How (and why) you should try to prevent falls

Did you know falls are the number one reason older people are taken into A&E, but are quite often preventable?

We hear a lot about the dangers of strokes and heart attacks in older people. But, as your parent or relative starts ‘coming of age’, it is crucially important to understand about the risks and dangers of falls, and to help make concerted efforts to prevent them.

Falling in older age is a really common problem. Approximately a third of people over 65 and half of people over 80 will have a fall at least once a year – with fall rates even higher for those living in care homes. Most falls happen during normal activities, like walking, getting up from a chair or performing basic daily chores. Even older people who seem to be strong and healthy can fall.

If your parent has already experienced a fall, it is highly likely that they will have another. That’s why it is so important to find out the cause of the fall and take action to prevent them from falling. While you can’t prevent all falls, you can decrease the risk of falling so that your parent or relative falls less, or at least falls with less chance of getting a serious injury. 

Read on to learn more about falls in old age, and what you can do to help reduce your parent or elderly relative’s risk of falls and protect them from injury.

Note: If you’re parent older relative has a fall, they should seek medical attention and get an assessment — especially if they hit their head or it’s their first major fall. It’s important to determine the cause of the fall, in case there is an underlying disease.

Why do you need to learn about falls?

You might think that falls are just an inevitable part of old age, and not have thought much about them. But falls can have truly devastating consequences, and should be taken seriously.

As well as causing immediate distress and pain, and potentially major injuries such as hip fractures, here are some facts about the impact of falls in older people that may surprise you:

• Falling is the most common cause of death from injury in people over the age of 75
• Around a third of people over 50 who fracture their hip die within one year
• A fifth of of older people who fracture their hip will go into long-term care in the first year following a fracture

Even if your parent or elder relative is physically unharmed from a fall, the shock and experience of the fall can have a lasting mental and emotional impact that can accelerate a decline in their health.

Older people commonly lose confidence in the aftermath of a fall, and the fear of falling again causes them to restrict their lives, decrease their social and physical activity and become more sedentary. Some people also start to drink less fluid, because they are scared of having to get up in the night to pee and falling on their way to the bathroom. Unfortunately, this all leads to a negative cycle of further physical and mental decline which, rather than preventing, actually increases the risk of falls.  

What do older people fall so much?

Falling is complicated by the fact that there are a range of risks and reasons that can cause an older person to fall, and often older people fall due to more than one reason.

But if you understand the reasons why older people fall and what the risk factors are, you can make changes or put practical measures in place to help prevent your parent or older relative from falling, and protect them from injury.

Here are some of the main reasons why older people have a higher risk of falling:

