Falls in Older Adults: What to Do, What Causes Them, and How to Prevent Them

What to do after a fall, when to call an ambulance, how to prevent the next one, and how to talk to your family about what comes next.

Produced by Visiting Angels Kirklees & Calderdale | visiting-angels.co.uk/kirklees-calderdale | 01484 360733

Please note: This guide is for general information only. It is not medical advice and does not replace a consultation with your GP or another healthcare professional. If you are worried about someone’s health or safety, always seek medical advice promptly. In an emergency, call 999. Before making any changes to medication, exercise, or care arrangements, speak to a qualified healthcare professional first.

What’s in this guide

• Part 1: What to do right now if you’ve had a fall
• Part 2: When to call 999 and when to monitor at home
• Part 3: What to do if you fall and can’t get up alone
• Part 4: The weeks after a fall
• Part 5: Why falls happen
• Part 6: How to prevent future falls
• Part 7: Room-by-room safety guide
• Part 8: Clothing and footwear
• Part 9: Health, lifestyle and nutrition
• Part 10: Garden and outdoor safety
• Part 11: Falls and dementia
• Part 12: Talking to your family about extra support

Introduction

If you’re reading this, a fall has probably happened, or you’re worried one might. Either way, you’re doing exactly the right thing.

Falls are very common in older age. Around one in three adults over 65 has a fall at least once a year, rising to one in two for those over 80. Most are preventable, and there is a great deal that can be done, both after a fall and before the next one.

The difficulty is that the information families need is spread across NHS pages, leaflets, and clinical guidance, none of which tell the whole story. This guide brings it all together. Whether you’re responding to a fall that’s just happened, trying to understand why falls keep occurring, or working out what changes to make at home, everything you need is here.

Part 1: What To Do Right Now

The first five minutes

Take a breath. The worst thing you can do immediately after a fall is rush. Moving someone before you understand what’s wrong can turn a manageable situation into a much more serious one.

Talk to them first. Ask where it hurts. Watch their face. Is their speech clear? Are they confused about where they are or what happened? Someone who can hold a clear conversation, isn’t in severe pain, and can move all four limbs is in a very different situation to someone who cannot.

Wait before you touch them. A broken hip, a spinal injury, or a bleed inside the skull doesn’t always cause obvious pain straight away. Give them thirty seconds to tell you what they’re feeling before you do anything else.

Call 999 immediately if any of the following apply

• They are unconscious, very drowsy, or can’t be woken
• They have hit their head and take any blood-thinning or antiplatelet medication. This includes warfarin, rivaroxaban (Xarelto), apixaban (Eliquis), clopidogrel, or regular aspirin prescribed for their heart or stroke prevention. With these medications, even a minor knock to the head can cause a slow bleed that becomes serious hours later, even if they seem completely fine at first
• There is severe pain in the hip, pelvis, back, or neck
• A limb looks deformed or is at an unusual angle
• They cannot move their legs or put any weight through them at all
• They fell from height: down stairs, off a chair, from a bed
• You notice signs of a stroke. Use the FAST test: Face drooping on one side, Arms weak or numb on one side, Speech slurred or confused. If any of these are present, call 999 immediately
• They were alone and may have been on the floor for more than an hour
• They lost consciousness before the fall, not after it. If they say “I don’t know what happened, I just found myself on the floor”, that needs urgent medical attention even if they seem physically fine

999 or 111? Call 999 when the situation feels urgent or you’re not sure. Call 111 if the fall seems minor, there’s no obvious injury, and you just want advice. When in doubt, always call 999. You will not be wasting anyone’s time.

If someone has been on the floor for a long time

If your loved one has been on the floor for more than an hour, whether they fell in the night or couldn’t reach the phone, treat it as a medical emergency even if there’s no visible injury.

Research by Professor Pip Logan at the University of Nottingham found that lying on the floor for a long time is dangerous in its own right. Within 90 minutes, the body can start to suffer from dehydration, cold, skin damage from pressure, and in some cases kidney problems caused by muscle damage from lying in one position. [2]

If you or your loved one lives alone, a personal alarm is worth taking seriously. Modern fall detectors come as wristbands or watches and alert a 24-hour monitoring centre automatically, without needing to press anything. A basic monitored alarm costs around £15 to £25 a month. Automatic fall detection devices range from around £25 to £50 a month. It is much better to have one in place before anything happens.

