[Epidemiology, morbidity, mortality, cost to society and the individual, and main causes for falls]

Falls are the leading cause of accidental death among the elderly, accounting for about 12 000 deaths per year. The risk of falls increases with age: one-third of subjects over 65 years old living in the community and half of those over 85 fall at least once a year. Despite their frequency, falls should not be trivialized, as they are associated with significant morbidity and care expenditure: 10% of falls have severe traumatic consequences, and30 % of hospital admissions for traumatic injury among elderly individuals are due to falls. Even when they have no physical repercussions, falls can have psychological effects (anxiety while walking, fear of falling), and can be complicated by a psychomotor disadaptation syndrome with voluntary restriction of activities of daily living in 30% of cases. Risk factors for falls are numerous, and falls are rarely due a single, precise reason. Recurrent falls are associated with balance and gait impairment and decreased muscle strength, sometimes due to a latent pathological condition. Factors that may favor falls in the home must be taken into account through targeted prevention actions. Among institutionalized populations, the risk of falls increases with the severity of dementia, the use of certain drugs (particularly psycho tropics) and the existence of wasting, which leads to a decline in quadriceps strength. About 1.5% of all health expenditure is related to falls. The majority of these costs are due to hospitalization, fractures of the proximal femur being the most costly complication. In recent years, thanks to the prevention of both osteoporosis and falls, the annual number of hip fractures has been stable at about 79,500 cases per year, standardized hospitalization rates have declined, and the average length of stay has decreased. With the increasing number of elderly people, one priority to reduce healthcare costs is to identify and correct factors of frailty in midlife, using a preventive approach.