Janet, a 66-year-old retired teacher, exercised regularly and prided herself on her balance. While rushing to answer her phone, she tripped over a lamp cord and broke her wrist.
“I was shocked it could happen to me,” Janet says. “I’d focused on fitness but forgot about basic home safety.”
At a physical therapy session to help strengthen her broken wrist, Janet learned that her fall really resulted from multiple factors. Home hazards, her tendency to rush, and a blood pressure medication that made her mildly lightheaded when she stood up all played a role.
“Now I know fall prevention isn’t just about taping down my throw rugs,” Janet says. “It’s about how I move, where my attention is, how medications affect me, and how rushing creates risk. It’s all connected.”
Falls Matter at Every Age
Falls are the leading cause of injury-related deaths among people 65 and older, with one in four older adults falling annually. According to the STRIDE study (Strategies to Reduce Injuries and Develop Confidence in Elders), falls cause approximately 30,000 deaths, 3 million emergency visits, and 800,000 hospitalizations yearly in the U.S. Alarmingly, one-third of those over 60 who experience ground-level falls die within three years.
Fall prevention matters across all ages, especially as we enter middle age when subtle changes in balance, strength, and reaction time begin to emerge. Our vision also starts to change, making it easier to miss a step or fail to see something lying in our path at night.
Helena, 42, has a neurological disorder that can affect her gait and lead to falls. She’s taken specific steps to avoid falling and to recover from it if she does. She says, “I work very hard on ankle strength and push-ups so if I fall, I can get myself up. Without upper body strength, you may be stuck on the floor for a while.”
This highlights an often overlooked aspect of fall prevention: preparing to recover when they happen.
Creating Strength and Balance
Targeted exercise provides specific protection against falls. Recent research by Zhong, Meng, and Su found that certain types of exercise lower fall risk by targeting several factors:
- Balance and strength training improves posture control, gait stability, and coordination between nerve signals and muscle movements.
- Resistance training reduces age-related muscle loss and enhances joint mobility.
- Core and leg strength creates a stable base for movement.
- Upper body strength helps recovery after falls.
- Ankle mobility and strength improve reaction time during stumbles.
- Balance training teaches the body to recover from unexpected shifts.
The ancient martial art of tai chi incorporates many of these strategies. (Join me for a free YouTube session here.) But you don’t need formal classes or a lot of time to add fall prevention exercises to your daily routine. Here are some tips:
- While waiting for water to boil, practice standing on one leg (stay near the counter for support).
- During TV time, stand up and sit down without using your hands 10 times.
- On walks, incorporate balance challenges like heel-to-toe walking for 10 steps.
- Add five to 10 push-ups to your morning routine. (Wall push-ups are a good starting point.)
Helena notes, “Many people in their 40s can balance on one leg, but add a challenge and they’ll see they still need to build strength.” A Bosu balance ball is one way to challenge yourself at home.
Your Medications Matter
The STRIDE study highlighted the importance of reviewing medications that increase fall risk. Medications that can raise your risk of falling include:
- Benzodiazepines (anti-anxiety medications)
- Older antihistamines and certain antidepressants
- Muscle relaxers
- Some diabetes medications
- Alcohol, which interacts with many medications
All these can cause dizziness, drowsiness, unsteadiness, changes in thinking, and a drop in blood pressure when you stand up. Talk with your doctor about whether any of your medications, alone or combined with others that you take, are putting you at risk.
Increase Mindfulness and Awareness
Many falls occur during distraction or multitasking. Being present can significantly reduce risk. Research by Zhong, Meng, and Su highlights the importance of cognitive exercises that boost attention, spatial awareness, and decision-making abilities.
You can practice this type of awareness by:
- Scanning your environment before walking through it.
- Noticing when you’re rushing and consciously slowing down.
- Taking a moment (or several) to focus when switching activities.
- Paying special attention at high-risk times: getting up at night, getting in and out of vehicles, or walking on unfamiliar surfaces.
