Shan Liu, MD, MPH
Massachusetts General Hospital
The term “mechanical falls” has become commonly used in emergency departments, yet its definition and clinical implications have not been established. It implies that an external force or object led to the fall. Given that a third of older adults in the United States falls annually, over 2 million older adult non-fatal falls are treated annually in the ED1 and likely to increase as the older adult population grows,2,3 it is important to understand what is often termed “mechanical falls.”
While over a quarter of community-dwelling older adults have falls related to slipping, tripping, or stumbling,4,5 external factors are seldom the only cause of an older adult’s fall. Since older adult fall patients are at high risk for recurrent falls,6,7 ED evaluation should focus on determining such patients’ modifiable fall risk factors. Often, patients with “mechanical falls” have evaluations that focus on any fall-related injury whereas “non-mechanical falls” are often evaluated for potential cardiac etiologies for their fall. This dichotomy of “mechanical” vs. “non-mechanical” may lead to a less-thorough evaluation of the fall as older adult falls are multifactorial.6
We conducted a pilot study through secondary analysis of data from a chart review study that originally examined concordance of ED evaluation of older adult falls with ED fall guidelines.7 We had a sample size of 350 patients and found little difference among associated conditions between the two fall categories “mechanical” vs. “non-mechanical.” While this study was small, we found the term mechanical fall was inconsistently used and not associated with a discrete fall evaluation.
Future studies should further examine whether the term “mechanical fall” has any utility when describing an older adult’s fall etiology. Regardless, the term itself is misleading because it inaccurately implies that a benign etiology for an older person’s fall exists.