Falls and Fall Prevention in Older Adults

Overview

A simple accident, like tripping on a rug or slipping on a wet floor, can change your life. If you fall, you could break a bone or cause a head injury, which thousands of older adults experience each year. For older people, a broken bone can also be the start of more serious health problems and can lead to long-term disability.

If you or an older adult in your life has fallen, you are not alone. More than one in four people age 65 years or older fall each year. The risk of falling, and fall-related problems, rises with age. However, many falls can be prevented. Exercising, managing your medicines, having your vision checked, and making your home safer are all steps you can take to prevent a fall.

Many older adults fear falling, even if they haven’t fallen before. This fear may lead them to avoid activities such as walking, shopping, or taking part in social activities. But staying active is important to keeping your body healthy and actually helps to prevent falls.

Signs and Symptoms

Falls themselves may not always cause obvious symptoms, but balance disorders, a key risk factor for falls, can produce a range of warning. If you have a balance disorder, you might experience:

• Dizziness or vertigo (a spinning sensation)
• Falling or feeling as if you are going to fall
• Staggering when you try to walk
• Lightheadedness, faintness, or a floating sensation
• Blurred vision
• Confusion or disorientation

Other symptoms may include nausea and vomiting, diarrhea, changes in heart rate and blood pressure, and feelings of fear, anxiety, or panic. Symptoms may come and go over short periods or last for a long time and can lead to fatigue and depression.

Causes and Risk Factors

Many things can cause a fall. Balance problems can also be caused by certain medicines or medical conditions.

Age-Related Changes

• Eyesight, hearing, and reflexes may not be as sharp as they were when you were younger
• Age-related loss of muscle mass (known as sarcopenia), problems with balance and gait, and blood pressure that drops too much when you get up from lying down or sitting (called postural hypotension) are all risk factors for falling
• Your risk of having balance problems increases as you get older

Medical Conditions

• Certain conditions, such as diabetes, heart disease, or problems with your thyroid, nerves, feet, or blood vessels, can affect your balance and lead to a fall.
• Conditions that cause rushed movement to the bathroom, such as incontinence, may also increase the chance of falling.
• Older adults with mild cognitive impairment or certain types of dementia are at higher risk of falling.
• Low blood pressure can lead to dizziness when you stand up too quickly.
• Problems that affect the skeletal or visual systems, such as arthritis or eye muscle imbalance, can also cause balance disorders.

Medicines

• Some medicines can increase a person’s risk of falling because they cause side effects such as dizziness or confusion.
• The more medicines you take, the more likely you are to fall.

Lifestyle and Environmental Factors

• Foot problems that cause pain, and unsafe footwear such as backless shoes or high heels, can increase your risk of falling.
• Safety hazards in the home or community environment can also cause falls.
• Consuming alcohol can cause dizziness and balance problems by affecting how the inner ear works.

Related Health Effects

Falls can have serious consequences for older adults:

• Bone breaks and fractures can lead to a hospital or nursing home stay, long-term disability, or even death.
• Head injuries from falls can lead to both physical and cognitive disabilities, including difficulties with mobility, coordination, balance, memory, concentration and processing information.
• Falls are a common reason for trips to the emergency room and for hospital stays among older adults. Many of these hospital visits are for fall-related fractures.
• Too much alcohol can lead to balance problems and falls, which can result in hip or arm fractures and other injuries.
• Nicotine and alcohol use may decrease your bone mass and increase your chance of fractures.
• Being underweight increases the risk of bone loss and broken bones.

Osteoporosis is a disease that weakens bones, making them thin and brittle. For people with osteoporosis, even a minor fall may be dangerous.

Prevention Guidance

If you take care of your overall health, you may have a lower chance of falling. Most of the time, falls and accidents don’t just happen for no reason. Here are steps to help lower your risk:

Stay Physically Active

• Plan an exercise program that is right for you. Regular exercise improves muscles and makes you stronger. Exercise also helps keep your joints, tendons, and ligaments flexible.
• Mild weight-bearing activities, such as walking or climbing stairs, may slow bone loss from osteoporosis.
• Try to get at least 150 minutes per week of physical activity.
• Adults should do muscle-strengthening activities at least two days per week, according to the Physical Activity Guidelines for Americans.

