Falls in Elderly: Causes, Prevention & What To Do

What Increases the Risk of Falls in Older Adults?

Fall risk increases with age due to multiple factors including decreased balance and muscle strength, vision problems, certain medications, chronic diseases like diabetes and Parkinson's, reduced bone density (osteoporosis), and environmental hazards in the home. Understanding these risk factors is the first step to prevention.

Falls in older adults rarely have a single cause. Instead, they typically result from a combination of intrinsic factors (related to the person) and extrinsic factors (related to the environment). Research from the World Health Organization shows that approximately 28-35% of people aged 65 and older fall each year, with this percentage increasing to 32-42% for those over 70. Understanding the various risk factors helps identify individuals who would benefit most from preventive interventions.

The aging process naturally brings changes that affect balance and stability. Muscle mass decreases by approximately 3-8% per decade after age 30, accelerating after age 60. This loss of muscle strength, called sarcopenia, directly impacts the ability to maintain balance and recover from trips or slips. Additionally, sensory systems including vision, proprioception (body position awareness), and vestibular function (inner ear balance) decline with age, making it harder to navigate uneven surfaces or respond to sudden changes in position.

Chronic health conditions significantly increase fall risk. Conditions that affect the brain and nervous system, such as stroke, Parkinson's disease, and dementia, impair motor control, coordination, and judgment. Diabetes can cause peripheral neuropathy, reducing sensation in the feet and affecting balance. Cardiovascular conditions may cause orthostatic hypotension (a sudden drop in blood pressure when standing), leading to dizziness and falls. Arthritis affects joint mobility and can cause pain that alters gait patterns.

Medications That Increase Fall Risk

Certain medications are strongly associated with increased fall risk. These include sedatives and hypnotics (sleeping pills), antidepressants, antipsychotics, blood pressure medications, opioid pain relievers, and antihistamines. The risk increases when taking multiple medications (polypharmacy) because drug interactions can compound side effects. If you experience dizziness, drowsiness, or balance problems with any medication, speak with your healthcare provider about alternatives or dose adjustments.

Alcohol consumption also becomes more problematic with age. The body becomes more sensitive to alcohol's effects, meaning even moderate amounts can significantly impair balance, reflexes, and judgment. The interaction between alcohol and medications further increases risk.

How Do You Get Up After a Fall?

After falling, stay calm and assess yourself for injuries before attempting to get up. If uninjured, roll to your side, push up to hands and knees, crawl to sturdy furniture, and use it to support yourself while standing. Practice these movements beforehand so they're familiar when needed.

Knowing how to safely get up after a fall is crucial for older adults. The moments after a fall can be disorienting and frightening, but rushing to get up can cause additional injuries or result in another fall. Having a practiced technique gives you confidence and improves safety.

The first and most important step is to stay calm and remain on the floor while you assess your condition. Take several slow, deep breaths to reduce anxiety. Carefully move each part of your body – start with fingers and toes, then wrists and ankles, then elbows and knees, and finally shoulders and hips. Check if you hit your head, and assess whether you have severe pain anywhere. If you find you cannot move a limb or have significant pain, do not attempt to get up – call for help using your phone or personal alarm.

Step-by-Step Instructions for Getting Up Safely

If you determine it's safe to try getting up on your own, follow these steps:

1. Roll onto your side: If you're on your back, bend one knee and use your arms to help roll onto your side. Move slowly and deliberately.
2. Get onto hands and knees: From your side, push with your hands to raise your upper body while bringing your knees underneath you. You should now be on all fours.
3. Crawl to sturdy furniture: While staying on hands and knees, crawl slowly toward a solid piece of furniture like a sofa, heavy chair, or bed. Make sure it won't move – avoid wheeled furniture or light chairs.
4. Position yourself at the furniture: Face the furniture and place both hands firmly on it.
5. Move to half-kneeling: Bring one foot forward so you're in a half-kneeling position (one knee on the floor, one foot flat).
6. Push up to standing: Using both the furniture and your legs, push yourself up to standing. Keep your weight centered and rise slowly.
7. Turn and sit: Once standing, carefully turn and lower yourself onto the furniture to sit and rest. Remain seated for several minutes before walking.

How to Help Someone Who Has Fallen

If you find someone who has fallen, your first priority is to assess the situation calmly. Ask them if they're okay and whether they hit their head or have pain anywhere. Help them check if they can move their arms and legs. Do not rush to pull them up, as this can cause injury to both of you.