Part 2: Call 999 or Wait and See?

The NHS guidance on this isn’t always clear, which leaves families making difficult calls without enough information. Here’s a straightforward reference guide.

Quick-reference decision guide

The hidden hip fracture

A broken hip doesn’t always mean immediate collapse. Some people stand up, take a few steps, and say they feel fine. The break can be incomplete, and the pain builds as swelling develops over the following 24 to 48 hours.

If hip, groin, or thigh pain gets worse after a fall rather than gradually settling, get same-day medical attention. Don’t wait for a weekday GP slot if it happens at the weekend.

Part 3: What To Do If You Fall and Can’t Get Up Alone

This situation doesn’t get talked about enough. You fall, you’re not seriously hurt, but you can’t get up and there’s nobody there to help. It happens to thousands of people every year, particularly those living alone.

If you fall and can’t get up:

1. Stay as calm as you can. Panicking makes everything harder. Take slow, steady breaths.
2. Check yourself for pain before you move. If you feel severe pain in your hip, back, or neck, do not try to get up. Stay still and call for help.
3. If your phone or personal alarm is within reach, use it. If not, call out loudly. If you’re near a radiator or pipes, knock on them.
4. If you feel cold, try to pull a coat, blanket, or anything nearby over yourself. The cold can become a problem faster than most people expect.
5. If you feel able to try getting up, do it slowly. Roll onto your side first. Push up onto your hands and knees. Crawl to the nearest solid piece of furniture. Put both hands on the seat, bring your stronger foot forward flat on the floor, and push up slowly. Rest before you stand fully. This is the method the NHS recommends. [3]
6. If you can’t get up, stay as comfortable as possible and keep trying to attract attention. Don’t wear yourself out making repeated attempts. Help will come.

A note for family members: If your loved one lives alone and a call goes unanswered for longer than normal, trust that instinct. Many people have been found safe because someone drove round on a hunch.

Part 4: The Weeks After a Fall

The fall itself gets all the attention. The weeks that follow are where things can quietly go wrong, and where the right steps make an enormous difference.

Fear of falling: why it can make things worse, not better

After a fall, it’s completely natural to feel nervous about it happening again. But research shows that letting that fear take over can actually make another fall more likely, not less.

A large review of studies found that fear of falling is closely linked to depression, and that both increase the chances of falling again. [4] A separate analysis found that people who become anxious about falling often start walking more slowly, with a shuffling, wide-legged stride, which actually makes balance worse rather than better. [5]

The person is trying to be careful, but the way they’re moving has become less stable than before. Slowing down out of anxiety can reduce balance, not improve it.

Moving less after a fall feels safer. The evidence says the opposite.

If your loved one has become reluctant to walk to the kitchen alone, stopped using the stairs, or given up activities they previously managed, those changes need to be addressed, not accepted as permanent. Speak to a GP or physiotherapist about a structured plan to rebuild confidence.

Book a GP appointment within a week. Be specific.

A GP appointment after a fall isn’t just a routine check-up. It opens the door to specialist support that most families don’t know is available. NICE guidance recommends that anyone who has had a fall should have a thorough assessment covering balance, strength, vision, medication, and cognitive function. [6]

When you go, ask specifically for:

• A referral to a falls clinic or falls prevention programme
• A physiotherapy referral for balance and strength
• An occupational therapy referral for a home assessment
• A medication review, with falls as the specific focus

If you don’t ask for these by name, you may leave with a blood pressure check and a follow-up in three months. Be direct about what you’re asking for.

Medication: an often-overlooked cause of falls

Many common medications can affect balance, particularly in older adults. A medication review with your GP or pharmacist, which is free at most GP practices, can identify whether anything you’re taking may be contributing to falls.

