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.
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
- Anemia (low red blood cell count), which can be brought on by bleeding in the bowel or by other causes
- 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, balance, and leg strength. At a minimum, a gait assessment means that the doctor carefully watches the way the older person is walking. Asking the older person to stand up from a chair (without using the arms) can help assess leg strength. There are also some simple ways to check balance.
Simple things to do, if gait, balance, or leg strength don’t seem completely fine, are:
- Address any pain or discomfort, if that seems to be a cause of problems. Many older people are reacting to pain in their feet, joints, or back.
- Refer to physical therapy for gait and balance assessment. These assessments will usually include checking the older person’s leg strength. A physical therapist can often recommend suitable strengthening and balance exercises for seniors, and also can help fit the older person for an assistive device (e.g. a walker) if appropriate. For more on the proven Otago physical therapy program to reduce falls — including videos demonstrating the exercises — see “Otago and Proven Exercises for Fall Prevention.”
6. Evaluation for underlying heart conditions or neurological conditions. These chronic conditions are different from the “acute” types of illnesses that we usually look for right after a fall.
In a minority of cases, an older person may be falling because he or she has developed a chronic problem with the heart or blood pressure system. An example of this would be paroxysmal rapid atrial fibrillation, which causes the heart to sometimes race, or sick sinus syndrome, which can cause the heart to beat too slowly.
It’s also possible for older people to develop a new chronic neurological condition, such as Parkinson’s disease.
If you’re worried about these possibilities, ask the doctor “Do you think a heart condition might have caused this fall? Or do you think an underlying neurological condition could have caused this fall?”
It’s particularly useful for you to ask about these kinds of problems if the falls or near-falls keep happening, especially if you’ve already minimized risky medications and over-treatment of high blood pressure.
7. Evaluation for osteoporosis and fracture risk. Many older adults, especially women, develop thinner bones in later life. Osteoporosis isn’t technically a risk factor for falls, but it’s certainly a major risk factor for injury from a fall. In particular, people with osteoporosis are at much higher risk of having a hip fracture or other type of fracture when they fall.
For this reason, after an older person falls, it’s important to check and make sure they’ve been assessed for osteoporosis.
The US Preventive Services Task Force recommends that all women aged 65 or older be screened for osteoporosis., however many older women end up not getting screened.
If they do have osteoporosis, then it should be treated. Treatment with bisphosphonate medications has been proven to reduce fracture risk.
Calcium and vitamin D supplementation may also help, especially in older adults who have low levels of vitamin D. Other lifestyle changes can also help treat osteoporosis; for more on this, see here.
Note: The United States Preventive Services Task Force and other expert groups used to recommend vitamin D supplementation to help prevent falls, because research had initially identified an association between low vitamin D levels and falls. However, randomized trials were not able to show that vitamin D supplementation decreases falls, so vitamin D is no longer recommended for fall prevention.
8. Vision, podiatry, and home safety referrals. Could your loved one be in need of a vision check, podiatry care, or a home safety evaluation? If you’ve brought an older person in after a fall, it’s a good idea to talk to the doctor about whether these services might help.
I especially recommend home safety evaluations, if they are available in your area. Even something as simple as installing grab bars can make a difference, and home safety evaluations often uncover other simple changes that can prevent falls. Vision checks are also an excellent idea if the older person hasn’t had one recently.
How to use this information
Overwhelmed by this list? Here 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 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 revised by Dr. Kernisan in May 2023.
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.
Nicole Didyk, MD says
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!
Antoinette Maraiac says
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.
Nicole Didyk, MD says
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.
PV Valli says
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?
Nicole Didyk, MD says
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.
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
Nicole Didyk, MD says
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 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.
Nicole Didyk, MD says
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.
Crystal Thacker says
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.
Nicole Didyk, MD says
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.
Pamela Spaar says
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.
Nicole Didyk, MD says
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!
Pam Brown says
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.
Nicole Didyk, MD says
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.
Elizabeth Gentile says
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.
Nicole Didyk, MD says
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.
BEVERLY A WING-LONSKI says
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.