Causes of falls in older people

Q. My mother, 75, has had several falls, even after doing a supervised exercise program.

Could she have a cardiovascular problem?

A: About 30 percent of people older than 65 fall every year. Among the most common causes are balance and gait problems, visual impairment, environmental hazards, medications, and cardiovascular issues. The initial management, directed by the primary-care doctor, may include gait and balance training, modifying home hazards, minimizing drugs, and correcting a visual deficit. An office visit may reveal a cardiovascular cause like low blood pressure or abnormal heartbeat. Low blood pressure, especially when rising from a lying or sitting position, is a common cause of falls due to dizziness or fainting.

But quite often, the fall is caused by a transient period of slow - or fast - heartbeat or low blood pressure, which occurs sporadically and is not present at the office visit.

A cardiovascular cause should be suspected especially if the fall was linked to a brief loss of consciousness. Older patients often do not recall details of the event or of brief episodes of passing out. When assessing a patient who has fallen, it is helpful to get an eyewitness account. Still, more than half of falls are not witnessed.

A hidden cardiovascular problem can cause unexplained falls in older people. Once your primary doctor has ruled out other causes, a visit to a cardiovascular specialist should be considered and may require noninvasive tests to reach a diagnosis.

Recurrent falls are associated with high risk of injury, higher mortality, and loss of self-confidence. Treating any correctable cause is highly desirable.