9 reasons older people fall, and what to do about each one

Quick summary

Most falls come down to nine things: weak legs, medicines, blood pressure dropping on standing, eyesight, hearing, long-term conditions, dementia, not eating or drinking enough, and the house itself. Most of them are treatable. Start with a GP appointment and ask for a falls assessment and a medication review.

What causes falls in older adults?

The NHS lists the main causes as muscles getting weaker with age, conditions affecting mobility or balance such as arthritis, stroke or Parkinson’s, low blood pressure, side effects of some medicines, problems with eyesight or hearing, and dementia (NHS, Falls).

NICE adds that balance is affected by decline across the sensory systems, the nervous system and the muscles together, and that polypharmacy and medicines acting on the brain or the heart rhythm raise the risk (NICE NG249, April 2025).

Almost every fall traces back to something on the list below. They are in the order it is worth investigating them, which is not always the order most families start in.

1. Muscle weakness and poor balance

The one people write off as ageing, and the one with the strongest evidence behind fixing it.

Exercise reduces the rate of falls by around 23 per cent and the number of people who fall at all by around 15 per cent, across 108 randomised trials involving 23,407 people in 25 countries. The average participant was 76. Balance and functional training drove the effect (Cochrane, 2019).

The test at home is the chair test. If they cannot rise from a dining chair without pushing off with their hands, leg strength is already a problem.

2. Medicines, and how many of them

Falls that start within weeks of a new prescription are worth taking straight back to the surgery.

Taking four or more medicines is associated with an 18 per cent increase in fall rates in people over 60, and psychotropic medicines, meaning sleeping tablets, anxiety medicines, antidepressants and antipsychotics, carry additional risk of their own (Izza and colleagues, European Geriatric Medicine, 2020).

The research is uncomfortable on this. A study presented to the British Geriatrics Society found that three months after a hospital discharge following a fall, older people were on more falls-related medicines than they had been on admission, not fewer (British Geriatrics Society). 

3. Blood pressure dropping when they stand up

Postural hypotension is a drop in blood pressure on standing from sitting or lying down. It causes dizziness, unsteadiness, blurred vision and sometimes a blackout, and it is strongly associated with falls (Leeds Teaching Hospitals NHS Trust).

It is often caused or worsened by the very medicines someone takes for high blood pressure, which is why it sits so close to number two on this list.

It can produce no symptoms at all. The only way to find it is a lying and standing blood pressure check, so ask for that by name.

4. Eyesight

Vision problems including cataracts are on NICE’s list of modifiable risk factors, and cataract surgery is named in the guidance as something that can change a person’s risk.

Two things catch people out. New varifocals blur the ground through the lower part of the lens, which is exactly where you need sharpness on a staircase. And poor contrast matters more than poor acuity, so a cream stair carpet against a cream wall is a hazard even for someone who passed their eye test.

Free NHS sight tests are available to anyone aged 60 and over.

5. Hearing and the inner ear

The NHS lists hearing problems alongside eyesight as a cause of falls, and its own prevention advice tells people to get their ears and hearing checked because ear problems affect balance.

Balance depends on three systems working together: the inner ear, vision, and the sense of where your limbs are in space. Lose one and the other two compensate. Lose two and you fall. That is why an older person with cataracts and untreated hearing loss is at far greater risk than either problem alone would suggest.

6. Long-term conditions

NICE names arthritis, diabetes, Parkinson’s disease, stroke and learning disability among the conditions that raise falls risk, and treats them as significant enough that people aged 50 to 64 who have them should be assessed as though they were older.

Each does it differently. Arthritis through pain and stiffness. Stroke through weakness on one side. Parkinson’s through freezing, where the feet stop and the body keeps going, and through medication timing, since a dose given late can be the difference between walking to the kitchen and going down in the hallway. Diabetes through numbness in the feet and through hypoglycaemia.

If one of these is in the picture, the falls conversation belongs with whoever manages the condition, not just with the GP.

7. Dementia

Dementia appears on both the NHS and NICE lists, and the Cambridge research on time spent on the floor found that cognition was the only characteristic that predicted a long lie after a fall (Fleming and Brayne, BMJ, 2008).

So dementia raises both halves of the risk. It makes a fall more likely, and it makes the aftermath worse, because the person may not think to use a phone or an alarm.

One thing that is not dementia. Confusion that comes on over hours or days rather than months is usually delirium, often caused by infection, dehydration or a medicine. It is treatable and it needs a GP as soon as possible. 

8. Not eating and drinking enough

The NHS advice is to eat well and stay hydrated, because not eating and drinking enough can make you feel lightheaded or faint. Alcohol is on the same list, in the other direction.

Dehydration is also a recognised cause of postural hypotension, so this and number three are often the same problem arriving by different routes.

