Falls in older people

At a glance

  • Many older people are afraid of falling, but luckily most falls don't have serious consequences.
  • Falls are often caused by tripping hazards at home or wearing loose-fitting shoes.
  • Certain illnesses and medications can increase the risk too.
  • It is important to identify hazards in everyday life and take care of them.
  • Staying physically active can help to prevent falls.

Introduction

Photo of an older man in the garden
Zsolt Nyulaszi / Hemera / Thinkstock

Many older people are afraid of falling, breaking a bone and then needing nursing care. While this may be understandable, people who move less to avoid falling are more likely to fall than people who remain physically active.

It is more important to recognize potential hazards in everyday life and get rid of them. A suitable exercise program can also help to prevent falls.

Causes and risk factors

Falls are often caused by obstacles and tripping hazards in your home or in the stairwell, garden or entrance to your home. These include things like door thresholds, steps, curled-up edges of rugs and mats, and loose cables on the floor. It is easy to slip on smooth floors or loose rugs, in the shower or bathtub. Wearing loose-fitting slippers or shoes with very smooth soles, and walking in socks, can increase the risk of falls too.

Apart from that, falls are sometimes the result of health problems. Examples include:

Some medications may affect your concentration and reflexes, leading to falls. Alcohol can also increase the risk of falls. People who have already had one fall are at higher risk of falling again.

Prevalence

It is estimated that

  • 28 out of 100 people over 65, and
  • 34 out of 100 people over 85

who live in their own homes fall each year. Women tend to fall somewhat more often than men do. The rate is higher in people who live in nursing homes or residential care, where 50 out of 100 people fall each year. Falls are also more likely in hospitals than at home.

Effects

Usually, falls will only result in a bruise or scrape. But about 5 to 10 out of 100 falls at home lead to injuries such as broken bones, gashes or head injuries. In nursing homes and residential care, falls often have more serious consequences. This happens in about 10 to 30 out of 100 people who have a fall there.

If a bone breaks, it is usually a bone in the forearm. Hip or thigh fractures can greatly limit your ability to do everyday activities, and often result in long hospital stays. Especially in old age, falls with serious consequences increase the risk of needing long-term nursing care.

Prevention

Some of the measures you can take to avoid falls are quite simple. For example, you can go through your home to check for hazards and then take care of them or have someone do it for you. What else might be a good idea depends on your individual circumstances and health. Some useful measures may include

  • exercise programs,
  • walking aids such as Zimmer (walking) frames and other medical aids,
  • treating health problems that can lead to falls,
  • getting a new pair of glasses, and
  • talking to your doctor about the medications you take.

Occupational therapists can help you to implement various measures, too. For instance, they can go through your home and identify everyday situations that involve a higher risk of falling, then suggest ways to prevent falls.

Everyday life

Although there's so much advice out there about avoiding falls, it's important not to become too frightened in everyday life. As mentioned before, most falls don't lead to serious injury.

Staying active can help prevent falls. Especially in older people, it's important to stay physically active and mobile if possible – that can also help you to stay as independent as possible.

Cameron ID, Dyer SM, Panagoda CE et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 2018; (9): CD005465.

Gillespie LD, Robertson MC, Gillespie WJ et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012; (9): CD007146.

Moreland B, Kakara R, Henry A. Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged >/=65 Years - United States, 2012-2018. MMWR Morb Mortal Wkly Rep 2020; 69(27): 875-881.

Nickens H. Intrinsic factors in falling among the elderly. Arch Intern Med 1985; 145(6): 1089-1093.

Oliver D, Connelly JB, Victor CR et al. Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses. BMJ 2007; 334(7584): 82.

Reuben DB, Ganz DA, Roth CP et al. Effect of nurse practitioner comanagement on the care of geriatric conditions. J Am Geriatr Soc 2013; 61(6): 857-867.

Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. Clin Geriatr Med 2002; 18(2): 141-158.

Rubenstein LZ, Josephson KR. Falls and their prevention in elderly people: what does the evidence show? Med Clin North Am 2006; 90(5): 807-824.

Sherrington C, Fairhall N, Kwok W et al. Evidence on physical activity and falls prevention for people aged 65+ years: systematic review to inform the WHO guidelines on physical activity and sedentary behaviour. Int J Behav Nutr Phys Act 2020; 17(1): 144.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on May 3, 2022
Next planned update: 2025

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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