Worried about falling? Falls are common, but they are not a normal part of getting older, and many can be prevented.

Start here

A short welcome video, and a checklist to help you feel steadier.

• Balance and Falls: Staying Steady: why strength and balance matter as we age (video, 4:14)

Your first 30 days: a checklist

• Tell your doctor about any falls or near-misses in the past year. Many people don't, and it's the first step to getting help.
• Ask your doctor or pharmacist to review all your medicines, including sleep aids and over-the-counter products.
• Start strength and balance exercises, such as the Otago programme or a local falls prevention class, at least 3 times a week.
• Walk your home with a 'falls eye': clear clutter, fix loose rugs, add night lights and grab bars.
• Book an eye test, and keep your glasses clean and within reach.
• Wear well-fitting shoes or slippers with a firm, non-slip sole and a back.
• Learn how to get up from a fall, and keep a phone or personal alarm on you.
• Ask whether you should have a bone health check for osteoporosis.

• Starting exercise safely: a friendly guide for every body: How to start moving more with confidence: whether you need to check with your doctor, how much to aim for, how to build up, warming up, and the warning signs that mean stop. (7 min read)

Why falls happen

The common causes, and the strong evidence that exercise prevents falls.

• Why falls happen, and how strength and balance exercise helps: Who is at risk of falling, why falls happen, and the strong evidence that strength and balance exercise, like the Otago programme and tai chi, prevents falls in older adults. (7 min read)

Preventing falls

Exercise, a medicine check, your eyes and feet, and a safer home.

• Falls-proofing your home and health: a practical checklist: A room-by-room home safety checklist, plus a medicines review, eyesight, feet and footwear, bone health, hip protectors and vitamin D, to help you and your family lower the risk of falls. (7 min read)
• Choosing a physiotherapist: what to look for and what to ask: How to find a good physiotherapist (physical therapist) for back, joint or balance problems: checking they're licensed, what a good first visit looks like, signs of quality care, costs and coverage. (6 min read)

Strength and balance exercises

The Otago exercises, done about 3 times a week, lowered falls by about a third in trials. Always do balance exercises next to something sturdy, like a kitchen counter.

Before you start: Check with your clinician first if you have a new injury, recent surgery, osteoporosis or heart symptoms. Stop if you feel sharp pain, dizziness or chest pain. For chest pain, call 9-1-1.

• Otago Strength Exercises

  Leg-strengthening exercises from the Otago programme, for the front and back of the thigh, the side of the hip, and the calves.

  Balance & legs; level: Gentle, for older adults; you'll need: A sturdy chair or counter; how often: 3 times a week; video, 8:53

  Based on the Otago Exercise Programme

  Printable manual (opens ACC New Zealand, PDF)

• Otago Balance Exercises

  Balance exercises from the Otago programme, from knee bends and sideways walking to heel-to-toe standing, always next to something sturdy.

  Balance; level: Gentle, for older adults; you'll need: A kitchen counter or sturdy support; how often: 3 times a week; video, 7:05

  Based on the Otago Exercise Programme

  Printable manual (opens ACC New Zealand, PDF)

Staying strong and steady

Strength, sleep and staying active, at any age.

• What Exercise Does for Your Body: and how much you really need (video, 4:38)
• Why Sleep Matters: what happens while you rest (video, 4:54)

• Strength training basics: getting stronger at any age: A beginner's guide to strength training for adults of any age: why it matters, how often, how many sets and repetitions, choosing the right effort, good form, progressing safely, and simple exercises to start with. (7 min read)

When to get help

Call 9-1-1 or go to emergency now

• A fall with a hit to the head if you take a blood thinner. Go to an emergency department now, even if you feel fine
• After any head injury: confusion, drowsiness, a bad or worsening headache, vomiting, a seizure, or blacking out
• You can't get up, or you may have hurt your hip, back or neck. Don't let others lift you
• After a fall, a leg looks shorter or turned outward, or you can't put weight on it
• The fall came with chest pain, a racing or pounding heartbeat, shortness of breath, or blacking out
• Sudden weakness or numbness of the face, arm or leg, trouble speaking, or a face that droops. These can be signs of a stroke
• Someone doesn't respond or isn't breathing normally: call 9-1-1 and start CPR

Call 9-1-1 or go to the nearest emergency department. Don't drive yourself.

Tell your doctor

• Any fall, even if you weren't hurt. Tell your doctor at your next visit, or sooner if you're worried
• You've fallen twice or more in the past year, or you couldn't get up on your own after a fall
• You feel unsteady when you stand or walk, or you've had a near-miss
• You feel dizzy or light-headed when you stand up, or the room spins when you move your head
• New dizziness, sleepiness or unsteadiness after starting or changing a medicine
• Fear of falling is making you do less or stay home
• Changes in your eyesight, or numbness or pain in your feet
• Pain that keeps getting worse in the days after a fall, or a bump on the head and you take a blood thinner

Call your doctor or clinic soon, and ask about a falls check-up.

