This Journal feature begins with a case vignette highlightinga common clinical problem. Evidence supporting various strategiesis then presented, followed by a review of formal guidelines,when they exist. The article ends with the author's clinicalrecommendations.
A 79-year-old woman with a history of congestive heart failure,arthritis, depression, and difficulty sleeping presents fora follow-up visit. She takes several prescription medications,including an antidepressant, a diuretic, an angiotensin-convertingenzymeinhibitor, and a beta-blocker, as well as over-the-counter sleepand allergy medications. Her chronic conditions appear to bestable. Her daughter reports that the patient has fallen twiceduring the . . . [Full Text of this Article]
The Clinical Problem
Strategies and Evidence
Assessment and Intervention
Laboratory Tests and Imaging
Education and Other Measures
Areas of Uncertainty
Guidelines
Conclusions and Recommendations
Source Information
From the Departments of Internal Medicine and of Epidemiology and Public Health, Yale University School of Medicine, 333 Cedar St., P.O. Box 208025, New Haven, CT 06520-8025, where reprint requests can be addressed to Dr. Tinetti.
Gallagher, P., O'Mahony, D.
(2008). STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers' criteria. Age Ageing
0: afn197v1-afn197
[Abstract][Full Text]
Kannus, P., Niemi, S., Palvanen, M., Sievanen, H., Parkkari, J., Jarvinen, M.
(2008). Rising Incidence of Low-Trauma Fractures of the Calcaneus and Foot Among Finnish Older Adults. J. Gerontol. A Biol. Sci. Med. Sci.
63: 642-645
[Abstract][Full Text]
Robitaille, Y., Gauvin, L.
(2008). Fall prevention in older adults: towards an integrated population-based perspective. Inj. Prev.
14: 147-148
[Full Text]
Heesch, K C, Byles, J E, Brown, W J
(2008). Prospective association between physical activity and falls in community-dwelling older women. J. Epidemiol. Community Health
62: 421-426
[Abstract][Full Text]
Ebeling, P. R.
(2008). Osteoporosis in Men. NEJM
358: 1474-1482
[Full Text]
Cusimano, M D, Kwok, J, Spadafora, K
(2008). Effectiveness of multifaceted fall-prevention programs for the elderly in residential care. Inj. Prev.
14: 113-122
[Abstract][Full Text]
Cheung, A. M., Detsky, A. S.
(2008). Osteoporosis and Fractures: Missing the Bridge?. JAMA
299: 1468-1470
[Full Text]
Lyness, J. M.
(2008). Depression and Comorbidity: Objects in the Mirror are More Complex Than They Appear. AJGP
16: 181-185
[Full Text]
Bartoletti, A., Fabiani, P., Bagnoli, L., Cappelletti, C., Cappellini, M., Nappini, G., Gianni, R., Lavacchi, A., Santoro, G. M.
(2008). Physical injuries caused by a transient loss of consciousness: main clinical characteristics of patients and diagnostic contribution of carotid sinus massage. Eur Heart J
29: 618-624
[Abstract][Full Text]
Healy, T. C., Peng, C., Haynes, M. S., McMahon, E. M., Botler, J. L., Gross, L.
(2008). The Feasibility and Effectiveness of Translating a Matter of Balance Into a Volunteer Lay Leader Model. Journal of Applied Gerontology
27: 34-51
[Abstract]
van Helden, S., van Geel, A. C.M., Geusens, P. P., Kessels, A., Nieuwenhuijzen Kruseman, A. C., Brink, P. R.G.
(2008). Bone and Fall-Related Fracture Risks in Women and Men with a Recent Clinical Fracture. JBJS
90: 241-248
[Abstract][Full Text]
Djaldetti, R., Treves, T. A., Ziv, I., Melamed, E., Lorberboym, M.
(2007). 123I-FP-CIT SPECT Imaging of Dopamine Transporters in Patients with Recurrent Sudden Falls: Are Such Falls a Distinct Entity?. J. Nucl. Med. Technol.
