Facts on falling*

*Figures from Help the Aged, Towards Common Ground, 2008, and Age UK Encouraging Positive Attitudes to Falls Prevention in Later Life, 2005.

Common risk factors for falls

The probability of tripping and falling increases as we get older, and this is due to a range of different causes: - Decline in muscle strength is common as we age, which in turn reduces balance and makes it more likely for us to fall.

• Weaker bones and related conditions such as osteoporosis are common in the elderly and may cause more serious injuries in case of a fall. Menopause can also be a risk factor, as hormonal changes can lower bone density.
• Eyesight can deteriorate with age and conditions like cataracts increase, leading to a loss of balance and perception.
• Hearing loss strongly affects balance. People with hearing problems are less able to gauge where their body is in relation to people and objects around them.
• Conditions causing problems with your feet, such as bunions or arthritis, or wearing loose shoes (sometimes caused by difficulty in tying them up properly) can increase your risk of tripping.
• Certain medications can affect your sense of balance, making you feel dizzy.
• Conditions such as low blood pressure, dementia and heart disease can also lead to dizziness.

These risk factors are strictly linked to health conditions which are common in older people. However, you should also consider how your environment may impact your risk of falls, and if it may exacerbate the effects of those health conditions. Cluttered rooms, slippery floors and steps, and steep staircases and inaccessible bathing can all make it more likely for you to trip as you move around the house.

People with dementia are considered to be at a higher risk of falls because their condition can have an impact on their processing of information associated with movement and mobility. This means people with dementia can easily feel disoriented, fail to recognise their surroundings, or struggle to process what they see around them. This also means they may fail to communicate their needs and worries. Find more information about falls and dementia, or download our dementia guide.

In the next chapter, we’ll look at how to prevent falls in older people, from lifestyle changes for a stronger body and better balance, to practical tips on how to make your home more accessible.

Preventing and treating health risk factors

Keep your muscles and bones healthy

There are many things you can incorporate into your lifestyle to help you maintain a strong and healthy body as you get older. The following are a good place to start.

1: Stay active and exercise regularly

Exercise is one of the best ways to prevent falls. Regular physical activity reduces your risk of falling by improving your posture, balance and coordination. Strengthening your arms, shoulders, back and chest will make it easier for you to get up from a chair and maintain your balance, for example. Keeping your legs active will also help you maintain a good sense of balance.

It is recommended to build up to two and a half hours per week of activity which is intense enough to make your breathing harder. You can break this into 10-minute exercises throughout the week, if that helps. Important: Whatever type of activity you choose, make sure it is suitable for you. Work at your own pace, and stop immediately if you feel any pain. If you are unsure, or if you haven’t exercised in a long time due to a heart condition, ask your GP for some advice about what type of exercise may be best for you.

You have plenty of choices when it comes to physical exercises. Remember that even simple daily activities such as going for a walk or gardening can be counted as physical activity!

These exercises are particularly recommended if you’d like to strengthen your bones and muscles:

• Tai chi, dance and gardening are great ways to improve balance and build up on your muscles in a gentle way. They are recommended for older adults with only minor deficits to balance and who have not experienced a fall.
• Special strength and balance classes, such as those provided by the charity EXTEND, are specifically tailored to older people of various abilities, including those who have had a fall in the past. You can also call AgeUK on 0800 169 65 65 to find out if they run any classes in your local area.
• For people who find it difficult to stand for long periods of time, the NHS exercise guide features exercises where you can use a chair to support you.
• Yoga is ideal for fitter older adults as it helps build on strength, flexibility and balance which may benefit them as they get older.

Remember this guide is designed to give you cues and ideas, but you should always follow medical advice and if unsure consult your GP before making any changes to your routine.

2: Get plenty of calcium and vitamin D

Calcium and vitamin D are vital to build strong bones. Vitamin D regulates the amount of calcium in the body. In turn, calcium increases bone density: good levels of calcium help prevent fractures and osteoporosis. Check out our blog to find out more about arthritis and osteoporosis. Here are some tips on how to make sure you get enough calcium and vitamin D:

Calcium: It is easy to get the recommended dose of calcium entirely from your diet. Calcium-rich foods include dairy products, nuts, broccoli, kale, sardines and tofu.

