Pract Neurol 7:158-171 doi:10.1136/jnnp.2007.120980
  • Review

Why old people fall (and how to stop them)

  1. N C Voermans, Senior Registrar1,
  2. A H Snijders, Senior Registrar1,
  3. Y Schoon, Consultant Neurologist and Head of the Parkinson Center Nijmegen1,
  4. B R Bloem, Consultant Geriatrician and Head of the Falls & Syncope Clinic2
  1. 1Department of Neurology, Radboud University Nijmegen Medical Centre, the Netherlands
  2. 2Department of Geriatrics, Radboud University Nijmegen Medical Centre, the Netherlands
  1. Correspondence to:
 Dr B R Bloem
 Parkinson Centre Nijmegen (ParC), Department of Neurology, 935, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, the Netherlands; b.bloem{at}


    Falls in older people are a common, dangerous and frequently incapacitating problem. They are often perceived as being untreatable—but this is an overly negative perspective. In any event, in the next few decades we will increasingly be confronted with elderly fallers as life expectancy continues to rise. This applies particularly to general practitioners, emergency department staff, geriatricians and neurologists. In this review, we will underscore the clinical significance of falls in the elderly and then outline a practical approach for their management. Core elements of this approach include:

    • ascertaining whether or not the patient actually fell

    • reliably classifying the nature of the falls

    • identifying the causes and associated risk factors for falls

    • tailoring an individualised treatment to the identified contributing factors, in order to reduce falls and fall-related injuries, or even to prevent them altogether.


    Falls in the elderly are a major health problem, first and foremost for the affected individuals whose quality of life is markedly reduced, and also for the public health system because of the immense costs associated with falls and the resultant injuries. The risk of falls increases with age: about one third of those over 65 years of age fall at least once a year, and about half of them even more often.1 Apart from age, prominent risk factors include previous falls, female gender, concomitant neurological disease, living in a nursing home, fear of recurrent falling, and regular alcohol intake.2,3

 About one third of those over 65 years of age fall at least once a year

    Falling is serious, for several reasons:

    • Falls may cause severe injury, and in up to 25% of elderly fallers this requires medical attention.4 Hip fractures are common and widely feared, and secondary complications due to immobility are frequent.

    • Secondary immobility after a fall is …