Falls and fear of falling in later life

A fall can change more than your body. Even when nothing is broken, many people come away shaken. They start to worry about the next fall, walk less, stop going out alone, and see friends less often. Over time, that worry can shrink a whole life.

This guide is about both sides of falling in later life: the physical risk and the emotional one. It explains how fear and low mood can feed a cycle of weakness and isolation, and what breaks that cycle. For more on the fear itself, see Fear of falling.

How common falls are

Falls are the most common cause of head injuries in older adults. Each year, falls by older adults lead to about 4.5 million emergency room visits in the U.S. Most hip fractures are caused by falls.¹

Still, most falls do not cause serious injury. About 1 in 10 falls causes an injury that limits activity for a day or more or needs medical care.¹ What often lasts longer is the worry.

Signs that fear of falling is limiting your life

Some caution is healthy. It becomes a problem when it stops you from doing things you can safely do. Signs include:

• You avoid walking outside, shopping or going to church because you might fall
• You hold on to furniture or walls even on flat floors
• You have stopped bathing or showering as often because it feels risky
• You turn down invitations or stay home alone more than before
• You feel tense, watchful or on edge whenever you are on your feet
• You feel sad, frustrated or ashamed about needing help

Concerns about falling can happen even in people who have never fallen.⁷

The fear-and-falls cycle

Here is how the cycle often works. A fall or near-fall leads to worry. Worry leads you to move less. Moving less weakens muscles and balance, which can raise the risk of another fall.² It also cuts you off from people and the things you enjoy, which can feed low mood.²

Researchers are still sorting out how strongly fear predicts actual falls. For some people, too much caution can itself make walking less steady.² What is clear is that fear can shrink a person's world, and that staying active helps prevent falls.⁷

Some medicines used for sleep, anxiety and depression can also raise the risk of falls and confusion.⁵ See Anxiety in later life.

What raises fall risk

Many things add up:^7,4

• Weak legs and poor balance
• Medicines that cause dizziness, sleepiness or confusion, and taking many medicines
• Blood pressure that drops when you stand up
• Vision changes, including bifocal or progressive glasses when walking outside
• Hearing loss, even mild. See Hearing loss, mood and memory.
• Foot pain and unsafe shoes
• Home hazards such as clutter, loose rugs, poor lighting and no grab bars
• Alcohol. See Alcohol and older adults.

What helps

Practical steps

1. Tell your doctor about every fall, even if you were not hurt. A fall can be a sign of a health or medicine problem.⁷
2. Ask for a fall-risk check and whether you should take vitamin D. Ask about a bone density test.⁴
3. Bring all your medicines to a review, including sleep aids and allergy pills.⁴
4. Get your eyes checked every year and update your glasses.⁴ Ask about hearing too.
5. Start balance exercise. Join a class, ask for physical therapy, or use our Strength and balance training guide. Aim for regular practice over months.
6. Make one room safer each week. Start with the bathroom and stairs.⁴
7. Stand up slowly, wear low-heeled, non-slip shoes, and keep your hands free on stairs.⁷
8. Practice how to get up from the floor. If you fall, stay calm, check for injury, roll to your side, crawl to a sturdy chair, and rise slowly. If you are hurt or cannot get up, call for help or 911.⁷
9. Keep help within reach. Carry a charged phone. Consider a medical alert button. Arrange a daily check-in with someone.⁷

For family caregivers

• Ask about falls directly. Fewer than half of older adults who fall tell their doctor.¹ World guidelines urge health workers to ask, and to offer a full fall-risk assessment to people at high risk.⁹
• Do not overprotect. Doing everything for your parent can speed up weakness. Aim for safe activity, not no activity.
• Go to a class together or walk with them.
• Walk through the home looking for hazards, especially lighting at night and the bathroom.
• Notice mood. If your parent has stopped going out, seems down or anxious, or talks about being a burden, raise it with their doctor. See Helping someone with depression.

Special situations

Living alone. The fear of lying on the floor for hours is real. A charged phone, a medical alert device, a smartwatch with fall detection, and a daily check-in call all help.⁷ See Technology and staying connected.

Living with dementia. Falls are more common, and people may not remember or report them. Keep routes clear and well lit, and ask the doctor about medicines that cause sleepiness or confusion. See Daily routines in dementia care.

Rural areas. Ask about classes by video or phone, physical therapy at home, or programs through your local Area Agency on Aging. The Eldercare Locator (1-800-677-1116) can help you find them.

Language barriers. Some fall-prevention programs are offered in other languages.⁶ Ask for an interpreter at medical visits.

Frequently asked questions

I'm afraid of falling, so isn't it safer to stay home?

Not usually. Moving less weakens muscles and balance, which can make falls more likely.² Staying active helps prevent falls.⁷ Start with safe, supported exercise.

Can exercise help if I'm in my 80s or 90s?

Yes. The average age of people in the exercise trials was 76.³ A physical therapist can tailor exercises to your ability.

Should I use a cane or walker?

It may help. Make sure it is the right size and you know how to use it.⁷ Ask a physical therapist to fit it.

Can my sleeping pill cause falls?

Some can. Benzodiazepines and some sleeping pills raise the risk of falls and confusion in older adults.⁵ Talk with your doctor before changing anything.

When to get help

Call 911 after a fall if the person:

• Hit their head, especially if they take a blood thinner
• Cannot get up, or has severe pain, especially in the hip
• Is confused, very drowsy, or has trouble speaking

See a doctor soon if falls or near-falls keep happening, you feel dizzy when standing, or fear keeps you home.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.