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Falls may lead to functional impairment, fear of falling, decreased quality of life, high health care costs and mortality. A case of an older adult presented in this article, illustrates the multifactorial nature of risk of falling and fall prevention strategies. Recently, meta-analyses were performed to determine the effectiveness of interventions to prevent falls and to explore the effect of intervention components in reducing fear of falling. The single interventions whole body vibration, exercise and quality improvement strategies are associated with a reduction in number of fallers. Common components of multiple interventions significantly associated with a reduction in number of fallers are exercise, assistive technology, environmental modifications, quality improvement strategies and basic falls risk assessment. Interventions with meditation, holistic exercises or body awareness are more effective in reducing fear of falling than interventions without these components. The patient's risk evaluation and personal preferences should be taken into account when developing a treatment plan.

Treating elderly patients can be challenging. It is very important to carefully weigh the risks and benefits of potential treatments in individual patients. This treatment decision making can be guided by geriatric parameters. With the accumulating evidence on the added value on prediction of outcomes of (comprehensive) geriatric assessment in older patients with intensive treatment options, the question shifts from whether performing a (comprehensive) geriatric assessment is useful, to how to implement this into standard practice in a feasible and effective way. This paper discusses several issues regarding (comprehensive) geriatric assessment in elderly patients, like how to distinguish fit and frail patients and when performing a geriatric screening, geriatric assessment or a comprehensive geriatric assessment.

Hip fractures are a major health problem in the elderly. Several measures may reduce the number of hip fractures: prevention of falls, improving bone quality, and reducing the impact on the hip region during a fall; external hip protectors can be useful in this respect. Cluster-randomised studies have shown a significant reduction of hip fractures by 50% in elderly people wearing hip protectors who live in old-age homes or nursing homes and run an increased risk of falling. However, there is no evidence of a decreased number of hip fractures in studies in which individual randomisation was used. For elderly people living independently at home, there are still insufficient data on the effectiveness of hip protectors. An important problem with the use of hip protectors is the treatment compliance, which is generally very low. Many of the fractures in the intervention groups in published trials occurred at a time at which the protectors were not being worn. At present, there is too little evidence to decide definitely whether or not the use of hip protectors is useful.

Three patients, two women aged 79 and 80 and a man aged 84, showed symptoms of cognitive impairment caused by primary hyperparathyroidism. Parathyroidectomy lead to a marked improvement in the symptoms. The incidence of primary hyperparathyroidism increases with age. Most patients only show slight symptoms. In addition, clinical symptoms in elderly patients differ from those in younger patients with mental changes, general tiredness and reduced muscular strength being prevalent. In accordance with the literature, which shows high cure rates with low morbidity and mortality, we recommend that parathyroid surgery be considered in elderly patients who exhibit only slight or mental symptoms of primary hyperparathyroidism.