Falls: the numbers, and what actually reduces them

Falls are the thing that most often turns an independent life into a dependent one — not because a fall is usually fatal, but because a broken hip at 78 begins a chain of events that can end somewhere nobody chose.

They're also treated as bad luck, which is the part worth arguing with. A large share of fall risk is measurable and modifiable, and the best-supported intervention costs nothing at all.

The intervention that works

It isn't grab bars. Grab bars address a real hazard, but the strongest evidence sits with exercise done regularly at a difficulty that actually challenges your balance — programs combining balance, gait, functional and strength work. Which specific component does the most is not something the trials can cleanly separate.

Roughly a third fewer falls, from three sessions a week. No drug in this space comes close, and the effect compounds — stronger legs also mean an easier time on stairs, longer walks, and a better chance of getting up unaided if you do go down.

The word doing the work is challenging. Gentle seated movement is pleasant and does very little for balance. The programs with good trial evidence — Tai Chi, Otago — deliberately put you near the edge of your balance, safely, so the system adapts. Standing on one leg while holding a counter is closer to the target than a chair-based class.

The best-supported thing you can do about falls costs nothing, takes about half an hour three times a week, and is almost never what people go looking for.

Also on The Second Half Guide Your beneficiary form may outrank your will A will is the document everyone has heard of. For a lot of households, it isn’t the one that decides where the largest accounts go. Read it →

The other risk factors, roughly in order

• Medication. Psychoactive medications in particular — sleep aids, anti-anxiety medication, some antidepressants — carry a well-documented fall risk, and so does taking many medications at once. A pharmacist-led medication review is a legitimate and under-used request.
• Vision. Uncorrected vision, and specifically bifocals or progressives on stairs, which distort depth exactly where it matters. Some people keep a single-vision pair for walking.
• Blood pressure drops on standing. Very common, very treatable, and frequently the actual cause of a fall recorded as a trip.
• Feet and footwear. Pain, numbness, and shoes without a back. Slippers are a genuine hazard.
• The house. Loose rugs, poor lighting, no stair rail, clutter on the route to the bathroom at night.
• Fear of falling. Counter-intuitive but well documented: people who become afraid move less, weaken faster, and fall more.

Worth doing

• Start strength and balance work three times a week. Look for Tai Chi or a recognized falls-prevention class — many senior centers and Area Agencies on Aging run them free.
• Ask for a medication review naming falls as the reason. Bring everything, including supplements and anything over the counter.
• Get your eyes checked, and consider single-vision glasses for walking and stairs if you wear progressives.
• Ask your doctor to check blood pressure sitting and standing. It takes two minutes and is regularly the answer.
• Do the cheap house fixes: lighting, remove loose rugs, rails on both sides of stairs, a clear lit path to the bathroom.
• If you have fallen — even without injury — tell your doctor. One fall is the strongest predictor of the next, and it is the most under-reported event in medicine because people are embarrassed.

The last one matters most. Falls go unmentioned because they feel like evidence of decline, so the clearest warning sign gets hidden from the one person who could act on it.

A fall isn't a verdict about age. It's a data point about strength, medication, vision and blood pressure — every one of which can be changed.