Falls

Overview

A fall is when you suddenly go down to the floor or ground without meaning to. It might be a trip, a slip, or your legs giving way. Falls are not a normal part of getting older. They are usually caused by a mix of things — like weaker muscles, balance problems, poor eyesight, medicines, or hazards at home — and most of these things can be improved.

Yes, very common. Falls are one of the most frequent reasons older adults go to their doctor, attend an emergency department, or are admitted to hospital. They are also common in young children, who fall often as they learn to walk, run and climb.

Anyone can fall, but the risk rises with age, especially after 65. People are also more at risk if they have problems with their balance, muscles, eyesight or memory, if they take several medicines, or if they have had a fall before. Children fall often too, but usually with minor injuries.

Symptoms

Common symptoms

• Dizziness or light-headedness, especially when standing up quickly
• Bruises, grazes, cuts or sore muscles after a tumble
• A feeling of unsteadiness, or that your legs might 'give way'
• 'Near falls' — stumbling, tripping or grabbing for support but staying upright
• Feeling anxious or losing confidence about walking, especially on stairs or outdoors
• Tripping more often than usual, or catching your foot on things

Symptoms in children

• Frequent bumps and bruises from normal play — usually minor
• Crying after a fall, then settling and playing normally again
• Watch closely for signs of a head injury: being sick, unusual sleepiness, confusion, a bad headache, or clear fluid from the nose or ears

Symptoms in older adults

• Falls that happen more often, or without a clear reason
• Being unable to get up from the floor without help
• Losing confidence and cutting down on going out, shopping or socialising
• Unexplained bruising, or a family member noticing a change in walking
• Falls with no memory of the event, or a 'blackout' — this needs urgent medical attention

Causes

Main causes

• Weak muscles and poor balance, especially in the legs and core
• Problems with eyesight, such as needing new glasses or having cataracts
• Side effects from medicines, or effects of taking several medicines together
• A drop in blood pressure when standing up, which causes dizziness
• Long-term conditions such as arthritis, Parkinson's disease, diabetes, or problems with the heart, nerves or memory
• Hazards at home — loose rugs, trailing cables, clutter, poor lighting, slippery bathrooms
• Foot problems and unsuitable or worn-out footwear
• Drinking alcohol, which affects balance and judgement
• Being unwell, dehydrated, or recovering from an illness or operation

Risk factors

• Being over 65
• Having fallen before — this is one of the strongest warning signs
• Taking four or more medicines, or any medicine that affects alertness or blood pressure
• Weak bones (osteoporosis), which make a break more likely
• Poor vision or hearing
• Memory problems or dementia
• Living alone, or having difficulty with daily tasks
• Low mood, anxiety or a fear of falling
• Dangerous floors, stairs or bathrooms at home

When to see a doctor

See a doctor urgently if:

• You have had a bang to the head and feel sick, drowsy, confused, or have a bad headache
• You have fallen and cannot put weight on a leg or arm, or a joint looks swollen or out of shape
• You have fainted or blacked out, even briefly
• You have had two or more falls in the last few weeks
• You feel dizzy or unsteady that is new or getting worse

Book a routine appointment if:

• You have tripped or stumbled more than once, even if you did not fall
• You have lost confidence in walking or are avoiding going out
• You want your medicines, eyesight, feet or balance checked
• A relative or carer has noticed a change in how you walk
• You are worried about falling and would like to know what can be done

Diagnosis

Your doctor will usually start by asking what happened — where you were, what you were doing, whether you felt dizzy or tripped, and whether you lost consciousness. They will then look at your whole picture: your medicines, eyesight, feet, walking, balance, blood pressure, memory and home surroundings. The aim is to find the combination of causes so each one can be tackled.

Tests that may be done

• A walking and balance check — often called a gait and balance assessment, where you are asked to stand, walk and turn
• Blood pressure measured while lying or sitting and again after standing up
• A review of all your medicines, including anything bought over the counter
• A vision check, and sometimes a hearing check
• Blood tests to look for anaemia, vitamin levels, thyroid or kidney problems
• A heart tracing (ECG) if blackouts or an irregular heartbeat are suspected
• Bone health assessment, such as a bone density scan, if a fracture is likely
• An X-ray, scan or other imaging if you have injured yourself
• A memory or thinking check if there are concerns about confusion
• A home safety review, sometimes by an occupational therapist who visits you at home

What to expect at your appointment

Most of this is quick and painless, and much of it can be done in one or two appointments. Your doctor may refer you to other members of the team — a physiotherapist for strength and balance work, an occupational therapist for home changes, a pharmacist for a medicines review, or an eye specialist. You will usually leave with a clear plan and some practical steps to start straight away.

Treatment

Treatment for falls is about finding and fixing the causes, not just treating the injury. The strongest evidence is for exercise that builds strength and balance, together with practical changes to your home, your medicines, your eyesight and your footwear. If you did break a bone, treating the injury comes first, with rehabilitation afterwards.

