Falls in the Elderly: Under-appreciated Serious Sequela. A Narrative Review

Ground-level falls are highly prevalent in elderly patients, and are often recurrent. Serious fractures and brain injury are common. Other types of fall-associated harm may be largely under-recognized. We reviewed PubMed (English, last 50 years) using pre-defined key-words, and reference lists to identify relevant studies. A wide spectrum of potential harm was identified and classified into five domains: thoracic injury; internal abdominal injury; vascular events (cardiac, stroke, blood vessels, venous thromboembolism); herpesviruses reactivation; and psychological impact. All were found to be infrequent or rare (excepting psychological impact), associated with delayed recognition, and significantly increased morbidity and mortality. Thus, clinicians attending geriatric patients after an accidental fall need to be more aware of the potential of a wide spectrum of complications in several domains, extending well beyond the regularly evaluated fractures and brain injury. Point of care 'pan-CT' may be warranted since its sensitivity is considerably more than physical examination and radiography. Findings may uncover clinically-significant occult findings, albeit unusual. Post-discharge follow up must take into account the profound psychological impact of falls on the patients.