Vitamin D: Our bodies create vitamin D from direct sunlight on the skin. Try to get exposure to the sun for short periods of time during spring and summer, while ensuring skin protection from harmful UV rays. You can also take vitamin D supplements, especially over the winter, when we don’t get enough vitamin D from the sun.

3: Have your eyesight and hearing checked often

Hearing and eyesight play a very important role in movement as they help us measure the distance between objects within a certain space.

Make sure you have your eyesight and glasses prescription reviewed at least every two years, or more often as your optician advises. NHS eye tests are free for people over 60 years old. Special non-verbal tests are also available for people in the later stages of dementia or for those who have lost their speech.

As soon as you notice hearing problems, raise the issue with your GP. Hearing loss can negatively affect your balance and lead to a fall. Your GP will be able to refer you for a hearing test, if needed. If you are using hearing aids, make sure you wear them at all times.

4: Look after your feet

Talk to your doctor about any foot issues you may have, such as ingrown nails and corns, as these can greatly affect your balance. Avoid sandals and shoes with high heels, and always wear slippers with a good grip when you are at home. In general, wear shoes that fit well and offer a good support. Be aware of any issues in tying shoe laces and consider alternatives where appropriate.

5: Keep track of your medication

If you notice your medications make you feel sleepy or dizzy, let your GP know. These side effects may affect your balance and lead to a fall. Your doctor will be able to review your prescription, manage your doses, or suggest a different medication, if appropriate. Even if you are not experiencing any symptoms, the NHS advises to have your medicines reviewed at least once a year to make sure they’re still right for you. You should also ask your GP for advice if you suffer from conditions such as heart disease, dementia or low blood pressure, which can also cause dizziness and are sometimes linked to a higher probability of falling.

Making your home fall-proof

As much healthy and fit as you can be, if your home is full of trip hazards you’ll still be more likely to fall and injure yourself. In this section, we’ll look at how to make sure your home is as accessible and fall-proof as possible for you to feel safe at all times.

How to get expert advice from an occupational therapist

If you’d like to find out how to make your home a safer place to live in, you can get expert advice from an occupational therapist. Occupational therapy provides support to people whose health, wellbeing and medical conditions impact on their ability to do the activities that matter to them. As part of their role, they will look at different aspects of daily life in your home and other environments. The aim is to help improve your ability to carry out daily activities as independently and safely as possible. Their expertise can be really important to inform any changes that might help you manage the risks in your home. Occupational therapists may also recommend adaptations to your home such as grab rails or stairlifts - more information about the options available is included in the home adaptations section of this guide. How do I get occupational therapy? You can get occupational therapy for free through the NHS or social services, or pay for it yourself, depending on your situation.

1. Ask your GP for a referral.
2. Search your local council to check if you can get occupational therapy through them.
3. You can also pay for an occupational therapist yourself, using the list of qualified occupational therapists available through the Royal College of Occupational Therapy.

Check out the Royal College of Occupational Therapy website for more information on their role and what to expect from an occupational therapist.

Looking for trip hazards in your home

It is easy to spot trip hazards around the house, if you know what to look for. You can start from these major risk factors:

• Poor lighting
• Loose rugs, or mats placed at the top or bottom of the stairs
• Trailing cables, clutter and glass furniture that may be more difficult to see
• Wet floors and water spills
• Pets, as they can easily get between your feet and cause falls

Check every room in the house, as well as the doorway and corridors. These are some tips to make every room in your house safer and more accessible:

Generally speaking, a safe home is one that is clean, free of clutter, well-lit and practical, so that you don’t have to struggle to perform you daily tasks. Speaking of other architectural barriers in your home and outside, steps and stairways can pose a big risk. Check out these tips on how to use the stairs safely and reduce one of the biggest risk factors for falls.

