Falls prevention for elderly people

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As we get older, the risk of falling becomes more of a concern. With age, falls prevention becomes increasingly important to avoid complications, such as stays in hospital for broken bones, hip fractures and other fall related injuries.

Fortunately, there are some steps you or your loved one can take to mitigate the increased risk of falls.

Whether you or your loved one have a history of falls, struggle with a fear of falling, or simply want to be prepared for any eventuality, this guide explores the preventative steps you can take. If you or a loved one have already suffered a fall, read our guide to 12 symptoms to look for after a fall.

Read on to learn more about falls prevention for elderly people – and discover some small changes you can implement that could help make a real difference.

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What causes elderly people to fall?

As we get older, we become more susceptible to health issues and physical limitations that increase our risk of falling. Falls among the elderly population are therefore a significant public health concern. According to GOV.UK, around a third of people aged 65 and over, and around half of people aged 80 and over, fall at least once a year.1

Following a hip fracture, short and long term outlooks for people are generally poor. One year mortality increases between 18% and 33% and daily living activities such as shopping and walking become much more difficult.2

Understanding the risk factors that contribute to a fall is therefore vital to developing preventative measures and improving overall wellbeing in older adults.

What is a risk factor?

A risk factor is anything that can increase an individual’s likelihood of experiencing a fall. Risk factors can vary and may be physiological, environmental, behavioural or social. Identifying risk factors can help with falls prevention and reduce the danger.

What are the risk factors for falls? What causes a fall?

Weak muscles

Weak muscles can contribute to falls because muscles play a role in maintaining balance, stability and mobility. When muscles weaken, they’re less able to stabilise the body and struggle to react to sudden or unexpected circumstances. In particular, weak muscles below the waist, like the legs and ankles, can impair posture and mobility while standing, walking or changing positions. This can result in wobbling, stumbling and losing balance. When combined with uneven or hazardous environments, this can make a fall much more likely.

Weakness in the upper body can also increase the risk of a fall. Weaker arms and shoulders can mean someone has less chance of breaking their fall or grasp onto objects for support, increasing the risk of injury.

Poor balance

Poor balance can contribute to falls by impairing stability. Individuals with poor balance may experience difficulties adjusting to changes in the environment like the height of a surface, and this can make them susceptible to trips, stumbles and falls. They may also struggle to maintain equilibrium while standing still or performing tasks that require shifting their weight, such as reaching for objects or turning around.

In addition to this, poor balance can lead to instability when doing daily activities like walking and climbing the stairs, which could result in losing footing and falling. Older people in particular can experience age related decline in balance due to changes in muscle strength, joint flexibility and sensory perception, exposing them to higher risk of falling.

Dizziness and light headedness

Dizziness significantly contributes to falls as it disrupts your sense of spatial orientation and stability, making it harder to maintain balance and coordination. Dizziness can be caused by different things, like ear conditions, heart conditions (such as arrhythmias), medication side effects, dehydration, elderly delirium or neurological issues.

When dizzy, a person may also feel lightheaded, unsteady, or even feel like their environment is spinning, which is called vertigo. This can also lead to poor visual perception that make it harder to judge distances from objects or to detect potential hazards.

Blackouts, fainting and loss of consciousness

Blackouts contribute to falls because the person who blacks out or faints loses consciousness and therefore temporarily loses control of their body. Fainting can be caused by all sorts of factors such as heart abnormalities, dehydration, low blood pressure, medication side effects or neurological conditions.

During a blackout, individuals are unable to maintain balance or respond to surroundings, leading to falls. Unfortunately, this type of fall can occur without warning, resulting in injuries due to the lack of protective reflexes or attempts to break the fall.

Foot problems and footwear

Foot problems and inadequate footwear are a leading cause of falls because they compromise stability and increase the risk of tripping. Conditions like foot pain, deformities such as bunions, neuropathy or arthritis can affect balance and mobility. Additionally, ill fitting or unsupportive footwear can increase problems, causing discomfort, reduced flexibility and even altering gait. Shoes with inadequate ankle support further compromise balance and increase the risk of ankle sprains or falls.

