Falls Prevention at Home: A Practical Guide

Falls are the leading cause of injury-related death in people over 75. Beyond the immediate physical injury, a fall that results in a long lie — especially if the person cannot get up — can cause hypothermia, pressure injuries, dehydration, and a severe loss of confidence that can trigger a lasting reduction in mobility and independence. Preventing falls is one of the most important things families and carers can do.

Understanding the Risk Factors

Falls rarely have a single cause. They typically result from the combination of multiple risk factors:

Room-by-Room Hazard Audit

Walk through the home with fresh eyes — ideally with someone who is not used to it, as familiarity breeds blindness to hazards.

Hallways and Stairs

• Handrails on both sides of stairs — secure, continuous, extending beyond the top and bottom step
• No clutter on stairs or at the bottom of stairs
• Good lighting — ideally with a light switch at both top and bottom
• Stair gate if the person is at risk of falling down stairs (this may seem unusual for an adult but is appropriate in some cases of cognitive impairment)

Bathroom and Toilet

• Grab rails — beside the toilet, in the shower, beside the bath. These can be fitted by a handyperson for £50–150 or through a council adaptation scheme.
• Non-slip mat inside the bath or shower — and outside it
• Shower chair or perch stool if standing in the shower is risky
• Raised toilet seat if getting on and off the toilet is difficult
• Night light for nocturnal toilet trips

Bedroom

• Bed at the right height — too low makes getting up difficult; too high means legs do not reach the floor safely
• Clear path from bed to door and to bathroom, especially for night use
• Bedside lamp or motion-sensor night light — not walking in darkness
• Bed grab rail or bed lever if getting in and out is difficult

Living Spaces

• All rugs either removed or secured with non-slip underlay — loose rugs are among the most common causes of falls
• Cables tidied away — behind furniture, not crossing walkways
• Furniture arranged to allow easy movement with a walking aid if one is in use
• Chair at appropriate height — getting up from a low, soft sofa is difficult and risky
• Phone or alarm within reach of the most-used chair — if a fall happens, the person needs to be able to call for help

Exercise: The Most Effective Intervention

Exercise programmes that target balance and strength are the most evidence-based intervention for fall prevention. The Otago Exercise Programme and FaME (Falls Management Exercise) have both been shown in clinical trials to reduce falls by approximately 35–40% in older people at risk.

These programmes involve targeted exercises for lower limb strength (knee bends, toe stands, heel raises) and balance, performed several times per week. They are typically delivered by physiotherapists or trained fitness instructors but can also be done at home with initial instruction.

Referral routes include:

• GP referral to a falls prevention service (available in most areas)
• Physiotherapy referral following a fall or near-miss
• Self-referral to community exercise programmes (many councils and leisure centres run low-cost classes specifically for older people focused on balance and strength)

Walking alone is beneficial but is not sufficient as a falls prevention measure — it does not specifically challenge balance and does not build the strength needed to prevent falls.

Medication Review

Medications are a significant contributor to falls — particularly:

• Benzodiazepines and z-drugs (sleeping tablets, some anxiety medications) — strongly associated with falls and fall-related injury
• Antihypertensives — blood pressure medications can cause postural hypotension (dizziness on standing)
• Diuretics — increase urgency and night-time toilet trips
• Psychotropic medications — antidepressants, antipsychotics

A GP or pharmacist medication review can identify whether any medication is contributing to fall risk and whether it can be reduced, replaced, or timed differently. This is not about stopping essential medications — it is about weighing the benefits against the risk of falls and finding the right balance.

Vision and Footwear

Vision: Uncorrected vision problems significantly increase fall risk. An annual eye examination is recommended for everyone over 65. Bifocal or varifocal glasses can affect depth perception on stairs — if the person wears these, they should be reminded to look down and take stairs slowly.

Footwear: Worn-out slippers, backless slippers, and socks without shoes are among the most common footwear contributors to falls. Shoes with firm, non-slip soles and ankle support are safest. Many people find it difficult to change habits around footwear — but worn-out slippers really do cause falls.

Personal Alarms

A personal alarm (worn as a pendant or wristband) allows someone who has fallen to call for help. For people living alone, this is particularly important — a fall without the ability to call for help can mean hours or days before help arrives.

Telecare alarm systems, typically costing £10–25 per month including monitoring, connect to a 24-hour response centre. Some councils provide them free as part of a care package. They are also available privately from providers such as Careline, ARC, and others. Ask the council's adult social care team whether this can be provided or funded.

After a Fall: What to Do

If a fall has happened:

1. 1

   Do Not Rush to Get Up

   If the person is conscious and not in severe pain, encourage them to rest for a moment before attempting to get up. Getting up too quickly increases the risk of dizziness and a second fall.

2. 2

   Check for Injury

   Before helping them up, check for pain — particularly in the hip or wrist (the most common fracture sites). If they are in significant pain, cannot bear weight, or you suspect a fracture, call 999. Do not attempt to move someone with a possible fracture.

3. 3

   Help Them Get Up Safely

   If no injury is suspected: help them roll onto their side, get to hands and knees, move to a sturdy chair, and push up from the chair with both hands. Never lift someone directly from the floor — this risks back injury for both of you.

4. 4

   Seek Medical Review

   Any fall should be discussed with the GP — especially a first fall, a fall with injury, or a repeated fall. A falls assessment can identify reversible causes. Do not normalise falls as "just what happens" — most falls are preventable.