Preventing and Managing Falls in Older Adults

Evidence-based guide to fall prevention including risk factors, exercises, home safety, and what to do after a fall.

Falls are the leading cause of injury among seniors, but most are preventable. This evidence-based guide covers risk factors, prevention strategies, exercises, and recovery.

The Impact of Falls

Statistics:

1 in 4 older adults falls each year
3 million ER visits annually
800,000 hospitalizations
Falls cause 95% of hip fractures
Leading cause of injury death in seniors

Consequences:

Physical injury (fractures, head trauma)
Loss of independence
Fear of falling (restricts activity)
Decreased quality of life
Nursing home placement

Good news: Falls are largely preventable with proper interventions

Risk Factors

Medical Risk Factors

Vision problems:

Cataracts
Glaucoma
Macular degeneration
Poor depth perception
Bifocals (distort depth on stairs)

Chronic conditions:

Parkinson's disease
Arthritis
Stroke
Diabetes (neuropathy)
Dementia
Osteoporosis

Cardiovascular:

Orthostatic hypotension (dizziness when standing)
Heart rhythm problems
Dehydration

Medications (high risk):

Blood pressure medications
Sedatives/sleep aids
Anti-anxiety medications
Antidepressants
Pain medications
Multiple medications (4+ increases risk)

Physical decline:

Muscle weakness (especially legs)
Balance problems
Gait issues
Foot problems

Environmental Risk Factors

Home hazards:

Clutter and obstacles
Poor lighting
Loose rugs
Slippery floors
No grab bars
Stairs without railings
Uneven surfaces
Pets underfoot

Outdoor hazards:

Uneven sidewalks
Ice and snow
Wet surfaces
Poor lighting
Lack of railings

Behavioral Risk Factors

Risky behaviors:

Rushing to bathroom
Climbing on stools/chairs
Not using assistive devices
Wearing improper footwear
Not turning on lights at night
Alcohol use

Fall Risk Assessment

Self-Assessment Questions

Answer yes/no:

Have you fallen in the past year?
Do you feel unsteady when walking?
Do you worry about falling?
Do you need to push with hands to stand from chair?
Do you have trouble stepping up on curb?
Do you rush to bathroom?
Do you feel numbness in feet?
Do you take medications that make you dizzy?
Do you sometimes feel sad or depressed?
Do you have difficulty with daily activities?

If 4+ yes: High fall risk, see doctor for evaluation

Medical Evaluation

Doctor assessment:

Medication review
Vision and hearing tests
Blood pressure (sitting and standing)
Balance and gait evaluation
Muscle strength testing
Bone density scan
Vitamin D level

Timed Up and Go Test: Should complete in under 12 seconds

Sit in chair
Stand up
Walk 10 feet
Turn around
Walk back
Sit down

Over 12 seconds: Indicates fall risk

Prevention Strategies

Strength and Balance Exercises

Most effective prevention: Exercise programs reduce falls by 23%

Recommended:

Tai Chi: Reduces falls 45% (gold standard)
Balance exercises: Daily practice
Strength training: 2-3x per week
Walking: 30 minutes daily

Evidence-based programs:

Otago Exercise Program: Home-based, proven effective
Stepping On: 7-week workshop
A Matter of Balance: Group class
Silver Sneakers: Gym classes for seniors

Specific Exercises

Balance exercises (do daily, hold onto counter):

Single leg stand: 10 seconds each leg
Heel-to-toe walk: 20 steps forward
Side leg raises: 10 each side
Back leg raises: 10 each leg
Sit-to-stand: 10 repetitions without hands

Strength exercises (2-3x/week):

Chair squats: 10-15 reps
Wall push-ups: 10-15 reps
Toe raises: 15 reps
Heel raises: 15 reps
Resistance band exercises: For arms and legs

Progress gradually: Increase difficulty as strength improves

Medication Management

Steps to take:

Annual medication review with doctor or pharmacist
Question every medication: Still needed? Lowest effective dose?
Report side effects: Dizziness, drowsiness, confusion
Avoid high-risk medications when possible
Reduce polypharmacy: Fewer medications = lower risk

High-risk medications:

Sedatives (Valium, Xanax)
Sleep aids (Ambien, Benadryl)
Tricyclic antidepressants
First-generation antihistamines
Muscle relaxants

Ask about alternatives: Non-medication options

Vision Correction

Annual eye exams: Update prescriptions

Treat conditions: Cataracts, glaucoma

Proper glasses:

Avoid bifocals on stairs
Separate distance and reading glasses
Anti-reflective coating
Good lighting

Remove obstacles: Improve ability to see hazards

Home Safety Modifications

Lighting:

100+ watt equivalent in all rooms
Night lights in bedroom, bathroom, hallway
Motion-activated lights
Light switches at top and bottom of stairs
Flashlight by bed

Bathrooms (most falls occur here):

Grab bars by toilet and in shower
Non-slip mats in tub/shower
Raised toilet seat
Shower chair or bench
Handheld showerhead
Remove locks from bathroom doors

Floors:

Remove throw rugs or secure with non-slip pads
No clutter or cords in walkways
Secure all carpets
Non-slip wax on floors
Contrast tape on step edges

Stairs:

Railings on both sides
Good lighting
Contrasting colored tape on edges
No clutter
Repair loose steps or carpet

Bedroom:

Bed at proper height (knee-level when sitting)
Clear path to bathroom
Phone within reach
Lamp easily accessible

General:

Frequently used items at waist level
Non-skid backing on rugs
Cord management
Pet training (not underfoot)

See our Home Modifications Guide for details

Footwear

Proper shoes:

Low heel (½ inch or less)
Non-slip soles
Secure fit (not loose)
Closed toe and heel
Good arch support

Avoid:

Slippers (too loose)
Socks without shoes
High heels
Smooth-soled shoes
Backless shoes

Assistive Devices

When needed:

Canes for minor balance issues
Walkers for moderate instability
Wheelchairs for severe mobility problems

Must be properly fitted: See physical therapist

Use consistently: Don't leave behind because "only going to kitchen"

Maintain: Check tips, wheels, stability

Vitamin D and Calcium

Vitamin D deficiency: Increases fall risk

Recommended:

Vitamin D: 800-1,000 IU daily
Calcium: 1,200 mg daily (with food)

Check levels: Blood test for vitamin D

Food sources:

Vitamin D: Fatty fish, fortified milk, egg yolks
Calcium: Dairy, leafy greens, fortified foods

Bone Health

Prevent fractures if fall occurs:

Bone density test: Baseline at 65, repeat as recommended

Osteoporosis treatment: If diagnosed

Bisphosphonates (Fosamax, Boniva)
Other medications as prescribed
Weight-bearing exercise
Adequate calcium and vitamin D

Hip protectors: Pads worn in undergarments

Reduce hip fracture risk
For high-risk individuals
Compliance often low (uncomfortable)

Managing Specific Conditions

Orthostatic Hypotension

Dizziness when standing: Blood pressure drops

Prevention:

Rise slowly (sit 30 seconds before standing)
Stay hydrated (8 glasses water daily)
Compression stockings
Elevate head of bed
Review medications

Neuropathy

Numbness in feet: Common with diabetes

Management:

Control blood sugar
Foot exams regularly
Proper footwear
Visual compensation (watch feet when walking)

Dementia

Increased fall risk: Due to confusion, poor judgment

Strategies:

Simplify environment
Remove hazards
Consistent routines
GPS tracking if wandering
Consider memory care if severe

After a Fall

Immediate Response

If you fall:

Don't panic: Take deep breaths
Check for injury: Move slowly, assess pain
Call for help: Medical alert, phone, yell for help
Don't get up immediately: If injured
If uninjured and able: Roll to side, get on hands and knees, crawl to sturdy chair, use chair to pull up

Long lie: Over 1 hour on ground increases complications

Medical alert system: Critical for those living alone

When to Call 911

Call if:

Hit head
Severe pain
Can't bear weight
Confused
Bleeding heavily
Possible fracture
Can't get up

Even if okay: Report fall to doctor

Medical Follow-Up

Always tell doctor about falls:

Often not reported (embarrassment, fear)
Triggers important evaluation
Prevents future falls

Doctor should:

Ask about circumstances
Review medications
Check blood pressure
Assess gait and balance
Order tests if needed
Refer to physical therapy

Fear of Falling

Common after fall: Can become disabling

Consequences:

Restricting activities
Becoming more sedentary
Deconditioning
Actually increases fall risk

Treatment:

Matter of Balance program
Cognitive behavioral therapy
Gradual activity increase
Tai Chi
Physical therapy

Technology Solutions

Medical Alert Systems

Pendant or wristband: Press for help

Fall detection: Automatic alert if fall detected

GPS: For location if wandering

Cost: $25-$60/month

Highly recommended: For those living alone

See our Medical Alert Guide for details

Smart Home Technology

Motion sensors: Detect lack of movement, alert family

Smart lights: Automatic activation

Voice assistants: "Alexa, call for help"

Video monitoring: Family can check in

Balance of safety and privacy

Community Resources

Fall Prevention Programs

Evidence-based:

Tai Chi for Arthritis
Stepping On
Matter of Balance
Otago Exercise Program

Find programs:

Local Area Agency on Aging
Senior centers
YMCA/community centers
Hospitals

Often free or low-cost

Professional Services

Physical therapy:

Fall risk assessment
Individualized exercise program
Gait training
Balance training
Often covered by Medicare

Occupational therapy:

Home safety evaluation
Adaptive equipment recommendations
Activity modification

Home health:

If homebound
Therapy at home
Medicare may cover

Special Populations

After Hip Fracture

High risk: 50% fall again within first year

Critical:

Complete rehabilitation
Ongoing exercise
Home modifications
Proper equipment use

Parkinson's Disease

Freezing gait: Common problem

Strategies:

March in place
Step over imaginary line
Count steps
Rock side to side
Medication timing

Multiple Falls

Two or more falls: Needs comprehensive evaluation

Multifactorial assessment:

Medical evaluation
Home assessment
Medication review
Vision and hearing
Footwear
Exercise program

Fall Statistics by Location

Where falls occur:

Bathroom: 40%
Bedroom: 25%
Living room: 15%
Kitchen: 10%
Outside: 10%

Focus prevention: High-risk areas

Cost of Falls

Individual:

Medical costs: $14,000+ per fall with injury
Lost independence
Nursing home placement

Society:

$50 billion annually in medical costs
Largest share to Medicare

Prevention is cost-effective: $1 spent saves $4-$10

Resources

Programs

National Council on Aging: ncoa.org/falls-prevention
CDC Falls Prevention: cdc.gov/falls
Tai Chi for Health: taichiforhealthinstitute.org
Local Area Agency on Aging: eldercare.acl.gov

Tools

CDC STEADI (Stopping Elderly Accidents, Deaths & Injuries)
Fall prevention checklist
Home safety checklist

Professional Help

Physical therapy
Occupational therapy
Home safety evaluations
Balance and strength classes

Key message: Most falls are preventable. Exercise (especially Tai Chi), home modifications, medication review, and vision correction are proven interventions. Don't accept falls as normal aging.

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