35: 232-236
[Abstract][Full Text]
Corti, M.-C., Baggio, G., Sartori, L., Barbato, G., Manzato, E., Musacchio, E., Ferrucci, L., Cardinali, G., Donato, D., Launer, L. J., Zambon, S., Crepaldi, G., Guralnik, J. M.
(2007). White Matter Lesions and the Risk of Incident Hip Fracture in Older Persons: Results From the Progetto Veneto Anziani Study. Arch Intern Med
167: 1745-1751
[Abstract][Full Text]
Cigolle, C. T., Langa, K. M., Kabeto, M. U., Tian, Z., Blaum, C. S.
(2007). Geriatric Conditions and Disability: The Health and Retirement Study. ANN INTERN MED
147: 156-164
[Abstract][Full Text]
Baker, D. I., Gottschalk, M., Bianco, L. M.
(2007). Step by Step: Integrating Evidence-Based Fall-Risk Management Into Senior Centers. Gerontologist
47: 548-554
[Abstract][Full Text]
Beauchet, O., Dubost, V., Allali, G., Gonthier, R., Hermann, F. R., Kressig, R. W.
(2007). 'Faster counting while walking' as a predictor of falls in older adults. Age Ageing
36: 418-423
[Abstract][Full Text]
Roux, C., Briot, K., Horlait, S., Varbanov, A., Watts, N. B, Boonen, S.
(2007). Assessment of non-vertebral fracture risk in postmenopausal women. Ann Rheum Dis
66: 931-935
[Abstract][Full Text]
Voermans, N C, Snijders, A H, Schoon, Y, Bloem, B R
(2007). Why old people fall (and how to stop them). PN
7: 158-171
[Full Text]
Hylek, E. M., Evans-Molina, C., Shea, C., Henault, L. E., Regan, S.
(2007). Major Hemorrhage and Tolerability of Warfarin in the First Year of Therapy Among Elderly Patients With Atrial Fibrillation. Circulation
115: 2689-2696
[Abstract][Full Text]
Donat, H., Ozcan, A.
(2007). Comparison of the effectiveness of two programmes on older adults at risk of falling: unsupervised home exercise and supervised group exercise. Clin Rehabil
21: 273-283
[Abstract]
Ruthig, J. C., Chipperfield, J. G., Newall, N. E., Perry, R. P., Hall, N. C.
(2007). Detrimental Effects of Falling on Health and Well-being in Later Life: The Mediating Roles of Perceived Control and Optimism. J Health Psychol
12: 231-248
[Abstract]
Lim, M. R., Huang, R. C., Wu, A., Girardi, F. P., Cammisa, F. P. Jr
(2007). Evaluation of the Elderly Patient With an Abnormal Gait. J Am Acad Orthop Surg
15: 107-117
[Abstract][Full Text]
Kannus, P., Palvanen, M., Niemi, S., Parkkari, J.
(2007). Alarming Rise in the Number and Incidence of Fall-Induced Cervical Spine Injuries Among Older Adults. J. Gerontol. A Biol. Sci. Med. Sci.
62: 180-183
[Abstract][Full Text]
Ganz, D. A., Bao, Y., Shekelle, P. G., Rubenstein, L. Z.
(2007). Will My Patient Fall?. JAMA
297: 77-86
[Abstract][Full Text]
Hill, E. L., Cumming, R. G., Lewis, R., Carrington, S., Couteur, D. G. L.
(2007). Sleep Disturbances and Falls in Older People. J. Gerontol. A Biol. Sci. Med. Sci.
62: 62-66
[Abstract][Full Text]
Ehrlich, P. L.
(2006). Caring for the Frail Elderly in the Home: A Multidisciplinary Approach. Home Health Care Management Practice
19: 38-44
[Abstract]
Cook, W. L., Tomlinson, G., Donaldson, M., Markowitz, S. N., Naglie, G., Sobolev, B., Jassal, S. V.
(2006). Falls and Fall-Related Injuries in Older Dialysis Patients. CJASN
1: 1197-1204
[Abstract][Full Text]
Sayer, A. A., Syddall, H. E., Martin, H. J., Dennison, E. M., Anderson, F. H., Cooper, C.