The types of medication most commonly linked to falls include:

Blood pressure tablets and water tablets (diuretics). These can cause blood pressure to drop sharply when you stand up from sitting or lying down, leading to a few seconds of dizziness. This is a common cause of falls first thing in the morning when getting out of bed.

Sleeping tablets and benzodiazepines (including zopiclone and temazepam). These slow reflexes and affect coordination.

Antidepressants, particularly SSRIs and older tricyclic types. These are associated with both an increased chance of falling and weaker bones. [7]

Antipsychotics. These can cause muscle stiffness and affect the way you walk.

Sedating antihistamines, including some common cold and hay fever remedies available over the counter. Many people don’t realise these can affect balance.

Please don’t stop taking any medication without speaking to your GP first. But a review focused specifically on falls can identify whether safer alternatives, lower doses, or different timings might help.

Bone health: making falls less damaging

Osteoporosis doesn’t cause falls, but it affects what happens when one occurs. Someone with weaker bones is far more likely to break something in a fall than someone whose bones are strong.

A DEXA scan, which is a simple, painless bone density scan, can show whether this is a concern. Treatment is available and can meaningfully reduce the risk of fractures, even for people who have already broken a bone in a relatively minor fall. This is worth asking your GP about, particularly for women over 65 and anyone who has previously had a fracture from a minor bump or trip.

Part 5: Why Falls Happen

Falls are almost never caused by one thing alone. They tend to happen when several factors, physical, medical, and environmental, come together at once. That’s actually good news, because it means there are usually several things that can be changed.

Physical and medical causes

Muscle weakness. From around the age of 55, the body gradually loses muscle if we don’t actively work to maintain it. [8] Leg strength and core stability are the first to go, and both play a direct role in balance and preventing falls.

Balance and walking difficulties. These can develop gradually with age and reduced activity, or follow a stroke, Parkinson’s disease, or another condition affecting the nervous system.

Dizziness when standing up. A drop in blood pressure when you move from lying or sitting to standing causes a few seconds of light-headedness. It is most common first thing in the morning, which is why the first walk to the bathroom is one of the riskiest moments of the day.

Poor eyesight. Depth perception and side vision both decline with age. An out-of-date glasses prescription, cataracts, glaucoma, or macular degeneration all make it harder to judge distances and spot hazards.

Hearing loss. The part of the inner ear that controls balance is closely connected to the part that controls hearing. Research from Johns Hopkins found that even mild hearing loss was linked to a nearly three-fold increase in fall risk, separate from any other factors. [9]

Dementia and memory problems. Reduced awareness of hazards, moving without steadying first, and slower reactions all increase fall risk. People with dementia are two to three times more likely to have a fall.

Rushing to the toilet. Urgency, especially at night, is one of the most common causes of falls in older adults, and one of the most underestimated. If urinary urgency is a regular problem, it is worth raising with a GP.

Blood sugar problems. Low blood sugar, which can happen in people with diabetes, causes dizziness, confusion, and weakness. Falls that happen in the early morning or just before meals can sometimes be related to blood sugar dropping overnight.

Reduced feeling in the feet. Diabetes and poor circulation can reduce sensation in the feet, making it harder to feel changes in surface and stay steady.

Not drinking enough. Even mild dehydration lowers blood pressure and affects concentration. As we get older, the sensation of thirst becomes less reliable, so it’s possible to become quite dehydrated without feeling thirsty.

Alcohol. Alcohol directly affects balance and reaction time, and interacts with many common medications in ways that increase those effects further.

Things in the home

• Poor lighting, especially on the route from bedroom to bathroom at night
• Loose rugs or carpets with curling edges
• Slippery bathroom floors
• No grab rails next to the toilet, bath, or shower
• A handrail on only one side of the stairs, or one that is loose or too low
• Electrical cables across the floor
• Clutter on routes through the house
• Pets underfoot, particularly cats and small dogs
• Ill-fitting or the wrong type of footwear
• Outdoor hazards: wet leaves, ice, uneven paving, raised door thresholds

Part 6: How To Prevent Future Falls

Preventing falls isn’t about one big change. Research consistently shows that tackling several factors at the same time works far better than any single fix. [6] Here’s what that looks like in practice.

