Prevent from falling

“It takes a child a year to acquire autonomous movement and ten years to have completely independent mobility. An older adult can lose both on the same day.” Professor Bernard Isaacs (1924–1995)

Professor Bernard Isaacs, a prominent Scottish geriatrician, recognised and summarised in this famous quote the importance and impact that falls have on the acute loss of functional autonomy and on people's quality of life. When we ask ourselves how we want to live the additional years of life that social and economic developments have allowed us, the almost universal answer is that we want to live independently and happily. Mobility is a fundamental part of autonomy and quality of life. Falls, in turn, are an important cause of limited mobility and functional autonomy.

Falls are one of the main causes of illness and mortality in older adults. They are extremely common: one in three people over the age of 65 falls at least once a year and, after the age of 85, the annual incidence of falls increases to 51%. However, the importance of falls is not limited to their high prevalence, but above all to the serious consequences and associated costs. In Portugal, falls account for 70% of accidents in the population aged 65 or over.

Older adults are at increased risk of injury following a fall. Falls account for 87% of all fractures and 95% of femoral neck fractures in this age group.

Before the 1940s, falls in the elderly were considered unpredictable and inevitable. Today, we know that falls have multiple causes and that they can and should be prevented by identifying and treating risk factors. Those that are most consistently associated with the occurrence of falls are gait instability and loss of muscle function and mass. Balance disorders also contribute to the risk of falls and can be addressed and treated in specific rehabilitation consultations.

Side effects of medications also represent an important modifiable risk factor for falls, which is why medication should always be reviewed and adjusted during all medical assessments. Environmental factors, such as wearing shoes that do not provide stability to the foot or using carpets to decorate our homes, are also relevant. Loss of vision also increases the risk of falls, which is why it is essential to have regular check-ups with an ophthalmologist.

The global guidelines for the prevention and management of falls in older people, published in 2022, recommend the stratification of fall risk and a multidisciplinary approach for adults at high risk of falling. This approach presupposes the existence of specific consultations for falls, provided by multidisciplinary teams – usually made up of professionals specialized in Geriatrics, Internal Medicine, General and Family Medicine, Physical Medicine and Rehabilitation, Physiotherapists, Nutritionists, Nurses and Occupational Therapists, among other professionals. The existence of specific units for the management and prevention of falls – such as the one at CUF Tejo Hospital – therefore represents an important commitment to promoting active and healthy ageing. By centralizing specialized skills and care, these units maximize the effectiveness of interventions and reinforce the dignity and safety of the person.

World Falls Prevention Day is celebrated on June 24, 2025, and it is a day to remember that this serious public health problem continues to be neglected. It is up to all health professionals and the general population to raise awareness of this important geriatric syndrome. A fall is always a serious event that should never be underestimated. While it is true that it is normal for leaves to fall from some trees in autumn, it is unacceptable that people fall repeatedly, compromising their autonomy, self-esteem and quality of life.