As people get older, they may fall more often. Falls can obviously result in physical injury, which can be serious (e.g. fracture or head injury), but they can also have psychological effects, such as a fear of falling and a loss of confidence that can lead to a self-restricted reduction in physical activity and social interactions. 

Falls are costly to the individual and to society because they lead to additional GP visits, ambulance call outs, A&E attendance, hospital stays and increased social care costs. Falls cost the NHS more than £2 billion a year and there can be additional costs due to caring time and absence from work. As the number of older people in society increases, the impact of falls will grow. Preventing falls is therefore enormously important for individuals and for society.

Falls are not a normal part of ageing and there are many causes. These include: 

• The side effects of medicines
• The effects of diseases (such as arthritis, stroke and Parkinson’s disease) on a person’s ability to stand up and move around
• Sight, hearing or cognitive impairment
• Poor mobility, balance and co-ordination due to a lack of activity. 

Certain situations that commonly occur in the home can also make falls more likely. These include: 

• A lack of, or poorly positioned, hand rails
• Uneven or slippery flooring
• Poorly fitted rugs and mats
• Poor lighting
• Badly fitting footwear. 

Often, a combination of these factors leads to falls, so a multifactorial risk assessment should be carried out to assess an individual’s potential risk. Several different solutions might need to be adopted – for example, disease and medication management, changes to the physical home environment, or surgery for cataracts.

Facts about falls and fractures 

• The incidence of falls is increasing by about two per cent each year
• In England, the number of people aged over 65 is due to rise by a third by 2025; the number of people over 80 will double, and the number of people aged over 100 years will increase fourfold
• Around one-third of people aged over 65 and nearly half of those aged over 80 fall at least once a year. Between 10 and 25 per cent sustain a serious injury
• Most fractures in older people occur as a result of falling from standing height 
• Hip fractures are the most common cause of accident-related death in older people
• 20 per cent of people die within four months of a hip fracture and 30 per cent within a year
• One-third of people become totally dependent following a hip fracture.