If someone has fallen and may be badly hurt, call 9-1-1 or your local emergency number. Don't try to lift them yourself. Keep them warm and comfortable until help arrives. If you take a blood thinner and hit your head, get checked in an emergency department the same day, even if you feel well, because bleeding inside the head can develop slowly. For the second list, call your doctor or clinic soon and ask about a falls assessment.

• What to do if you fall: how to get up safely and when to call 9-1-1: Step-by-step instructions for getting up safely after a fall, what to do if you can't get up, when to call 9-1-1 (including a head injury on blood thinners), and how family can help. (6 min read)

Questions to ask your team

1. Am I at higher risk of falling? Why?
2. Can I have a falls risk check, or be referred to a falls prevention service?
3. Can you refer me to a physiotherapist for the Otago programme or a strength and balance class?
4. Could any of my health conditions be affecting my balance?
5. Would a walking aid help me?
6. How often should I do my exercises, and how do I make them harder safely?

From our guide Why falls happen, and how strength and balance exercise helps.

Go deeper

Written for clinicians and students. More technical material from Hibbert Medical, for readers who want more detail.

Podcast summaries

• Geriatrics podcasts: Clinicians who care for older adults, including falls and frailty.
• Rehabilitation podcasts: Rehab specialists and physiotherapists on exercise, pain and recovery.
• Exercise science podcasts: What the evidence says about activity, strength and training.

Lectures

• Falls Prevention and Gait Disorders: Residency geriatrics: why older adults fall, and what prevents it.
• Falls Prevention and Mobility Assessment: Residency family medicine: the falls check-up and simple mobility tests.
• Frailty: Screening, Diagnosis and Intervention: Residency geriatrics: frailty, and how exercise and nutrition help.
• Polypharmacy and Deprescribing: Residency geriatrics: how medicines can raise the risk of falls, and safely cutting back.
• Osteoporosis and Fracture Prevention in the Elderly: Residency geriatrics: protecting bones so a fall is less likely to break one.
• Normal and Pathological Gait Analysis: Residency rehab medicine: how clinicians watch you walk, and what they look for.
• Dizziness and Vertigo: A Systematic Approach: Residency family medicine: sorting out the causes of dizziness.

Seminars

• Geriatrics in Primary Care: Clerkship seminar: caring for older adults, including falls and medicines.
• Neurorehabilitation: Clerkship seminar: rebuilding movement and balance after injury or illness.

Clinical cases

• Osteoporotic Hip Fracture: A fall, a broken hip, and why bone health matters.
• Polypharmacy and Deprescribing: Too many medicines, and how a review can lower the risk of falls.
• Frailty, Polypharmacy and Hospital-Acquired Delirium: An older adult in hospital, and what keeps them moving.
• Benign Paroxysmal Positional Vertigo (BPPV): A common, treatable cause of dizziness and unsteadiness.
• Sarcopenia in an Aging Adult: Muscle loss with age, and how strength training helps.

Common questions

Aren't falls just part of getting older?

Falls become more common with age, but they are not a normal or unavoidable part of getting older. Most falls happen because of a mix of things, like weaker muscles, balance problems, medicines, eyesight and hazards at home. Many of these can be changed.

Does exercise really prevent falls?

Yes. A large Cochrane review of over 100 trials found that exercise reduces the number of falls in older people living at home by about a quarter. Programmes that combine balance and strength exercises work best, reducing falls by about a third. The key is doing them regularly, at least 3 times a week, and keeping them up.

What is the Otago programme?

The Otago Exercise Programme was developed in New Zealand. It's a set of leg strengthening and balance exercises, plus walking, that you do at home about 3 times a week, often started with a physiotherapist. In trials, it reduced falls and fall injuries by about a third in older adults living at home.

If I fall, should I try to get up?

First, stay calm and check yourself for pain or injury. If you're not hurt and feel able, roll onto your side, get onto your hands and knees, crawl to a sturdy chair, and use it to slowly get up. If you are hurt or can't get up, call for help, keep warm and change position gently every so often while you wait.

I'm scared of falling. Is that normal?

Very normal, especially after a fall. But fear can make people move less, which weakens muscles and makes falls more likely. Strength and balance exercise builds both your body and your confidence. If fear is still holding you back, talk to your care team. Support, including talking therapies, can help.

Sources for this page

1. Sherrington C, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019
2. Montero-Odasso M, et al. World guidelines for falls prevention and management for older adults. Age Ageing. 2022
3. NICE NG249: Falls: assessment and prevention in older people and in people 50 and over at higher risk
4. CDC: Facts about older adult falls
5. CDC STEADI: Patient and caregiver resources
6. Robertson MC, et al. Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data. J Am Geriatr Soc. 2002
7. Public Health Agency of Canada: You CAN prevent falls!
8. NHS: Falls