How To Prevent Falls in Older People

Amelia Murphy, National Center for Health Research

Trip Warning Sign

The leading cause of injuries in older adults is falling.[1] Falls can lead to loss of independence, early admission into long-term care facilities, disability, and even death. In fact, falls are the leading cause of fatal injuries in older adults.

We often hear about ways to prevent heart disease, cancer, osteoporosis, or viral infections, but what about preventing something as simple as falling? One out of every three people 65 years and older fall each year, and once they’ve fallen, they’re two to three times more likely to fall again.[2]

It is ironic that millions of women take medication or dietary supplements to prevent bone fractures when the safest, most effective  way to prevent broken bones is to prevent falling. Falls can cause fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.  Even when bones aren’t broken, falls can result in a trip to the emergency room. In 2012, 2.4 million older adults went to the ER due to a fall, and over 722,000 of those patients were hospitalized. Overall, these falls cost $30 billion in 2012—and that’s just in medical costs. About 22,900 older adults died in 2011 from injuries due to falling.[1]

Unfortunately, as our population ages, this problem isn’t going away.

Many older adults are not aware they are at risk of falling until it happens. Little by little, it gets harder to pick up their feet or balance on one leg. These gradual changes are hard to notice until the person falls. It doesn’t help that threats—objects that can trip us up or make us lose our footing—are all around us in everyday life, such as stairs, throw rugs, slippery bathtubs, concrete curbs in parking lots, tree roots, and even pets.[3]

Besides conditions in their homes and communities, older adults’ medications can increase the risk of falling. For example, drugs for high blood pressure, depression, and anxiety can cause dizziness, confusion, and poor concentration, which can result in falls. Atypical antipsychotic medications are too often given in nursing homes, and can be especially harmful. Medication given to help people sleep better often still cause drowsiness the next morning, and that increases the risk of falling.

How Can We Fix This Problem?

We can start by lowering the chances of a fall happening just as we would with any other risk to our health and wellbeing, such as washing our hands to prevent a cold or wearing a helmet to prevent injury while biking.

Things you can change around the house:

  • This is the easiest one: Get rid of throw rugs and make sure your carpet is even
  • Make sure your furniture would not topple if grabbed for support (if it does, bolt it to the wall)
  • Improve lighting (Aging eyes might need better light and also need nightlights )
  • Install grab bars where they might be needed (near toilets and showers)
  • Wear an electronic pendent with a button to push to call for help

If you check out long-term care facilities, you will see some of the safeguards that can help. To better understand how an older person might see, architects and designers walk around with tinted, blurry glasses. Some of their ideas include installing floor lighting, like the kind used in the aisles of airplanes, to highlight the pathway to the bathroom. They have also tried painting the shower edge or the edge of the stairs a contrasting color to make these areas more visible.

Steps an individual can take to decrease their risk of falling:

  1. Improve balance and strength
    • Take regular exercise classes that include moves or postures that require balance, such as yoga or Tai chi. These forms of exercise involve slow deliberate movements along with breathing and muscle activity, which improves balance.
    • Integrate balance and strength practice into everyday life. For example: stand on one foot while brushing your teeth, or stand with one foot in front of the other.
  2. Maintain health
    • Drink water! Dehydration can cause dizziness.
    • Eat foods with VitaminD to increase muscle strength.[4]
    • Get screened for osteoporosis (a condition where bones get weak or brittle) but only get treated if necessary – these medications have risks and only modest benefits.
    • Have your eyes checked yearly.
  3. Wear the right glasses
    • Bifocal and progressive lenses make falling more likely, so wear single vision glasses when needed for safe walking.[5]
  4. Reduce your drug dosage, or eliminate unnecessary ones
    • Hypertension drugs can lead to a higher risk of falls with uncertain benefits for the heart for older people.[6]
    • Avoid sleeping pills and anti-anxiety medication that can reduce concentration and instead try warm milk, hot chamomile tea, or listen to soft music to relax.
  5. Focus on your mindset
    • Many people develop a fear of falling after they’ve fallen. Although caution is helpful, fear can cause older people to limit their activities, which leads to less movement, loss of physical fitness, and can eventually increase their risk of falling.[1]
    • People may resist the transition to a cane or walker, but using these aids can prevent problems down the road.

The Bottom Line

Preventing falls can save lives and improve the quality of life for millions of people. The good news is that while falls are dangerous, there are ways to prevent them. Better yet, researchers have started a five-year, $30 million study to figure out the most effective ways of preventing falls in older people living on their own. This is the largest study of its kind, and it is funded by the Patient-Centered Outcomes Research Institute (a nonprofit organization) and the National Institute on Aging.[7] Once the results of this study are released, we may have even better tips for preventing falls in the home. Meanwhile, focus on maintaining your balance and health, and work to make your home as safe as possible.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

  1. Centers for Disease Control and Prevention. Falls Among Older Adults: An Overview. September 22, 2014. http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
  2. Centers for Disease Control and Prevention. Preventing Falls: What Works. 2008. http://www.cdc.gov/homeandrecreationalsafety/images/cdccompendium_030508-a.pdf https://www.cdc.gov/homeandrecreationalsafety/pdf/cdc_falls_compendium_lowres.pdf
  3. Hafner, K. “A Tiny Stumble, a Life Upended.” The New York Times. November 3, 2014. http://www.nytimes.com/2014/11/04/science/a-tiny-stumble-a-life-upended.html
  4. Grimaldi AS, Parker BA, Capizzi, JA, Clarkson PM, Pescatello LS, White MC, Thomspson PD. “25(OH) vitamin D is associated with greater muscle strength in healthy men and women.” Med Sci Sports Exerc. 2013; Jan 45(1):157-62.
  5. “Poor vision and falls.” Editorial. BMJ. 2010; 340:c2456.
  6. Tinetti ME, Han L, Lee DSH, McAvay GJ, Peduzzi P, Gross CP, Zhou B, Lin H. “Antihypertensive Medications and Serious Fall Injuries in a Nationally Representative Sample of Older Adults.” JAMA Intern Med. 2014; 174(4):588-595.
  7. Shalender Bhasin, MD Thomas Gill, MD David B. Reuben, MD. “Randomized Trial of a Multifactorial Fall Injury Prevention Strategy: A joint initiative of PCORI and the National Institute on Aging of the National Institutes of Health.” 2014. http://www.pcori.org/research-results/2014/randomized-trial-multifactorial-fall-injury-prevention-strategy-joint