What to Do After a Fall: A Family Guide

Stay calm and check the person

Do not rush to lift. Take a breath and keep your voice calm. Kneel beside the person, reassure them, and ask what happened. Do not move them yet.

Check:

1. Are they awake and responsive? Do they answer questions? Can they tell you their name and where they are? 2. Are they breathing normally? If not breathing or unresponsive, call 112 at once and begin first aid if trained. 3. Any bleeding? Press firmly on a bleeding wound with a clean cloth. 4. Did they hit their head? Ask, and look for a bump, a cut, bruising, drowsiness or confusion. 5. Where does it hurt? Neck, back, hips, wrists, shoulders, ribs, head? 6. Can they move their arms and legs? Ask them to wiggle fingers and toes, without forcing it. 7. Do they have chest pain, breathlessness, palpitations or dizziness? A fall may be caused by a heart problem or stroke. 8. Is the leg shortened or turned outwards, or is there deformity? This suggests a hip or leg fracture. 9. Is there a new weakness on one side, slurred speech or a drooping face? This may be a stroke; see stroke warning signs and first hour. 10. How long were they on the floor? A long lie increases risks; see long lie after a fall.

When to call 112 immediately

Call 112, India's emergency number, if the person:

• is unconscious, unresponsive, or becomes drowsy or confused;
• has a head injury with vomiting, severe headache, drowsiness, confusion, fits, bleeding from the ear or nose, or unequal pupils, or has hit their head and takes blood thinners (even if they seem fine at first);
• has neck or back pain, numbness, tingling or weakness in the limbs, or cannot move a limb: do not move them;
• has a suspected fracture: severe pain, a deformed or shortened limb, inability to bear weight, particularly hip, thigh or pelvis;
• has chest pain, breathlessness, a very fast, slow or irregular pulse, fainting, or looks pale, sweaty or blue;
• shows stroke signs: face drooping, arm weakness, slurred speech;
• has heavy bleeding that does not stop with pressure;
• has had a seizure;
• cannot get up and is in significant pain;
• has fallen multiple times or was found after a long time on the floor, cold or confused;
• or if you are unsure. It is better to call and not need help.

Many states also have an ambulance number, such as 108. See ambulance and emergency numbers in India. Give clear information: age, what happened, symptoms, medical conditions and medicines, address, floor and landmark.

Keep the person still, warm and comforted until help arrives. Do not give food or drink if they might need surgery or are drowsy. Do not give medicines unless instructed by a medical professional. Cover with a blanket. Stay with them. Unlock the door, switch on lights and have someone wait to guide the ambulance; see how an emergency alert system works.

If there is a suspected neck or back injury

Do not move the person unless they are in immediate danger, such as from fire. Ask them to stay still, and support the head in the position found, without twisting. Wait for the ambulance.

If the person seems unhurt and wants to get up

If they are alert, breathing normally, have no severe pain, no head injury concerns, can move all limbs without pain and feel able, you may help them up slowly. Do not pull them up by the arms.

How to help a person up safely:

1. Let them rest for a minute or two and check how they feel. Dizziness may be due to low blood pressure; see dizziness and low blood pressure when standing. 2. Bring a sturdy chair (with no wheels) and place it close. 3. Help them roll onto their side, then onto hands and knees, if they can, taking their time. 4. Guide them to crawl or shuffle to the chair, and place their hands on the seat. 5. Have them bring the stronger leg forward, foot flat, and push up through the legs and arms while you steady them from the side or behind, using a transfer belt if you have one; see how to use a transfer belt. 6. Turn and sit on the chair slowly. 7. Check again for pain, dizziness and injuries. Give water, if safe, and let them rest. 8. Do not lift the whole body weight yourself. If they cannot help, call for assistance. Back injuries to carers are common; see how to lift and transfer safely.

If the person can get up alone, see how to get up after a fall, step by step for the technique.