1. Improve visibility on stairs by adding lights, and make sure you always turn the lights on before climbing the stairs
2. If you have wooden stairs which are slippery, consider adding abrasive strips
3. Always hold the handrail
4. Avoid carrying objects with both hands when climbing the stairs, and never carry bulky objects that block your vision
5. Take your time when using the stairs and don’t rush. One trick to ensure you always pay attention is to count each single step while using the stairs
6. If you use a walking aid or have a leg injury, ask for assistance while using the stairs

Home adaptations and telecare to prevent falls

If you feel that the simple precautions we’ve outlined in the previous pages are not enough to make you feel safe from accidental falls, there are a whole host of aids, adaptations, and assistive technologies that can allow you to continue living independently in your own home. Common home adaptations to avoid falls include:

• Handrails and grab rails
• Bath equipment such as non-slip mats, chairs/hoists, specialist bathtubs with a side opening, and hands-free toilets with automatic washing
• Access ramps, stair lifts and wheelchair lifts
• Powered riser-recliner chairs and beds

Beyond home adaptations, assistive technology known as telecare can help you feel safe and connect you with people who can help you in case of an emergency. Here are some examples of telecare you may want to consider:

• Emergency bracelets or pendants. The person wearing them can press a button in case they fall and by doing so activate an alarm or a call to a loved one, carer or directly to the ambulance.
• Fall detectors are similar to emergency pendants or bracelets, but don’t require you to press any buttons. They can detect the falling motion and activate an alarm automatically
• Smart shoes can detect if you have a fall and alert your loved one or carer
• Bed occupancy sensors can turn the light on and off automatically, which can be very helpful when getting in and out of bed, to go to the bathroom for example
• Special door entry intercoms can be activated remotely from where you are sitting, so that you don’t have to rush to the door when someone is visiting

For other useful tips on home adaptations, check out the Age UK website. Our blog features some information on how to fund home improvements.

How to pay for home adaptations

Depending on you situation, you may be eligible for financial support to help you pay for the home adaptations you need. The first step is to request a free needs assessment from your local authority. This assessment takes into account your needs and your ability to independently carry out daily activities. Based on the results, the local authority will consider:

• What type of support you need
• Any changes to your home that may help you
• The cost associated with the support you need

If you qualify for assistance, you may be able to access these forms of support from the local authority:

• The local authority may arrange minor home adaptations, which can be fully or partially free of charge.
• The local council may offer grants to help you make the necessary modifications to your home.
• You may be referred to Home Improvement Agencies, government-funded organisations that can help you arrange home adaptations.

Whether you receive financial support or not also depends from a financial assessment that follows the needs assessment. For more information about eligibility criteria, download our Funding Care Guide.

Fear of falling doesn’t help you to avoid falls. In fact, it can lead to a vicious cycle which increases the probability of tripping or falling. The more worried about falling you become, the less likely you are to stay active. Not only can inactivity cause low mood and depression, but also reduced strength and balance, making it more likely for you to fall.

It is therefore very important for you to tackle your anxiety and fear as soon as you notice them.

How to deal with anxiety about falling

If you notice that your fear of falling is affecting your daily activities and preventing you from living a fulfilling life, here are some things you can do:

Support groups can also give you advice on how to manage your anxiety. Call the Age UK Advice Line on 0800 678 1602 to find out more about support groups in your local area.

Be prepared

If you are getting older and are worried about falling, it is important that you have a plan of action so that you know what to do in case of an emergency. Here are our top three tips: Always have a personal alarm or mobile phone on you so that you can call for help when you need it. You can find out more about alarm bracelets or pendants in the chapter about telecare. Make sure a loved one, carer or neighbour has a spare key, or consider installing a key safe, so that they can get to you quickly in an emergency. Learn how to get up from the floor by reading the following paragraphs in this guide, and by watching this video from the Royal Society for the Prevention of Accidents. Share this guide with your loved ones and/or carers as well, so that they know how to help you in case you fall.

