Risk Assessment and Prevention of Falls—Reply

In Reply We appreciate the comments of Dr Strandberg and of Dr Jones and colleagues, who noted that our recent review¹ did not address alcohol and postprandial hypotension, respectively, as potential risk factors for falls in older adults. They correctly highlight that the etiology of falls in older adults is inherently multifactorial, and for individual patients, both of these factors may be highly salient. Jones and colleagues reference a systematic review that described an association between syncope and postprandial hypotension in older adults²; however, a subsequent systematic review and meta-analysis reported an inconsistent relationship between postprandial hypotension and falls.³ A high prevalence of heavy alcohol use among those presenting with fall-related injuries has been noted across all ages, but the prevalence appears to be lower among older compared with younger cohorts,⁴ and evidence from other studies has failed to show an association between alcohol use and falls in older adults.⁵ This conflicting evidence is likely the reason why neither factor is commonly included as part of assessment recommendations in fall prevention guidelines. Additionally, these factors have not been systematically addressed in randomized trials of prevention strategies, which were the focus of our review.

Nevertheless, multifactorial geriatric syndromes such as falls require an individualized assessment of contributing factors in each patient. A careful evaluation including the history of fall circumstances, related symptoms, and timing may uncover factors beyond those listed in guidelines that warrant intervention, such as postprandial hypotension or unhealthy alcohol use.