The journal of nutrition, health & aging

, Volume 15, Issue 1, pp 79–84 | Cite as

How to manage recurrent falls in clinical practice: Guidelines of the French society of geriatrics and gerontology

  • Olivier BeauchetEmail author
  • V. Dubost
  • C. Revel-Delhom
  • G. Berrut
  • J. Belmin



Health care professionals need a simple and pragmatic clinical approach for the management of recurrent fallers in clinical routine.


To develop clinical practice recommendations with the aim to assist health care professionals, especially in primary care in the management of recurrent falls.


A systematic English and French review was conducted using Medline, Embase, Pascal and Cochrane literature. Search included systematic reviews, meta-analyses, controlled trials, cohort studies, case-control studies and transversal studies published until July 31, 2008. The following Medical Subject Heading (MeSH) terms were used: “aged OR aged, 80 and over”, “frail elderly”, “Accidental Fall”, “Mental Recall”, and “Recurrent falls”. The guidelines were elaborated according the Haute Autorité de Santé methods by a multidisciplinary working group comprising experts and practitioners.


A fall is an event that results in a person coming to rest inadvertently on the ground or floor or other lower level and should be considered as a recurrent event as soon as a subject reported at least two falls in a 12-month period. Recurrent falls impose a prompt and appropriate management with the first aim to systematically evaluate the severity of falls. The evaluation of fall severity should be based on a standardized questionnaire and physical examination. It is recommended not to perform cerebral imaging in the absence of specific indication based on the clinical examination and to reevaluate the subject within a week after the fall. Prior to any intervention and after an evaluation of signs of severity, it is recommended to systematically assess the risk factors for falls. This evaluation should be based on the use of validated and standardized tests. The education of recurrent fallers and their care givers is required in order to implement appropriate intervention. In the event of a gait and/or balance disorders, it is recommended to prescribe physiotherapy. A regular physical activity should be performed with low to moderate intensity exercise. It is recommended to perform rehabilitation exercises with a professional, between therapy sessions and after each session, in order to extend rehabilitation benefits to the daily life.


The clinical guidelines focused on management (i.e., diagnosis, assessment and treatment) of recurrent falls in clinical routine. They provide answers to the following clinical questions: 1) How to define recurrent falls? 2) How to identify severe falls? 3) How to assess recurrent falls? and 4) How to treat recurrent falls?

Key words

Recurrent falls clinical recommandations management 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hauer K, Lamb SE, Jorstad EC, Todd C, Becker C; PROFANE-Group. Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age Ageing. 2006;35:5–10.CrossRefPubMedGoogle Scholar
  2. 2.
    Shumway-Cook A, Ciol MA, Hoffman J, Dudgeon BJ, Yorkston K, Chan L. Falls in the Medicare population: incidence, associated factors, and impact on health care. Phys Ther. 2009;89:324–332.CrossRefPubMedGoogle Scholar
  3. 3.
    Tinetti ME, Doucette J, Claus E, Marottoli R. Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc. 1995;43:1214–1221.PubMedGoogle Scholar
  4. 4.
    Stalenhoef PA, Diederiks JP, Knottnerus JA, Kester AD, Crebolder HF. A risk model for the prediction of recurrent falls in community-dwelling elderly: a prospective cohort study. Clin Epidemiol. 2002;55:1088–1094.CrossRefGoogle Scholar
  5. 5.
    Stalenhoef PA, Diederiks JP, Knottnerus JA, de Witte LP, Crebolder HF. The construction of a patient record-based risk model for recurrent falls among elderly people living in the community. Fam Pract. 2000;17:490–496.CrossRefPubMedGoogle Scholar
  6. 6.
    Pluijm SM, Smit JH, Tromp EA, Stel VS, Deeg DJ, Bouter LM, Lips P. A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study. Osteoporos Int. 2006;17:417–425.CrossRefPubMedGoogle Scholar
  7. 7.
    Stel VS, Pluijm SM, Deeg DJ, Smit JH, Bouter LM, Lips P. A classification tree for predicting recurrent falling in community-dwelling older persons. J Am Geriatr Soc. 2003;51:1356–1364.CrossRefPubMedGoogle Scholar
  8. 8.
    Stel VS, Smit JH, Pluijm SM, Lips P. Balance and mobility performance as treatable risk factors for recurrent falling in older persons. J Clin Epidemiol. 2003;56:659–668.CrossRefPubMedGoogle Scholar
  9. 9.
    Gardner MM, Robertson MC, Campbell AJ. Exercise in preventing falls and fall related injuries in older people: a review of randomised controlled trials. Br J Sports Med. 2000;34:7–17.CrossRefPubMedGoogle Scholar
  10. 10.
    Robertson MC, Campbell AJ, Gardner MM, Devlin N. Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data. J Am Geriatr Soc. 2002;50:905–911.CrossRefPubMedGoogle Scholar
  11. 11.
    Oliver D, Hopper A, Seed P. Do hospital fall prevention programs work? A systematic review. J Am Geriatr Soc. 2000 Dec;48(12):1679–1689.PubMedGoogle Scholar
  12. 12.
    American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopedic Surgeons panel on falls prevention. Guideline for the prevention of falls in older persons. J Am Geriatr Soc 2001;49:664–772.CrossRefGoogle Scholar
  13. 13.
    Crombie IK, Irvine L, Williams B, McGinnis AR, Slane PW, Alder EM, McMurdo ME. Why older people do not participate in leisure time physical activity: a survey of activity levels, beliefs and deterrents. Age Ageing. 2004;33:287–292.CrossRefPubMedGoogle Scholar
  14. 14.
    Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE initiative. The Strengthening the Reporting of Observational Studies in Epidemiology [STROBE] statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344–349.CrossRefGoogle Scholar
  15. 15.
    Begg C, Cho M, Eastwood S, Horton R, Moher D, Olkin I, Pitkin R, Rennie D, Schulz KF, Simel D, Stroup DF. Improving the quality of reporting of randomized controlled trials. The CONSORT statement. JAMA. 1996;276:637–639.CrossRefPubMedGoogle Scholar

Copyright information

© Serdi and Springer Verlag France 2011

Authors and Affiliations

  • Olivier Beauchet
    • 1
    • 6
    Email author
  • V. Dubost
    • 2
  • C. Revel-Delhom
    • 3
  • G. Berrut
    • 4
  • J. Belmin
    • 5
  1. 1.Department of Internal Medicine and Geriatrics, Angers University Hospital; UPRES EA 2646University of Angers, UNAMAngersFrance
  2. 2.Formadep, KorianParisFrance
  3. 3.Haute Autorité de SantéSaint-DenisFrance
  4. 4.Department of GeriatricsNantes University Hospital and University of NantesNantesFrance
  5. 5.Department of GeriatricsHôpital Charles Foix, Ivry-sur-Seine, and Université Pierre et Marie Curie UPMCParisFrance
  6. 6.Department of Internal Medicine and GeriatricsAngers University HospitalsAngers Cedex 9France

Personalised recommendations