Memory loss, confusion or cognitive impairment such as dementia

There’s often a connection between the risk of falls in older people and memory issues such as dementia.

  1. Cognitive decline
    Dementia, such as Alzheimer’s and other forms of cognitive impairment, result in memory loss, as well as reduced attention. Cognitive impairments may compromise someone’s ability to recognise hazards and they may also struggle to plan movements or react to losing balance.
  2. Gait and balance disturbances
    Dementia affects motor skills and coordination, which means a person’s gait and balance are impacted. Older adults with dementia may shuffle, adopt wider stances and reduce arm swing, which together create instability and an increased falls risk.
  3. Medication use
    Individuals with dementia often require medication to manage symptoms. Some medications have side effects which can include dizziness, drowsiness, or orthostatic hypotension, which all increase the risk of falling.
  4. Behavioural symptoms
    Changes in behaviour caused by dementia, like wandering, restlessness, or being more impulsive all increase exposure to hazards and risky situations. For example, someone with dementia may wander into an unsafe area, try to climb the stairs or even their furniture, or move erratically.
  5. Underlying health conditions
    Dementia often occurs alongside other health conditions like osteoporosis, Parkinson’s disease, or visual and hearing impairments. These all exacerbate a person’s fall risk in their own right because they affect muscle weakness, senses and mobility.
Vision problems

Vision problems have an obvious effect on fall risk in older adults. If vision is impaired, hazards are harder to see and this may result in a fall. Common conditions in older adults like cataracts, glaucoma, or macular degeneration reduce visual ability, making it harder to detect any obstacles and trip hazards – especially at night.

Hearing issues

Hearing issues result in an increased risk of falls in older adults because they reduce awareness of the surrounding environment. Conditions such as hearing loss or an inner ear disorder impair the ability to detect auditory cues that might otherwise alert someone to a potential hazard or an approaching object. Sadly, difficulties with communication and understanding verbal instructions may also lead to confusion that makes someone less safe.

Alcohol

Alcohol can contribute to falls in anyone by affecting balance, coordination and cognitive function. As we age, our bodies metabolise alcohol more slowly, increasing the impairment we experience even when we consume less alcohol. Alcohol can also exacerbate age related decline in muscle strength and reactions, so it becomes harder for older people to maintain stability and react quickly. Alcohol can also impair judgment and decision making, leading to risky behaviour or situations that may increase the likelihood of an accident.

Bladder or bowel conditions

Bladder or bowel conditions are a risk factor for falls in older adults because they impact mobility and urgency. Conditions such as urinary incontinence or frequent urination lead to a sudden need to use the bathroom, which may cause someone to rush and lose balance. Bowel disorders like diarrhoea or constipation have a similar effect, prompting hurried movements that may result in slipping and falling.

Why do falls matter?

Falls are a huge concern for older adults and represent a significant danger. Even a minor fall can result in a serious injury and fall injuries can have lasting consequences on health, wellbeing and overall quality of life. Here are some key considerations about falls in elderly people:

Increased risk of injury

Falls are a leading cause of injury among older adults, often resulting in fractures, sprains, bruises or head trauma. These injuries can lead to hospitalisation, disability, chronic pain and even mortality, particularly in frail or vulnerable individuals. Falls are the most common cause of death by injury in people aged over 65.3

Losing independence

Falls can diminish a person’s independence, not just because of physical injury but also due to a lack of confidence moving about.

Psychological impact

Falls, and fear of falling, can have lasting psychological consequences like anxiety, depression and lost confidence. Studies show a link between falling and depression.4

Underlying health concerns

If you’re unsure why you or a loved one has fallen over, it is important to remember falls can be a red flag for underlying health issues like osteoporosis, cardiovascular disease, neurological disorders or medication side effects. They can therefore serve as an important warning sign to improve overall health and you should seek professional medical help.

