The role of medical assessment and intervention in the prevention of falls

Evidence that falls amongst older people can be prevented now requires researchers and policy makers to elucidate the most comprehensive and cost-effective approach to implementation. The syndrome of falls and fractures in later life reflects the combined age-associated influences of cumulative susceptibility to health problems and reduced adaptive reserve. The major contribution of health factors to falling has long been recognised clinically and has also emerged clearly in epidemiological studies of risk. A fall in an older adult, especially if recurrent, may be a key signal of unmet medical need and should accordingly trigger an in-depth diagnostic process and clinical intervention by an appropriately skilled physician. Although well-designed controlled studies specifying this approach as part of a multifactorial intervention are comparatively few, recent published trials have confirmed the anticipated substantial returns in fall prevention achieved for community-dwelling patients with a history of falling. Larger-scale studies are now required, and further research is needed to achieve effective prevention strategies in institutional care. Combined calcium and vitamin D may act via neuromuscular and skeletal mechanisms in fracture prevention. The requirement for medical assessment has now appropriately been incorporated into national and international guidelines.