Although most falls do not cause injury, the results of a fall can be serious. If you break a bone this can lead to long-term disability. Broken bones do not always heal completely as you get older and a serious injury could mean that you would no longer be able to live without support. This is why, if you are aged 65 or older and have had a fall, it is important to see your doctor to find out if anything needs to be done to prevent you from falling again.
What causes falls in older people?
People of all ages have falls. In many cases they are caused by a minor accident and the person comes to no harm. Older people who have falls, however, are likely to have more serious injuries and to fall over again.
There are many reasons why falls happen in older people, such as:
- Hazards in the home.
- Ill-fitting footwear.
- Muscle weakness: this can be due to lack of exercise, a stroke or glandular problems (for example, thyroid or adrenal disorders, steroid medicines).
- Problems with walking and/or balance.
- Arthritis: painful joints can make you less nimble and want to move around less. Lack of exercise can lead to muscle wasting and weakness.
- Dizzy spells: this can be light-headedness, a feeling that the ground is moving or a feeling that you or the surroundings are spinning.
- Confusion: this can be due to medicines, brain problems such as dementia (see below) or general illnesses such as infections.
- Drop attacks: this describes sudden falls in which there is no loss of consciousness. This can be due to orthostatic hypotension (see below), a mini-stroke (transient ischaemic attack), or heart problems (for example, atrial fibrillation).
- Postural hypotension: this means a sudden drop in blood pressure when you stand up. It usually happens within the first few weeks of starting blood pressure tablets. Occasionally it can be due to a lack of fluid in the body (dehydration) or to a condition affecting the nerve supply to blood vessels (autonomic neuropathy).
- Fainting: this means a loss of consciousness which comes on suddenly and lasts for a short time. It can happen for many reasons. Postural hypotension and heart problems are common causes. It can also be caused by fits as a result of epilepsy or alcohol withdrawal.
- Alcohol: apart from the fact that alcohol can make you drowsy and clumsy, it can also cause long-term medical problems that make falls more likely. These include peripheral neuropathy. This is a condition of the nerves that can cause numbness and pins and needles of the feet or problems with balance sensation. A disorder of the brain (Wernicke-Korsakoff syndrome) can also cause falls.
- Problems with vision: for example, clouding of the lens of the eye (cataract) and visual field defects, where part of the field of vision appears to be missing. Breakdown of the cells lining the back of the eye is known as age-related macular degeneration. It is a common cause of poor vision in older people. Sometimes an outdated prescription for glasses or bifocal lenses may increase fall risk. Older people at risk of falling may be better with two different pairs of glasses.
- Problems with the brain and nervous system: this includes strokes, Parkinson's disease, peripheral neuropathy (commonly due to diabetes), and dementia - a condition involving loss of thinking ability due to Alzheimer's disease and several other causes.
- Medicines can cause falls in a variety or ways - for example:
- Sleeping tablets and tranquillisers (for example, diazepam) can make you drowsy and clumsy.
- Psychotropic medicines (for example, chlorpromazine) can cause confusion.
- A long list of medicines can cause postural hypotension. This is not only blood pressure medicines but also those used to treat other conditions such as depression, anxiety and Parkinson's disease
- Anticonvulsant medicines: these are used to treat epilepsy and can slow down your reaction times and increase the risk of falls.
- Studies show that taking more than four medicines can increase the risks of falls, no matter what the medicines are.
What can be done to prevent falls?
Depending on your health and ability, you may find you can do a lot to help yourself. Support is also available from the NHS and social services.
See your doctor
If you have had a fall or feel you are at risk of having falls, you should ask your GP to do a falls risk assessment. This involves a general check-up (for example, blood pressure, weight, and examination of your circulation and lungs). This is carried out to make sure you do not have any conditions likely to increase your risk of falls.
If you do have a long-term condition such as diabetes, the doctor will check that this is not causing complications likely to lead to falls. You may need tests to check whether you have any conditions which make it more likely that you will break a bone if you do fall (for example, osteoporosis). The doctor will also check your medication to make sure you are not on any medicines likely to cause problems.
Your GP will be able to give you contact details of any other support that is necessary, such as the council or social services. If the doctor finds that your risk of falling is high (for example, if you are an older person who has already had a fall), you may be offered help from a hospital-based falls clinic or local falls prevention service.
Check your home for hazards
Have a look around your home to see whether there is anything that could have caused your fall or would be likely to make you fall in the future. Things that need to be considered include:
- Loose rugs or mats (especially on a slippery floor).
- Electrical leads (trailing across the floor).
- Wet surfaces (especially in the bathroom).
- Poor lighting.
- Furniture which has been poorly placed.
- Objects scattered on the floor - books, papers, shoes.
- Stairs - loose carpets, broken handrails.
- Storage - frequently-used items placed on high shelves, which can only be reached by standing on a chair or stool.
- Making sure that shoes and slippers are comfortable and fit properly.
Community teams working for the local council may be able to fix problems around the home and install handles or rails free of charge.
Take lots of exercise
Keep active and exercise as much as you can. This strengthens muscles, keeps joints supple and works the systems in your body which control balance and movement. A physiotherapist may be able to suggest an activity programme but you should take the lead in deciding what sort of exercise you are most comfortable with. For example, some people enjoy attending an exercise class whilst others prefer to take up activities such as dancing, swimming or t'ai chi. Activities which develop muscle strength and balance are particularly helpful.
Healthy eating is important to stop you becoming deficient in vitamins (especially vitamin D), iron, starchy foods and proteins. Keep up your fluid intake to stop you becoming low in body fluid (dehydrated).
Be sensible about alcohol
You should drink alcohol sensibly. Advice can be found in the separate leaflet called Alcohol and Sensible Drinking. If you are already at increased risk of falling (for example, if you are an older person who has already had a fall), even moderate drinking can increase your risk of having a fall.
Have your eyes tested regularly
Have your eyes checked every two years, or as often as your optician advises. If you are already having problems with your eyes, get them checked now. People aged 60 or over can have a free eye test.
Further reading and references
; NICE Clinical Guideline (June 2013)
; British Geriatrics Society, 2010
; NICE CKS, January 2014 (UK access only)
; Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012 Sep 129:CD007146. doi: 10.1002/14651858.CD007146.pub3.
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