Preventing falls in older age: reducing the risk at home and in a care home

Why older people fall

NI Direct, the Northern Ireland government's information service, says falls are the most common cause of injury-related deaths in the UK among people over 75. Ageing raises the risk, and several things add to it:

• Balance problems, muscle weakness and poor vision.
• Long-term conditions such as heart disease, dementia and low blood pressure, which can cause dizziness or brief loss of consciousness.
• Hazards such as wet or freshly polished floors, dim lighting, loose rugs or carpets, reaching for high storage, stairs and rushing to the toilet.
• Osteoporosis, which makes injuries more likely. The risk is higher with smoking, heavy drinking, steroid use or a family history of hip fractures.

Practical ways to reduce the risk

• Exercise: exercises that build strength and balance can reduce the risk. The WHO says older adults with poor mobility should do activity to improve balance and prevent falls on three or more days a week. See staying active in later life.
• Home hazards: use non-slip bathroom mats, clean up spills promptly, clear clutter and keep all areas well lit. Get help with heavy items.
• Vision: have a sight test if there are vision problems, even if the person already wears glasses.
• Medicines: ask a doctor to review medicines, since side effects can increase the risk of falls. See managing medicines in a care home.

In the UK, NI Direct says a GP can arrange a home hazard assessment. In other countries, ask the local health authority or social services whether a similar service exists.

What to do after a fall

If the person is not hurt

NI Direct advises staying calm and not getting up quickly. Roll onto the hands and knees, use a stable piece of furniture to pull up slowly, and rest before carrying on.

If the person is hurt or cannot get up

Attract attention by calling out, banging on a wall or floor, or using an alarm call button. If possible, crawl to a phone and call emergency services. Cover yourself with a blanket, especially the legs and feet, and change position at least every half hour or so.

What to ask a care home

These are our suggested questions, based on the risks and prevention steps above:

• How do you assess each resident's risk of falling when they arrive, and how often do you review it?
• Are floors, lighting, bathrooms and corridors set up to reduce hazards?
• Do you offer strength and balance activities, and who leads them?
• How do you help residents who need to go to the toilet urgently, especially at night?
• What happens after a fall: who checks the resident, who is told, and how do you learn from it?
• Are residents' medicines and eyesight checked regularly?

For more on what to look for on a visit, see our care home visit checklist.

Frequently asked questions

Can falls really be prevented?

Not every fall, but many risk factors can be reduced. NI Direct points to exercise for strength and balance, safer homes, sight tests and medicine reviews.

Should an older person who has fallen be moved to a care home?

Not necessarily. A fall is a reason to look at the causes and the home setup first. A care home may be right if falls keep happening or support is needed day and night. See home care or care home?.

What should a person do if they fall and cannot get up?

NI Direct advises attracting attention, using an alarm if there is one, calling emergency services if possible, keeping warm with a blanket and changing position at least every half hour or so.

Sources and further reading

• NI Direct: Falls
• WHO: Physical activity (ageing)

Related guides

• Staying active in later life: movement and balance in a care home
• Managing medicines in a care home: what a good system looks like
• Mouth, sight and hearing care: everyday health checks that are easy to miss
• Home care or a care home? How to decide