Falls Prevention at Home and Outdoors

Most are preventable, and the interventions with the best evidence are not the ones people expect.

Exercise is the strongest intervention

Programmes combining strength and balance training have the best evidence for reducing falls, and the effect is substantial.

Balance work needs to be genuinely challenging to be effective — standing on one leg with decreasing hand support, heel-to-toe walking, sit-to-stand repetitions without using hands.

Tai chi has a particularly good evidence base and is widely available in community settings.

Frequency matters: the effective programmes involve exercise several times weekly, sustained over months rather than weeks.

Medication review

Several common medications increase fall risk — sedatives, some antidepressants, blood pressure medication causing postural drops, and anything causing drowsiness or dizziness.

Taking multiple medications increases risk further through interactions.

An annual medication review with a pharmacist or doctor specifically considering fall risk is worthwhile and frequently identifies changes that can be made.

Vision and footwear

Annual eye examinations, and prompt treatment of cataracts, which affect depth perception and contrast.

Bifocal and varifocal lenses can increase fall risk on stairs by distorting depth perception at the point of looking down. Single-vision distance glasses for walking outdoors are sometimes recommended.

Footwear with a firm fastening, low heel and good grip. Slippers without backs are implicated in a substantial number of household falls.

The home

Remove loose rugs and trailing cables. Repair uneven flooring and worn stair coverings.

Improve lighting throughout, particularly on stairs and on the route between bedroom and bathroom, using motion-activated night lights.

Handrails on both sides of stairs, extending beyond the top and bottom steps.

Grab rails by the toilet and in the shower, fixed properly into studs rather than suction-mounted.

Keep frequently used items at waist to shoulder height to eliminate reaching and the use of step stools.

After a fall

Any fall warrants assessment, even without injury, because it frequently indicates an underlying cause — infection, a medication effect, a cardiac problem or deteriorating balance.

Fear of falling causes reduced activity, which reduces strength and increases risk further. Addressing confidence is part of prevention rather than separate from it.

Consider a personal alarm for anyone living alone, since time spent on the floor after a fall substantially worsens outcomes.