(2006). Falls, Sarcopenia, and Growth in Early Life: Findings from the Hertfordshire Cohort Study. Am J Epidemiol
164: 665-671
[Abstract][Full Text]
Peel, N. M., McClure, R. J., Hendrikz, J. K.
(2006). Health-protective behaviours and risk of fall-related hip fractures: a population-based case-control study. Age Ageing
35: 491-497
[Abstract][Full Text]
Li, W., Keegan, T. H.M., Sternfeld, B., Sidney, S., Quesenberry, C. P. Jr, Kelsey, J. L.
(2006). Outdoor Falls Among Middle-Aged and Older Adults: A Neglected Public Health Problem. Am. J. Public Health
96: 1192-1200
[Abstract][Full Text]
Durso, S. C.
(2006). Using clinical guidelines designed for older adults with diabetes mellitus and complex health status.. JAMA
295: 1935-1940
[Abstract][Full Text]
Quandt, S. A., Stafford, J. M., Bell, R. A., Smith, S. L., Snively, B. M., Arcury, T. A.
(2006). Predictors of falls in a multiethnic population of older rural adults with diabetes.. J. Gerontol. A Biol. Sci. Med. Sci.
61: 394-398
[Abstract][Full Text]
Andresen, E. M., Wolinsky, F. D., Miller, J. P., Wilson, M.-M. G., Malmstrom, T. K., Miller, D. K.
(2006). Cross-Sectional and Longitudinal Risk Factors for Falls, Fear of Falling, and Falls Efficacy in a Cohort of Middle-Aged African Americans. Gerontologist
46: 249-257
[Abstract][Full Text]
Littbrand, H., Rosendahl, E., Lindelof, N., Lundin-Olsson, L., Gustafson, Y., Nyberg, L.
(2006). A High-Intensity Functional Weight-Bearing Exercise Program for Older People Dependent in Activities of Daily Living and Living in Residential Care Facilities: Evaluation of the Applicability With Focus on Cognitive Function. ptjournal
86: 489-498
[Abstract][Full Text]
Hylek, E. M., D'Antonio, J., Evans-Molina, C., Shea, C., Henault, L. E., Regan, S.
(2006). Translating the Results of Randomized Trials into Clinical Practice: The Challenge of Warfarin Candidacy Among Hospitalized Elderly Patients With Atrial Fibrillation. Stroke
37: 1075-1080
[Abstract][Full Text]
Gage, B. F., Birman-Deych, E., Radford, M. J., Nilasena, D. S., Binder, E. F.
(2006). Risk of Osteoporotic Fracture in Elderly Patients Taking Warfarin: Results From the National Registry of Atrial Fibrillation 2. Arch Intern Med
166: 241-246
[Abstract][Full Text]
Blair, E., Gruman, C.
(2005). Falls in an Inpatient Geriatric Psychiatric Population. J Am Psychiatr Nurses Assoc
11: 351-354
[Abstract]
Volpato, S., Leveille, S. G., Blaum, C., Fried, L. P., Guralnik, J. M.
(2005). Risk Factors for Falls in Older Disabled Women With Diabetes: The Women's Health and Aging Study. J. Gerontol. A Biol. Sci. Med. Sci.
60: 1539-1545
[Abstract][Full Text]
Robitaille, Y., Laforest, S., Fournier, M., Gauvin, L., Parisien, M., Corriveau, H., Trickey, F., Damestoy, N.
(2005). Moving Forward in Fall Prevention: An Intervention to Improve Balance Among Older Adults in Real-World Settings. Am. J. Public Health
95: 2049-2056
[Abstract][Full Text]
Ray, W. A., Taylor, J. A., Brown, A. K., Gideon, P., Hall, K., Arbogast, P., Meredith, S.
(2005). Prevention of Fall-Related Injuries in Long-term Care: A Randomized Controlled Trial of Staff Education. Arch Intern Med
165: 2293-2298
[Abstract][Full Text]
Maurer, M. S., Burcham, J., Cheng, H.