Exercise: the single biggest thing you can do

Of everything that can be done to reduce fall risk, staying active and building strength and balance has the strongest evidence behind it.

The Otago Exercise Programme, a home-based programme of leg-strengthening and balance exercises developed at the University of Otago in New Zealand, has been shown across multiple clinical trials to reduce falls by around 35 percent. [10] It can be prescribed by a physiotherapist and done at home with no special equipment.

Tai chi has similarly strong evidence, with one large review finding it reduced falls by around 43 percent. [11] It works on balance and confidence at the same time, and the group setting can help with the isolation that sometimes follows a fall.

For anyone with limited mobility, chair-based exercises, gentle yoga, walking with poles, or light resistance bands all help. Consistency matters more than intensity. Short daily sessions build strength over weeks in a way that occasional bursts don’t.

The NHS recommends at least 150 minutes of moderate activity per week, including two sessions focused on strength. A physiotherapist can help you work out a safe starting point, whatever your current level of mobility.

Walking aids

Using a walking stick, rollator, or walking frame is not a sign of giving up. Used properly, they reduce fall risk by improving stability.

The important word is properly. A stick that’s the wrong height, or used on the wrong side, can make things worse rather than better. Ask a physiotherapist or occupational therapist to help find the right aid and show you how to use it. Your GP can refer you.

Stairlifts

If stairs have become difficult or worrying, a stairlift removes that risk entirely. They can be fitted in most standard staircases and are available to buy or rent. Some local councils and charities offer grants toward the cost for people who qualify. An occupational therapist can advise on whether one is suitable and what type would work for your home.

Practical steps to take now

• Ask your GP for a falls assessment. Be clear that you’d like a full review, not just a general check-up
• Ask for a medication review specifically focused on falls
• Book an eye test if it’s been more than two years
• Ask your GP to check your blood pressure both sitting and standing. This reveals the kind of dizziness that causes morning falls and is rarely checked at routine appointments
• Get blood sugar levels checked, particularly if you have diabetes or a family history of it
• Ask about a hearing test. The link between hearing and balance is well established but rarely raised
• Ask about a bone density scan if you’re a woman over 65, or if you’ve had a fracture from a relatively minor knock or trip
• Ask about vitamin D. Many older adults in the UK are low in it, and it plays a role in muscle strength and bone health. Your GP can advise. [12]

Time of year matters

Falls are more common in winter. Ice and wet leaves make outdoor surfaces more dangerous. Low winter sun creates glare that affects depth perception, particularly for anyone with cataracts. Central heating dries the air and can contribute to dehydration. Cold muscles are slower to react.

In summer, the main risk is not drinking enough. Dehydration in hot weather affects blood pressure and concentration quickly. Pay particular attention to fluid intake during warm spells.

Part 7: Room-by-Room Safety Guide

More than half of all falls in older adults happen at home. [1] The bathroom, bedroom, and staircase account for most of them. Here’s what to look at in each room.

The bathroom

The bathroom carries more risk than any other room in the house. Wet floors, stepping over the bath edge, getting up from the toilet half-asleep, and moving quickly in low light all combine in a small space.

Doors and access

• Remove internal door locks if there’s any risk of being unable to get out after a fall, or replace with a type that can be opened from outside
• A door that opens outward means someone fallen behind it can still be reached

Bath and shower

• Fit a grab rail specifically for getting in and out of the bath or shower, positioned at the right height for the person using it
• Use non-slip mats both inside and outside the shower or bath, secured to the floor
• Consider a shower chair or bath seat for anyone who finds standing difficult
• A bath transfer bench lets you sit on the edge and slide in, rather than stepping over the side

The toilet

• Fit a grab rail next to the toilet. Getting up from a seated position is one of the most physically demanding things we do as we get older
• Consider a raised toilet seat, which reduces the effort needed to stand up
• Put motion-sensor lighting in and outside the bathroom, and on the route from the bedroom

Storage and clutter

• Keep toiletries in a cupboard rather than on the floor or bath edge
• Fit a shelf or caddy inside the shower so nothing needs to be picked up from the floor
• Hang towels on a rail rather than leaving them on the floor

The bedroom

The bedroom is most risky in the moments around sleep: getting up in the night to use the toilet, getting dressed in the morning, and the light-headedness that can follow lying down for several hours.

