Falls in Older Adults

What to do after a fall

If you fall:

1. Stay still for a moment and take a few breaths. Check yourself for pain or injury.
2. If you are hurt or cannot get up, call for help using a phone, alert pendant or by shouting. Keep warm with anything nearby and change position gently if you can to protect your skin.
3. If you are not hurt, roll onto your side, get onto your hands and knees, crawl to a sturdy chair, and slowly push yourself up, sitting before standing.
4. Tell your doctor about the fall, even if you were not injured.

If someone else falls:

• Do not rush to lift them. Check if they are responsive, breathing and in pain.
• Call 911 for head injuries, suspected fractures, unconsciousness or if they cannot get up.
• Keep them warm and comfortable until help arrives.

Why older adults fall

Falls are rarely caused by a single factor. Risk rises with each additional factor.

Factors within the person

• Muscle weakness, especially in the legs, and sarcopenia (age-related muscle loss)
• Balance and walking problems from aging, arthritis, stroke, neuropathy or Parkinson's disease
• Orthostatic hypotension: a drop in blood pressure on standing, causing dizziness
• Vision problems: cataracts, glaucoma, macular degeneration, and bifocal or varifocal glasses on stairs
• Cognitive impairment and dementia
• Foot problems and poorly fitting shoes
• Urinary urgency and incontinence, leading to rushing to the bathroom at night
• Heart rhythm problems and fainting
• Acute illness: infections, dehydration and delirium
• Fear of falling, which leads to reduced activity and weakness

Medicines

Medicines are one of the most modifiable risk factors. Polypharmacy, taking 4 or more medicines, increases risk. Higher-risk medicines include:

• sleeping pills, benzodiazepines and sedating antihistamines
• antidepressants and antipsychotics
• opioids
• blood pressure medicines and diuretics, especially when doses are changed
• diabetes medicines that can cause low blood sugar

Environmental factors

• Loose rugs, clutter, cords and slippery floors
• Poor lighting, especially at night
• No grab bars in the bathroom
• Stairs without handrails
• Icy or uneven outdoor surfaces

Consequences of falls

• Fractures: more than 95% of hip fractures are caused by falls, usually falling sideways. Wrist, spine, pelvis and upper arm fractures are also common. Osteoporosis makes fractures more likely
• Head injuries, including bleeding in the brain, especially with blood thinners
• "Long lie": lying on the floor for hours, causing dehydration, pressure sores, pneumonia and muscle breakdown
• Loss of confidence, reduced activity and social isolation
• Loss of independence and moving into care

Fall risk assessment

The CDC STEADI approach asks every older adult yearly:

• Have you fallen in the past year?
• Do you feel unsteady when standing or walking?
• Do you worry about falling?

A "yes" leads to a fuller assessment, which may include:

• Timed Up and Go test: time to rise from a chair, walk 10 feet (3 m), turn and sit. Over 12 seconds suggests increased risk
• 30-second chair stand test for leg strength
• 4-stage balance test
• Blood pressure lying and standing
• Medication review
• Vision check, foot exam and cognitive screening
• Home safety review
• Bone health assessment and vitamin D levels

Preventing falls

Exercise

Exercise programs that combine balance and strength training reduce falls by about 20 to 25%. Examples include tai chi, the Otago program and supervised physical therapy. Aim for balance and strength activities at least 3 times a week, building up gradually.

Medicine review

Ask your doctor or pharmacist to review all medicines, including over-the-counter sleep aids, and reduce or stop those that increase fall risk where possible.

Vision and feet

• Have an eye exam yearly, and consider cataract surgery when advised
• Use single-vision distance glasses for walking outdoors
• Wear well-fitting, low-heeled shoes with non-slip soles
• See a podiatrist for foot pain or deformities

Home safety

• Remove trip hazards and secure rugs
• Install grab bars in the bathroom and handrails on both sides of stairs
• Use night lights between the bedroom and bathroom
• Keep frequently used items within easy reach
• Use a non-slip mat in the shower

Other measures

• Stand up slowly, sitting on the edge of the bed for a moment first
• Use walking aids prescribed by a physical therapist
• Treat vitamin D deficiency. Routine high-dose vitamin D for everyone is not recommended
• Treat osteoporosis to reduce fracture risk
• Consider a personal alarm if you live alone
• Limit alcohol

Frequently asked questions

What is the most common cause of falls in older adults?

Most falls have several causes together. The most common contributors are leg muscle weakness, balance and walking problems, medicines that cause dizziness or drowsiness, low blood pressure on standing, poor vision and hazards at home.

What should an elderly person do after a fall?

Stay still and check for injuries. If hurt or unable to get up, call for help and keep warm. If uninjured, roll to the side, crawl to a sturdy chair and rise slowly. Always tell a doctor about the fall, even without injury.

How can falls in the elderly be prevented?

Regular strength and balance exercise, such as tai chi, is the most effective step. A medicine review, yearly eye checks, good footwear, removing home hazards, installing grab bars and treating low blood pressure on standing all reduce risk.

Why are falls so dangerous for older people?

Older adults are more likely to break bones because of osteoporosis, to have bleeding in the brain especially if on blood thinners, and to lose confidence and independence after a fall. Lying on the floor for a long time can also cause serious complications.

When should you go to the hospital after a fall?

Go to the hospital after a head injury, especially with blood thinners, confusion, vomiting or headache, if you cannot bear weight or get up, if you have severe pain or deformity, or if the fall followed fainting, chest pain or sudden weakness.