Falls in older people: why they happen, how to reduce the risk and what to do after one

A fall is not just a matter of a bruise. NICE's falls guideline describes its aim as reducing falls and their associated distress, pain, injury, loss of confidence, loss of independence and mortality. NHS inform makes a similar point, explaining why older people are at higher risk and why a fall may be more serious in later life.

The consequences are not only physical. The NHS says that making changes to prevent falls helps people keep their confidence and independence, and NHS inform has dedicated guidance on fear and anxiety about falling, because worry about falling can lead people to move less, which can itself make them weaker and less steady.

For these reasons, a fall is generally treated as a prompt to look at the whole picture rather than as an isolated accident, even when no injury resulted.

The NHS describes falls as common, particularly in older people, and lists several contributors: muscles getting weaker with age; conditions that affect mobility or balance such as arthritis, stroke or Parkinson's disease; low blood pressure; side effects of some medicines; problems with eyesight or hearing; and dementia. NHS inform adds guidance on foot problems and footwear, bone health, vision and hearing, medication, nutrition and home hazards as part of the same picture.

It is usually several things together. A person with slightly reduced vision, a medicine that causes dizziness on standing, worn slippers and a loose rug may each be manageable alone, but together they raise the chance of a fall. This is why the assessment described below looks broadly.

• Muscle weakness and reduced balance, often linked to being less active.

• Low blood pressure, including a drop in blood pressure on standing.

• Medicines that cause drowsiness, dizziness or low blood pressure.

• Poor eyesight, hearing or ear problems affecting balance.

• Long-term conditions such as arthritis, stroke, Parkinson's disease or dementia.

• Unsuitable footwear, clutter, loose wires or rugs, and poor lighting or stairs without rails.

The NHS lists a set of everyday measures. Stay active, with strength and balance activities at least twice a week; wear shoes or slippers that fit well and grip; wear a personal alarm or carry a mobile phone; use a non-slip mat in the bath or shower; consider safety rails on steps and grab rails in the bathroom; consider a walking aid; eat and drink well, because not eating or drinking enough can cause lightheadedness; look after bone health with calcium and vitamin D; and have regular eye and hearing checks.

It also suggests speaking to a GP or pharmacist if you think a medicine could be affecting your balance, avoiding tasks you find difficult such as lifting or reaching without help, avoiding clutter and trip hazards, and not drinking too much alcohol. A person worried about falls can ask the local council for a free care needs assessment, which can include changes to make the home safer.

NHS inform also describes falls risk screening, strength and balance exercise videos for use at home, home safety checks and telecare services that use technology to support people at risk of falling to live safely at home.

The NHS advice starts with staying calm and taking a couple of minutes to check for pain or injuries. If you feel able to get up, take your time: roll onto your side, push up onto hands and knees, find something stable such as heavy furniture or a bath, put one foot flat on the floor, stand slowly and then sit and rest.

If you cannot get up, use a phone or personal alarm if you can reach one, or shout or bang on a wall or floor. Keep warm by covering yourself with whatever you can reach, keep moving by rolling from side to side or moving arms and legs, and try to change position about every 30 minutes to help prevent pressure sores.

If someone else has fallen, the NHS says to keep them comfortable and warm, to help them up carefully only if they are able and to avoid trying to lift them yourself. Call 999 if they may have injured the head, back, neck or hip, or cannot get up. NHS 111 is the route if they may be in pain, injured or unwell.

The NHS says that if you have had falls, or a GP thinks you are at risk, they will check your balance by asking you to get up and move around and may refer you to a specialist falls service. Help from a falls service may include checking for problems such as muscle weakness, osteoporosis or eyesight problems, strength and balance training, checking the home is safe and arranging adaptations, and reviewing medicines. Conditions affecting balance or strength may need treatment in their own right.

The NHS adds that in some areas people can refer themselves directly to services that help after a fall, and suggests asking GP reception, checking the surgery website, contacting the local integrated care board or searching online. NICE NG249 covers risk assessment and prevention for all people aged 65 and over and for those aged 50 to 64 at higher risk, and its recommendations cover identifying people at risk, comprehensive falls assessment and interventions to reduce risk.

Fear of falling is a recognised problem in its own right. NHS inform has pages on managing anxiety about falling, relaxation techniques such as breathing exercises, and knowing what to do if you fall, saying that these can improve confidence and quality of life. It also has guidance on falls and dementia, since dementia symptoms can raise the risk.

The outlook is generally better where the contributing factors are identified and acted on. Strength and balance exercise, medicine review, eyesight and hearing checks and a safer home are each modest steps, but the NHS and NICE both treat them as the core of prevention.

Falls assessment in the NHS is delivered through GP practices, community falls services, physiotherapy and, where needed, hospital clinics for older people. The NHS notes that some people can refer themselves, which can be quicker than waiting for a GP appointment. Local councils provide care needs assessments and may arrange equipment and home adaptations.

Private options include a private physiotherapist for strength and balance work, an optician or audiologist, a private GP for a medicines review, or a geriatrician appointment for a comprehensive assessment. These can be useful for faster access, but the building blocks of care are the same, and the NHS pathway includes a falls service that looks across all of them.