Falls and Fractures in Older Adults: Causes and Prevention

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A simple accident like tripping on a rug or slipping on a wet floor can change your life. If you fall, you could break a bone, which thousands of older adults experience each year. For older people, a broken bone can also be the start of more serious health problems and can lead to long-term disability.

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If you or an older adult in your life has fallen, you’re not alone. More than one in four people age 65 years or older fall each year. The risk of falling — and fall-related problems — rises with age. However, many falls can be prevented. For example, exercising, managing your medications, having your vision checked, and making your home safer are all steps you can take to prevent a fall.

Many older adults fear falling, even if they haven’t fallen before. This fear may lead them to avoid activities such as walking, shopping, or taking part in social activities. But staying active is important to keeping your body healthy and actually helps to prevent falls. So don’t let a fear of falling keep you from being active! Learn about what causes falls and how to lower your risk of falling so you can feel more comfortable with staying active.

What causes falls in older adults?

Many things can cause a fall.

• Your eyesight, hearing, and reflexes might not be as sharp as they were when you were younger.
• Certain conditions, such as diabetes, heart disease, or problems with your thyroid, nerves, feet, or blood vessels can affect your balance and lead to a fall.
• Conditions that cause rushed movement to the bathroom, such as incontinence, may also increase the chance of falling.
• Older adults with mild cognitive impairment or certain types of dementia are at higher risk of falling.
• Age-related loss of muscle mass (known as sarcopenia), problems with balance and gait, and blood pressure that drops too much when you get up from lying down or sitting (called postural hypotension) are all risk factors for falling.
• Foot problems that cause pain, and unsafe footwear such as backless shoes or high heels, can also increase your risk of falling.
• Some medications can increase a person’s risk of falling because they cause side effects such as dizziness or confusion. The more medications you take, the more likely you are to fall.
• Safety hazards in the home or community environment can also cause falls.

Steps to take to prevent falls

If you take care of your overall health, you may have a lower chance of falling. Most of the time, falls and accidents don’t just happen for no reason. Here are a few tips to help lessen your risk of falls and broken bones, also known as fractures:

Read and share this infographic and help spread the word about how to help prevent falls.

• Stay physically active. Plan an exercise program that is right for you. Regular exercise improves muscles and makes you stronger. Exercise also helps keep your joints, tendons, and ligaments flexible. Mild weight-bearing activities, such as walking or climbing stairs, may slow bone loss from osteoporosis, a disease that makes bones weak and more likely to break
• Try balance and strength training exercises. Yoga, Pilates, and tai chi can all improve balance and muscle strength. You can also try lifting weights or using resistance bands to build strength. Learn more about different types of exercises to improve balance and strength.
• Fall-proof your home. Check out these tips for changes you can make to your home that will help you avoid falls and ensure your safety.
• Have your eyes and hearing tested. Even small changes in sight and hearing are linked to an increased risk for falls. When you get new eyeglasses or contact lenses, take time to get used to them. Wear your glasses or contacts as your eye doctor advises. If you have a hearing aid, be sure it fits well and wear it.
• Find out about the side effects of any medicines you take. If a drug makes you sleepy or dizzy, tell your doctor or pharmacist.
• Get enough sleep. If you are tired, you are more likely to fall.
• Avoid or limit alcohol. Too much alcohol can lead to balance problems and falls, which can result in hip or arm fractures and other injuries.
• Stand up slowly. Getting up too quickly can cause your blood pressure to drop. That can make you feel wobbly. Get your blood pressure checked when lying and standing.
• Use an assistive device if you need help feeling steady when you walk. Using canes and walkers correctly can help prevent falls. If your doctor tells you to use a cane or walker, make sure it’s the right size for you. Walker wheels should roll smoothly. If you borrow walking support equipment from a friend, ask your health care provider to make sure the equipment is the correct size and is safe to use. This is exceptionally important when you’re walking in areas you don’t know well or where the walkways are uneven. A physical or occupational therapist can help you decide which devices might be helpful and teach you how to use them safely.
• Take extra caution when walking on wet or icy surfaces. These can be very slippery! Use an ice melt product or sand to clear icy areas by your doors and walkways.
• Keep your hands free. Use a shoulder bag, fanny pack, or backpack to leave your hands free to hold on to railings.
• Choose the right footwear. To fully support your feet, wear nonskid, rubber-soled, low-heeled shoes. Don’t walk on stairs or floors in socks or in shoes and slippers with smooth soles.
• Consider staying inside when the weather is bad. Some community services provide 24-hour delivery of prescriptions and groceries, and many take orders over the phone.
• Always tell your doctor if you have fallen since your last check-up, even if you did not feel pain when you fell. A fall can alert your doctor to a new medical problem or issues with your medications or eyesight that can be corrected. Your doctor may suggest physical therapy, a walking aid, or other steps to help prevent future falls.

