A narrative review assembles the harms that follow ground-level falls in older people beyond the fractures and head injuries that dominate assessment. It groups the under-recognised harms into five domains: thoracic injury, intra-abdominal injury, vascular events (cardiac, stroke, vessel injury and venous thromboembolism), herpesvirus reactivation, and psychological impact.
Most of these are individually infrequent or rare, apart from the psychological consequences, but they share delayed recognition and, when missed, worse outcomes. The review argues clinicians should actively consider this wider spectrum rather than clearing a faller once a fracture and head injury are excluded.
The practical shift is in the assessment mindset: after a fall, ask what else the mechanism and the patient's frailty could have caused, keep the fear-of-falling and loss of confidence on the problem list, and arrange follow-up that addresses them. The review's suggestion of broader point-of-care imaging is one option to weigh, not a blanket rule.
- Harm after an older adult's fall extends beyond fractures and head injury.
- Consider thoracic, intra-abdominal, vascular, viral-reactivation and psychological domains.
- Most occult injuries are uncommon but are missed because they are not sought.
- Keep fear of falling and lost confidence on the problem list and in follow-up.
- Weigh broader imaging case by case rather than applying it to every faller.
Why it matters
It widens the post-fall assessment from the fracture in front of you to the harms that are routinely missed.
Don't overread it
A narrative review is not a guideline; the suggestion of routine point-of-care pan-CT is the author's proposal, not an established standard.
The statistics, in plain English
This is a narrative review, which summarises the literature without pooling it, so it signals what to look for rather than quantifying how often each harm occurs.
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