent falls, see my article Why Older People Fall & How to Reduce Fall Risk . You can also learn more about clinically proven exercises that reduce falls here.
This article was first published in 2014, and was last updated by Dr. K in September 2024.
BEVERLY A WING-LONSKI says
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.
BEVERLY A WING-LONSKI says
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.
Nicole Didyk, MD says
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.
Debra Elizabeth Sharpe says
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.
Nicole Didyk, MD says
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.
Tracy says
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
Nicole Didyk, MD says
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.
Michelle says
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
Nicole Didyk, MD says
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.
Terrie says
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.
Nicole Didyk, MD says
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.
Krystal Peck says
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.
Nicole Didyk, MD says
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.
Mary says
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.
Nicole Didyk, MD says
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.
Andrea says
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?
Nicole Didyk, MD says
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.
Asif Zafar Durrani says
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.
Leslie Kernisan, MD MPH says
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!