Falls Prevention for Older Adults

Risk Factors for Falls

Falls are rarely caused by a single factor. Multiple risks compound each other:

Having fallen once significantly increases the risk of falling again. Fear of falling itself is a major risk factor — it leads to reduced activity, which causes deconditioning, which increases fall risk.

Removing Home Hazards

Many falls can be prevented by simple changes to the home environment. Go through each room:

• Remove loose rugs — these are the single most common trip hazard. Either remove them entirely or secure them with non-slip backing and tape.
• Secure loose carpets — fix any edges that have lifted
• Clear walkways — remove clutter from hallways, around furniture, and on stairs
• Improve lighting — ensure all areas are well lit, particularly hallways, stairs and the route to the bathroom at night. Motion-activated night lights are excellent.
• Install grab rails — by the toilet, in the shower or bath, beside the bed, at the top and bottom of stairs. An OT can advise and arrange installation.
• Move essentials to accessible heights — avoid reaching up or bending down for things used frequently
• Non-slip mat in shower and bath
• Raised toilet seat — reduces the effort of sitting down and standing up

Exercise and Strength

Exercise is the single most effective falls prevention intervention. Strength and balance exercises reduce falls risk by up to 40%. The Otago Exercise Programme and Falls Management Exercise (FaME) programmes have the strongest evidence.

What helps:

• Balance training — Tai Chi is excellent evidence-based balance training. Many local leisure centres run classes specifically for older adults.
• Strength training — sit-to-stand exercises, leg raises, heel raises. A physiotherapist can provide a programme.
• Walking — regular walking on varied terrain (grass, uneven paths) helps maintain balance.
• Ask the GP for a referral to the community physiotherapist or a falls prevention programme

Medication Review

Many common medications increase fall risk — often several medications together. Request a medication review from the GP or pharmacist, specifically asking about falls risk. Key medications to review include:

• Sleeping tablets (benzodiazepines, Z-drugs) — the most significant medication falls risk
• Blood pressure medications — can cause dizziness on standing (postural hypotension)
• Diuretics — the urgency they cause can lead to rushing
• Antidepressants — many affect balance and coordination

Do not stop medications without medical advice. But a medication review specifically for falls risk is a standard NHS service — ask for it.

Vision and Hearing

• Eye tests — have eyes tested at least every two years. Glasses that are the wrong prescription increase falls risk. Bifocals can cause misjudging steps — single-lens glasses may be safer for walking.
• Cataracts — cataract surgery is one of the most effective falls prevention interventions. If vision is reduced by cataracts, push for a referral.
• Hearing — hearing loss affects balance and spatial awareness. Have hearing checked and use hearing aids if prescribed.

After a Fall

If someone falls and cannot get up, call for help. If alone and unable to get up:

1. Stay calm. Panic wastes energy.
2. Check for injury before moving.
3. If possible, roll onto the side, then push up to a crawling position, and crawl to a sturdy piece of furniture to pull up against.
4. If unable to get up, call for help or use an emergency alarm if one is available.
5. If on the floor for more than an hour, hypothermia is a risk — cover with a blanket if possible.

After any fall, see the GP — even if there is no injury. An assessment may identify treatable risk factors. Repeat falls should always be investigated.

Getting a Falls Assessment

Ask your GP for a referral to the community falls prevention service. This typically includes:

• Gait and balance assessment
• Medication review
• Vision check
• Home hazard assessment (from an OT)
• Referral to exercise programme