Fear of falling

Many older adults worry about falling. Some worry makes sense. It reminds you to turn on a light or hold the stair rail. But for some people, the fear grows until it starts to run their life. They stop going for walks, skip family events, or stay home most of the day.

This page explains when fear of falling becomes a problem, why it can raise the chance of a fall, and what helps. The good news: fear of falling can be eased, often with simple exercise, a safety plan and group classes.

What fear of falling is

Fear of falling means a lasting worry about falling that makes you avoid things you are able to do. Researchers also call it "concern about falling" or low "falls confidence."²

Some fear is healthy. It can protect you from real dangers, like an icy sidewalk. The problem starts when the fear is bigger than the actual risk, or when it keeps you from things that matter to you.

Common signs include:

• Avoiding stairs, showers, shopping or walks you used to handle
• Holding onto walls or furniture even when you do not need to
• Turning down invitations because of worry about the trip or the place
• Staying seated or in bed much of the day
• Feeling tense, dizzy or shaky when you think about walking somewhere new

Why it matters

The fear-and-falls cycle. When you move less, your leg muscles and balance get weaker. That makes a fall more likely, which can make the fear worse.¹ Studies link fear of falling with less physical activity, weaker physical and mental performance, less social life, more falls and lower quality of life.² Most of those studies looked at one point in time, so they cannot prove which comes first.²

Loneliness and mood. Staying home can cut you off from friends, faith groups and family. Fear of falling is also linked with depression.² Read more on loneliness in later life and depression in later life.

Who is more likely to have it. A past fall is the biggest risk factor. Women and older people report it more often. It is also linked with dizziness, problems with walking or balance, depression, poorer health and needing help with daily tasks.² How common it is depends on how it is measured. Studies of older adults living at home found anywhere from 3% to 85%.²

Falls in older adults: the facts

Falls are common and can be serious, but most do not cause a serious injury.

• More than 1 in 4 people age 65 and older fall each year. Fewer than half tell their doctor.¹
• Falling once doubles your chance of falling again.¹
• Roughly 1 in 10 falls leads to an injury that limits activity for a day or more or needs medical care.¹
• Falls cause about 4.5 million emergency room visits a year among older adults in the U.S.¹
• Falls are the most common cause of head injury in older adults.¹

These numbers are a reason to take falls seriously, not a reason to stop moving. Staying active, in a safe way, is one of the best ways to lower your risk.^4,5

A Matter of Balance

A Matter of Balance is a group program made for people who have started to limit their activity because they worry about falling.⁶

How it works. The program has 8 classes of 2 hours each. Groups meet once a week for 8 weeks or twice a week for 4 weeks. Each group has about 8 to 12 people.⁶ Two trained coaches lead the classes. The coaches do not need to be health professionals.⁶ Classes are offered in person in community settings and also remotely.⁶

What you learn. In the classes, people:⁶

• Learn to see falls and fear of falling as things you can control
• Set realistic goals to be more active
• Practice simple exercises for strength, coordination and balance
• Learn how to get down to and up from the floor safely
• Look for fall risks at home and make small changes
• Practice speaking up for what you need
• Work on turning discouraging thoughts into encouraging ones

Classes use group talk, role-play and a little homework.⁶ Much of this comes from cognitive behavioral therapy (a type of talk therapy that looks at how thoughts, feelings and actions affect each other). See our page on CBT.

Does it work? The program is based on a group class tested in a 1998 study in the Boston area. In that trial, 434 adults age 60 and older who feared falling and had cut back on activity were randomly assigned to the group program or a comparison group.⁷ Right after the classes, people in the program planned more activity and felt more in control of getting around. A year later, they had better social lives and moved around more widely.⁷ The study authors called the benefits modest, and they faded over time without a refresher.⁷ Today the program reports better confidence about falls, better handling of falls and more activity.⁶ Moderate evidence

How to find a class. Ask your local Area Agency on Aging, senior center, hospital or YMCA. The Eldercare Locator, a free service of the U.S. government, can connect you with local aging services. Call or text 1-800-677-1116.¹¹ MaineHealth, which trains the program's coaches, also answers questions about classes.⁶

Exercise: the strongest tool for falls

Exercise works on both sides of the problem. It makes falls less likely, and it can build confidence.

