Why are falls a concern for older people?

Falls are a major health concern for older people (those aged 65 years and over). Older people are much more likely to be admitted to hospital after a fall than younger people.

Falls are the number one cause of accidental injury in older Australians. One in 4 people who are aged 65 years and over have at least 1 fall per year.

Even when falls don't cause an injury, they can trigger a loss of confidence and lead to an ongoing fear of falling.

Over time, this can lead to an older person becoming less active, which increases the risk of falling again.

There are things you can do to lower the chance of having a fall or being seriously injured in a fall. Having healthy habits and an awareness of what causes falls can help.

What causes falls?

If someone falls, it's not necessarily because they were not concentrating or they are clumsy. There are many reasons why older people might have a fall, including those listed below.

Changes to the body

Our bodies change slowly over the years as part of normal ageing.

As you get older, you may notice:

• difficulty with balance or feeling dizzy or lightheaded
• weaker muscles or less feeling in your feet and legs
• pain in your joints, that may affect your mobility
• poorer eyesight or difficulty with sudden light changes or glare
• slower reaction times
• new health problems such as incontinence
• gaps in memory, dementia or Alzheimer's disease

These changes can be due to normal ageing, or an illness or other medical conditions. Sudden changes to how you think or behave may be due to delirium.

Changes to your body can affect the way you move around. You may find it harder to lift your feet or feel unsteady when you walk. It might get harder to judge heights and distances. These changes make you more likely to fall.

Dangers in and around the home

Around half of all falls happen in and around the home. Common household hazards are:

• poor lighting
• unsafe or poorly fitting shoes or slippers
• slippery surfaces, such as wet or polished floors
• trip hazards such as rugs, floor mats and electrical cords
• steps or uneven surfaces

Poor general health and wellbeing

People who don't keep physically active may have poorer balance and weaker muscles. This can increase your risk of falling.

Not drinking enough water can lead to dehydration. Not eating well can lead to malnutrition. These health problems can make it difficult for you to stay strong enough to move about easily.

If you had surgery or have a short-term illness like the flu, you may be more likely to fall while you recover.

Other reasons for a fall

Some conditions that are more common in older people can increase your chance of falling. These include:

• A history of previous falls — if you have fallen more than once in the past 6 months, you are more likely to fall again.
• Low blood pressure — you may feel light-headed, dizzy or unsteady while moving.
• Postural (orthostatic) hypotension — this is when your blood pressure drops when you change position, such as going from sitting to standing. This can be due to a medical condition or due to medicine side effects.
• Stroke, Parkinson's disease and arthritis — change the way you move, and can make it harder to react quickly or stop yourself if you stumble.
• Diabetes — changes in blood sugar levels can make you feel faint. Diabetes can also affect your eyesight and reduce sensation in your feet and legs.
• Depression — some types of antidepressant medicines can increase your risk of falling.
• Medicines that cause drowsiness such as sleeping pills and strong pain relievers containing opioids.

If you have osteoporosis (thin, weak bones), there's a higher chance of breaking a bone if you fall.

When should I see my doctor?

Speak with your doctor if you've had a fall — even if you feel fine.

Falls can be a sign of many different health issues, including:

• a new medical problem
• a side effect of your medicines
• balance problems
• muscle weakness

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Your doctor can assess your risk of falls and suggest ways to reduce your chance of falling again.

It's also a good idea to see your doctor for regular check-ups. Your doctor can help you manage your health as you get older. It's a good idea to address any concerns as soon as you can.

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How are falls treated?

Once you are over 65 years of age expect to be asked if you sometimes fall.

If you've had a fall, or are concerned about your risk of having a fall, your doctor will work out which causes apply to you. Depending on your risk factors, they may suggest the following things.

Falls prevention plan

Your doctor can work with you and your family or carers to predict, prevent and manage falls. They may refer you to other health professionals such as a physiotherapist, occupational therapist or dietitian if you are at high risk of falls.

You may also find it reassuring to carry a personal alarm. You can use it to quickly call for help if you fall.

Vitamin D and calcium supplements

Your doctor might suggest some changes to what you eat.

Talk with your doctor about whether you may benefit from vitamin D and calcium supplements. These supplements may help to improve your bone health and reduce the chance that a fall will cause a fracture.

Balance and exercise

Older people should aim for 2 or 3 hours of physical activity every week. You can do this:

• at home
• at a community exercise class
• following a program from a physiotherapist

There is evidence that doing exercises that improve your balance and ability to move can prevent harm from falls.

Your doctor can also help with any episode of dizziness or fainting.