Lighting

• Put a plug-in night light or motion-sensor light on the route from the bed to the bathroom. Walking to the toilet in the dark is one of the most common times a fall happens
• Make sure a light or lamp can be reached from the bed without getting up
• Replace old yellow bulbs with white daylight bulbs throughout the home. The difference in visibility is significant

Getting out of bed

• Set bed height so your feet rest flat on the floor when you sit on the edge. Beds that are too high or too low both increase risk
• Consider a bed rail if you need support when changing position
• Before you stand, sit on the edge of the bed for thirty seconds first. This gives your blood pressure time to adjust, and many falls happen in the first few steps after getting up
• Keep any walking aid within arm’s reach of the bed

Everyday habits

• Keep glasses, medication, phone, and hearing aids on the bedside table. Searching for them in low light is a common cause of falls
• Remove anything stored on the bed that could slip to the floor
• Keep slippers beside the bed so you put them on immediately when you get up
• Avoid nightwear that is too long and could catch underfoot when you stand

Steps and stairs

Handrails

• Fit handrails on both sides of the staircase. A single rail leaves one side with nothing to hold
• Handrails should extend past the top and bottom step so there’s something to hold before and after the stairs
• Round or oval rails give a more secure grip than flat-topped ones
• Check that all rails are firmly fixed by pushing sideways with some force

The stairs themselves

• Repair any loose, worn, or torn stair carpet straight away
• Fit carpet or non-slip rubber treads on bare wood or laminate stairs
• Install a motion-sensor light on the staircase
• Make sure light switches are accessible at both the top and bottom

Living room and hallway

Chairs

• Choose chairs with firm armrests. Deep, soft sofas are very hard to get up from and encourage the kind of sudden lurch that causes falls
• Keep a walking aid within easy reach of your usual chair
• When you get up, stand first, pause, then walk. Rushing straight from sitting to walking is a common fall pattern

Carpets and rugs

• Tape down all rug corners with double-sided tape and use non-slip backing underneath
• Remove rugs from carpeted rooms. The edge of a rug on carpet is a trip hazard
• Check that all fitted carpets lie flat, especially at doorways

Cables and clutter

• Run all cables along walls, not across the floor
• Use cable tidies or covers at floor level
• Move low coffee tables that are easy to walk into
• Clear a wide, unobstructed path between the front door, sitting area, kitchen, and bathroom
• Keep hallways completely clear

The kitchen

Storage

• Move the things you use most often to between hip and shoulder height. Reaching up high or bending low both carry real risk
• Move heavy pots and appliances to lower cupboards
• If you need to reach something higher up, use a proper non-slip step stool. Never stand on a chair
• Consider a lazy Susan in deep cupboards so you don’t have to reach to the back

Wet floors and spills

• Put an absorbent, non-slip mat in front of the sink
• Clear up any spill immediately. Even a small amount of water on a hard kitchen floor is enough to cause a fall
• Use a long-handled mop so you don’t have to bend
• Wear shoes with a non-slip sole in the kitchen, not socks

Seating

• Use kitchen chairs with firm armrests
• Avoid chairs with wheels. They shift unpredictably when you put weight on them to stand up

Visiting Angels Kirklees & Calderdale Homecare: As part of every initial assessment, our carers carry out an informal review of the home and flag any hazards they notice during regular visits. A formal home assessment by an occupational therapist is available through your GP or local council and can, in some cases, fund adaptations to the home. We cover Huddersfield, Halifax, Brighouse, Holmfirth and the surrounding area.

Part 8: Clothing and Footwear

What you wear has a direct effect on fall risk, particularly first thing in the morning and during the night.

