Preventing falls in older adults: risk checks and home safety

Falls can cause injury and can shake an older person's confidence and independence. This article explains why falls happen, what to do if one happens and how to lower the risk, using information from the NHS, the World Health Organization (WHO), MedlinePlus and the US Centers for Disease Control and Prevention (CDC).

1. Introduction

The WHO defines a fall as an event in which a person comes to rest unintentionally on the ground, the floor or another lower level ^[2]. Anyone can fall, but the NHS notes that the risk is higher with age or with mobility problems, and that preventing falls helps people keep their confidence and independence ^[1].

The numbers are large. The CDC reports that falls caused over 43,000 deaths among adults aged 65 and older in the United States in 2024, making them the leading cause of injury death in that age group, along with about 4.5 million emergency department visits ^[4]. Worldwide, the WHO says falls are the second leading cause of unintentional injury death, after road traffic injuries, and that over 80% of fall deaths happen in low- and middle-income countries ^[2]. MedlinePlus adds that older adults are more likely to break a bone when they fall, especially if their bones are weak (osteoporosis), and that a broken hip can lead to disability and loss of independence ^[3].

2. Why falls happen

Falls usually have more than one cause. The sources list these common contributors ^{[1, 3]}:

• Muscles that weaken with age, especially in the legs, which makes it harder to stand up from a chair or walk on uneven ground.
• Balance problems and slower reflexes, which make it harder to regain footing.
• Conditions that affect movement or balance, such as arthritis, stroke or Parkinson's disease.
• Low blood pressure (hypotension), diabetes and nerve damage (neuropathy).
• Problems with eyesight or hearing.
• Dementia.
• Some medicines that cause dizziness, confusion or slowed responses. MedlinePlus also notes that taking several medicines raises the chance of side effects, including falls ^[5].
• Alcohol, which affects balance and reflexes.

The WHO adds that unsafe surroundings, physical inactivity and poor mobility or vision, particularly in care homes, also raise the risk ^[2].

3. What to do after a fall

The NHS gives clear steps ^[1].

If you can get up, move slowly. Roll onto your side, push up onto your hands and knees, and hold something sturdy such as heavy furniture, a bath or a sink. Place one foot flat, stand up gradually, then sit and rest.

If you cannot get up, call for help with a phone or personal alarm if you can reach one. If not, shout or bang on a wall or the floor. Keep warm with any covering within reach and keep gently moving your arms and legs. The NHS advises changing position about every 30 minutes to reduce the risk of pressure sores, which are areas of damaged skin caused by long periods of pressure.

If someone else falls, keep them warm and comfortable. Help them up only if they are able to get up, and do not lift them yourself ^[1].

4. What a doctor or falls service may check

The NHS says a doctor or falls service may ^[1]:

• Check balance and movement.
• Look for muscle weakness, weak bones or eyesight problems.
• Review medicines, because some can affect balance.
• Recommend strength and balance training.
• Check the home for safety and suggest changes.
• Look for and manage any condition that affects balance or strength.

The WHO describes this approach as a multifactorial intervention, meaning an individual risk assessment followed by tailored referrals ^[2]. The CDC also offers a short questionnaire called the Falls Free CheckUp to help people assess their own risk ^[4].

5. Lowering the risk of falls

No single step prevents every fall, but the sources describe several measures that help ^{[1, 2, 3]}.

Keep the body strong

• Be active every day. The NHS suggests strength and balance exercises at least twice a week ^[1].
• The WHO lists gait, balance and functional training and Tai Chi as measures for older people ^[2].
• Eat well and drink enough fluids, because low intake can cause lightheadedness. Eat calcium-rich foods and get enough vitamin D to support bone health ^[1]. The WHO notes that vitamin D supplements are advised for people who are deficient, so ask your doctor before taking any ^[2].

Check eyes, ears and medicines

• Have regular eye tests ^{[1, 3]} and hearing checks ^[1].
• Ask your doctor or pharmacist whether any of your medicines might affect your balance ^[1]. The WHO includes reducing or stopping medicines that act on the mind or mood (psychotropic medicines) among its measures, but any change must be decided by your doctor. Do not stop a medicine on your own ^{[2, 5]}.
• Avoid drinking too much alcohol ^{[1, 3]}.

Make the home safer

• Remove trip hazards such as loose wires and rugs and reduce clutter ^[1].
• Fit grab rails in the bathroom, use a non-slip bath or shower mat and consider safety rails on steps ^{[1, 3]}.
• Wear well-fitting, non-slip shoes or slippers ^[1].
• Carry a mobile phone or a personal alarm, and use a walking aid if one is recommended ^[1].

6. When to see a doctor

The NHS advises seeing a doctor if you have fallen or are worried about your balance or mobility. Contact a doctor or health helpline promptly if the person may be in pain, injured or unwell. Call for an ambulance if the person may have injured their head, back, neck or hip, or cannot get up ^[1].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

7. Conclusion

Falls are common and can be serious, but they are not an unavoidable part of ageing. Strength and balance exercise, regular eye and hearing checks, a review of medicines with a doctor and a safer home all help to lower the risk. Anyone who has fallen, or who is worried about falling, should talk to a doctor, who can check the cause and plan the right help.