Preventing Falls in Older Adults: Balance, Home and Habits

Train balance and strength

Programmes that mix leg strengthening and balance, such as the Otago exercises, tai chi or a physiotherapist's plan, reduce falls significantly.

Check the home

Remove loose rugs and clutter, add night lights, install grab bars in the bathroom and handrails on both sides of stairs, and wear shoes with firm soles at home.

Check the body

Have your eyes tested every year, review medicines with a doctor or pharmacist, since some cause dizziness, and get any foot pain looked at.

If you fall

Stay calm and check for injury. If you cannot get up, call for help. Tell your doctor afterwards, even if you feel fine.

Footwear and clothing

Wear shoes that fit well, with a firm, low heel, a non-slip sole, and a secure fastening. Avoid backless slippers, high heels, worn soles and walking in socks on smooth floors. At night, keep slippers or shoes by the bed. Avoid long, loose clothes that can trip you. Make sure glasses are clean and correct. If your feet are painful, see a podiatrist. Good footwear is an easy, inexpensive fall prevention measure.

Check the soles regularly for wear.

Alcohol, hydration and nutrition

Alcohol impairs balance and judgement and interacts with medicines; keep it low or avoid it. Dehydration lowers blood pressure and causes dizziness, so drink enough. Poor nutrition weakens muscles and bones; eat enough protein, calcium and vitamin D. Treat anaemia and other deficiencies. Small changes in diet and hydration contribute to steadier legs.

Everything is connected to balance.

Bathrooms, stairs and night-time safety

Many falls occur in the bathroom and at night. Fit grab bars by the toilet and shower, use a non-slip mat and shower seat, and keep the floor dry. Place a night light along the route from bed to bathroom. Keep a commode or urinal by the bed if needed. Sit on the bed edge for a minute before standing to avoid dizziness.

On stairs, use the handrail, take your time and keep both hands free. Do not carry heavy items.

Plan ahead for night-time trips so that you do not have to rush.

Why older people fall

Falls rarely have one cause. Weak legs, poor balance, slow reflexes, poor vision, hearing loss, low blood pressure on standing, foot pain, urinary urgency at night, medicines that cause dizziness, alcohol, cluttered homes and unsafe footwear all add up. Fear of falling can make things worse by reducing activity and strength. The more risk factors a person has, the higher the chance of a fall, so addressing several at once gives the best protection.

Falls are a leading cause of injury and injury-related death in older adults worldwide. A hip fracture can change independence for good, so prevention is worth real effort.

Exercise that really reduces falls

A Cochrane review of 108 trials found that exercise programmes reduce the rate of falls by about a quarter, with balance and functional exercises, and programmes including tai chi, showing the strongest effects. Effective programmes challenge balance, such as standing with feet close together, tandem stance, heel-to-toe walking, sit-to-stand and stepping over objects. The Otago Exercise Programme, delivered by physiotherapists at home, is well studied. Aim for at least three hours a week of challenging balance exercise over time, building gradually and supported by a chair or counter.

A room-by-room home safety check

Entrance: good lighting, a handrail, a non-slip mat. Living room: clear walkways, firm chairs with arms, no trailing cables. Kitchen: items within easy reach, non-slip floor, a stable step-stool. Bathroom: grab bars, non-slip mat or tiles, a shower seat, a raised toilet seat. Bedroom: bedside light, bed at knee height, clear path to the bathroom with a night light. Stairs: handrails on both sides, bright edges, good light. Outdoors: even paths, repaired steps. Shoes: well-fitted, firm-soled and non-slip; avoid walking in socks or loose slippers.

Medicines, vision and feet

Several medicines raise fall risk: sleeping tablets, sedatives, some antidepressants, antipsychotics, strong pain medicines and some blood pressure drugs that cause dizziness on standing. Ask your doctor or pharmacist to review them. Have your eyes tested yearly and update glasses; consider single-vision glasses for walking outdoors. Care for your feet: trim nails, treat corns and wear supportive shoes. Numb or painful feet need a podiatrist's attention.

Getting up from the floor, and building confidence

Learn how to get up safely: roll onto your side, push up to hands and knees, crawl to a sturdy chair, kneel with one foot forward and push up. Practise with a physiotherapist. Fear of falling is real; talk about it, and keep active in small steps. Tai chi, dance and group classes build balance and confidence. A personal alarm gives reassurance if you live alone.