Falls

The commonest reason older people end up in hospital. Almost never simply bad luck.

What it is

Around one in three people over 65 falls each year. Falls are the leading cause of injury-related death in that age group, and a hip fracture changes a life permanently: many people never return to their previous independence.

The phrase that causes the most harm is "she just had a fall". Falls have causes, usually several stacked together, and almost every one of them can be reduced.

Look for: medication, blood pressure dropping on standing, poor vision, weak legs, a urinary tract infection, unsafe footwear, poor lighting, and fear of falling itself.

Signs you might notice

Furniture walking: holding on to things to cross a room.

Near misses that nobody reports, which are the best available warning.

Rising from a chair with difficulty, or needing several attempts.

Dizziness on standing up, which suggests postural hypotension and is very treatable.

Confidence dropping, and activity dropping with it.

How it can affect day-to-day life

Fear does as much damage as the fall. After one fall people move less, so muscles weaken, so balance worsens, so the risk climbs. That spiral is the reason a single fall predicts the next one.

The long lie is the serious version: somebody on the floor for hours develops pressure damage, dehydration and muscle breakdown that harms the kidneys.

Falls also drive admission to residential care more than almost any other single event.

Supporting someone well

Get a medication review. Sedatives, some blood pressure tablets and anything anticholinergic all raise risk, and four or more medicines together raises it further.

Check lying and standing blood pressure. It takes two minutes and finds a very common, fixable cause.

Get a strength and balance programme. Not general advice to stay active: a proper evidence-based class. This is the intervention with the best trial evidence.

Fix the house: lighting, loose rugs, trailing wires, the route to the toilet at night, and grab rails where they are actually needed.

Sort out footwear and feet. Well-fitting shoes, and a podiatrist for nails and pain.

Check vitamin D and vision.

In a service, record near misses as well as falls. Fiducia Together keeps falls, observations and medicines in one clinical record, so the pattern behind three unexplained falls becomes visible instead of appearing as three separate incident forms.

Where to get help

Ask a GP for a falls assessment, or a referral to the local falls service. They exist in most areas.

After any fall with a head injury, especially on blood thinners, seek medical advice the same day even if the person seems fine.

Age UK provide practical home safety guidance and can arrange help.