How to Reduce the Risk of Falls at Home: A Comprehensive Guide

Falls are a major concern for the older population, but they are not an inevitable part of ageing according to Age UK. Comprehensive preventative strategies can substantially reduce the risk and preserve independence.

Falls are a pervasive clinical concern, affecting approximately one in three people aged 65 and over annually, and rising sharply to 50% for those aged 80 and older. They are the single biggest cause of accidental injuries in the home and the largest cause of accidental death among those over 65 in the UK. Unaddressed fall hazards in the home alone are estimated to cost the NHS in England £435 million annually in subsequent emergency hospital admissions.

The risk of falling is typically multifactorial, involving physiological, pharmacological, sensory, and environmental risks. However, comprehensive falls prevention strategies can mitigate these issues. The single greatest risk factor for a future fall is having experienced a previous fall.

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Immediate Action – Making Your Home Safe

Reducing environmental hazards is a core component of prevention, as many falls occur in and around the home.

Identifying and Eliminating Trip and Slip Hazards

• Remove or Secure Floor Coverings: Get rid of throw rugs and mats and move them away from the top or bottom of stairs. Ensure that any remaining carpets are secured and not wrinkled or fraying.
• Clear Clutter: Keep areas like stairs and hallways clear of clutter and obstacles. Ensure floors are clear of trailing wires (including telephone or electrical cords).
• Flooring: Avoid using high-gloss wax on floors.
• Pets: If you have a pet, consider putting a collar with a bell on it, as pets can get under your feet.

Structural Aids and Lighting

• Install Safety Rails: Think about installing fitted handrails in helpful places, such as on both sides of the stairs, by the bath, and in the garden.
• Bathroom Safety: Use non-slip mats in the bath or shower area to prevent slipping.
• Improve Lighting: If you wake up during the night, install a night light near the bed to ensure you can see where you are going, or consider a motion-activated light.

Professional Home Hazard Assessment

• Care Needs Assessment: If you think you might need adaptations to your home, contact the adult social services department of your local council to ask for a free Care Needs Assessment.
• Specialist Intervention: Evidence suggests the home hazard assessment and intervention should be carried out using a validated tool. Consideration should be given to having this intervention performed by an Occupational Therapist (OT), as NICE guidelines suggest greater benefit when delivered by an OT.
• Handyperson Schemes: Some local Age UK branches offer Handyperson schemes to assist with small repairs and home-safety checks.

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Individual Interventions – Strengthening Your Body

Addressing physiological risk factors, particularly muscle weakness and balance impairment, is highly effective in fall prevention.

Exercise for Strength and Balance

• The Most Effective Intervention: Moving more and staying active is the best thing you can do to remain mobile and independent. Exercise is the single most effective behavioural intervention and can reduce the risk of falling by an estimated 35% to 54%.
• What to do: Physical activity guidelines recommend activities that explicitly improve strength and balance at least twice a week. Effective elderly rehabilitation programmes should be progressive, tailored to the person’s specific needs, and focus on functional components such as balance, coordination, strength, and power.
• Home-Based Programmes: The Otago Exercise Programme (OEP) is an internationally recognised, home-based programme delivered by a physiotherapist, which uses adjustable ankle weights for resistance training. It has been proven effective, particularly for adults aged 80 and older who have fallen in the last year. Participants should aim to do the exercises three times each week, and walk on the days in between.

Medication Review and Management

• Pharmacological Risk: The use of certain medicines is recognised as a major and modifiable risk factor for falls. Risk increases if you are on four medications or more (polypharmacy).
• Medication Review: If you have had a fall, a full medication review should be part of the assessment. A structured review should be carried out to identify and adjust Falls-Risk-Increasing Drugs (FRIDs). Clinicians may use tools like STOPPFall to support this process.
• Psychotropic Medicines: For people taking psychotropic medicines (e.g., sleeping tablets, antidepressants), a clinical review is required to discuss the increased risk of falls and plan withdrawal where appropriate, considering liaison with specialist mental health services. Withdrawal of medication should always be done under the supervision of a suitable clinician.

Footwear, Diet, and Sensory Health

• Footwear: Poorly fitting shoes or slippers contribute to the risk of falling. Wear well-fitted shoes or slippers with gripping soles and avoid walking in bare feet or socks.
• Hydration and Nutrition: Make sure you are drinking lots of fluids, aiming for 6 to 8 glasses a day, to prevent feeling lightheaded or dizzy. Eating regular, balanced meals helps maintain strength and vitality.
• Bone Health (Osteoporosis): Stronger bones reduce the risk of more severe effects (such as a fragility fracture) if you do fall. You need adequate intake of calcium and vitamin D to maintain strong bones.
• Vision and Hearing: Problems with your eyesight or hearing can be causes of falls. If you have visual impairment caused by cataracts, you should be referred to an ophthalmologist.

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When to Seek Professional Guidance

Clinicians should routinely ask older people about falls and observe for deficits in gait and balance.

Consulting Your GP

• Initial Step: If you have had a fall or are worried about feeling unsteady on your feet, tell your doctor (GP), even if you feel fine otherwise.
• Referral: Your GP can check your balance and the way you walk and may refer you to a specialist physiotherapy or falls service for further help.

Comprehensive Falls Assessment

A specialist falls service or another appropriate team can provide a comprehensive falls assessment for people at higher risk.

• Who Should Be Offered an Assessment: NICE recommends a comprehensive assessment after a fall in the past year if you live with frailty, needed medical treatment for a fall injury, lost consciousness in relation to a fall, could not get up independently, or have fallen at least twice in that year. Other people who have fallen should still have their walking and balance checked.
• What is Assessed: The assessment looks for problems such as muscle weakness, weak bones (osteoporosis), vision and hearing problems. It includes a cardiovascular examination (including a lying and standing blood pressure test), gait/balance assessment, and a medication review.

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Emergency Preparedness – What to Do If You Fall

Making a plan in case you fall is an important part of prevention.

Immediate Actions After a Fall

• Stay Calm: If you fall, try to stay calm.
• Check for Injury: Take a couple of minutes to check for any pain or injuries and see if you think you can get up.
• If you can get up and do not suspect an injury: Take your time. If comfortable, roll onto your side, push yourself onto your hands and knees and move to a stable support. Place one foot flat on the floor and rise slowly, then sit and rest. Do not force a painful movement.
• If you cannot get up: Call 999, using a reachable phone or alarm. Keep warm while waiting. For the future, consider an appropriate personal alarm and response plan with your family or care team.

When to Call Emergency Services (999)

• Call 999 if: You or someone else has fallen and may have injured the head, back, neck, or hip, or if the person cannot get up.
• Do Not Lift Them Yourself: Keep the person comfortable and warm while waiting for help. If they can get up without a suspected injury, you may guide and reassure them, but do not lift them or pull on their arms. Follow the NHS advice on falls.

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Resources and Further Reading

• Age UK Advice Line: 0800 678 1602 (open 8am-7pm, 365 days a year). Visit Age UK Falls Prevention.
• Chartered Society of Physiotherapy (CSP): Provides the guide “Get up and go – a guide to staying steady”.
• RoSPA (Royal Society for the Prevention of Accidents): Offers advice on making the home a safer environment.
• NHS Website: Central resource for advice on falls prevention.
• Government Publications: Falls: applying All Our Health.