What could be causing my 80-year-old father's repeated falls?

There are two kinds of falls in older adults: those that occur as a result of an accident, and those that signal there's some kind of underlying condition. The first kind is seen in more robust elders, can happen anywhere, either at or away from home, is normally a one-time occurrence, and -- if the person is injured ?- usually results in a good recovery. Common causes include things like tripping over a rug or slipping on a smooth surface.

The second kind of fall is seen in more frail elders who already have chronic disorders and who need help with day-to-day activities. It usually happens in or near home, the person falls more than once, and it's often a sign of new underlying disease or an indication that one of his existing conditions is getting worse. Common underlying or new diseases associated with these kinds of falls are urinary tract infection, respiratory infection, or heart disease. If the person is injured in a fall of this sort, recovery is usually slow and less complete.

Anything that causes dizziness can lead to a fall -- for example, a sudden drop in blood pressure when the person stands up or gets out of bed at night or light-headedness caused by a medication. So it's a good idea to scrutinize every medicine your father is taking, whether it's a prescription, an over-the-counter drug, or an alternative therapy such as an herbal supplement.

The first question I would ask about your father is, why does he have to get up at night to go to the bathroom? As we age, our kidneys become less efficient, and it's not uncommon for robust older adults to get up once during the night to urinate. When someone needs to get up more than once, though, the underlying cause should be investigated. It could be as simple as drinking too much fluid in the evening, taking a water pill (diuretic) too late in the day, or having a treatable disorder of the urinary tract or prostate gland. It could even be a disorder like diabetes or heart failure, where the body tries to get rid of excess fluid that has accumulated in the tissues.

Your father's doctor can get insight into why he is falling by giving him a thorough medical evaluation, with attention paid to mental and mood testing and gait and balance, as well as a discussion of his day-to-day function. Lab tests should be ordered to help make a diagnosis and manage any disease. A detailed medications and supplements review as described above is a must.

Another step is to make his bedroom and hallway as safe as possible for him if he does need to get up at night.

• Are there loose rugs?
• Is the floor slippery?
• Is the bed too high?
• Can he see his way to the bathroom?
• Would a bedside commode be safer and easier for him?

To sum up the ways to help prevent falls and injury:

• Find out why he's getting up at night.
• Look for underlying disease and treat it.
• Make his surroundings safe.