If they can get up safely, position sturdy furniture nearby and guide them through the steps described above. You can provide stability by holding their arm, but let them do the work of standing up using their own strength and the furniture for support. If they cannot get up, have severe pain, hit their head, or seem confused, call emergency services. Keep them comfortable with a pillow and blanket while waiting for help, and stay with them to provide reassurance.

How Can You Prevent Falls in Older Adults?

Fall prevention requires a multi-faceted approach: regular balance and strength exercises (proven to reduce falls by 23-40%), home safety modifications, proper footwear, medication review with your doctor, regular vision and hearing checks, adequate nutrition including vitamin D and calcium, and appropriate use of walking aids when needed.

Preventing falls is far more effective than treating fall injuries, and the evidence strongly supports that falls are largely preventable. The Cochrane Database of Systematic Reviews has identified several interventions with strong evidence of effectiveness. Exercise programs that include balance training and muscle strengthening can reduce falls by 23-40%. Home hazard assessment and modification reduces falls by approximately 26%. Medication review and optimization also contributes to risk reduction.

The most effective approach combines multiple strategies tailored to individual risk factors. What works for one person may not be appropriate for another, so fall prevention should be personalized based on a thorough assessment of each person's specific risks and needs.

Exercise: Balance and Strength Training

Physical activity is one of the most powerful tools for fall prevention. Exercise improves muscle strength, flexibility, coordination, and balance – all factors that help prevent falls and reduce injury severity if a fall does occur. The key is choosing the right types of exercise and performing them consistently.

Balance exercises challenge your ability to maintain stability. These can include standing on one foot, walking heel-to-toe, tai chi, and specific balance training programs. Strength training, particularly for the legs and core, provides the muscle power needed to recover from a stumble or maintain position on uneven surfaces. Studies show that exercise programs that specifically include balance training are most effective at reducing falls.

Start slowly and progress gradually, especially if you haven't been physically active. Consider working with a physical therapist or certified exercise professional who has experience with older adults. Group exercise classes can provide both physical benefits and social support, which improves adherence. Practice getting up and down from the floor as part of your exercise routine – this builds both strength and confidence.

Home Safety Modifications

Since most falls occur at home, making your living space safer is essential. A systematic approach to identifying and eliminating hazards can significantly reduce fall risk. Consider having a professional home safety assessment, or conduct your own review room by room.

Throughout the home:

• Remove or secure loose rugs with non-slip backing or double-sided tape
• Keep walkways clear of clutter, cords, and obstacles
• Ensure adequate lighting in all areas, especially hallways and stairs
• Install night lights in bedrooms, bathrooms, and hallways
• Keep frequently used items within easy reach, avoiding the need for step stools
• Consider wearing sturdy, non-slip footwear indoors instead of going barefoot or wearing socks

In the bathroom:

• Install grab bars next to the toilet and in the shower/bathtub
• Use non-slip mats inside and outside the tub/shower
• Consider a shower seat or bench
• Raise the toilet seat if needed

On stairs:

• Install sturdy handrails on both sides
• Ensure steps are in good repair and have non-slip surfaces
• Mark edges of steps with contrasting tape if visibility is poor
• Keep stairs free of clutter

Outdoor Safety

Falls are particularly common outdoors during winter when surfaces become slippery. Take extra precautions during cold weather:

• Use ice cleats or traction devices on your shoes
• Walking aids like canes can also be fitted with ice tips
• Apply sand or salt to walkways around your home
• Consider wearing hip protector garments, which can reduce the impact if you fall
• Carry a backpack with padding that can protect your back if you fall backward
• Report icy sidewalks to building management or local authorities

Nutrition and Bone Health

Adequate nutrition supports both fall prevention and injury reduction if falls occur. Poor nutrition leads to muscle weakness and frailty, increasing fall risk. Bone health is equally important – strong bones are less likely to fracture if you do fall.

Vitamin D and calcium are particularly important for bone health and may help reduce fall risk. Vitamin D deficiency is common in older adults, especially those who spend little time outdoors. Ask your doctor about checking your vitamin D levels and whether supplementation is appropriate for you. Calcium can be obtained through dairy products, leafy greens, and fortified foods, or through supplements if dietary intake is insufficient.

Maintaining a healthy weight and eating adequate protein supports muscle strength. If you've lost your appetite or unintentionally lost weight, discuss this with your healthcare provider, as malnutrition significantly increases fall and fracture risk.

What Injuries Can Falls Cause?

Common fall injuries include hip fractures (often requiring surgery and extended rehabilitation), wrist fractures (from catching yourself), head injuries including traumatic brain injury, vertebral compression fractures in the spine, and upper arm fractures. Women are at higher risk for fractures due to higher rates of osteoporosis.

