Should an older person go to hospital after a fall?

Quick summary

Not always. Go to A and E or call 999 if they hit their head, take blood thinners, cannot put weight through a leg, or seem confused. Otherwise ring 111 and let a clinician decide. A fall with no injury usually needs a GP appointment rather than a hospital, but it does need one.

What actually decides it?

Typically four things:

• Did they hit their head.
• Are they on a medicine that thins the blood.
• Can they put weight through both legs.
• Are they behaving like themselves.

A yes to the first two together, or a no to either of the last two, points at hospital. Everything else tends to be a 111 conversation.

Sources: NHS, Falls and NHS, Head injury and concussion.

Why do blood thinners change the answer?

Because they change what a minor bump can turn into.

Anticoagulants stop the blood clotting as it normally would. A small bleed inside the skull that would seal itself in anyone else can keep going, and the symptoms can appear hours later, long after everyone has decided it was nothing. The NHS lists anticoagulant medicines specifically as a reason to seek advice after a head injury.

This is the single most common reason a family gets this decision wrong. Somebody looks fine at eight in the evening, goes to bed, and is not fine at two in the morning. If they take a blood thinner and they hit their head, they get assessed the same day. Say the drug name when you call.

How do I know if they have broken a hip?

You can never know for certain. What you are looking for is enough to justify the call.

The classic signs are pain in the hip, groin or thigh, inability to stand or bear weight, and a leg that looks shorter or rotated outwards compared with the other one. But hip fractures do not always look like that. Some people with an impacted fracture can still walk, badly, which is exactly how they get missed on the day and diagnosed a week later.

Over 70,000 people in England, Wales and Northern Ireland break a hip each year, and most are older people who have fallen (National Hip Fracture Database, 2025). If the pain is in that area and it is getting worse rather than settling, that is a hospital job even if they walked to the sofa.

What if they seem confused?

Treat new confusion as urgent, whether or not they hit their head.

Confusion that comes on over hours or days is usually delirium, and the common causes are infection, dehydration, pain and medication. It is a frequent reason older people fall in the first place, so it can be the cause rather than the consequence. Either way it needs assessing the same day.

The distinction that matters: a person with dementia who is confused in their usual way is not the same as a person who is more confused than yesterday. Families spot the second one instantly and then talk themselves out of it. Do not.

The argument against going

Worth stating plainly, because most articles pretend it does not exist.

An emergency department is a hard place to be in, especially with the elderly. Trolleys are uncomfortable, waits are long, and time spent lying still, out of routine and without proper food or sleep, can leave a frail person weaker and more confused than the fall did. 

It is a reason to use 111 properly rather than defaulting to A and E for everything, and to say clearly on the call that the person is frail, so they can be routed to an urgent care response at home if one is available. It is not a reason to sit on a head injury.

What if they refuse?

An adult with capacity can refuse hospital, and that includes refusing unwisely.

Ask what specifically they are afraid of. It is nearly always one concrete thing, usually being kept in, losing the car, or a care home being raised. It often helps to say that paramedics assess at home and frequently leave people where they are.

If they have a head injury, are on blood thinners, or seem confused, call anyway and explain the refusal. Confusion may mean they cannot make that particular decision at that moment, and that is for a clinician to judge rather than you.

They did not go. What now?

Watch the next 48 hours, then book the GP either way.

Things that change the decision after the event: a headache that keeps building, repeated vomiting, drowsiness at a normally alert time, new confusion, weakness on one side, or hip, groin or thigh pain that worsens rather than settles. The NHS notes that symptoms after a head injury can last up to two weeks, and anything beyond that should go to a GP.

NICE guidance from April 2025 says anyone aged 65 and over who has fallen should have their gait and balance assessed, and that a fuller falls assessment should be offered to anyone injured, knocked out, living with frailty, or unable to get up alone (NICE NG249). Skipping hospital does not mean skipping that.

Which hospital, if they do go?

Across Cheshire East and the High Peak, it depends where they live. Macclesfield, Wilmslow, Knutsford, Prestbury and Bollington go to Macclesfield District General. Alsager goes to Leighton Hospital in Crewe. Whaley Bridge and Chapel-en-le-Frith often route to Stepping Hill in Stockport. Kidsgrove and Biddulph go to Royal Stoke.

Cavendish Hospital in Buxton and Leek Moorlands Hospital are community hospitals without emergency departments, so an ambulance will not take someone there.

Frequently asked questions

If an old person falls should they go to the hospital?

Only if there are signs that need hospital assessment: a head injury, blood thinners, inability to bear weight, new confusion, or an obvious deformity. A shaken but uninjured person is usually better served by 111 and then their GP.

Can I drive them to A and E myself?

Only if they can walk and get in and out of a car without pain. If there is any chance of a hip, spine or neck injury, call 999 and wait, because moving them yourself can make the injury worse.

How long should I watch someone after a head injury?

Somebody should be with them for the first 24 hours, and you should keep an eye out for two weeks. It is fine to let them sleep, but they should be rousable, and you should be able to wake them and get a sensible answer.

They went to A and E, were checked and sent home. Is that the end of it?

No. A and E rules out the immediate injury; it does not investigate why the fall happened. That is the GP’s job, and it usually means a lying and standing blood pressure check and a medication review.

What if they fall again the same week?

Treat it as more urgent than the first one and say “second fall this week” when you ring. A cluster of falls in a short period suggests something acute, such as an infection, a new medicine or a heart rhythm problem, rather than a stumble.

About Visiting Angels Cheshire East

Visiting Angels Cheshire East provides care at home across Macclesfield, Wilmslow, Congleton, Knutsford, Alsager and the villages of East Cheshire, along with Buxton, Whaley Bridge 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.
• Short term packages stay short term. Care after a fall should reduce as someone recovers, and we will tell you when it can.
• Carers trained in stroke recovery, Parkinson’s, dementia and complex care.
• Live-in care available, up to full time, for the first weeks home if that is what is needed.

Val had support at home after her hip replacement:

“Super service, very pleasant and caring staff that came to see me when I had my hip replacement done. Will miss our tea and chat now.”

Valerie Hewitt, Google review

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

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.

If someone is coming home from hospital and you are working out what they will need, call us on 01625 720157. You can also WhatsApp us or send an enquiry, and you can see what our services cover.

Authored by Dr Niall Jawad, Director, Visiting Angels Cheshire East.

Published 13th September 2026. Last updated 13th September 2026.

This article is general information, not medical advice, and no substitute for a professional who knows the person. It cannot tell you whether a particular person needs hospital; if you are unsure, ring 111, and call 999 in an emergency. 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. 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.