(2005). Diabetes Mellitus Is Associated With an Increased Risk of Falls in Elderly Residents of a Long-Term Care Facility. J. Gerontol. A Biol. Sci. Med. Sci.
60: 1157-1162
[Abstract][Full Text]
Kannus, P.
(2005). KANNUS RESPONDS. Am. J. Public Health
95: 1306-1306
[Full Text]
Raisz, L. G.
(2005). Screening for Osteoporosis. NEJM
353: 164-171
[Full Text]
Shumway-Cook, A., Ciol, M. A, Gruber, W., Robinson, C.
(2005). Incidence of and Risk Factors for Falls Following Hip Fracture in Community-dwelling Older Adults. ptjournal
85: 648-655
[Abstract][Full Text]
Landi, F., Onder, G., Cesari, M., Barillaro, C., Russo, A., Bernabei, R., on Behalf of the Silver Network Home Care Study Gr,
(2005). Psychotropic Medications and Risk for Falls Among Community-Dwelling Frail Older People: An Observational Study. J. Gerontol. A Biol. Sci. Med. Sci.
60: 622-626
[Abstract][Full Text]
Kannus, P., Parkkari, J., Niemi, S., Palvanen, M.
(2005). Fall-Induced Deaths Among Elderly People. Am. J. Public Health
95: 422-424
[Abstract][Full Text]
Li, F., Harmer, P., Fisher, K. J., McAuley, E., Chaumeton, N., Eckstrom, E., Wilson, N. L.
(2005). Tai Chi and Fall Reductions in Older Adults: A Randomized Controlled Trial. J. Gerontol. A Biol. Sci. Med. Sci.
60: 187-194
[Abstract][Full Text]
Gill, T. M., Allore, H. G., Holford, T. R., Guo, Z.
(2004). Hospitalization, Restricted Activity, and the Development of Disability Among Older Persons. JAMA
292: 2115-2124
[Abstract][Full Text]
Schuurmans, H., Steverink, N., Lindenberg, S., Frieswijk, N., Slaets, J. P. J.
(2004). Old or Frail: What Tells Us More?. J. Gerontol. A Biol. Sci. Med. Sci.
59: M962-M965
[Abstract][Full Text]
Keys, P. A., Tress, D. R.
(2004). Preventing Falls in the Elderly: The Role of the Pharmacist. Journal of Pharmacy Practice
17: 149-152
[Abstract]
Gillespie, L.
(2004). Preventing falls in elderly people. BMJ
328: 653-654
[Full Text]
Leonard, D. R., Farooqi, M. H., Myers, S.
(2004). Restoration of Sensation, Reduced Pain, and Improved Balance in Subjects With Diabetic Peripheral Neuropathy: A double-blind, randomized, placebo-controlled study with monochromatic near-infrared treatment. Diabetes Care
27: 168-172
[Abstract][Full Text]
Lawlor, D. A, Patel, R., Ebrahim, S.
(2003). Association between falls in elderly women and chronic diseases and drug use: cross sectional study. BMJ
327: 712-717
[Abstract][Full Text]
Li, F., Fisher, K. J., Harmer, P., McAuley, E., Wilson, N. L.
(2003). Fear of Falling in Elderly Persons: Association With Falls, Functional Ability, and Quality of Life. J. Gerontol. B Psychol. Sci. Soc. Sci.
58: P283-290
[Abstract][Full Text]
Peek-Asa, C., Zwerling, C.
(2003). Role of Environmental Interventions in Injury Control and Prevention. Epidemiol Rev
25: 77-89
[Full Text]
Leslie, W. D., Roe, E. B., Szul, M., LoGerfo, J. P., Rubenstein, L. Z., Tinetti, M. E.
(2003). Preventing Falls in Elderly Persons. NEJM
348: 1816-1818
[Full Text]
Torgerson, D., Porthouse, J., Kannus, P. A, Kurrle, S. E, Cameron, I. D, Meyer, G., Warnke, A., Muhlhauser, I.
(2003). Effectiveness of hip protectors. BMJ
326: 930-930
[Full Text]
(2003). Clinical Management of Patients Who Fall. JWatch Neurology
2003: 4-4
[Full Text]