What to do if you fall

Whether you are at home or somewhere else, a sudden fall can be startling and upsetting. If you do fall, stay as calm as possible and take the following steps:

• Breathe. Take several deep breaths to try to relax. Remain still on the floor or ground for a few moments. This will help you get over the shock of falling.
• Decide if you are hurt. Getting up too quickly or in the wrong way could make an injury worse.
• Crawl to a sturdy chair. If you think you can get up safely without help, roll over onto your side. Rest again while your body and blood pressure adjust. Slowly get up on your hands and knees, and crawl to a sturdy chair.
• Slowly sit down in the chair. Put your hands on the chair seat and slide one foot forward so that it’s flat on the floor. Keep the other leg bent so the knee is on the floor. From this kneeling position, slowly rise and turn your body to sit in the chair.
• Get help. If you are hurt or cannot get up on your own, ask someone for help or call 911. If you are alone, try to get into a comfortable position and wait for help to arrive. Prepare for a fall by keeping a well-charged cordless or mobile phone with you at all times and arrange for daily contact with a family member or friend. Emergency response systems are another option: These systems enable you to push a button on a special necklace or bracelet to call for help. Some smartwatches also have this feature.

Keep your bones strong to prevent fall-related fractures

Having healthy bones won’t necessarily prevent a fall, but if you do fall, healthy bones may help prevent serious injury, such as breaking a hip or other bone. Bone breaks and fracture can lead to a hospital or nursing home stay, long-term disability, or even death. Getting enough calcium and vitamin D can help keep your bones strong. So can staying active. Try to get at least 150 minutes per week of physical activity.

Other ways to maintain bone health include quitting smoking and avoiding or limiting alcohol use. Tobacco and alcohol use may decrease your bone mass and increase your chance of fractures. Additionally, try to maintain a healthy weight. Being underweight increases the risk of bone loss and broken bones.

Osteoporosis is a disease that weakens bones, making them thin and brittle. For people with osteoporosis, even a minor fall may be dangerous. Talk to your doctor about osteoporosis.

Falls are a common reason for trips to the emergency room and for hospital stays among older adults. Many of these hospital visits are for fall-related fractures. You can help lower your risk of fractures by keeping your bones strong and following the tips above to avoid falls.

For more information

Centers for Disease Control and Prevention (CDC)
800-232-4636
888-232-6348 (TTY)
[email protected]
www.cdc.gov

National Resource Center on Supportive Housing and Home Modifications
213-740-1364
homemods@usc. edu
www.homemods.org

Rebuilding Together
800-473-4229
[email protected]
www.rebuildingtogether.org

National Falls Prevention Resource Center
571-527-3900
www.ncoa.org/center-for-healthy-aging/falls-resource-center/

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

Content reviewed:
September 12, 2022

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How to Prevent Falls at Home

One out of four older adults will fall this year, but fewer than half of them will talk with their doctors about it, according to the Centers for Disease Control and Prevention (CDC). Per the CDC, falls are the No. 1 cause of injuries in adults over 65, resulting in hip fractures, cuts, and even serious head and brain injuries that can be fatal.