Clothing

• Avoid trousers, skirts, nightgowns, or dressing gowns that trail on the floor. A local alterations service can shorten anything that might catch underfoot
• Avoid long scarves or jewellery that could snag on door handles, furniture, or walking aids
• Don’t leave dressing gown cords loose where they could wrap around your feet
• Get dressed sitting down where you can, rather than standing on one leg

Slippers and indoor footwear

• Never walk on a smooth floor in socks. It is one of the most avoidable causes of a slip
• Choose slippers with a non-slip sole, a firm back strap (not backless), and a Velcro fastening
• Avoid very thick foam soles. Some feel of the floor under your feet helps with balance
• Keep slippers right beside the bed so you put them on the moment you get up

Outdoor shoes

• Choose shoes that fit well, have a non-slip rubber sole, a low heel, and ankle support
• Velcro fastenings are often easier than laces and give a more consistent fit
• Leave room for thick socks in cold weather. Cold feet lose sensation and are less reliable on uneven ground
• Use a long-handled shoe horn so you don’t have to bend down to put shoes on

Feet

• Trim toenails regularly. Nails that are too long change the way you walk in ways that increase fall risk
• See a podiatrist or chiropodist for foot pain, thickened nails, bunions, or calluses. These aren’t cosmetic issues, they affect how safely you walk
• If you have diabetes, make sure you have regular podiatry appointments. Reduced feeling in the feet is a known cause of falls

Part 9: Health, Lifestyle and Nutrition

Eyesight

Good vision is central to balance. Your brain uses what your eyes see to keep your body stable. When eyesight is affected by an out-of-date prescription, cataracts, or macular degeneration, staying balanced becomes much harder work.

• Get an eye test at least every two years. If you’re over 70, the NHS recommends annually. Your optometrist may suggest more frequent checks if you have cataracts, glaucoma, macular degeneration, or diabetes
• Keep a spare pair of glasses in the kitchen and bedroom so you’re never searching for them in low light
• Reading glasses are designed for close-up tasks. They affect your ability to judge distances and see to the side while moving. Be particularly careful on stairs or uneven ground if you’re wearing reading glasses or bifocals

Hearing

Hearing and balance are more closely connected than most people realise. The inner ear controls both, and research from Johns Hopkins found that even mild hearing loss was linked to a nearly three-fold increase in fall risk, separate from any other factors. [9]

• Have a hearing test every 18 to 24 months, or sooner if you’ve noticed any change
• If you wear hearing aids, make sure they’re regularly serviced and you have a plan for if one stops working

Blood pressure

Blood pressure that is too high or too low can both contribute to falls. A drop in blood pressure when you stand up is particularly worth knowing about, because it’s rarely tested during routine appointments and often goes unnoticed.

• Have your blood pressure checked regularly at your GP surgery
• A home blood pressure monitor can be useful. Taking a reading in the morning, shortly after getting up, gives a clearer picture of what’s happening when fall risk is highest
• If you feel light-headed or dizzy when you stand up, tell your GP and ask them to check your blood pressure both sitting and standing. This specific test is what identifies the problem

Blood sugar

Blood sugar problems are common in older adults and can cause dizziness, confusion, and weakness. Low blood sugar is particularly likely in the long gap between dinner and breakfast, or if a meal has been missed or delayed. Falls in the early morning or just before meals can sometimes be linked to blood sugar dropping.

• Ask your GP to check your blood sugar levels as part of routine monitoring
• If you take insulin or other diabetes medication, ask your GP whether your current dose is right

Nutrition

What you eat affects both your muscle strength and your bone strength, both of which directly affect how likely you are to fall, and how serious a fall is if it happens.

Protein is essential for maintaining muscle. Many older adults don’t eat quite enough of it. Aim for protein at every meal: eggs, dairy, fish, lean meat, beans, or lentils. The recommended amount is at least 1g of protein per kilogram of your body weight each day. [13]

Calcium supports bone strength. Good sources include dairy products, fortified plant milks, canned fish with bones, and leafy green vegetables. Aim for around 1,000mg per day if you’re over 50.

Vitamin D supports both bone strength and muscle function. Many older adults in the UK don’t get enough, particularly in winter. Ask your GP whether a supplement is right for you. [12]

Hydration

Even mild dehydration can lower blood pressure and affect concentration. As we get older, the thirst sensation becomes less reliable, which means it’s possible to be quite dehydrated without feeling thirsty.