Falls can result in a wide range of injuries, from minor bruises to life-threatening trauma. The severity depends on factors including the height of the fall, the surface landed on, how the person landed, and their underlying bone and tissue health. Older adults are more vulnerable to serious injuries because of decreased bone density, thinner skin, and reduced ability to heal.

Hip fractures are among the most serious fall injuries. Approximately 95% of hip fractures are caused by falls, usually by falling sideways. Hip fractures almost always require surgery and extended rehabilitation. They carry significant risks: about 20% of hip fracture patients die within one year, and many survivors experience permanent disability and loss of independence. Signs of hip fracture include severe pain in the hip or groin, inability to bear weight on the leg, and the leg appearing shortened or turned outward.

Wrist fractures commonly occur when people fall forward and try to catch themselves with outstretched hands. While generally less serious than hip fractures, they cause significant pain, swelling, and difficulty using the hand. Many require casting, and some need surgical repair.

Head injuries are particularly concerning. Even a "mild" blow to the head can cause traumatic brain injury, and older adults on blood thinners are at increased risk of brain bleeding. Symptoms of head injury may not appear immediately and can include headache, confusion, dizziness, nausea, and changes in behavior or consciousness. Any head impact during a fall warrants medical evaluation.

Vertebral compression fractures occur when the force of impact compresses the vertebrae in the spine. These fractures cause severe back pain and can lead to height loss and spinal curvature (kyphosis). They may occur with relatively minor trauma in people with osteoporosis.

Upper arm fractures typically occur when falling forward or to the side without catching yourself with your hands. They cause pain, swelling, and difficulty moving the arm.

When Should You Seek Medical Care After a Fall?

Seek emergency care immediately if you cannot get up, hit your head, have severe pain, visible deformity, cannot bear weight, or experience confusion or loss of consciousness. Even without obvious injury, see a doctor within 24-48 hours after any fall to check for hidden injuries and discuss prevention.

After any fall, it's important to evaluate whether medical care is needed. Some injuries are obvious and require immediate attention, while others may not be apparent right away. When in doubt, err on the side of caution and seek medical evaluation.

Call emergency services immediately if you or someone who has fallen:

• Cannot get up from the floor
• Hit their head during the fall
• Has severe pain anywhere
• Has visible deformity (limb at wrong angle)
• Cannot bear weight on a leg
• Is confused, disoriented, or loses consciousness
• Has bleeding that won't stop
• Is taking blood thinning medications and hit their head

Even if you don't have these emergency symptoms, see a healthcare provider within 24-48 hours after any fall. Some injuries, particularly internal bleeding or subtle fractures, may not cause immediate symptoms. A medical evaluation can identify hidden injuries and provide an opportunity to discuss fall prevention strategies to reduce future risk.

During your medical visit, your provider may assess your gait and balance, review your medications, check your vision and blood pressure (including orthostatic changes), and discuss home safety. This comprehensive approach helps identify modifiable risk factors and create a personalized prevention plan.

How Are Fall Injuries Treated?

Treatment depends on the type and severity of injury. Minor injuries may need rest and over-the-counter pain relief. Fractures often require immobilization (casts, splints) or surgery. Hip fractures almost always need surgical repair and rehabilitation. Head injuries require monitoring and may need imaging or surgery for bleeding.

Treatment for fall injuries varies widely depending on what injuries occurred. Many fall injuries, fortunately, are minor – bruises, scrapes, and strains that heal on their own with rest, ice, and over-the-counter pain medications. However, more serious injuries require prompt medical attention and specific treatments.

Fractures require immobilization to allow bone healing. Some fractures can be treated with casts or splints, while others need surgical repair with plates, screws, or rods to stabilize the bone. Hip fractures almost always require surgery, either to repair the fracture or to replace the hip joint. Recovery involves physical therapy to restore strength and mobility.

The goal of fracture treatment extends beyond healing the bone – it includes restoring function and preventing future falls. Physical therapy and occupational therapy help patients regain strength, balance, and the ability to perform daily activities safely. Rehabilitation may occur in a specialized facility or at home with visiting therapists.

Head injuries require careful evaluation and monitoring. CT scans may be needed to check for bleeding inside the skull. Mild concussions require rest and monitoring for worsening symptoms. More serious injuries may require hospitalization for observation or surgery to relieve pressure from bleeding.

Regardless of the specific injury, recovery from a fall should include addressing the factors that contributed to the fall in the first place. This might include medication adjustments, physical therapy to improve balance and strength, home modifications, and treatment of any underlying conditions that increased fall risk.