• Decreased physical activity – As older people tend to slow down and become less physically active, they become less flexible, lose muscle and bone mass, and have problems with balance and coordination. This makes them weaker and more unsteady on their feet which not only increases their likelihood of falling, but also heightens their risk of being more seriously injured from a fall.  Being less physically active and staying indoors more also reduces exposure to the sun, meaning the body produces less vitamin D – a vitamin that is essential for keeping our bones strong. Vitamin D deficiency is common in older people.
• Taking multiple medications – Studies show that older people are more likely to fall if they take four or more medications, and many older people take more than five. Certain medications have side effects or interact with each other causing drowsiness, dizziness and low blood pressure, which can affect balance. These include medicines for depression and anxiety, sleeping problems, diabetes, and heart conditions.
• Poor vision – Poor vision approximately doubles the risk of falls in older people and is one of the more frequent reasons that older people fall. Our eyes and vision deteriorate with age, particularly after the age of 60, reducing our sensitivity to contrast and depth perception. This means it is harder to judge the depths of things like stairs or pavements, and tripping risks can blend into the background making them harder to spot. Age-related eye problems include normal changes like presbyopia (the reason we need reading glasses as we get older) and cataracts, as well as more serious eye diseases like glaucoma, macular degeneration and diabetic retinopathy. 
• Poor hearing – There is growing evidence that hearing loss contributes to falls. Balance and hearing are directly connected, sharing a common nerve pathway to the brain. One study in people aged 40 – 69 found that even mild hearing can triple your chance of falling.
• Neurological disorders – As people get old, they become more vulnerable to disorders of the brain and nervous system, such as Parkinson’s Disease, Stroke, Alzheimer’s and other forms of dementia. These diseases can cause what are known as ‘motor’ symptoms such as tremor, stiffness and slowness of movement which affect mobility and balance, increasing the risk of falling.
• Bone and joint conditions – The damage caused to knees and hips from joint conditions like arthritis can interfere with balance and mobility, increasing the risk for a fall while bone diseases like osteoporosis weaken bones which raises the risk of fracture. 
• Urinary incontinence – Older people often suffer from some sort of urinary incontinence and can’t always sleep through the night without waking up to pee. Urinary incontinence can cause people to rush to the bathroom, which is particularly hazardous in the night when it is harder to see.
• Low blood pressure (hypotension) – Although low blood pressure can lower the risk of heart disease or stroke, it can sometimes mean that not enough blood is flowing to the brain which causes people to feel light-headed, dizzy, weak and unsteady. This is particularly an issue when an older person stands up quickly from sitting or lying down (postural hypotension) causing a big drop in blood pressure.
• Foot pain – Foot pain, numbness (neuropathy) in the legs and feet, and inadequate footwear contribute to many falls in older people.
• Dehydration – Dehydration (not enough water in the body) is common in older people, and often a contributing cause when an older person has a fall. This is because dehydration can cause low blood pressure (hypotension), weakness and dizziness, all of which can increase the risk of falls.  
• Drinking alcohol – It’s common knowledge that getting drunk can make people stumble and fall over, but even drinking small amounts of alcohol can increase the risk of falling in older people. The part of your brain that controls coordination is very sensitive to alcohol, and our tolerance to alcohol diminishes with age so you feel the effects more strongly and more quickly. Certain medications can also exacerbate the effects of alcohol on balance and judgement.
• Hazards around the home – Most falls in older people happen at home.  Certain things in the home environment can increase the risk of falls such as wearing ill-fitting slippers, poor lighting, loose rugs and slippery surfaces in the bath or shower.  

How to prevent falls in older people

While falling is common and the causes of falls are complex, falling frequently or having a bad fall doesn’t have to be an inevitable part of ageing. You can help prevent your parent or older relative from falling, and reduce their risk of injury, using some relatively simple measures to modify their home environment, lifestyle and physical health.  

Here are 10 ways to help ‘fall-proof’ your parents:

1. Encourage and help them to exercise – The first and most important prevention measure is regular exercise. The key is to find a form of exercise that they enjoy, and can do safely and consistently. Walking is especially good, as are exercises that focus on gait, strength and balance like Pilates or Tai Chi. There is there is a lot of evidence that Tai Chi can help with falls.
2. Create a safe home environment – Creating a safe home environment by making a few simple adjustments can be one of the most effective ways to prevent a fall.
   • Make sure electrical cords and extension leads are tucked away, and not stretched across walkways
   • Ensure rooms are well lit with sufficient lighting, and consider putting in nightlights in bedrooms and hallways
   • Remove mats and rugs or secure them to the floor with carpet tape or a non-slip underlay
   • Put non-skid mats in the bath and shower, and install grab rails around the bathroom.  An occupational therapist can help with this, and social services can provide some equipment for free if your parent is eligible.
   • Buy your parent some non-slip slippers that have good support and don’t fall off easily
   • If they have stairs in their home, ensure there are handrails on both sides of the stairs
   • Insist that they don’t climb on stools or stepladders, and get someone else to help with any jobs that require this.  
3. Review their medication – Go through your parent’s medications with their doctor and make sure they are all really needed. Sometimes a medication might get prescribed but isn’t needed later on as things change. You or your parent should inform their doctor if any medications make them feel dizzy or drowsy – there may be alternatives.
4. Improve their diet – It’s important that older people get enough calcium, vitamin D and protein in order to maintain healthy muscles and bones. A supplement containing both calcium and vitamin D might be needed if their diet isn’t good and they don’t get out much into the sunshine. Limiting their alcohol intake to two drinks or less a day and making sure they get plenty of fluids to stay hydrated will also help reduce their risk.
5. Regular eye examinations – Schedule yearly eye examinations to check for vision changes, ensure they have the correct glasses prescription and have any vision issues like cataracts corrected with surgery.
6. Get their hearing tested – They should get their hearing tested every two years, or anytime you think their hearing may have deteriorated, and have a hearing aid fitted if necessary. There are many discrete hearing aid options available these days at different price points, and you can get hearing aids for free on the NHS if they get a referral the an NHS audiologist via their GP.
7. Make sure they look after their feet – As well as wearing low-heel, non-slip footwear, it’s important your parents’ feet are kept in good condition. Toenails should be kept short and any painful foot deformities or corns should be treated by a chiropodist or podiatrist. 
8. Encourage them to use a walking aid – Many older people will initially flat out refuse to use a walking stick, thinking it makes them look old and vulnerable.  But if they have already fallen a couple of times and are unsteady, they should use one all the time.  A walking stick is less ageing that a hip fracture!
9. Communicate and be observant – Routinely ask your parent about falls, and look out for changes in their balance and gait. Are they struggling more to stand up from sitting without losing their balance? Do you think they need to have a medical or fall risk assessment?
10. Create a fall action plan – Consider and discuss how your parent would access help if they had a bad fall. If they live alone, how would they get help? Who else has a key and can get into the home easily? Would they be open to wearing a personal alarm linked to a fall-response service?

In summary

Falls and fall risks in old age should not be underestimated.  If your parent or elder relative has already had a fall, chances are it will happen again.

If you want to avoid your parent or elder relative having a nasty fall and ending up in A&E, you and they need to be proactive about fall prevention. The good news is that falls don’t have to be inevitable, and there are plenty of ways you can help to reduce your parent or elder relative’s risk of falls. Not only can taking these measures safeguard them against immediate injuries from falls, they can also help reduce their fear of falling, allowing them to lead more active and fulfilling lives.

If you think they are at risk of falls, or you’ve noticed changes in their balance, you or they should contact their GP to check for underlying causes and get a falls risk assessment. The earlier you intervene the better.

Common questions

• What causes frequent falls in the elderly?

Frequent falls in the elderly often stem from a combination of factors such as muscle weakness, balance issues, medication side effects, and environmental hazards. However, frequent falls can also signify an underlying neurological condition. If an elderly person you know is frequently falling, you should arrange a consultation with their GP for a thorough assessment and referral to a specialist if needed.

• What should you do after an elderly person falls?

If an elderly person falls, assess the situation for injuries and call emergency services if needed. If they aren’t hurt and feel strong enough to get up, remove any hazards in the area and assist them up gently. Monitor for signs of confusion, pain or swelling, and seek medical attention if you have any concerns. Keep a record of the incident, and consult healthcare professionals when in doubt.

• Can elderly people get grab rails installed for free in the UK?

Yes. If an elderly person is at risk of falls or has mobility issues, social services will carry out a home assessment, and can provide and install grab rails for free (funded by the council).  You can arrange for a home assessment by contacting their local council.

• How do you get someone a falls assessment?

To get someone a falls assessment, first make an appointment with their GP surgery. A GP can evaluate their risk factors, medical history, and conduct a physical examination to assess their balance and mobility. If needed, their GP might refer them directly to a community falls clinic (or other hospital clinic) for more detailed assessment by a specialist, such as a physical therapist or an occupational therapist.