Do Balance and Strength Training Exercises

• Yoga, Pilates, and tai chi can all improve balance and muscle strength.
• You can also try lifting weights or using resistance bands to build strength.
• Muscle-strengthening exercises can help you stay independent and prevent fall-related injuries.
• Balance exercises help prevent falls and can improve stability.
• Learn more about different types of exercises to improve balance and strength.

Fall-Proof your Home

• Install a ramp with handrails to the front door.
• Remove area rugs and fix all carpets firmly to the floor.
• Ensure good lighting, particularly at the top and bottom of stairs.
• Install grab bars near toilets and in the tub or shower.
• Reduce fall hazards with nonslip strips on floors or surfaces that may get wet.

Protect your Vision and Hearing

• Even small changes in sight and hearing are linked to an increased risk for falls.
• When you get new eyeglasses or contact lenses, take time to get used to them.
• If you have a hearing aid, be sure it fits well and wear.

Manage your Medicines

• Find out about the side effects of any medicines you take. If a drug makes you sleepy or dizzy, tell your doctor or pharmacist.
• Talk with your healthcare provider about medicine side effects.

Keep your Bones Strong

• Having healthy bones won’t necessarily prevent a fall, but if you do fall, healthy bones may help prevent serious injury.
• Getting enough calcium and vitamin D can help keep your bones strong.
• Quitting smoking and avoiding or limiting alcohol use can help maintain bone health: Tobacco and alcohol use may decrease your bone mass and increase your chance of fractures.
• Try to maintain a healthy weight: Being underweight increases the risk of bone loss and broken bones

Other Important Steps

• Get enough sleep: If you are tired, you are more likely to fall.
• Avoid or limit alcohol: Too much alcohol can lead to balance problems and falls, which can result in hip or arm fractures and other injuries.
• Stand up slowly: Getting up too quickly can cause your blood pressure to drop, making you feel wobbly. Get your blood pressure checked when lying and standing.
• Use an assistive device if you need help feeling steady when you walk. Using canes and walkers correctly can help prevent falls. A physical or occupational therapist can help you decide which devices might be helpful and teach you how to use them safely.
• Take extra caution when walking on wet or icy surfaces. Use an ice melt product or sand to clear icy areas by your doors and walkways.
• Keep your hands free by using a shoulder bag, fanny pack, or backpack to leave your hands free to hold on to railings.
• Choose the right footwear: Wear nonskid, rubber-soled, low-heeled shoes. Don’t walk on stairs or floors in socks or in shoes and slippers with smooth soles.
• Always tell your doctor if you have fallen since your last check-up, even if you did not feel pain when you fell.

Treatment and Management

If you have a balance problem that another health condition or a medicine is to blame, your doctor will treat the condition, suggest a different medicine, or refer you to a specialist.

Coping With Falls

Whether you are at home or somewhere else, a sudden fall can be startling and upsetting. If you do fall, stay as calm as possible and take the following steps:

• Breathe. Take several deep breaths to try to relax. Remain still on the floor or ground for a few moments to help you get over the shock of falling.
• Decide if you are hurt. Getting up too quickly or in the wrong way could make an injury worse.
• Crawl to a sturdy chair. If you think you can get up safely without help, roll over onto your side. Rest again while your body and blood pressure adjust. Slowly get up on your hands and knees, and crawl to a sturdy chair.
• Slowly sit down in the chair. Put your hands on the chair seat and slide one foot forward so that it’s flat on the floor. Keep the other leg bent so the knee is on the floor. From this kneeling position, slowly rise and turn your body to sit in the chair.
• Get help. If you are hurt or cannot get up on your own, ask someone for help or call 911.

Prepare For a Fall Before It Happens

• Keep a well-charged cordless or mobile phone with you at all times.
• Arrange for daily contact with a family member or friend.
• Consider an emergency response system: These systems enable you to push a button on a special necklace or bracelet to call for help. Some smartwatches also have this feature.
• Consider setting up a smart home device that can quickly connect you to contacts or emergency response teams. Some smartwatches can even detect sudden fall-like movements and automatically call for help.