How to get up from a fall

If you live alone, it is important that you learn how to safely get up after a fall by yourself. Check out this step-by-step guide:

The first thing you need to do is to understand if you’re injured. Take a moment to calm down and check if you feel any pain. If you are hurt, call for help using you personal alarm or mobile phone. If you don’t have one, try shouting and banging on the wall to grab your neighbours’ attention.

If you are not hurt, very carefully roll on your side and come to all-fours. Crawl towards a piece of sturdy furniture.

Holding on to the object, slide a leg forward and place the foot flat on the floor. Your other knee should stay on the floor.

Using your arms and legs, push yourself up and pivot around until you’re sitting on the piece of furniture. Take some time to calm down and check again if you feel any pain or achiness. It’s a good idea to inform your GP that you had a fall and watch out for any related pain during the few days after the fall. If you are in any doubt or think that you might’ve done a more serious injury, contact emergency services and go to hospital to be checked. Below you can find a list of symptoms to look out for after a fall.

How to help someone getting up after a fall

Find out what to do (and not to do) if a relative or the person you are looking after has a fall. Important note: It is very common for a caregiver to hurt themselves while trying to lift someone who has fallen. And it is also common for them to cause further injury to the person who has fallen while trying to get them up. When in doubt, it’s always best to call 911 for help. Make sure you also check the NHS first aid advice.

What NOT to do

• You should never try to lift someone up. The person who fell should lift themselves up - you are only there to reassure them and keep them steady. If they are hurt and can’t lift their own weight, you should call 999.
• Don’t rush and don’t try to move them unless they are able and willing to do that themselves. You could cause panic or further injury.

What to do

1. Keep calm and try to keep the person calm by asking them to take deep breaths.
2. Ask them if they feel pain anywhere and how severe is the pain.
3. If you think they are hurt, call an ambulance. If the injury is severe (such as a broken bone) don’t move them, keep them warm and wait for the ambulance to arrive.
4. If they don’t have any injuries and want to get up, place one sturdy chair next to the person’s head, and another next to their feet. For the following steps, remember that the person should be able to do the physical work themselves. If you try to lift or move them yourself, you risk to hurt them and/or yourself. If they can’t move or rise from the floor themselves, call an ambulance.
5. Instruct the person to roll on their side and come to hands-and-knees.
6. Move the chair closest to their head so that they can put their hands on the seat.
7. Ask them to bring a leg forward so that the foot is flat on the floor.
8. Move the second chair directly behind them, then ask them to use both their arms and legs to push themselves up and sit back into the chair. You can help them stay steady, but make sure they are getting up by themselves.
9. Allow them to calm down as they are seated, until they feel confident to stand up again.

When to see a doctor after a fall

It is advised to see your GP in the days immediately following a fall, even if you think you can manage your pain and recover by yourself. Even serious injuries can sometimes go unnoticed without a diagnosis. You should not underestimate your pain or soreness, as by doing so you may aggravate them later or cause them not to heal correctly. It is always best to err on the side of caution. A doctor will be able to check all the causes that could have contributed to the fall and give you some advice to avoid future accidents. They may suggest speaking to adult social services and consider an assessment which can give helpful pointers and may even lead to some home aids being provided, which can be free of any charge. It is absolutely essential for you to see your doctor as soon as possible if:

• You hit your head during the fall
• You lost consciousness
• You vomited after the accident
• You can’t remember what happened
• You have an intense headache
• You can’t put weight on the injured body part
• You feel dizziness and nausea

If you are a relative or carer of the person who experienced the fall, make sure to check on them for a few days following the accident, and help them arrange a GP appointment if they haven’t already. Find more information on when and where to get help after a fall.

Where to find further information and support

Here are some charities and organisations who can help you find more information, practical help and personalised advice. Age UK: charity offering help to older people in the UK

• Advice Line: call 0800 678 1602 for advice about care, benefits and more. - Befriending services: with Call in Time, a volunteer befriender will phone an older person at an agreed time for a chat. Face-to-face befriending is also available in certain areas. NHS Inform: Scotland’s national health information service
• The Preventing Falls guide provides plenty of information about falls in the elderly.