Older adults
Falls are not an inevitable part of getting older
The single most useful thing an older person can tell their GP is that they have had a fall. It is also the thing most often left out, because it felt embarrassing or because nothing was broken.
The short version
- A first fall is the strongest predictor of a second. It is also the best opportunity to prevent one.
- Common treatable causes include blood pressure dropping on standing, medication side effects, poor vision and weak legs.
- Strength and balance exercise genuinely reduces falls, and a care plan can bring in subsidised physiotherapy.
- Tell us about a fall even if you were not hurt and nobody saw it.
Falls are treated as a footnote of ageing, something to be expected and endured. They are not. Most have identifiable causes, and a good proportion of those causes can be addressed.
The reason it matters: a fall that breaks a hip changes everything that follows it. Preventing the second fall is one of the highest-value things general practice does, and it depends almost entirely on someone mentioning the first.
Why people fall
Rarely one thing. Usually several small ones lining up:
- Blood pressure dropping on standing. Common, easily measured, and frequently caused by the medication being taken for blood pressure.
- Medicines. Sleeping tablets, some antidepressants, sedatives and several blood pressure medicines all increase falls. So does taking a lot of medicines at once.
- Vision. Out-of-date glasses, cataracts, and multifocals on stairs — which are a genuinely common culprit.
- Weak legs and poor balance. Muscle is lost steadily from midlife unless it is actively maintained.
- Feet and footwear. Pain, numbness, long toenails, and slippers with no back.
- The home. Rugs, cords, poor lighting, no rail where there should be one.
- Alcohol, which is under-reported and interacts with several of the above.
- Low vitamin D and inner ear problems.
What a GP can actually do
A falls assessment is not vague advice to be careful. It is specific:
- Blood pressure measured lying and then standing, looking for a drop
- A review of every medicine, with the aim of stopping what is no longer needed
- Watching you walk, stand from a chair and turn, which is more informative than it looks
- Checking vision, feet and footwear
- Blood tests where relevant, including vitamin D, iron and thyroid
- Referral to physiotherapy or exercise physiology for strength and balance work
- Referral for a home safety assessment
- Assessment of bone health, since fracture risk is the reason falls matter
Deprescribing is often the biggest win. Reducing or stopping medicines that are no longer needed — safely, and with a plan — frequently does more to prevent falls than anything else on this list. Bring every medicine to the appointment, including the ones you have stopped taking.
The exercise that actually works
Walking is good for you, but on its own it does not prevent falls. What works is training balance and leg strength specifically, several times a week, at a level that is genuinely challenging.
That means standing on one leg while holding a bench, sitting to standing without using your hands, heel-to-toe walking, stepping in different directions, and progressive resistance work. Done properly it reduces falls measurably.
A chronic disease care plan brings Medicare-subsidised visits to a physiotherapist or exercise physiologist, which is exactly what they are for. Those visits are among the most commonly left unused each year.
What to do around the house
- Remove loose mats, or tape them down
- Improve lighting, particularly on stairs and the route to the bathroom at night
- Rails on stairs and beside the shower and toilet
- A non-slip mat in the shower
- Keep the things you use most at waist height
- Wear shoes with a firm back and a flat sole indoors, not slippers
- Think about how you would call for help if you fell and could not get up
If you have already fallen
Tell us. Even a stumble, even a near-miss, even if it was weeks ago and you feel fine. It is the piece of information that triggers everything above.
If you are 75 or over, you are entitled to an annual health assessment, which is bulk billed and covers falls risk along with medicines, memory, mood, hearing and vision. It is one of the most useful appointments available and one of the least requested.
After a fall, seek urgent care if you hit your head — particularly if you take a blood thinner — if you cannot bear weight, if there is deformity or severe pain, or if you lost consciousness or cannot remember the fall.
Questions we get asked
I had a fall but wasn't hurt. Is it worth mentioning?
Yes. A first fall is the strongest predictor of a second, and it is the best opportunity to find out why. Nobody will make anything of it, and it is genuinely the most useful thing you can tell us.
What is a 75+ health assessment?
An annual appointment for everyone aged 75 and over covering medicines, mobility, falls, memory, mood, hearing, vision and how you are managing at home. It is bulk billed with a valid Medicare card and takes about an hour.
Can I get help with exercise?
Yes. A chronic disease care plan gives you Medicare-subsidised visits to a physiotherapist or exercise physiologist. Ask your GP whether you qualify.
General information only. This article is general health information for people in the Port Stephens area. It is not advice about your individual situation and it does not replace a consultation with a doctor. If you are worried about a symptom, book an appointment or call us on (02) 4008 4400. In an emergency, call 000.
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