9. The house, the stairs and the shoes

Last, deliberately. This is where most families start, and starting here can waste months while the real cause goes unlooked at.

It still matters. NICE recommends a home hazard assessment using a validated tool, ideally carried out by an occupational therapist. The NHS advice covers clutter, loose wires and rugs, non-slip mats, grab rails, and shoes or slippers that fit well and grip.

Which of the nine is it?

How do these get found?

Through a falls assessment, which is ordinary GP and community service work.

NICE says a full falls assessment should be offered to anyone who has fallen in the last year and is living with frailty, was injured badly enough to need medical treatment, lost consciousness, or was unable to get up on their own. Anyone else who has fallen should at least have their gait and balance assessed.

Free local programmes run across all three counties this patch covers, and they are the right first call for most people. Stand Strong in Cheshire East on 0300 123 5026. Live Stronger for Longer in Derbyshire on 01773 766922, covering Buxton and Whaley Bridge. Steady On Your Feet for Leek, Biddulph and Kidsgrove.

Frequently asked questions

What are the 3 most common causes of falls in older adults?

Muscle weakness and impaired balance, medication side effects, and blood pressure dropping on standing. Those three account for the largest share, which is why they head the list above. NHS and NICE guidance also name vision and hearing problems, arthritis, stroke, Parkinson’s, dementia and home hazards.

How many older people fall each year?

Around a third of people aged 65 and over, and around half of people aged 80 and over, fall at least once a year (Office for Health Improvement and Disparities, 2022).

Can falls actually be prevented, or is it just ageing?

Government guidance states that falls and fractures in older people are often preventable. The evidence for strength and balance exercise is rated high certainty by Cochrane, which is about as strong as evidence gets in this field.

Which medicines are worst for falls?

The research points at psychotropic medicines, meaning sleeping tablets, anxiety medicines, antidepressants and antipsychotics, plus medicines affecting heart rhythm and blood pressure. The total number matters independently of which ones they are.

Can more than one of the nine be involved at once?

Usually. That is the point of a full falls assessment rather than a single test, and it is why NICE describes it as identifying a person’s individual risk factors, plural. Fixing one of four contributing causes will not stop the falls, which is why families sometimes conclude nothing works.

Does a carer reduce the risk of falling?

Not directly. A carer can make sure someone is not rushing to the bathroom in the dark, can prompt the exercises a physiotherapist set, and can be there at the time of day the falls keep happening. The prevention itself comes from the assessment, the medication review and the exercise.

About Visiting Angels Cheshire East

Visiting Angels Cheshire East provides care at home across Macclesfield, Congleton, Knutsford, Wilmslow, Alsager and the villages of Cheshire East, along with the High Peak and the Staffordshire border towns.

• You choose your caregiver. You meet them before care starts, and if it is not right you say so and we send someone else.
• No visit is ever shorter than an hour. There is no such thing as a fifteen minute call here.
• You see the same faces. Our carer turnover is 12 per cent, against a sector figure of 23.7 per cent (Skills for Care, 2025).
• Carers trained in dementia, Parkinson’s, stroke recovery and complex care.
• Live-in care available, up to full time, where someone should not be on their own overnight.

Iain wrote this about the help his mother receives:

“Visiting Angels have been a great help to my mother with cleaning, shopping, taking her for walks and by simply keeping her company.”

Iain Brook, Google review

The walks are the part that matters on this page. Getting out is what keeps legs strong, and shopping and cooking are how numbers eight and one get addressed at the same time.

Not sure what you need yet? Start with a free assessment

If you have read this far you probably have a GP appointment to book. Once that is under way, and you want to work out whether help at home is needed alongside it, the first conversation with us costs nothing.

Our free home care assessment is a visit at a time that suits you, with no obligation afterwards. In it we will:

• Work out what is actually difficult, and which times of day, which is usually what a visit should be built around.
• Talk through a realistic package, and what it would cost.
• Look at the money with you, and point you towards the funding, benefits and grants you may be entitled to, including the ones most families are never told about.
• Tell you honestly if you do not need us yet, or if someone else is a better fit.

To talk it through with someone who knows the area, call us on 01625 720157. You can also WhatsApp us or send an enquiry, and you can read more about how we work.

Authored by Dr Haroon Ahmad, Managing Director, Visiting Angels Cheshire East.

Published 6 September 2026. Last updated 6 September 2026.

This article is general information, not medical advice, and no substitute for a professional who knows the person. The author is a director of the company and is not acting in a clinical capacity, and Visiting Angels Cheshire East provides personal care at home rather than medical or nursing care. Speak to a GP, a pharmacist or NHS 111 about your own situation, and call 999 in an emergency. Information correct at the date of publication. To the fullest extent permitted by law, GB Care at Home Ltd accepts no liability for any loss or injury arising from reliance on it.