Even when there’s no serious injury, a fall can be so frightening that people may avoid certain activities out of fear they’ll fall again. And that’s not unreasonable, because if you fall once, your chance of falling again doubles, according to the CDC.

Whether it’s slippery floors, rickety stairs, or electrical cords, some of the most common causes of falls are in the home, where you might have a false sense of security. That’s why fall prevention starts with creating a safe living space.

It doesn’t have to involve a complete house remodel. You can make your home safe from falls with just a few basic changes. Elder care experts offer the following advice for preventing falls at home.

1. Clean up clutter. The easiest way to prevent falls is to keep your home neat and tidy. Remove all clutter, such as stacks of old newspapers and magazines, especially from hallways and staircases.
2. Repair or remove tripping hazards. Sometimes home fixtures can contribute to falls, which can then lead to back pain and other injuries. Examine every room and hallway, looking for items such as loose carpet, slippery throw rugs, or wood floorboards that stick up. Then repair, remove, or replace those items for more effective fall prevention.
3. Install grab bars and handrails. If your mobility is limited, these safety devices can be crucial for going up and down stairs, getting on and off the toilet, and stepping in and out of the bathtub without injuring yourself. Gary Kaplan, DO, the founder and medical director of the Kaplan Center for Integrative Medicine in McLean, Virginia, suggests installing grab bars by toilets and bathtubs and handrails in stairways and hallways. Have a handyman or family member help with this if necessary.
4. Avoid loose clothing. You want to feel comfortable at home, but very baggy clothes can sometimes make you more likely to fall. Opt for better-fitting and properly hemmed clothing that doesn’t bunch up or drag on the ground.
5. Light it right. Inadequate lighting is another major hazard. To create a home that’s easier to navigate, install brighter light bulbs where needed, particularly in stairways and narrow hallways. Robert Bunning, MD, the associate medical director of inpatient services at MedStar National Rehabilitation Hospital in Washington, DC, recommends adding night-lights in bedrooms and bathrooms for better guidance at night.
6. Wear shoes. Socks may be comfortable, but they present a slipping risk. Preventing falls at home can be as simple as wearing shoes. You can also purchase nonslip socks that have grips on the soles of the feet if shoes are too uncomfortable.
7. Make it nonslip. Bathtubs and showers, as well as floors in kitchens, bathrooms, and porches, can become extremely dangerous when wet. To prevent falls on slick surfaces, Dr. Kaplan recommends nonslip mats.
8. Live on one level. Even with precautions like guardrails, stairs can present a significant falling hazard. “If possible, live on one level,” says Kaplan. “Otherwise, be extra careful when you negotiate stairs.” If it’s not possible to live on one level, try to limit the trips you take up and down the stairs.
9. Move more carefully. Dr. Bunning explains that many people fall at home by moving too quickly from a sitting to a standing position and vice versa. Preventing falls can be as easy as taking your time. “All you have to do is pause after going from lying down to sitting and from sitting to standing,” he says. “Also take a pause before using the railing on stairs, whether you’re going up or down.”
10. Join a preventive exercise program. Many community centers, gyms, and health systems offer exercise programs for older adults aimed at preventing falls. These exercise regimens focus on improving balance and strengthening muscles. A physical therapist can also recommend exercise programs and assistive devices, if necessary, to keep you safe.

For older adults, fall prevention means injury prevention. Ask your loved ones to help you ensure that your rooms and stairways are clutter-free and well-equipped with lighting, handrails, grab bars, and nonslip mats — all of which can go a long way toward keeping you safe in your home. In the event a fall does occur, having a proper Medicare plan can help alleviate surprise medical costs.

Additional reporting by Rachael Robertson. 

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