Major Trauma Following Low-Energy Falls in Older Adults: A Meta-Analysis

Background: Low-energy falls represent the predominant mechanism of major trauma in older adults, yet they remain inadequately recognised within existing trauma triage frameworks. We sought to quantify mortality and adverse clinical outcomes following low-energy falls in this population. 

Methods: We performed a systematic review according to PRISMA guidelines, searching MEDLINE, Embase, Cochrane Library, and grey literature sources from database inception through December 2024. Eligible studies included adults aged 65 years or older who sustained low-energy falls resulting in major trauma, defined as Injury Severity Score ≥16 or requiring trauma centre admission. Two independent reviewers screened citations, extracted data, and assessed study quality using the Newcastle-Ottawa Scale. Our primary outcome was all-cause mortality at 30 days. Results: Twenty-three studies involving 312,847 older adults met our inclusion criteria. The pooled 30-day mortality rate was 7.8% (95% confidence interval 6.1–9.6%; I² = 74.3%). Intensive care admission occurred in 18.4% of patients (95% CI 14.2–23.1%), whilst 27.6% required operative intervention (95% CI 22.8–32.9%). Mortality increased progressively with age: 5.1% among those aged 65–74 years, 7.9% for ages 75–84 years, and 13.8% for those aged 85 years and above. Patients with polytrauma demonstrated significantly higher mortality compared with isolated injuries (11.7% versus 5.8%; p < 0.001).

Conclusions: Low-energy falls result in considerable mortality and morbidity among older adults, with outcomes that match or exceed those observed following high-energy trauma in younger cohorts. Early involvement of geriatric medicine specialists and implementation of age-appropriate care pathways may improve outcomes for this growing patient population.
Keywords: accidental falls; aged; wounds and injuries; trauma centres; mortality; systematic review; meta-analysis