Exercise lowers falls. A large Cochrane review (a careful summary of many studies) looked at 108 trials with more than 23,000 older adults living at home.⁴ Exercise cut the number of falls by about 23%, close to 1 in 4 fewer falls. It cut the number of people who fell by about 15%.⁴ The types that worked best were:⁴

In 2024, the U.S. Preventive Services Task Force (USPSTF, an expert panel that advises on prevention) recommended exercise to prevent falls for adults 65 and older who are at higher risk.⁵ Programs in the studies often met 2 to 3 times a week, for about a year.⁵ They included physical therapy and group classes, and some used dance or tai chi.⁵

Exercise eases fear, at least for a while. Another Cochrane review looked at 30 trials with about 2,900 older adults.³ Exercise such as tai chi, yoga, balance training and strength training lowered fear of falling by a small to moderate amount right after the program.³ It did not cause more falls.³ Whether the benefit lasts is not clear, and the evidence was low quality.³ Promising

Where to start:

• Try our simple strength and balance routine, which includes chair options.
• Read about tai chi and try a gentle session at /practice/tai-chi/.
• Ask your doctor about physical therapy. A physical therapist can check your walking and balance and build a plan that fits you. Medicare Part B covers outpatient physical therapy that is medically needed. Your doctor or another qualified provider must certify that you need it. You usually pay 20% after the Part B deductible.¹⁰

When fear needs its own help

Sometimes the body gets stronger, but the fear stays. A UK national guideline from NICE (the agency that writes health guidelines for England) says doctors should consider cognitive behavioral approaches when strength and balance exercise has not eased concern about falling.⁸

A therapist can help you:

• Check your thoughts. For example, "If I go to the store, I will fall and no one will help me." A therapist helps you weigh that thought against the facts. Our thought check tool walks through this.
• Face fears step by step. This is called exposure (slowly and safely doing the things you have been avoiding). You might start by walking to the mailbox with someone, then alone, then to the corner. See exposure therapy.
• Calm the body. Slow breathing, like the cyclic sigh, can ease the racing heart and tight muscles that come with worry.

If fear of falling comes with panic attacks, constant worry or low mood, it may be part of a wider anxiety or depression problem. Both are very treatable at any age. See anxiety in later life, phobias and finding geriatric mental health care.

Lower your real risk, too

Fear shrinks when you know you have done what you can. The CDC suggests these steps:⁹

1. Tell your doctor if you have fallen, feel unsteady or worry about falling. Ask for a fall risk check.
2. Review your medicines with your doctor or pharmacist, including over-the-counter ones. Some cause dizziness or sleepiness. See medicines that can affect mood and memory. Do not stop or change any medicine on your own.
3. Ask about vitamin D and whether a bone density test for osteoporosis (thin, weak bones) is right for you.
4. See an eye doctor at least once a year. For walking outside, ask whether glasses with only your distance prescription would help, since bifocals can make steps and curbs harder to judge.
5. Make your home safer. Clear things you could trip on. Add grab bars by the tub and toilet, rails on both sides of stairs, and brighter lights.

For a full room-by-room list, see making the home safer and preventing falls.

Have a plan for "what if I fall?"

Much of the fear is about what happens after a fall. Having a plan can take away some of that worry. The NICE guideline says people at risk should talk with a health worker about what to do after a fall, including how to get up and when and how to call for help.⁸

• Ask a physical therapist or your doctor to show you a safe way to get up from the floor. A Matter of Balance also teaches this.⁶
• Keep a phone where you can reach it, even from the floor. Some people carry a cell phone in a pocket or wear a medical alert button.
• Set up a daily check-in call with a friend or family member if you live alone.

For family members and caregivers

Families often feel fear of falling too, on behalf of a parent or partner. It is natural to want to keep someone safe. But doing everything for a loved one, or keeping them in a chair, can weaken their muscles and their confidence.

• Encourage safe activity instead of rest all day. Offer to walk with them or join a class together.
• Help them make the home safer, and go with them to a doctor visit to ask about falls.
• Listen to their fears without brushing them off.
• If your loved one is living with dementia, falls need a special plan. See preventing falls in dementia.

You can find more support for yourself on our caregivers pages.

When to get help

Talk with your doctor if:

• You have fallen, even once, in the past year
• You feel unsteady, dizzy or weak when you stand or walk
• Fear of falling is keeping you home or away from people and activities you value
• You feel down, anxious or hopeless much of the time

Fear of falling is common, and it is not a sign of weakness. With the right exercise, a good plan and some support, many people get back to a fuller life.

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.