Medications review

Some medicines cause side effects such as:

• drowsiness
• confusion
• unsteadiness or dizziness

Since these side effects can increase your risk of falling, your doctor or pharmacist can review your medicines. They will check to see if any changes to your medicines are needed.

Older people often take multiple medicines and may not be sure what they are all for.

Bladder and bowel control

As you get older it can be harder to control when you urinate (do a wee) or defecate (do a poo). You may fall when you are hurrying to the toilet.

Some causes of incontinence (loss of bladder or bowel control) can be treated by your doctor. Tell your doctor if you have having difficulty making it to the toilet on time.

Podiatry assessment

Ageing can cause changes to your feet, which can change the way you walk and your balance.

If you have painful or swollen feet or have tingling or pins and needles, see a podiatrist. They can provide advice on ways to improve your circulation, decrease swelling and reduce pain in your legs and feet.

Good shoes can help with your mobility.

Vision and hearing checks

Early detection of eye problems can stop them from getting worse. See your optometrist to get your eyes checked regularly.

If you wear glasses, have them checked each year. If you struggle to see well due to cataracts, surgery to remove these will help you reduce the likelihood of falls and fractures.

Being able to hear well can help you notice hazards around you. Find out about hearing tests.

Hip protectors

A hip fracture is most often caused by a fall in older people. You can get hip protectors which are placed inside special underwear. The protectors sit over your hips to protect them in case of a fall. They may be suitable for people who have osteoporosis or who fall frequently.

How can falls be prevented?

There are many ways to reduce the risk of falls, including:

Lifestyle changes

• Keep physically active. Whatever your age, aim to do at least 30 minutes of activity, most days of the week. This will help you stay strong and improve your balance. Suitable activities include tai chi, dancing and group exercise programs.
• Maintain a healthy diet. Enjoy a wide variety of foods, particularly during hot weather. Food supplements may help if you are underweight.
• Stand up slowly after you have been lying down or sitting to prevent posture-related dizziness.

Changes around the home

You can reduce the risk of falls by addressing factors in your home that increase your risk of falls.

Lighting

Good lighting around the house is important. Simple changes can help improve visibility and reduce your chance of a fall:

• Turn lights on when you walk around.
• Leave hallway lights on at night.
• Reduce sun glare inside your house by using net curtains or blinds on your windows.

Slipping

Think about the best footwear to use around the home and fix dangerous surfaces to reduce the risk of slipping:

• Use non-slip mats in wet zones, such as the shower and bathroom. For larger rooms, consider a non-slip flooring material in the whole area.
• Install handrails or a seat in the shower or bath. Place non-skid tape on the edges of steps and stairs to make them easier to see.
• Remove moss, slime or fallen leaves from outdoor paths.
• Wear well-fitting shoes.

Tripping

Even small things can be trip hazards:

• Keep walkways clear of clutter and tape down electrical cords along skirting boards.
• Mark any small changes in floor level with contrasting colour so they're clearly seen.
• Install a draught excluder on the bottom of doors instead of using loose fabric that may be a trip hazard.
• Get rid of old mats and torn or stretched carpet. Tape down turned-up rug corners.

What are the complications of a fall?

Falls can cause hip and thigh injuries. They are the most common reason for hip fracture hospital admissions (9 in 10 cases). Falls can also lead to head injuries, wrist fractures and other injuries.

Hip fractures can reduce your independence and cause you to become more reliant on family members and carers. This may also increase your chance of moving into an aged care facility following the injury.

After a fall, you may become fearful of falling again and lose confidence in walking. You may start to be less physically active. Over time, reduced movement may increase your risk of further falls due to:

• poor balance
• weak muscles
• stiff joints

Resources and support

Help is available to keep older people safe from falls:

• The Australia and New Zealand Falls Prevention Society has a collection of resources for older people and their families.
• Healthy Bones Australia has articles on moving safely and recovering from a fracture. You can also call them on 1800 242 141 for general information about bone health or osteoporosis.
• Go to Occupational Therapy Australia to find a private practice OT in your area who can help you assess your home and make safety changes.
• Injury Matters, based in Western Australia, offers tips on making your home safer, as well as a home safety checklist and Stay on Your Feet materials.
• Watch this video from Queensland Health to learn some simple steps to reduce your chance of falling in the bathroom. Read a fact sheet for health professionals about preventing falls in Community care produced by the Australian Commission on Safety and Quality in Health Care.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.

Languages other than English

Health Translations Victoria provides fact sheets on preventing falls for older people and staying on your feet in several languages.