• Aim for 6 to 8 drinks per day. Tea, coffee, low-sugar squash, and milk all count, not just water
• Keep a drink visible and within reach throughout the day as a reminder
• Drink more in warm weather
• Alcohol directly affects balance and reflexes, and amplifies the effects of many common medications. Cutting back is one of the most straightforward changes you can make

Part 10: Garden and Outdoor Safety

Around 30 percent of falls in older adults happen outside, and these tend to be more serious because outdoor surfaces are harder and help may not be immediately at hand. [14]

The answer isn’t to stop going outdoors. Fresh air, activity, and staying connected to the world are all good for health in ways that directly reduce fall risk over time. The answer is preparation.

Paths and steps

• Apply waterproof textured paint or anti-slip strips to steps, paths, and decking
• Replace steps with a gentle ramp where possible. For anyone with reduced leg strength, a ramp is considerably safer
• Fit handrails on both sides of any outdoor steps, extending past the top and bottom step
• Install motion-sensor lights along paths and around the outside of the house
• Keep all paths, steps, and decking clear of pots, tools, and debris

Weather

• Stay in during icy conditions unless you really need to go out. Black ice is invisible and even a short journey carries significant risk
• Wear outdoor shoes with proper grip and ankle support. Indoor shoes and slippers are not safe outside
• Spread salt or grit on paths before icy weather arrives, not after a fall
• Where a path looks icy, grass can sometimes offer more grip. Be aware though that uneven or wet grass is its own hazard for anyone with balance difficulties
• Ask a family member, neighbour, or carer to clear snow from the path to your front door
• Wear sunglasses on bright days. Low winter sun creates glare that makes it much harder to see changes in level, particularly for anyone with cataracts
• Take care with reading glasses and bifocals outdoors. They are not designed for walking on uneven ground and can affect your sense of depth and distance

Kerbs and pavements

• Uneven paving slabs, raised kerb edges, and deteriorated tarmac are a consistent cause of outdoor falls. If you find a dangerously uneven surface, it can be reported to the local council
• When using a walking aid outdoors, check kerb heights carefully before stepping up or down
• Stick to level ground where you can

Garden hazards

• Have any protruding roots, low branches, or plants overhanging paths cut back
• Keep garden furniture in a regular, consistent position. Furniture that has been moved is a common cause of trips

Part 11: Falls and Dementia

Falls are significantly more common in people living with dementia, and preventing them requires a slightly different approach.

People with dementia are two to three times more likely to fall than those without, and more likely to fall repeatedly. There are a number of reasons for this: reduced awareness of hazards means furniture or a wet floor may not be noticed; moving impulsively without steadying first; difficulty judging distances and step heights; and restlessness at night, which means falls can happen in the early hours when no one is nearby.

What tends to help:

• Keep the home layout as consistent as possible. Rearranging furniture is genuinely disorienting for someone with dementia and turns familiar spaces into new hazards
• During transfers, whether that’s standing up from a chair, getting out of bed, or moving from the toilet, physically accompany the person rather than giving verbal instructions from a distance
• Consider hip protectors for anyone at high risk of fractures. These are padded shorts worn under clothing, designed to absorb the impact of a fall on the hip. They’re available online and from mobility equipment suppliers and can reduce the severity of a hip fracture even if they don’t prevent the fall itself
• Plan specifically for night-time. Good lighting throughout the night, a low bed height, and a bed sensor alarm that alerts a carer when someone gets up all help manage the period of highest risk

It’s also worth being honest with yourself: for someone with moderate to advanced dementia, falls can’t always be prevented. The focus shifts from trying to stop every fall to reducing injury when one does happen and making sure it’s found quickly.

Part 12: Talking to Your Family About Extra Support

For many families, a fall is the moment everything changes. Everyone has been quietly managing: the daily phone calls to check in, the trips to help with shopping, the low-level anxiety that’s become background noise. A fall brings it all to the surface.

