Falls Prevention: How to Reduce Fall Risk

Introduction

Falls are a leading cause of injury in older adults — but they are not simply an inevitable part of getting older. Many falls have identifiable causes that can be addressed. Understanding fall risk, making practical changes at home, reviewing medicines, and building strength and balance can all reduce the likelihood of a fall and its consequences.

This guide is for people who want to understand their fall risk, support someone at higher risk, or find practical strategies to stay safer.

Key Points

Falls are common with age but are not inevitable — many causes are modifiable
Multiple risk factors acting together dramatically increase fall risk
Strength and balance training is among the most effective preventive strategies
Medication review is important — some medicines significantly increase fall risk
After any fall with injury, loss of consciousness, or repeated falls, seek medical review
Home safety changes can meaningfully reduce hazards

Why Falls Matter

A fall can have consequences well beyond the immediate injury. In older adults with reduced bone density, a fall can cause a hip, wrist, or vertebral fracture — injuries that can lead to prolonged hospitalisation, loss of independence, and in some cases, life-threatening complications.

Even without physical injury, falls can cause lasting loss of confidence. Fear of falling can lead people to reduce their activity — which in turn weakens muscles and balance, increasing the risk of the next fall.

Falls are a leading reason for emergency department presentations in adults over 65. They are also among the most preventable.

Falls Are Not Inevitable

Falls become more common with age, but this does not mean they are unavoidable. Many people who are at elevated fall risk can substantially lower that risk through:

Targeted exercise programmes
Medication review and adjustment
Home modifications
Vision and hearing care
Management of contributing conditions

The aim is not to eliminate all movement or physical risk — restriction of activity can itself increase frailty and fall risk. The aim is to identify and address what is modifiable.

Common Causes and Risk Factors

Falls are usually the result of multiple risk factors combining, rather than a single cause.

Muscle Weakness and Deconditioning

Loss of muscle strength — particularly in the legs — makes it harder to recover balance after a stumble. Reduced leg strength is one of the most important and modifiable risk factors for falls. When this muscle loss is significant enough to affect strength and physical function, it is called sarcopenia — a condition more common in older adults, people with chronic disease, and those who have had prolonged periods of inactivity or hospitalisation.

See: Sarcopenia: Muscle Loss, Strength, and Healthy Aging

Balance Problems

Inner ear problems, neurological conditions, and deconditioning can all affect balance. Balance deteriorates with age but can be substantially improved with targeted training.

Dizziness and Fainting

Dizziness, light-headedness, and fainting significantly raise fall risk. Common causes include sudden drops in blood pressure when standing (orthostatic hypotension), heart rhythm problems, and medication side effects.

See: Dizziness — When to Worry | Syncope and Fainting

Vision Problems

Poor vision makes it harder to identify hazards, judge depth, and react to uneven surfaces. Even mildly reduced vision increases fall risk. Regular vision assessment and appropriate correction are important.

Foot Problems and Footwear

Painful or numb feet, toe deformities, peripheral neuropathy, and poorly fitted footwear all contribute to falls. Shoes with firm soles, good grip, and a proper fit are safer than loose slippers, socks on smooth floors, or unsecured footwear.

Medications

Several types of medicine raise fall risk, including:

Sedatives, sleep medicines, and benzodiazepines
Blood pressure medicines — particularly if causing dizziness when standing
Diuretics (fluid tablets)
Antidepressants and antipsychotics
Opioid pain medicines
Some diabetes medicines (through hypoglycaemia)
Antihistamines

The more medicines a person takes, the higher the overall fall risk. A GP or pharmacist can review medicines for fall-related effects. Never stop or reduce prescription medicines without speaking with a clinician first.

Alcohol

Alcohol affects balance, reaction time, and judgement. Even moderate use can increase fall risk, particularly in older adults or people taking other medicines that interact.

Low Blood Pressure When Standing

Orthostatic hypotension — a sudden drop in blood pressure when moving from sitting or lying to standing — causes brief light-headedness and is a common cause of falls, particularly in people on blood pressure medicines, those who are dehydrated, or those with heart disease or diabetes.

Acute Illness

Infection, dehydration, or any sudden change in health can trigger a fall. A fall in an older adult with no other obvious cause may be the first sign of an underlying acute illness.

Home Hazards

Common household fall risks include:

Poor lighting — particularly on stairs and in bathrooms
Loose or unsecured rugs and mats
Unstable furniture
Trailing cables or cords
Wet or slippery floors
Stairs without rails
Low toilet seats and baths without grab rails
Pets underfoot
Clutter in walkways

Cognitive Impairment

Dementia and cognitive impairment increase fall risk through reduced awareness of hazards, impulsive behaviour, and difficulty following safety strategies.

See: Dementia Overview

Who Is at Higher Risk

Fall risk is highest in people who have:

Had a previous fall — one of the strongest predictors of the next fall
Osteoporosis or low bone density — increasing fracture severity when falls occur
Frailty — reduced muscle reserve and resilience
Parkinson’s disease — postural instability, freezing, and gait changes
Dementia — impaired judgement and hazard recognition
Stroke history — weakness, spasticity, or coordination problems (see Stroke Recovery and Rehabilitation)
Heart disease, CKD, or diabetes — through medication effects and neurological changes
Multiple medicines (polypharmacy)

See: Frailty: What It Means and How to Reduce Risk | Osteoporosis | Parkinson’s Disease Overview

What to Do After a Fall

If someone falls:

Do not rush to get up — take a moment to check for pain, dizziness, or injury before moving
If injured or in severe pain — call for help; do not attempt to get up without assistance
If alone and unable to get up — move to a supported position and use an alarm, phone, or wait until help arrives
Seek medical review — particularly after injury, head impact, loss of consciousness, or repeated falls

Falls without obvious injury should still be reviewed by a clinician if they are unexpected, repeated, or have no clear explanation.