How to prevent falls

Falls are not always avoidable, but there are certain steps you or your loved one can take to limit risk. If you’re afraid of falling, you should speak with a healthcare professional in the first instance.

Keeping active to help prevent falls

It might seem logical that moving less would reduce the risk of a fall because you’re staying still. However, being active is one of the best ways to actually prevent falls. Being active maintains muscle strength, improves balance and increases coordination.

Being active means different things to different people, depending on ability and limitations to mobility. Many people think it requires visiting local gyms, but mild exercises are often sufficient to reduce risk. NHS Inform suggests engaging in physical activity up to 150 minutes per week to reduce the risk of falls.5

As we’ve mentioned above, before beginning any exercise, the first step should be to consult with your GP or a physical therapist, especially if you have medical conditions or concerns. That said, here are some activity ideas for older people:

  1. Strength training
    Engaging in strengthening exercises can build muscle strength, particularly in the lower body. If possible, exercises like squats, lunges, leg lifts and calf raises can improve stability and reduce the risk of falls.
  2. Balance exercises
    Some exercises can enhance stability and ultimately result in better balance. Activities for elderly people like standing on one leg and balance specific exercises like tai chi or yoga can improve balance and coordination.
  3. Flexibility training
    Performing stretches can maintain and improve flexibility in your muscles and joints. Stretching prevents stiffness, improves range of motion and reduces the risk of falls from tripping over obstacles or losing your balance.
  4. Cardiovascular exercise
    Engaging in aerobic activities such as walking, swimming, cycling or even dancing (if possible) can improve cardiovascular health and endurance. Regular aerobic exercise can enhance overall fitness levels, reduce fatigue and support mobility and independence.
  5. Functional activities
    Incorporating activities into daily routines may improve agility as well as mobility. Tasks such as walking up and down stairs, carrying groceries or getting in and out of chairs mimic real life movements and help maintain independence.

Eating well to help prevent falls

Eating a healthy, balanced diet can make a real difference to the risk of falling. This is because it can reduce light headedness, dehydration, tiredness and depression. According to NHS Inform, there are some basic dietary principles to follow:

  1. Fruit & Veg
    The NHS says a third of what you eat should be fruit and vegetables – at least 5 a day
  2. Carbohydrates
    The NHS says another third should come from bread, cereals and starchy carbs like rice, potatoes, pasta and more. The NHS also recommend a fibre rich diet, which could mean opting for legumes like red kidney beans or swapping white potato for sweet potato
  3. Calcium
    The NHS recommends getting your full dose of calcium each day, which means consuming plenty of dairy like milk, yoghurt and cheese
  4. Protein
    Meat, fish, eggs and beans are great sources of protein to help with muscle repair. The NHS says to aim for 2-3 portions daily

In addition to this, eating regularly is important. Elderly people sometimes struggle or refuse to eat, but this is dangerous and can increase the risk of falls as well as many other health complications. Read our guide if your elderly parent isn’t eating and sleeping all the time.

Keeping hydrated to help prevent falls

As well as a nutritious and regular diet, drinking lots of fluids – 6 to 8 glasses a day – helps prevent dehydration and, in doing so, reduces the risk of a fall. If you don’t drink enough, it’s likely that you will start to get lightheaded which increases fall risk.

Looking after feet to help prevent falls

Looking after your feet is essential for preventing a fall, as feet directly impact balance, stability and mobility. Here are some tips:

