Falls as a Geriatric Syndrome: How to Prevent Them? How to Treat Them?

This quotation from the late Bernard Isaacs still portrays, four decades after being written, the crude consequence that an older adult may experience after a single fall (1). Despite the enormous efforts of researchers and clinicians to understand the falls syndrome, there is still a significant gap between the knowledge gained about this challenging syndrome and the clinical application of the proven interventions available. The aim of this chapter is to reduce this gap and to provide a rationale for the integration of a risk assessment for falls and fractures into research on the emerging problem of senile osteoporosis in older population.

Falls and fall-induced injuries in older people are worldwide problems with substantial clinical and public health implications. They are both associated with advancing age and an increased risk of disability, dependency, premature nursing home admission, and mortality (2). First describ -ed almost 40 years ago as the geriatric syndrome “Instability,” falls have become increasingly important in recent years (3). A fall is defined as “an unintentional change in position resulting in coming to rest at a lower level or on the ground” (4). Loss of consciousness owing to seizures or acute stroke are not included in the fall definition, although they can also present as an episode of instability and a change of position to a lower level (5,6). Although falls can have multiple and diverse etiologies, they generally share similar risk factors, as they frequently result from the accumulated effect of impairments in multiple systems. Therefore, an intelligent approach to address such a complex problem must first take into consideration the most likely causes, contributing factors, and associated co-morbidities. Because falls and fractures in older adults have an entangled relationship, a characterization of the risk factors for fractures caused by falls must be also considered in this joint approach.