Why are falls concerning for older people?

Anyone can have a fall, but falls are a major health concern for older people (those aged 65 and over).

Falls are the number one cause of accidental injury in older Australians. As our population ages and the number of older people grows, the number of falls and fall-related hospitalisations increases. 1 in 4 people who are aged 65 and over have at least 1 fall per year.

Even when falls don't cause an injury, they often trigger a loss of confidence in an older person and lead to an ongoing fear of falling. Over time, this can lead to a person becoming more inactive, which further increases the risk of falling.

There are things you can do to reduce the chance of you or your loved one having a fall and/or being seriously injured in a fall. Motivation, healthy habits and awareness of how to reduce the risk can all play a part in preventing older people from having a fall.

Why might older people fall?

If someone falls, it's not necessarily because they are 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 gradually and over many years as part of the normal ageing process. As you get older, you may notice:

• more difficulty with balance, such as feeling unsteady when you walk
• weaker muscles that may make it harder to lift your feet when you walk
• 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 they might be caused or exacerbated by an illness or condition. This can affect the way you move around — and sometimes cause us to fall.

Dangers in and around the home

6 out of 10 falls happen in and around the home. Common household hazards include:

• poor lighting
• unsafe footwear, such as loose slippers or narrow heels
• slippery surfaces, such as wet or polished floors or spills
• trip hazards such as rugs, floor mats and electrical cords
• steps or uneven surfaces

Neglecting general health and wellbeing

Older people who don't keep physically active may have poorer balance and weaker muscles, which can increase the risk of falling.

Not eating well and/or not drinking enough water can lead to dehydration or malnutrition, which can make it difficult to stay strong enough to move about safely.

What other risk factors are there for a fall?

Certain conditions can increase the likelihood of a person 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 — older people with naturally low blood pressure 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 a medicine's side effect.
• Stroke, Parkinson's disease and arthritis — these conditions 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 antidepressants can increase the risk of falling.

• Osteoporosis — characterised by thin, weak bones — is not a risk factor for falls. However, if someone does fall, there's a higher chance of them breaking a bone.

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

Your doctor can suggest ways to reduce your chance of falling in the future.

It's also a good idea to see your doctor for regular check-ups. This helps to address any concerns before they contribute to a more serious fall in the future.

How are falls treated?

If you have had a fall, or you're concerned about your risk of having a fall, your doctor may suggest the following treatments.

Vitamin D and calcium supplements

Speak to your doctor about whether you may benefit from vitamin D and calcium supplements. This may help to improve your bone health and reduce the likelihood that a fall will cause a fracture.

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 to see if changes are needed.

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 from walking, or have other symptoms such as tingling or pins and needles, see a podiatrist. They can provide advice on ways to improve your circulation, decrease swelling and reduce pain in the legs and feet.

Eyesight assessments and cataract surgery

Early detection of eye problems can stop them from getting worse. See your optometrist or doctor to get your eyes checked regularly. If you struggle to see well due to cataracts, surgery to remove these will help you reduce the likelihood of falls and fractures.

Hip protectors

A hip fracture is the most common injury from a fall in older people.

Hip protectors are placed inside special underwear and positioned over the hips to protect them in case of a fall. They reduce the likelihood of a breaking a hip, particularly for those who have osteoporosis or who fall frequently. Consider whether hip protectors might be suitable for you.

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, especially poor lighting, slipping, and tripping.

Lighting

Good lighting around the house is important. Simple changes can help improve visibility and reduce the chances 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

Change what you wear 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 hand rails 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 tripping hazard.
• Get rid of old mats and torn or stretched carpet, or tape down turned-up corners.

What are the complications following a fall?

Falls can cause hip and thigh injuries both in males and females. 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 also cause a heavy long-term burden as older people become less independent, 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 poorer balance, weaker muscles and stiffer joints.

Resources and support

• Watch this video from Queensland Health to learn some simple steps to reduce your chance of falling in the bathroom.
• Visit Western Australia Health's Stay on Your Feet website to learn how to keep yourself safe and steady.
• Healthy Bones Australia has some helpful articles on moving safely and recovering from a fracture. You call them on 1800 242 141 for general information about bone health or osteoporosis.
• Occupational Therapy Australia to find a private practice OT in your area to help you assess your home and make changes to keep you safe and independent.
• Injury matters offers tips on making your home safer, as well as a home safety checklist and other resources.

Other languages

Do you prefer to read languages other than English?

• Queensland Health's website has falls prevention resources translated into several languages.
• Health Translations Victoria has fact sheets on falls and preventing falls for older people translated into several languages.