Exercise and Balance Training

Exercise is among the most effective strategies for reducing falls. Programmes that combine strength and balance training — delivered by a physiotherapist, exercise physiologist, or in a supervised group — have the strongest evidence.

Strength Training

Resistance exercise targeting leg muscles helps prevent the muscle loss that increases fall risk. This can include chair-based exercise, resistance bands, or weights — adapted to current fitness and any medical conditions.

Balance Training

Balance exercises challenge the body’s ability to control position — for example, single-leg standing, heel-to-toe walking, and Tai Chi. Tai Chi in particular has a reasonable evidence base for reducing fall frequency in older adults.

Supervised and Group Exercise

Supervised exercise programmes tailored to fall risk — often available through hospitals, physiotherapy services, or community health programmes — tend to produce better outcomes than unsupervised activity alone, particularly for people with significant frailty or previous falls.

The right exercise plan depends on fitness level, medical conditions, and individual fall history. A physiotherapist or exercise physiologist can design a safe, targeted programme. The goal is increased activity, not unnecessary restriction.

Home Safety

Simple changes to the home environment can meaningfully reduce fall risk:

Lighting — improve lighting in corridors, stairs, and bathrooms; use night lights; ensure switches are accessible
Rugs and mats — remove loose rugs, or secure edges firmly; avoid mats in high-traffic areas
Bathrooms — install grab rails in the shower and near the toilet; use a non-slip bath mat; consider a shower chair
Stairs — ensure rails on both sides; mark step edges if visibility is poor; avoid carrying bulky items on stairs
Footwear — wear well-fitting shoes with non-slip soles; avoid walking in socks or loose slippers on smooth floors
Clutter — keep walkways clear; store frequently used items at waist height to avoid excessive reaching or bending
Furniture — ensure chairs are stable and at an appropriate height for rising safely
Cables and cords — secure or reroute power cords away from walking paths

An occupational therapist can conduct a home assessment and recommend specific modifications.

Medication Review

Medication review is an important and often overlooked component of falls prevention. A GP or clinical pharmacist can:

Identify medicines that affect balance, alertness, or blood pressure
Review whether dosing, timing, or alternative medicines could reduce fall risk
Assess for drug interactions that compound risk
Advise on orthostatic hypotension and whether dose changes are appropriate

Never stop or reduce prescribed medicines without speaking with a clinician first.

See: Medication Safety: How to Avoid Common Medicine Problems — for a detailed overview of which medicines raise fall risk and how to approach a medication review.

Vision, Hearing, Feet, and Footwear

Regular vision assessment and corrected vision reduce fall risk. Cataracts and uncorrected refractive errors are addressable and worth attending to.

Hearing loss can affect spatial awareness and balance through shared vestibular pathways. Addressing hearing problems may have additional benefits beyond communication.

Foot care — including management of neuropathy, calluses, deformities, and nail problems — is relevant for people with diabetes, peripheral vascular disease, or persistent foot pain. A podiatrist can assess foot health and footwear suitability.

Bone Health and Fracture Prevention

Falls cause fractures most often in people with reduced bone density. Preventing and treating osteoporosis does not prevent falls, but it reduces the severity of injury if a fall does occur.

See: Bone Health Basics | Osteoporosis | Fractures and Falls

Assistive Devices

Walking aids — including walking sticks and frames — can provide balance support and reduce fall risk when used correctly. An incorrectly sized or improperly used aid can itself be a hazard. A physiotherapist or occupational therapist can advise on the most suitable aid and ensure it is properly fitted.

Personal alarm devices allow people who live alone to call for help if they fall and cannot get up — reducing the time spent on the floor after a fall.

When to Seek Urgent Help

Seek emergency care after a fall if there is:

Head injury or loss of consciousness
Chest pain or shortness of breath
Sudden weakness, numbness, or facial drooping (possible stroke)
Severe pain, particularly in the hip, wrist, or spine
Inability to stand or bear weight
Confusion or changed mental state
Suspected fracture

Repeated falls without obvious explanation, or falls with dizziness, always warrant medical review — even without injury.

FAQ

Are falls a normal part of aging? Falls become more common with age, but they are not simply normal or inevitable. Many fall risks can be identified and meaningfully reduced.

What are common causes of falls? Falls are often linked to balance problems, muscle weakness, dizziness, medicines that affect blood pressure or alertness, poor vision, foot problems, home hazards, or acute illness.

What exercise helps prevent falls? Strength and balance training — particularly when supervised — can meaningfully reduce fall risk. A physiotherapist can advise on a suitable programme based on individual health and fitness.

Should someone see a doctor after a fall? Medical review is important after any fall with injury, head impact, loss of consciousness, dizziness, chest pain, new weakness, confusion, or repeated falls.

How can the home be made safer? Useful steps include improving lighting, removing loose rugs, installing handrails, checking footwear, and keeping frequently used items easy to reach. An occupational therapist can assess the home.