Living With a Chronic Balance Disorder

• Some people with a balance disorder may not be able to fully relieve their dizziness and will need to find ways to cope with it.
• Chronic balance problems can affect all aspects of your life, including your relationships, work performance, and your ability to carry out daily activities.
• Support groups provide the opportunity to learn from other people with similar experiences and challenges.
• Talk to your doctor about whether it’s safe to drive, and about ways to lower your risk of falling during daily activities, such as walking up or down stairs, using the bathroom, or exercising.
• To reduce your risk of injury from dizziness, do not walk in the dark.

Home Safety Systems

• Many state and local governments have education and/or home modification programs to help older people prevent falls. Check with your local health department, search the Eldercare Locator, or call 800-677-1116 to find your local Area Agency on Aging to see if there is a program near you.

Preventing Falls at Home: Room by Room

Many falls happen at home, where we spend much of our time and tend to move around without thinking about our safety. Here are changes you can make throughout your home to help prevent falls:

Floors, stairways, and hallways:

1. Ensure there are handrails on both sides of any stairs and make sure they are secure.
2. Ensure there is good lighting with light switches at the top and bottom of stairs and on each end of a long hall.
3. Keep areas where you walk tidy. Don’t leave books, papers, clothes, or shoes on the floor or stairs.
4. Check that all carpets are fixed firmly to the floor.
5. Put no-slip strips on tile and wooden floors.
6. Don’t use throw rugs or small area rugs.
7. Don’t walk on slippery, newly washed floors.
8. Mark the edges of steps with bright or reflective tape.

Bathrooms:

1. Mount grab bars near toilets and on both the inside and outside of your tub and shower.
2. Place nonskid mats, strips, or carpet on all surfaces that may get wet.
3. Leave a light on in the bathroom at night or use a night light that turns on automatically in the dark.
4. Consider a plastic shower stool and a hand-held shower head to make bathing easier.

Bedrooms:

1. Put night lights and light switches close to your bed.
2. Keep a flashlight by your bed in case the power goes out and you need to get up.
3. Place a landline or well-charged phone near your bed.

Kitchen:

1. Keep frequently used pots, pans, and kitchen utensils in a place where they are easy to reach.
2. Clean up spills immediately.
3. Prepare food while seated to prevent fatigue or loss of balance.

Outdoor spaces:

1. Make sure steps leading to your front door are not broken or uneven.
2. Add non-slip material to outdoor stairways.
3. Keep the lawn, deck, or porch areas clear of debris, such as fallen branches.
4. Consider installing a grab bar near the front door to provide balance while locking or unlocking the door.
5. In the winter, treat outdoor walkways with an ice melt product or sand to make them less slippery.
6. Consider installing a ramp with handrails to the front door.

Other living areas:

1. Keep electrical cords near walls and away from walking paths.
2. Arrange furniture so it is not in your way when you walk.
3. Make sure your sofas and chairs are the right height for you to get in and out of easily.
4. Don’t stand on a chair or table to reach something that’s too high — use a “reach stick” instead or ask for help.
5. Know where your pet is whenever you’re standing or walking, so your cat or dog doesn’t trip you.
6. Keep a list of emergency numbers in large print near each landline phone and save them under “favorites” on your mobile phone.

If you have fallen, your doctor might suggest that an occupational therapist, physical therapist, or nurse visit your home. These healthcare providers can assess your home’s safety and advise you about making changes to lower your risk of falls.

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on falls.

Find Treatment

To diagnose a balance problem, your primary doctor may refer you to an otolaryngologist or audiologist. A vestibular rehabilitation therapist can help develop an individualized treatment plan.

Many state and local governments have education and/or home modification programs to help older people prevent falls. Search the Eldercare Locator or call 800-677-1116 to find your local Area Agency on Aging.

Community Support

• Centers for Disease Control and Prevention
• National Falls Prevention Resource Center
• National Resource Center on Supportive Housing and Home Modifications
• Rebuilding Together
• National Center for Injury Prevention and Control, Centers for Disease Control and Prevention

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH.  

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.  

NIH supports research on the causes and prevention of falls.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.  

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Tips to Prevent Falls and Stay Independent as You Age