  1. Regularly check feet
    Look at your feet daily for signs of injury, blisters, cuts or sores. Treat wounds to prevent infection, which affects mobility.
  2. Wear proper footwear
    Choose well fitted, supportive shoes with non slip soles and secure fastenings. Avoid high heels, loose or worn out shoes. Footwear with inadequate arch support can impair balance and increase the risk of tripping or slipping.
  3. Care for your feet
    Keep feet clean and dry. Trim toenails to prevent ingrown nails and avoid cutting them too short. Moisturising feet regularly can prevent dryness and cracking, but too much lotion between toes can cause fungal infections.
  4. Exercise your feet
    Perform exercises to strengthen foot muscles, improve flexibility and maintain motion. Simple exercises like toe curls, ankle circles and picking up objects with your toes can help improve foot function and balance. Read our guide to exercises for swollen ankles.
  5. Arrange check ups
    Schedule regular foot appointments with a podiatrist or specialist, especially if you have pain, deformities or chronic conditions like diabetes. Early detection and management of problems can prevent complications and thereby reduce fall risk.

Looking after vision & hearing to help prevent falls

Looking after your vision and hearing is crucial for preventing falls in older people. Here are some key ways you can do this:

  1. Have a regular eye test
    Regular eye examinations are essential for maintaining optimal vision health and detecting age related eye conditions such as cataracts, glaucoma, macular degeneration and diabetic retinopathy. Vision changes can affect depth perception, peripheral vision and contrast sensitivity, increasing the risk of trips, slips and falls. Ask yourself if you’ve had an eye exam in the past year. If not, older adults should schedule one as soon as possible to prevent future falls.
  2. Wear the right eyewear
    Older adults should wear appropriate eyewear, such as glasses or contact lenses, which are prescribed by an optician. Wearing outdated or incorrect prescriptions can make vision worse and increase the incidence of falls in older people.
  3. Book a regular hearing test
    A regular hearing assessment is essential to detect age related hearing loss, communication difficulties and any disorders. If hearing loss is left untreated, it can result in difficulties with understanding verbal communication, detecting auditory cues and maintaining awareness of your surroundings. All these things can lead to falls and fall related injury.
  4. Wear a hearing aid
    If hearing loss has been identified, hearing aids and other assistive listening devices can improve communication and awareness. Hearing aids amplify sounds, enhance speech and reduce background noise. This can help with navigating to reduce fall rates.

Managing medication to help prevent falls

Check the side effects on any medication you or your loved one is taking and discuss risks with a doctor or pharmacist. They will be able to determine if there are increased risks of instability or imbalance and can therefore advise you accordingly.

Looking after bone health to help prevent falls

Maintaining bone health can also help with reducing the risk of falls and fractures in older people. As we age, bones often become weaker and more fragile, which increases susceptibility to fractures from falls. Here are several ways to promote bone health:

  1. Nutrition
    Consuming a balanced diet that’s rich in calcium and vitamin D helps bone health. Calcium builds and maintains bone density, while vitamin D facilitates calcium absorption. Dairy, leafy greens, fortified foods – which are foods with added nutrients – and supplements can all help boost calcium and vitamin D intake.
  2. Regular exercise
    Weight and resistance exercises can strengthen bones and lead to better balance, reducing fall risk. Activities such as walking, gardening for the elderly, dancing, stair climbing and weightlifting can enhance bone density.
  3. Fall prevention exercises
    Specific exercises that target balance, agility and coordination can help older adults improve stability. As above, tai chi, yoga and balance training programs may improve posture control, enhancing balance and reducing the likelihood of falls.
  4. Medication management
    Some medication, like corticosteroids and certain osteoporosis treatments, may weaken bones. Discuss medication with your elderly healthcare provider to identify potential side effects and, if necessary, alternative options.
  5. Bone density screening
    Regular bone density testing can identify osteoporosis or osteopenia, conditions which involve low bone mass and increased fracture risk. Early detection can mean a timely intervention and treatment that could prevent further bone loss and reduce the risk of fractures.

How to adapt the home to prevent falls

Whether you’re living with elderly parents or they live alone, there are steps that can be taken to prevent falls by adapting the environment to reduce potential hazards and create a safer living space. Here are some common environmental hazards and solutions to consider:

Trip hazards

Consider hazards like loose rugs, electrical cords, clutter and uneven flooring. All these things can increase the risk of tripping and causing serious injuries. Try securing or removing a loose rug or investing in a rug grip. You can tape down electrical cords along skirting boards and decluttering areas where people are moving about can also help. It’s also practical to repair or replace any uneven flooring.