That conversation, about whether more help is needed, is hard. Most people associate needing help with losing independence. For someone who has looked after themselves for 70 or 80 years, the idea of a carer in their home can feel like a step they’re not ready to take.

But research shows that the right support after a fall makes a real difference. A study published in Age and Ageing found that people who had regular home care following a fall had significantly fewer hospital admissions and reported better wellbeing six months later compared to those who didn’t. [15] Home care doesn’t lead toward a care home. For most people, it’s what keeps them out of one.

It helps to be specific about what a carer actually does. They’re there during the morning routine, which is the riskiest time of day. They notice small changes in how someone is moving or managing that a weekly family visit would miss. They can go with someone to the bathroom at night if that’s needed. They help with exercises set by a physiotherapist. They provide a steady, experienced presence at the moments that matter most. That’s not about taking someone’s independence away. It’s about making sure independence lasts as long as possible.

Visiting Angels Kirklees & Calderdale: Our free in-home assessment takes about an hour and there’s no obligation. We come to you, walk through the home, talk through the daily routine, and discuss what support might look like. That might be one morning visit a week. It might be daily support. We’ll work out together what makes sense. We cover Huddersfield, Halifax, Brighouse, Holmfirth and all surrounding areas. Call us on 01484 360733 or visit visiting-angels.co.uk/kirklees-calderdale.

Falls Are Not Inevitable

They feel inevitable because they’re so common, and because the medical system often treats the injury without addressing what caused it. But most falls happen when several specific, changeable factors coincide at one unlucky moment.

Change enough of those factors and the falls stop happening.

The families who handle this best are not the ones who restrict what their loved one can do. They are the ones who understand what’s actually going on, make targeted changes, and put the right support in place. That gives the person they care about the best chance of staying independent, in their own home, on their own terms.

References

[1] Public Health England. Falls: applying All Our Health. GOV.UK, updated 2022.

[2] Logan PA et al. Outcomes of older people who fall: the relationship between time spent on the floor and subsequent health outcomes. Age and Ageing, 2012.

[3] NHS. Falls — what to do if you fall and how to prevent them. NHS.uk, 2023.

[4] Wu X et al. Association between falls, fear of falling and depressive symptoms in community-dwelling older adults. Healthcare, 2024.

[5] Iaboni A, Flint AJ. The complex interplay of depression and falls in older adults: a clinical review. American Journal of Geriatric Psychiatry, 2013.

[6] National Institute for Health and Care Excellence. Falls: assessment and prevention in older people. NICE Guideline NG249, April 2025.

[7] Vestergaard P et al. Selective serotonin reuptake inhibitors and other antidepressants and risk of fracture. Calcified Tissue International, 2008.

[8] Cruz-Jentoft AJ et al. Sarcopenia: European consensus on definition and diagnosis. Age and Ageing, 2010.

[9] Lin FR, Ferrucci L. Hearing loss and falls among older adults in the United States. Archives of Internal Medicine, 2012. Johns Hopkins Bloomberg School of Public Health.

[10] Campbell AJ et al. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ, 1997. University of Otago.

[11] Li F et al. Effectiveness of a therapeutic Tai Ji Quan intervention vs a multimodal exercise intervention to prevent falls among older adults at high risk of falling. JAMA Internal Medicine, 2018.

[12] Royal Osteoporosis Society. Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management. National Osteoporosis Society, 2013, updated 2020.

[13] Bauer J et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. Journal of the American Medical Directors Association, 2013.

[14] Li W, Kelsey JL et al. Outdoor falls among middle-aged and older adults: a neglected public health problem. American Journal of Public Health, 2006.

[15] Fairhall N et al. Effect of a multifactorial, interdisciplinary intervention on risk factors for falls and fall rate in frail older people: a randomised controlled trial. Age and Ageing, 2014.

Please note: This guide is for general information only and does not constitute medical advice. It is not a substitute for professional assessment or treatment. Individual circumstances vary. Always speak to a qualified healthcare professional before making changes to medication, exercise, or care arrangements. In an emergency, call 999.

Visiting Angels Kirklees & Calderdale | visiting-angels.co.uk/kirklees-calderdale | 01484 360733