Maria, whose mother has fallen several times, observed: “Half her falls happened because she wasn’t thinking about where she was walking. She steps on air instead of noticing the curb, and even tripped over one of her exercise dumbbells.”
Managing Fear of Falling
Fear of falling creates a dangerous cycle. Your anxiety increases fall risk by causing tension in your body, changing your gait, and tempting you to avoid strengthening activities. Strategies for managing the anxiety include:
- Acknowledging that it’s normal and OK to be worried about falling.
- Building confidence with safe, easy balance challenges (make sure you have something to hold onto, someone is with you, or both).
- Celebrating small improvements in strength and balance. Every bit helps!
- Using necessary supports, such as walking sticks and stable footwear, without embarrassment.
James’ Story: Overcoming Fear
After breaking his hip, 81-year-old James became consumed by fear. He stopped gardening, attending his men’s Bible study (he had to walk up a few steps to get there) and even going to the mailbox if it was rainy or windy.
James’ daughter noticed how isolated he was becoming and talked with him about what was happening. He started working with a physical therapist specializing in fall prevention and learned that his tension was making him less stable. They practiced “mindful walking”—staying aware while remaining relaxed. By incorporating Scripture recitation during walks, James found his body moved more fluidly when focused on familiar words rather than fear.
Six months later, he was back to his regular activities. He had even added a weekly balance class at the local senior center. He says, “I still have momentary flashes of fear, but now I have tools to manage them instead of letting them manage me.”
Staying Safe at Home
The home is where one in six falls occurs. Key safety measures recommended by the National Institute on Aging include:
- Installing handrails on both sides of stairs and bright lighting in stairways and hallways.
- Keeping walking areas clear of clutter, cords, and small rugs.
- Mounting grab bars near toilets and in tubs and showers.
- Using nonskid mats in wet areas and keeping a flashlight by your bed.
- Arranging furniture to create clear, sufficiently wide walkways in your home.
- Keeping toys, decorative items (e.g., floor baskets and plants), and everyday items like shoes and backpacks out of your walkways.
- Wearing stable shoes with nonslip soles and winter footwear with ice grippers.
Managing Low Blood Pressure
This condition occurs when your blood pressure drops suddenly when you stand up. If you’ve experienced this, you know how dizzy and lightheaded you can feel. Ways to manage it include:
- Getting up slowly from sitting or lying positions.
- Staying well-hydrated throughout the day.
- Avoiding alcohol and hot baths, which can make symptoms worse.
- Asking your clinician if you should wear compression stockings or socks. These can help push blood back toward your heart.
- Talking with your doctor about medications that may cause this problem or make it worse.
If you have low blood pressure or feel dizzy often, talk to your doctor. Your sodium levels may be low. Ask if a daily electrolyte drink or making other changes could help.
Fall Prevention as Part of Daily Life
Here are some strategies to work fall prevention into every day as part of whole person health.
- Habit stacking: Add balance exercises to existing routines, such as brushing your teeth.
- Multipurpose activities: Choose exercises that build strength while accomplishing other tasks or during relaxation time. For example, you can do a few strengthening exercises while watching TV or listening to a favorite podcast.
- Family involvement: Make balance games a family activity.
Taking a whole person approach helps prevent falls through a multifaceted approach: building strength, maintaining awareness, managing emotions, creating safe environments, and addressing medical factors.
The small changes you make today—strengthening your ankles, practicing mindful walking, reviewing medications, creating safer environments—all contribute to a life where falls become less likely and less damaging when they do happen. Fall prevention is not about limiting your life but building confidence and expanding your options.
Resource
References
Bhasin S, et al. Preventing Serious Falls among Older Adults — The STRIDE Study. PCORI. 2022.
Zhong, Y.-J., Meng, Q., & Su, C.-H. (2024). Mechanism-Driven Strategies for Reducing Fall Risk in the Elderly. Healthcare, 12(23), 2394.