Why Lying on the Floor After a Fall Is Dangerous

What is a long lie?

A long lie is the time a person spends on the floor after a fall without being able to get up or call for help. Studies of older adults who fall have found that a substantial share are unable to get up on their own, and that a significant number remain on the floor for an hour or more. The risk is highest for those who live alone, have no way to call for help within reach, have weak muscles, have dementia or have injuries.

What happens to the body

Pressure damage to skin and muscle. Lying on a hard floor presses on the skin and muscle over bony areas such as the hips, tailbone, shoulder and heels. After a few hours the tissue can begin to break down, particularly in frail skin; see preventing bedsores at home.

Muscle breakdown (rhabdomyolysis). Prolonged pressure or immobility can cause muscle cells to break down and release substances into the blood, which can harm the kidneys. It is more likely after many hours, and shows as dark urine, muscle pain and weakness. It needs urgent medical attention.

Dehydration. A person who cannot reach water becomes dehydrated, which affects the kidneys, blood pressure and thinking; see hydration for older adults.

Hypothermia or heat injury. Lying on a cold floor in winter or a hot room in summer can lead to a dangerous drop or rise in body temperature, particularly in older people who regulate temperature poorly; see cold weather health risks for seniors and heat stroke and dehydration in seniors.

Pneumonia and chest problems. Lying still on the floor can lead to shallow breathing and infection, especially if the person cannot cough or reposition.

Untreated injuries. A fracture, a head bleed or internal injury can worsen while waiting. A broken hip left unattended is painful and delays surgery, which affects recovery; see hip fracture recovery at home.

Pain, cold and exhaustion.

Incontinence and distress. A person who cannot reach a toilet may soil themselves, with embarrassment and skin damage.

Fear and loss of confidence. The psychological impact can be profound. People who have lain helpless for hours often become afraid to walk or stay alone, restrict their activities and become weaker, which raises the risk of another fall.

Hospital admission and decline. Studies report that a long lie is associated with a higher chance of hospital admission, longer stays, loss of mobility and, in some studies, higher mortality in the following months. Some of this is due to the underlying frailty rather than the lie alone, but prompt help clearly reduces harm.

Who is at highest risk

• People who live alone or are left alone for long periods.
• Those with dementia or confusion, who may not call for help or understand the situation.
• People with weak muscles, severe arthritis or neurological conditions, who cannot rise.
• People on blood thinners, at risk of bleeding.
• Those with diabetes, heart disease or a history of strokes.
• People with hearing or vision problems, or a language barrier.
• Those who fall at night, when nobody is awake.
• Those with a history of previous falls.
• People who have no phone, pendant or alarm within reach, or a phone left on a table across the room.

Preventing a long lie

You cannot prevent every fall, but you can reduce the time spent on the floor.

1. A way to call for help that is on the body. A pendant or wrist alarm worn all day, not left on a shelf; see panic pendant buying guide and fall detection watch guide. Automatic detection may help if the person cannot press the button, but it can miss falls; see fall detection and false alarms.

2. Call points at floor level. Wall buttons or pull cords in the bathroom, bedroom and toilet, reachable from the floor; see calling for help from the bathroom. A phone in a pocket or on a low table.

3. A regular check-in routine. A daily phone call, message or visit at a fixed time, with a plan if there is no answer. A neighbour who sees the curtains opened each morning. See home safety for seniors living alone.

4. Sensors, with consent. Door, bed or motion sensors that alert a family member to unusual inactivity, such as no movement in the morning; see door sensor guide and privacy and dignity with monitoring.

5. Entry for helpers. A key safe, a neighbour with a key, or a door that can be opened from outside; see lock and door safety for seniors.

6. Knowing how to get up, or how to stay safe on the floor: practise with a physiotherapist; see how to get up after a fall.

7. Preventing the fall itself. Fix hazards, review medicines, improve balance and strength; see falls risk assessment at home and balance exercises for seniors.

If you are on the floor and cannot get up

Tell your parent, in advance, what to do:

1. Stay calm. Take a few slow breaths. 2. Check for injury gently. Do not try to get up if in severe pain or if you suspect a break. 3. Call for help: press the pendant, shout, bang on the wall or floor, use a phone if within reach, and call 112. 4. Keep warm: pull a blanket, a rug, a towel, clothing or a cushion over you if within reach. 5. Change position every so often if you can, rolling onto the side or moving the arms and legs, to relieve pressure. 6. Try to reach a phone or a chair, only if it is safe and you are not injured. 7. Make noise at intervals, not constantly: call out, tap or ring. 8. Do not give up. Help will come.

If you find someone on the floor

Follow what to do after a fall: check responsiveness, breathing, bleeding and signs of injury, call 112 if there is any serious concern, keep the person warm and do not lift them quickly. After a long lie, even if the person says they are fine, a medical check is advisable, because complications such as dehydration, muscle breakdown, pressure damage, hypothermia and hidden fractures may not be obvious. Tell the doctor how long they were on the floor.

Warning signs after a long lie include dark or very little urine, severe muscle pain or swelling, confusion, shivering or very cold skin, fever, breathlessness and new pain. These need urgent medical care. See knowing when to call the doctor.

Supporting recovery of confidence

After a long lie, a person may be afraid. Listen without minimising. Review what happened and fix what can be fixed. Encourage gentle movement, and involve a physiotherapist to rebuild strength and confidence. Arrange a more reliable alert system and regular contact. Discuss living arrangements honestly, without pressure; see when home care is no longer enough. If fear of falling leads to withdrawal or low mood, speak to a doctor; see depression in older adults and anxiety in older adults.

What technology can and cannot do

Alerts shorten the time to help, but they cannot promise that someone will arrive within minutes. They depend on being worn, charged and connected, and on a responder who acts; see how an emergency alert system works and responding to an alert: who does what. A person who is unconscious cannot press a button. The strongest protection is a combination of fall prevention, a reliable call method, regular contact and a plan for entry.

When to ask a professional

See a doctor after any fall or long lie, and soon if the person has dark urine, muscle pain, confusion or fever. Ask about the causes of falls, such as low blood pressure, medicines, heart rhythm and vision. A physiotherapist can help rebuild strength and teach safe ways to get up. An occupational therapist can advise on alarms and home set-up. For information on services for senior citizens, call Elderline 14567. In an emergency, call 112.