If you cannot get them up safely, make them comfortable on the floor with a pillow and blanket, keep them warm, call for help (neighbour, family, 112) and stay with them. Use a lifting cushion or emergency lifting equipment only if trained; ambulance crews and fire services may help lift without injury.

Care after the fall

Even if the person seems fine, falls matter.

Immediate aftercare:

• Check for hidden injuries: bruises, grazes, swelling, tenderness, limping, pain on moving the hip, wrist or shoulder. Older bones fracture easily, and some fractures, such as in the wrist, hip, pelvis or spine, are subtle.
• Clean cuts and grazes with clean water, cover with a clean dressing; see wound care at home for older adults.
• Apply a cold pack wrapped in cloth to swelling for 10 minutes at a time.
• Rest and observe, and give water or a light meal.
• Pain relief: ask a doctor or pharmacist before giving any medicine; some common painkillers are risky for older adults; see painkillers and older adults.
• Keep warm, particularly if they have been on the floor.
• Do not leave them alone for the next day or two, if possible.

Tell the doctor. Contact the person's doctor the same day or next morning, even if there is no obvious injury, since the fall may signal an underlying problem such as infection, a heart rhythm problem, low blood pressure, medicine effects or a new neurological condition.

What to watch for over the next 48 hours

Seek urgent medical help if any of these appear after a fall, particularly after a bang to the head:

• Increasing drowsiness, difficulty waking, new confusion, memory loss, unusual behaviour.
• Severe or worsening headache, repeated vomiting.
• Weakness, numbness, slurred speech, loss of vision, or difficulty walking.
• Fits.
• Clear fluid or blood from the nose or ears.
• Increasing pain, swelling or bruising, or inability to put weight on a limb.
• Breathlessness or chest pain (possible rib fracture, collapsed lung or heart problem).
• Abdominal pain or pale, sweaty appearance (possible internal bleeding).
• Passing blood or being unable to pass urine.
• Fever or feeling very unwell.

Older adults on blood thinners (anticoagulants or antiplatelets) can bleed inside the head slowly, with symptoms appearing hours or days later. They should be checked by a doctor after any head knock.

Find out why it happened

A fall is rarely just an accident. Ask what the person was doing, whether they felt dizzy or faint beforehand, whether they tripped on something, what they were wearing on their feet, and whether there are new medicines, illness, poor eating or drinking, alcohol or new weakness or confusion. Share the answers with the doctor, who may check blood pressure lying and standing, heart rhythm, eyesight, medicines, balance and home hazards; see falls risk assessment at home, polypharmacy and deprescribing and vertigo, BPPV and balance.

Prevent the next fall

• Fix the cause where possible: treat infection, adjust medicines, correct vision, treat low blood pressure.
• Make the home safer: lighting, clear floors, bathroom bars and seat; see bathroom safety checklist, flooring, rugs and trip hazards and bedroom setup for night safety.
• Use the right walking aid, set to the right height; see how to choose a walking stick and walking aids and footwear.
• Footwear: see choosing shoes for older feet.
• Strength and balance exercise, guided by a physiotherapist; see balance exercises for seniors.
• Get a way to call for help, such as a pendant or watch; see panic pendant buying guide and fall detection watch guide.
• Address fear of falling: the fear can lead to inactivity and weakness. Encourage safe activity and reassure.
• Consider bone health: a fall in a person with osteoporosis risks a fracture; see osteoporosis home care guide.
• Keep a record of falls, including date, time, place and cause.

Emotional care

A fall can leave a person frightened and ashamed. Be kind, not blaming, and encourage gentle activity. If anxiety or low mood persists, speak to the doctor; see anxiety in older adults.

When to ask a professional

See a doctor after any fall, particularly if there was a head injury, dizziness, fainting, repeated falls, new confusion, pain or a change in walking. A physiotherapist can assess balance and strength and prescribe exercise. An occupational therapist can assess the home. A pharmacist can review medicines. For support and information about services for senior citizens, call Elderline 14567. Call 112 in an emergency.