Poor lighting

Watch out for hazards such as dim lighting in hallways, staircases, bathrooms and other areas that could make it difficult to spot obstacles and navigate safely. It’s best to install bright, even lighting fixtures, especially in areas where you or your loved one move about more such as hallways and staircases. Use motion activated lights or nightlights to illuminate pathways during night time hours. Ensure light switches are easily accessible at room entrances.

Slippery surfaces

Wet or slippery surfaces in bathrooms, kitchens and entryways increase the risk of slips and falls. Use non slip mats or rugs in bathrooms, showers and kitchen areas. Clean up spills immediately and use anti slip treatments on floors.

Stairs

Steep stairs, inadequate lighting and a lack of handrails can all mean navigating stairs is extra risky. If possible, opt for stairs with a gradual incline and if not, at least ensure sufficient tread depths are in place. Install handrails on both sides of the stairs. Contrasting colours on steps, such as stickers, could improve visibility.

Lack of handrails

Does your home have handrails or grab bars along staircases, bathrooms and near entryways? Handrails on both sides of a staircase and grab bars near toilets, baths and showers can assist with balance and mobility. Ensure they’re securely mounted and can support body weight.

Inadequate bathroom safety features

Slippery floors, low toilet seats and lack of support in bathrooms all increase fall risk, especially for older people and those with mobility issues. Install a raised toilet seat or grab bars near the toilet to facilitate safe transfers. You could also consider installing a walk in shower or bath with a low threshold for easier access.

Poorly organised storage

Overhead storage, cluttered shelves and poorly organised cupboards pose risks of falling objects and obstacles. Rearrange storage areas to keep frequently used items within reach and at waist level. Secure heavy or breakable items on lower shelves. You could try and use organisers, bins and shelving units to maintain a clutter free environment.

Uneven outdoor surfaces

Uneven paving, steps and driveways all increase the risk of trips and falls when entering or leaving your home. Repair or replace damaged paths and steps to ensure even surfaces. Install handrails along outdoor stairs and ramps for support. Keep outdoor pathways well lit and free from debris and vegetation.

What can you do about a fear of falling?

A fear of falling is a common concern among older adults. A survey by Age UK found that 4.3 million older people worry about falling over, with 36% of those surveyed saying it was their main concern.6 Fear can lead to heightened anxiety and apprehension. It can start due to experiences with previous falls, a sense of losing balance and mobility, or worries about getting injured and losing independence. As a result, fear of falling can significantly impact quality of life, restricting what someone does each day, isolating them and decreasing physical and functional abilities.

The way in which a fear of falling manifests varies from person to person. Often, it could involve feeling uneasy, worrying a lot or being increasingly vulnerable. Some older adults may avoid certain activities or environments they think are riskier, such as climbing the stairs, walking on uneven surfaces or going outdoors. Others may experience more physiological symptoms such as an increased heart rate, sweating or muscle tension in response to situations that trigger fear of falling. There are some relaxation techniques to help prevent falls.

How and why does relaxation help to prevent falls?

According to NHS Inform, learning to control anxiety is one way of helping to prevent falls by reducing fear and increasing confidence. Unfortunately, stress and anxiety can lead to physical tension in the body and impair cognitive function, decreasing balance and increasing fall risk. Relaxation can reduce stress and anxiety levels. Importantly, poor sleep quality is also associated with increased fall risk due to fatigue, cognitive impairment and diminished motor ability. Relaxation can improve sleep quality, thereby enhancing overall physical and mental wellbeing. Here are some ideas for relaxation:

