How Doctors Think About Falls

Written By: Dr. Jassin Jouria

Falls- Some Statistics 

The statistics surrounding falls are staggering. The Center for Disease Control (CDC) reports that on average, one US older adult (65+) suffers a fall every second. This accounts for a total of 36 million falls per year, resulting in more than 32,000 deaths.

Why Do Falls Happen?

Falls can occur in any age group, but studies show that falls become more frequent with age: 18% of falls happen in the young, 21% in middle-aged individuals, and 35% in the elderly.

The risk factors for falls include both physiological (relating to normal bodily functions) and pathological (relating to physical or mental disease) factors. The physiological changes happen as we grow older. The body loses its core strength due to weak muscles, the bones become brittle, and the joints become less flexible.

The pathological risk factors include:

  • Environmental Causes: These include factors like missing steps or seats, bumping into objects, sliding off surfaces, etc. This category includes falls during sports activities as well.
  • Medical Causes: These include:
    • Weakness of muscles due to stroke or arthritis
    • Poor balance caused by conditions such as Parkinson’s
    • Postural hypertension, which leads to a rapid fall in blood pressure on standing
    • Dizziness or lightheadedness caused by dehydration or vertigo
    • Irregular heart rate, either too slow (bradycardia), too fast (tachycardia), or irregular rhythm (arrhythmia)
    • Confusion or memory-related issues
    • Problems with feet such as ulcers
    • Vision or hearing-related issues
    • Excessive use of alcohol
    • Use of certain medication such as sleeping tablets and blood pressure tablets
    • Bladder and bowel related issues

Mechanical vs. Syncopal Falls- How Do They Differ? 

Another way of classifying falls is to divide them into two categories: mechanical and syncope falls. This classification is broad and does not cover all possible causes but it is commonly used in medical practice.

Mechanical Falls

Mechanical causes are related to environmental causes. These falls happen without the sufferer becoming unconscious. Mechanical causes for falls include:

  • Poor lighting
  • Uneven or slippery walking surface
  • Loose rugs, carpets, mats, or clothing on the floor
  • Missing stairs due to too many stairs or steep stairs
  • Tripping due to objects in the way
  • Lack of handrails or lack of support while walking
  • Inappropriate furniture or furniture impeding the walking route
  • Tripping into the walking aids
How doctors think about falls
How doctors see falls

Syncopal Falls 

Syncopal falls happen due to a transient loss of blood, oxygen, or blood sugar to the brain leading to a momentary loss of consciousness. Syncopal falls results mainly due to:

    • Hematological Causes: These include:
      • Erratic blood sugar: Erratic blood sugar such as high blood sugar (hyperglycemia) or low blood sugar (hypoglycemia) increases the risk of falls.
      • Low hemoglobin: Low hemoglobin leads to anemia that leads to symptoms like shortness of breath, lethargy, unsteadiness, and falls.
      • Infection: Infection anywhere in the body leads to lethargy, unsteadiness, and falls.
      • Electrolyte abnormalities: Electrolyte abnormalities such as low sodium (hyponatremia) or low potassium (hypokalemia) can lead to muscle weakness, lethargy, unsteadiness, and falls.
    • Cardiogenic Causes: These include:
  • Cardiogenic drugs: A variety of drugs either reduce the heart rate or the strength of heart muscle contraction that compromises the supply of blood to the brain. These medications can include beta-blockers, calcium channel blockers, etc.
    • Irregular heartbeat or rhythm: The heart normally beats in a rhythm fashion and the average heart rate is 60-100 beats per minute. If the heart is beating too fast (tachycardia), too slow (bradycardia), or irregularly (arrhythmia), it can prevent a regular supply of blood to the brain leading to a fall.
    • Reduced heart contractility: Things such as a heart attack can lead to damage to heart muscles and it reduces the supply of blood to the brain.
  • Vascular Causes: Vascular causes include:
    • Low blood volume (Hypovolemia): Bleeding can lead to a reduced supply of blood to the vital organs and can trigger a fall.
    • Orthostatic hypotension: In elderly individuals, the blood pools into the legs as they stand. This reduces the supply of blood to the brain and leads to a fall.
    • Vasodilation: Vasodilation involves the blood vessels dilating abnormally, which results in a reduction in the blood supply to the brain. It is mainly a side effect of medication such as blood pressure tablets.
  • Obstructive Causes: The most important causes include:
    • Myocardial infarction: Myocardial infarction or heart attack results from a reduction in the supply of blood to the heart. As the blood flow reduces, the heart muscles start to die and this affects the blood supply to other body parts including the brain.
    • Pulmonary embolism: Pulmonary embolism is a clot in the lungs. It can have effects similar to a heart attack, especially when the clot is big.
    • Aortic stenosis: Aortic stenosis means tightening of one of the heart valves. As the heart valves get narrow, the blood supply from the heart to the brain reduces.

How Do Doctors Differentiate Between Mechanical and Syncopal Falls?

There are several ways through which doctors can tell if you had a mechanical or a syncopal fall. Below are some key differences a doctor looks for when evaluating someone with a fall.

Mechanical fall Syncopal fall
Before the event  The person does not get any warning signs and might feel completely well. The person may or may not get warning signs. In conditions, such as orthostatic hypotension, you may get dizzy before you fall but if your fall is due to a heart-related condition, you may not get a warning.
During the event  The person remains conscious throughout the fall. The person may lose consciousness and may not be able to recall the fall itself.
After the event  The person remains conscious and remains aware of the surroundings. The person may remain unconscious for some time and may take some time before getting back to normal.
Physical examination The physical examination might be completely normal and might only show the injuries due to the fall. In addition to the injuries, the physical examination might reveal signs pointing towards the cause such as signs of infection, signs of heart attack, signs of a tight heart valve, etc.
Investigations  Investigations might be normal. Investigations can point towards the cause such as electrolyte imbalance, heart rhythm issues, etc.
Occupational assessment This might show the reason for fall such as uneven flooring, slippery rugs, etc. Might be normal

How Do Doctors Treat Falls?

The treatment depends on identifying the reason for the fall. If doctors can identify a medical reason for the fall, the treatment would focus on managing the issue. For example, if a fall occurred due to low sodium levels, the treatment would be focused on treating sodium levels.

Once the doctors have done their assessments and have treated the medical causes, they can then refer you to physiotherapy or occupational therapy. Physiotherapists and occupational therapists can help you deal with mechanical reasons for a fall.

How doctors think about falls
Meet the Author Dr. Jassin Jouria
Dr. Jassin Jouria is a practicing Emergency Medicine Physician who specializes in resuscitation of critical patients. The majority of his clinical work is at the Decatur County Memorial Hospital Emergency Department in Greensburg, Indiana. Learn More About the Author.


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