Self-care at home

• Stay active. Regular movement keeps your muscles and balance working well.
• Keep pathways clear, remove loose rugs, and tidy trailing cables.
• Make sure stairs and hallways are well lit, with light switches at the top and bottom.
• Wear well-fitting shoes with a firm, non-slip sole and a low heel — avoid walking in slippers or socks.
• Keep things you use often within easy reach, so you do not need to climb or stretch.
• Have a plan for getting help if you do fall: keep a phone or alarm within reach, day and night.
• Learn how to get up from the floor safely, or ask a physiotherapist to show you.
• Stand up slowly from a chair or bed, and hold on to something steady for a moment.
• Tell someone if you feel dizzy or unsteady — do not just put up with it.

Medical treatments

Your healthcare team will look at each cause they find. That might mean adjusting or stopping medicines that make you drowsy or lower your blood pressure, treating low blood pressure or a heart rhythm problem, and correcting poor vision or painful feet. A physiotherapist can guide you through a strength and balance programme, which is the single most effective way to reduce falls. An occupational therapist can suggest home changes and equipment such as grab rails or a raised toilet seat. Your doctor may also check your bone strength and treat weak bones so that a fall is less likely to cause a break. Always ask your doctor or pharmacist before changing any medicine, and never stop one on your own.

When is surgery considered?

Surgery is only needed if you have injured yourself. A broken hip usually needs an operation, often within a day or two, followed by physiotherapy to get you walking again. Other broken bones may need a cast, a pin, or occasionally an operation. Surgery is not a treatment for falls themselves — preventing the next fall is just as important afterwards.

Living with this condition

After a fall, it is natural to feel shaken and to want to move less. But staying still for too long makes muscles weaker and balance worse, which raises the risk of another fall. Try to keep doing your normal daily activities, with sensible adjustments. Small changes — a night light, a handrail, a stool in the kitchen, a bag instead of carrying things in your arms — can make a big difference to how safe and confident you feel.

Lifestyle tips

• Build strength and balance into your week: walking, gardening, tai chi, or a group class designed for falls prevention
• Ask about local strength and balance programmes — they are often run in community centres and are sociable as well as helpful
• Have your eyesight checked regularly, and consider a second pair of glasses for walking outdoors if your main pair is varifocal
• Review your footwear and replace worn or loose slippers
• Keep alcohol within low-risk levels, as it affects balance
• Ask for a home safety check if you are unsure where the risks are
• Keep a phone, keys and any personal alarm with you, even at home
• Tell family, friends or neighbours how to check on you

Diet and exercise

Eating well and moving well go together. Aim for regular meals with enough protein — such as beans, eggs, fish, dairy or meat — to keep muscles strong, and enough calcium and vitamin D for bone health (your doctor can check whether you need a supplement). Drink enough fluids through the day, as dehydration causes dizziness. For exercise, the best choices are those that challenge your balance and build leg strength, done two to three times a week, plus something that raises your heart rate. A physiotherapist or falls prevention class can tailor this to you, and it is safe to start gently and build up.

Mental health and emotional wellbeing

Fear of falling is very common after a fall, and it can become a problem in its own right. It can lead to avoiding stairs, going out less, and feeling isolated or low. This is understandable, and it is treatable. Talking to your doctor or a physiotherapist about your confidence is a good first step — they can help you rebuild it gradually. Some people also find it helps to talk to a counsellor or a support group. If low mood, anxiety or hopelessness is affecting your daily life, please tell your doctor, and remember that crisis support is available through your local health service or emergency number if you ever feel unsafe.

Prevention

Yes. Falls are one of the most preventable health problems in older age. The most effective approach combines strength and balance exercise with a review of your medicines, an eyesight check, safer footwear, and changes to your home. Doing several of these together works much better than doing just one.

Vaccines

Vaccines do not prevent falls directly, but staying up to date with the vaccinations recommended for your age and health helps you avoid illnesses like flu that can leave you weak, unsteady or in bed for days — all of which raise your risk of falling.

Screening programmes

Ask your doctor about a falls risk check if you are over 65, have had a fall or a near-miss, or feel unsteady. This usually includes a walking and balance check, a medicines review, a blood pressure check when standing, and an eyesight check. If you have risk factors for weak bones, a bone density scan may be recommended, because treating weak bones means a fall is less likely to cause a break.

Complications

If left untreated

• Broken bones, especially hip, wrist and arm fractures — hip fractures often need surgery and a long recovery
• Head injuries, which can be more serious in people who take blood-thinning medicines
• Loss of confidence and reduced activity, which leads to weaker muscles and more falls
• Loss of independence, difficulty managing at home, and sometimes a move into residential care
• Loneliness, low mood and anxiety
• Pressure sores, chest infections or dehydration if someone is stuck on the floor for a long time
• Longer recovery after each fall, and a higher chance of further falls

Long-term outlook

The outlook is genuinely encouraging. Most falls can be prevented, and most people who fall recover well — especially when they get help early. Strength and balance programmes reduce falls by a significant amount, and small home changes are cheap and effective. If you have had a fall, the most useful thing you can do is tell your doctor, so the causes can be found and tackled. Many people end up walking more confidently than before.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.