What it is
Falls are unintentional descents to the ground or a lower surface, representing a leading cause of injury and mortality in older adults.
Unintentional descents to the ground or lower surface, particularly significant in older adults where they represent a major cause of injury and functional decline.

At a glance
What it is
Falls are unintentional descents to the ground or a lower surface, representing a leading cause of injury and mortality in older adults.
Commonly experienced as
Evidence context
Safety
See staying safeHistory & Origin
A fall is defined as an unintentional event in which a person comes to rest on the ground, floor, or lower level. Falls are the second leading cause of accidental injury deaths globally and the primary cause of injury in adults over 65. In older adults, fall risk is multifactorial: intrinsic factors include muscle weakness (sarcopenia), balance impairment, gait abnormalities, cognitive decline, visual impairment, orthostatic hypotension, and polypharmacy (particularly sedatives, antihypertensives, and diuretics). Extrinsic factors include environmental hazards such as poor lighting, loose rugs, and uneven surfaces. In younger individuals, falls typically follow acute episodes such as syncope, seizure, or intoxication. Falls in older adults predict functional decline, fear of falling, social withdrawal, and institutionalisation.
The Evidence
Falls in older adults are well-studied, with strong evidence for multifactorial prevention strategies including exercise, medication review, and home safety assessment.
Falls are preventable — and the evidence on how is strong
Falls are a leading cause of injury in older adults, with well-established, modifiable risk factors. Multifactorial prevention programmes — combining exercise, medication review, and environmental changes — have the strongest evidence base.
Seek urgent care if a fall involved loss of consciousness, as cardiac or neurological causes must be ruled out. If weight-bearing is not possible after a fall, fracture should be assessed. Multiple falls in a short period warrant prompt multifactorial review. Older adults who hit their head in a fall should be monitored for signs of intracranial injury.
Balance and strength training — including the Otago programme and tai chi — are the most consistently effective interventions across multiple trials. NICE guidelines recommend structured multifactorial risk assessment for older adults who have fallen. Vitamin D supplementation is supported where deficiency is present. Hip protectors reduce fracture risk in high-risk settings.
Bed rest following a fall — without a specific injury requiring it — accelerates deconditioning and raises future fall risk. Over-restriction of activity driven by fear of falling can paradoxically worsen physical function. Supported, gradual return to movement is generally preferable to prolonged rest.
Intrinsic risk factors include muscle weakness, balance and gait impairment, cognitive decline, visual changes, orthostatic hypotension, and polypharmacy — particularly sedatives and antihypertensives. Extrinsic factors include poor lighting, loose rugs, and uneven surfaces. Identifying and addressing modifiable factors is central to effective prevention.
Tai chi has been validated in multiple randomised controlled trials as an effective fall prevention intervention in older adults. Yoga and qigong are widely used to support balance, body awareness, and lower-limb strength. These approaches complement — rather than replace — structured medical risk assessment and any indicated clinical management.
A GP, geriatrician, or physiotherapist can conduct or refer for a structured multifactorial fall risk assessment. Medication review by a pharmacist or prescriber is important where polypharmacy is a factor. Occupational therapists can assess home hazards. Optometrists should be involved where vision changes are present. Self-managed approaches work best alongside — not instead of — professional assessment.
Safety first
General, informational guidance — not diagnostic. A qualified practitioner can advise on your own situation.
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