The changing approach to falls in the elderly.

The annual incidence of falls is approximately 30 percent in persons over the age of 65 years. The risk of falls is greater in older persons, with the annual incidence increasing to 50 percent in those over age 80. Because of the significant incidence of falls in the elderly, physicians should have an organized approach to fall assessment and prevention. Most falls in the elderly are caused by complex interactions of intrinsic and extrinsic factors. A thorough history is essential to identifying the intrinsic or extrinsic factors involved. Approximately one half of falls in the elderly can be attributed to accidents and extrinsic causes such as slippery floors, and the remainder from intrinsic causes such as lower extremity weakness, gait disorders, effects of medications or acute illness. Extrinsic and intrinsic factors that are identified may be amenable to one of three management approaches: treating acute or reversible deficits, reducing the cumulative burdens of deficits, or using adaptive devices for irreversible deficits. A careful and focused evaluation can identify factors that can be corrected or therapeutic interventions that will lessen the risk of a subsequent fall.