Merck Manual

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Prevention of Injuries in Older Adults


Magda Lenartowicz

, MD, Altais Health Solutions

Reviewed/Revised May 2023

Clinicians should evaluate the risk of injuries in older patients and advise them and/or their caregivers on how to prevent injuries.


Older adults are vulnerable to injury due to falls Falls in Older Adults A fall is defined as an event that occurs when a person inadvertently drops down to the ground or another lower level; sometimes a body part strikes against an object that breaks the fall. Typically... read more . A falls prevention program, including exercise (with or without physical therapy) and possibly vitamin D supplementation, should be implemented for people who are at high risk of falls or who have already fallen.

Driving hazards

All older people should be reminded to use lap and shoulder belts and to refrain from driving when they are under the influence of alcohol or psychoactive drugs or medications.

For older adults, risk of injuring themselves and others while driving is higher than that for younger adults because of age-associated changes and conditions common among older adults. Driving ability should be investigated with further questions and, if indicated, with formal assessment for any of the following:

  • Poor visual acuity

  • Dementia

  • Functionally significant impairment of neck or trunk movement

  • Poor motor coordination

  • Bradykinesia

Also, a family member’s or friend’s concern about the patient’s driving ability should prompt further inquiry and assessment.

Formal assessment of driving ability Functional Assessment of the Older Driver Adequate visual, motor, and cognitive abilities are needed to drive safely and require functional assessment to identify deficits. Some of these assessments can be done by primary health care... read more can be done by an occupational therapist. Many states have laws that mandate physician reporting of suspected impaired drivers. Sensitivity is required when a health care professional must recommend cessation of driving because such a recommendation threatens autonomy.

Home hazards

The home may have many hazards. For example, people with peripheral neuropathy are at increased risk of burns from excessively hot water; burns can be prevented by setting the hot water heater temperature at < 49° C. For people with dementia, using electrical and gas appliances is particularly dangerous; use of alarms and automatic shut-off features on appliances can help. Smoke and carbon monoxide detectors should be installed and maintained. Firearms should be safely stored or removed from the home.

All patients or their caregivers can complete a home safety checklist to identify hazards, including those that increase the risk of falls Home Assessment Checklist for Hazards That Increase Risk of Falling Home Assessment Checklist for Hazards That Increase Risk of Falling . Physical and occupational therapists may visit a patient’s home to assess its safety.

Drugs Mentioned In This Article

Drug Name Select Trade
Calcidol, Calciferol, D3 Vitamin, DECARA, Deltalin, Dialyvite Vitamin D, Dialyvite Vitamin D3, Drisdol, D-Vita, Enfamil D-Vi-Sol, Ergo D, Fiber with Vitamin D3 Gummies Gluten-Free, Happy Sunshine Vitamin D3, MAXIMUM D3, PureMark Naturals Vitamin D, Replesta, Replesta Children's, Super Happy SUNSHINE Vitamin D3, Thera-D 2000, Thera-D 4000, Thera-D Rapid Repletion, THERA-D SPORT, UpSpring Baby Vitamin D, UpSpring Baby Vitamin D3, YumVs, YumVs Kids ZERO, YumVs ZERO
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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