Private falls in older adults clinic in London, same-day GP.

Why people fall

Rarely one thing. A typical fall involves three or four of these together, and removing even one or two changes the risk substantially.

• Medication — the most modifiable factor of all. Blood pressure tablets, diuretics, sedatives, sleeping tablets, antidepressants, opioids and medicines for prostate symptoms. Taking four or more regular medicines raises risk independently.
• Blood pressure dropping on standing, which is common, easily measured and easily treated.
• Muscle weakness and poor balance — the strongest predictor, and the most improvable.
• Poor vision, including new varifocals, which distort depth perception on stairs.
• Foot problems and unsuitable footwear — slippers, backless shoes, worn soles.
• Heart rhythm problems, particularly if there was no warning before the fall.
• Home hazards, alcohol, low vitamin D, and continence problems causing rushing at night.

Strength and balance

• Strength work — sit-to-stand from a chair, heel raises, step-ups. Build repetitions gradually.
• Balance work — standing with feet together, then heel-to-toe, then on one leg, holding a worktop and progressing to no hands. Aim for a few minutes daily.
• Tai chi has good evidence for reducing falls.
• Walking alone is not enough — it does not challenge balance or build leg strength sufficiently.
• A physiotherapist-designed programme is considerably more effective than generic exercises.

Around the home

• Remove loose rugs and trailing cables; repair uneven flooring and worn stair carpet.
• Improve lighting, especially on stairs and the route to the toilet at night. Use a night light or motion-sensor light.
• Grab rails by the toilet, bath and stairs; a second stair rail.
• Keep everyday items at waist height — no step stools or reaching up.
• Well-fitting shoes indoors and out, with a firm back and non-slip sole. Not slippers.
• Consider a personal alarm, particularly for anyone living alone.

If you fall and cannot get up

• Do not rush. Roll onto your side, then onto hands and knees, crawl to sturdy furniture, and use it to rise slowly.
• If you cannot get up, keep warm, move your limbs to maintain circulation, and attract attention — bang on a wall or the floor.
• Tell someone about every fall, even one you were not hurt by. Unreported falls are the ones that predict the serious one.