The Scale of the Problem
Falls are not an inevitable part of ageing - but they are extremely common. Around one in three adults over 65 falls at least once a year. For those over 80, the figure rises to one in two. In the UK, falls cost the NHS over £2 billion a year and account for more than 250,000 hospital admissions annually.
The consequences of a fall can be devastating. Hip fractures - one of the most common serious injuries from falls - carry a 30% mortality rate within a year in older adults. Even falls that do not cause serious physical injury can lead to a loss of confidence, reduced activity, social withdrawal and a significant decline in overall health and independence.
The good news is that falls are largely preventable. Identifying and addressing risk factors - both in the person and in their environment - can dramatically reduce fall frequency.
Risk Factors for Falls
Falls rarely have a single cause. They typically result from a combination of factors relating to the person, their medications and their environment.
Person-related factors
- Muscle weakness, particularly in the legs
- Balance and gait problems
- Poor vision or hearing
- Cognitive impairment (dementia, delirium)
- Previous falls (the strongest predictor of future falls)
- Fear of falling (paradoxically increases fall risk by causing hesitancy and reduced activity)
- Postural hypotension (blood pressure drops when standing, causing dizziness)
- Urinary urgency (rushing to the toilet)
- Foot problems (painful feet, poorly fitting footwear)
- Dehydration and malnutrition
Medication-related factors
Many common medications increase fall risk. The most significant include:
- Sedatives and sleeping tablets (benzodiazepines, Z-drugs): cause drowsiness and impair balance
- Blood pressure medications: can cause postural hypotension
- Diuretics: can cause dehydration and urgency
- Antidepressants: particularly tricyclics and SSRIs
- Antipsychotics: cause sedation and movement problems
- Antihistamines: cause sedation
Anyone taking four or more medications (polypharmacy) is at significantly increased fall risk. A medication review with the GP or pharmacist can identify drugs that could be reduced or stopped.
Home Hazard Assessment and Adaptations
The home environment is responsible for a significant proportion of falls. A systematic assessment of the home can identify hazards that are easy to address.
Floors and walkways
- Remove loose rugs and mats, or secure them with non-slip backing
- Clear clutter from walkways and stairs
- Ensure cables and wires are secured away from walking areas
- Repair uneven flooring
- Ensure adequate lighting throughout, particularly on stairs and in hallways
- Consider nightlights for the route to the bathroom
Bathroom
The bathroom is one of the highest-risk areas in the home. Wet floors, low toilet seats and getting in and out of the bath all present significant fall risks.
- Install grab rails next to the toilet, bath and shower
- Use a non-slip mat in the bath or shower
- Consider a shower chair or bath board
- Raise the toilet seat if needed
- Keep the floor dry - use a bath mat outside the shower
Bedroom
- Ensure the bed is at the right height - not too low or too high
- Keep a light within easy reach of the bed
- Remove obstacles between the bed and the bathroom
- Consider a bed rail if the person is at risk of rolling out of bed
Stairs
- Ensure handrails are secure and extend the full length of the stairs
- Mark the edges of steps with contrasting tape if vision is poor
- Keep stairs clear of objects
- Consider whether a stairlift is appropriate
Exercise and Strength Building
Exercise is one of the most effective falls prevention interventions. Programmes that improve strength, balance and gait - such as Tai Chi, the Otago Exercise Programme and NHS-approved strength and balance classes - have strong evidence for reducing falls.
Even simple daily activity helps: walking, chair-based exercises and gentle stretching all contribute to maintaining muscle strength and balance. A physiotherapist can assess an individual's specific needs and prescribe an appropriate exercise programme.
What to Do if Someone Falls
If someone falls, the priority is to stay calm and assess the situation before attempting to help them up. Moving someone too quickly after a fall can cause further injury.
- Check for injuries - do not move them if you suspect a serious injury
- Call 999 if they are injured, in pain, or cannot get up safely
- If they are not injured and want to get up, help them to roll onto their side, then onto their hands and knees, and then onto a sturdy chair
- Stay with them and keep them warm while waiting for help if needed
- Record the fall and report it to the care coordinator and GP
How MoralCare Supports Falls Prevention
Falls prevention is embedded in everything we do. Our carers are trained in falls risk assessment, safe moving and handling, and the use of equipment. We carry out home safety checks as part of every new care assessment and flag concerns to the family and occupational therapy team.
Every MoralCare client has a QR emergency code displayed in their home. If a paramedic attends following a fall, they can scan it instantly to access the care plan, medication list, allergies and GP details - saving critical time in an emergency.