  1. Progressive Muscle Relaxation (PMR)
    PMR involves tensing and relaxing different muscle groups to release tension and promote relaxation. Older people can practice PMR to reduce muscle stiffness, improve their flexibility and enhance awareness of their body.
  2. Deep breathing
    Deep breathing exercises focus on rhythmic, slow breathing patterns to relax and calm the nervous system. Diaphragmatic breathing and guided breathing techniques may help reduce stress and anxiety, thereby lowering fall risk.
  3. Mindfulness meditation
    Mindfulness meditation involves cultivating present moment awareness and non-judgemental acceptance of thoughts, emotions and bodily sensations. By practicing mindfulness, older individuals can improve concentration, balance and emotional resilience, reducing the likelihood of falls.
  4. Yoga & tai chi
    Yoga and tai chi combine gentle movements, breathwork and mindfulness practices to promote relaxation, balance and flexibility. These mind-body exercises are particularly beneficial for improving proprioception, coordination and muscle strength, reducing fall risk in older adults.
  5. Guided imagery & visualisation
    Guided imagery involves mentally picturing peaceful and calming scenes or memories to evoke relaxation and reduce stress. By engaging in guided imagery exercises, some older individuals can enhance relaxation, manage anxiety and improve their overall wellbeing.

You can explore specific relaxation exercises to help prevent falls on the NHS Inform website here.

How can Home Care help to prevent falls in older people?

Home Care services, such as the ones provided by Alina Homecare, can play a crucial role in preventing falls in older people by mitigating risk factors, promoting safety and providing support to maintain independence. Here are several ways Home Care can help you or your loved one:

  1. Assessment & evaluation
    Home Care providers should conduct a comprehensive fall risk assessment to identify a client’s risk factors such as muscle weakness, balance impairments, medication side effects and environmental hazards. If you enquire with Alina Homecare, we begin by conducting free no obligation home visits where we meet with you to assess your needs and abilities. By evaluating the home, we can then develop a personalised care plan, including a fall prevention plan, tailored to your specific needs.
  2. Medication management
    Home Care companies often assist older people with medication management, including transporting people to appointments, and communication with other healthcare professionals. By ensuring that medications are taken as prescribed, a Home Care provider can thereby help reduce risk of falls related to medication use. With Alina Homecare, our digital care monitoring app. automates these medication reminders to ensure things stay on track.
  3. Mobility assistance
    Home Care can include mobility care and support with general activities of daily living to older adults who may have difficulty moving around their homes. This may include assistance with getting in and out of bed, walking, using mobility aids such as walkers or canes and practicing safe techniques for navigating stairs and uneven surfaces. If you need additional support, you may want to consider Overnight Care where a Carer stays in the home overnight to offer support and reassurance.
  4. Exercise & rehabilitation
    Home Care companies can offer support with exercise programs and rehabilitation services that have been recommended by healthcare professionals to improve strength, balance and flexibility in older adults. Our Carers can assist with prescribed exercises, monitoring progress and encouraging participation in physical activity to reduce fall risk and improve overall mobility and function.
  5. Continuous monitoring & support
    When you choose Home Care, look for a provider that can give you or your loved one access to ongoing monitoring and support to identify changes in health status, mobility or fall risk factors. Our Carers update our digital care monitoring app. with each home visit so a client’s loved ones can keep track of their mood and behaviour once consent is granted. It’s all about your peace of mind.
Falls prevention for elderly people infographic

References

1. GOV.UK, “Falls: applying All Our Health“, Reviewed 19 March 2024
2. See above
3. UKHSA, “Cost of Falls“, Reviewed 19 March 2024
4. Andrea Iaboni, M.D., D.Phil., F.R.C.P.C. and Alastair J. Flint, M.B., F.R.C.P.C., F.R.A.N.Z.C.P., “The Complex Interplay of Depression and Falls in Older Adults: A Clinical Review“, Reviewed 19 March 2024
5. NHS Inform, “Keeping Active to Prevent Falls“, Reviewed 19 March 2024
6. Age UK, “Falls in later life: a huge concern for older people“, Reviewed 19 March 2024