Fall prevention for older adults: what to do at home after 65

The World Health Organization estimates that 684,000 people die from falls worldwide every year, making falls the second leading cause of unintentional injury death, and that adults over 60 suffer the greatest number of fatal falls. In the United States, the CDC reports that more than one in four people aged 65 and over falls each year, but less than half tell their doctor, and that falling once doubles the chances of falling again.

Those figures say nothing about one person’s risk. They do say that a fall deserves to be taken seriously, including the ones that cause no injury: many people who fall, the CDC notes, become afraid of falling.

Preventing falls does not mean moving less

Cutting back on activity out of caution costs strength and balance, and can keep the risk high instead of lowering it. The World Guidelines for Falls Prevention, published in 2022 by an international panel, set out a multifactorial approach: understand how the fall happened, look for the factors that can be changed, then act on them in a coordinated way. Your doctor assesses your health, a pharmacist can review your medicines, a physical therapist works on balance and walking, an occupational therapist looks at your home and everyday movements.

The World Guidelines recommend that clinicians routinely ask older adults about falls, and suggest three key questions:

If the answer is no to all three, the risk of falling in the coming year is considered low. The advice is then to stay physically active and to check again in a year, or sooner if one of these signs appears.

If the answer is yes to any one of them, tell your doctor. The CDC says the same: tell a provider right away if you fall, worry about falling or feel unsteady. Your doctor will work out your level of risk, with questions about the fall or falls and simple tests, such as standing up from a chair, walking three meters, turning around and sitting back down. Depending on the result, prevention ranges from strength and balance exercise to a full assessment of every risk factor, sometimes by a specialist team.

When a fall counts as severe

The guidelines treat a fall as a sign of high risk when it caused an injury, when it is one of two or more falls in a year, when the person could not get up without help, when it happened for no clear reason and may point to a brief loss of consciousness, or when the person is frail. These situations call for a thorough assessment.

If the person cannot get up, is hurt, has fainted or shows a sudden or unusual symptom, call emergency services. This article cannot tell you how serious a fall is: if in doubt, that is for the emergency team or a doctor to decide.

Write down what happened

Once things are under control, note where and when it happened, what you were doing, the shoes you were wearing, the lighting, any obstacle, and what you felt just before. Did you trip? Feel dizzy? Feel weak? Lose consciousness? The answer shapes the assessment: a fall with no clear cause is not looked at like a simple stumble. Our guide on how to prepare for a doctor’s appointment helps you describe these facts without interpreting them.

Learn how to get up

According to the World Guidelines, getting up from the floor is a skill best relearned through practice, and some fall prevention exercise programs teach it specifically. The guidelines stress it for people who have already spent a long time on the floor after a fall.

Balance, strength and walking

Struggling to get up from a chair, walking more slowly or feeling less sure of yourself can justify an assessment. Exercises that improve balance and make your legs stronger lower your chances of falling, says the CDC, and help you feel more confident. The World Guidelines recommend balance and functional exercises, such as sit-to-stand and stepping, three or more times a week, progressed in intensity for at least twelve weeks and ideally continued beyond. Tai Chi is one option, cited by both the CDC and the WHO.

These exercises should not be picked at random: they depend on your abilities, your health conditions and your level of risk. Ask your doctor which program suits you; a physical therapist can build a progression. The goal is not performance, but keeping the ability to stand up, turn around, step over a threshold and catch yourself when you lose your balance.

Eyes and feet

Poor vision, from conditions such as glaucoma or cataracts, increases the chances of falling: the CDC advises an eye check once a year, with glasses updated if needed, and a foot check once a year too. Wear well-fitting shoes with good support, inside and outside the house.

Vitamin D and general health

The WHO lists vitamin D supplements among fall prevention measures, for people who are deficient. The CDC suggests asking your provider about them rather than starting on your own.

As you get older, the way medicines work in your body can change, the CDC explains, and some medicines, or combinations of medicines, can make you sleepy or dizzy and cause a fall. The World Guidelines call for a structured medication review that considers reducing psychotropic drugs and other fall-risk-increasing medicines, and the WHO lists reducing or withdrawing psychotropic drugs among proven fall prevention measures.

That does not make these medicines “bad,” or mean you should stop them: the decision belongs to your doctor. Your part is to give a complete picture of what you take, over-the-counter products and supplements included. An up-to-date medication list lets your doctor and pharmacist see what could be reassessed.

Start with your everyday routes

Follow the path between your bed, the bathroom, the kitchen, your armchair and the front door. The CDC’s home fall prevention checklist starts with the same priorities:

• keep stairs and walkways clear, and coil or tape cords next to the wall;
• remove small throw rugs, or use double-sided tape so they don’t slip;
• improve the lighting, with a lamp within easy reach of the bed and a nightlight on the way to the bathroom;
• keep things you use often on lower shelves, so you don’t need a step stool;
• fit grab bars next to and inside the tub and next to the toilet, non-slip mats in the tub and shower, and handrails on both sides of the stairs.

A grab bar only helps if it sits where you actually need it. The World Guidelines find home hazard assessment more likely to work when it is carried out by an occupational therapist, who watches how you move in your own home before suggesting changes.

After a fall, fear can lead you to go out less, move less and ask for help with things you used to manage alone. That caution is understandable, but it can keep the risk high. Talk about it openly: worrying about falling is one of the three screening questions, and the World Guidelines recommend assessing it in a structured way.

A cane or a walker can restore some confidence, provided it suits you: the guidelines ask clinicians to check that a walking aid is appropriate and used properly. Balance and strength exercises also help rebuild confidence.

A plan that fits on one page

A useful plan records the circumstances of each fall, the factors identified, the actions agreed, who is responsible, by when, and what changed afterwards: an eye test, a medication review, a balance program, better lighting, then a follow-up on the date agreed with your doctor. That structure stops advice piling up without anyone knowing whether it was followed. It applies to preventing a first fall as much as a repeat one, two moments our article on primary, secondary and tertiary prevention helps tell apart.

With MyTwin for patients, your reports, test results and measurements sit together in one app, and you can talk to a health professional, by video or in person, to adjust your care. If a relative helps you, agree on what they can see: your health information remains yours.