Falls
Anyone can fall, but past sixty a fall stops being mere clumsiness. At that age a bone breaks from standing height, and a few hours spent on the floor…
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Anyone can fall, but past sixty a fall stops being mere clumsiness. At that age a bone breaks from standing height, and a few hours spent on the floor without help sometimes do more harm than the fracture itself. There is a second side to it that gets discussed less often: a fall is almost never pure chance. Behind it there is usually something fixable — blood pressure that drops on standing, one sleeping tablet too many, spectacles that have not been checked, weak legs. Once the cause is sorted out, falls become markedly less frequent, and that makes this one of the few interventions in medicine with a proven effect.
The first minutes on the floor
Do not spring up. Lie still for a minute, get your breath back and check yourself over: do the arms and legs move, where does it hurt, is there any blood, is the room spinning. Only then decide whether to get up unaided.
If you feel you can manage, get up in stages rather than in one go: roll onto your side, push up with your arms onto hands and knees, and crawl to something solid — a heavy armchair, the bed, the bath. Bring your stronger leg forward with the whole foot flat on the floor and push yourself up, holding on with your hands. Once up, do not rush off: sit down and rest until the weakness passes.
If getting up is not going to happen, the job changes: now it is about calling for help and not getting cold. Reach for your phone or press your alarm. If neither is within reach, bang on the radiator, the wall or the floor and shout for the neighbours; knocking carries through a building better than a voice does. Cover yourself with whatever you can reach — a blanket, a coat, a tablecloth, a rolled-up rug; the floor pulls heat out of you faster than you would expect. Move your arms and legs, wiggle your fingers, and shift position at least every half hour. Hours spent lying on the same side are dangerous in themselves: the compressed muscle begins to die, the products of its breakdown punish the kidneys, the body loses water and warmth, and pressure sores form over the bony points within hours. That is exactly why a phone belongs in a pocket rather than on the bedside table in the next room.
When to call an ambulance
Call an ambulance (across Europe the single emergency number is 112) if any of this follows a fall:
- the person cannot get up, or cannot put weight on a leg;
- one leg looks shorter than the other and the foot is turned outwards — that is how a leg lies with a hip fracture;
- the head was struck, particularly with loss of consciousness, vomiting, confusion, severe headache, drowsiness or unequal pupils;
- the person takes blood-thinning medication and has hit their head, even if everything looks fine on the outside: blood under the coverings of the brain can build up slowly and cause symptoms days or weeks later;
- the fall was preceded by a blackout, or the person cannot remember how they ended up on the floor;
- there is chest pain, breathlessness, an irregular heartbeat, weakness in an arm or leg, a drooping face or trouble speaking;
- there is severe back or neck pain with numbness or pins and needles in the limbs;
- a wound is deep or the bleeding will not stop with pressure;
- the person has been on the floor for several hours.
While help is on the way, nobody who has fallen is hauled up by force or dragged: with a broken hip or a spinal injury that makes things worse. Cover them, put something soft under the head and stay with them.
A fall is rarely an accident
"I just tripped" is the commonest explanation and the most misleading. What deserves attention is the second before the fall. If everything went dark on standing, blood pressure is probably dropping with the change of position. If the room began to spin on turning over in bed or looking up at a shelf, that resembles benign positional vertigo, caused by displaced crystals inside the inner ear; unpleasant, but fixed with head manoeuvres in one or two sessions. If there is no memory of it at all, there was a blackout, and that is a question for the heart: a rhythm disturbance or a narrowed aortic valve floors a person with no warning whatsoever. And a sudden run of falls and muddle in an older person often means a urine infection or pneumonia, which at that age run their course without fever or cough.
Among the slower causes, the usual ones are weakness of the thigh and calf muscles, arthritis in knees and feet, the after-effects of a stroke, Parkinson's disease, dementia, nerve damage from diabetes, failing sight and hearing, dehydration and undernutrition. Alcohol deserves a line of its own: it affects balance more than it does in the young and sits worse alongside medication.
The tablets that make people fall
This is the most underrated cause and at the same time the most correctable. People are floored by sleeping tablets and sedatives, antidepressants and antipsychotics, strong painkillers, blood pressure medicines and diuretics, drugs for an enlarged prostate, diabetes treatments when the sugar goes too low, and anything with an anticholinergic effect that leaves the head foggy. The risk grows not only with each of them separately but with their number: the longer the list, the higher the chance of falling.
Do not stop anything on your own, because withdrawing a sleeping tablet or a blood pressure medicine abruptly is more dangerous than the drug itself. The right move is different: take every box along to your doctor or pharmacist at once, including anything bought over the counter and any supplements, and ask for the list to be reviewed specifically with falls in mind. Often something can be dropped, something moved to the evening and something swapped.
What a doctor will check
The assessment for falls is simple and yields a great deal. The doctor asks you to rise from a chair without using your arms, walk a few metres, turn and sit down again: that short test shows leg strength, balance and gait all at once. Blood pressure is taken twice, lying down and a minute or two after standing, because otherwise the postural drop goes unnoticed. After that it depends: a heart tracing if a blackout is suspected, blood tests for haemoglobin, glucose, sodium, calcium and vitamin D, a check of sight and hearing, a look at the feet.
Bones are considered separately. A fracture from a fall at standing height in someone over fifty is in itself a reason to look for osteoporosis rather than just a piece of bad luck. Bone density is measured by a scan and, if the diagnosis is confirmed, it is treated, because the next fracture is almost always worse than the last.
A house you do not fall in
Most falls happen in a person's own home, and the alterations needed there are cheap.
- Clear the floor of cables, stacks of newspapers and bags; loose mats are either fixed down or thrown out, because a sliding rug floors more people than any piece of furniture.
- Brighten the lighting everywhere you walk and put a night light on the route to the toilet: half of all night-time falls happen on that journey.
- Grab rails by the bath and the toilet, a non-slip mat in the shower and a stool inside it are the best money you will spend on safety.
- Stairs need a handrail on both sides and a clearly visible step edge; a strip of contrasting colour on the top and bottom steps is worth sticking down.
- Move whatever you use daily to somewhere between waist and shoulder height. Do not climb on chairs or step ladders — ask for help.
- Indoors you need enclosed shoes with a fixed heel and a non-slip sole. Backless slippers, walking about in socks and going barefoot on a smooth floor are a common cause of falls.
- Keep the phone on you, not on the table. An alarm button on a cord or a wristband makes sense if you live alone.
Strength and balance
Of everything offered against falls, exercise works best — and not just any exercise, but leg strength and balance work specifically. Walking is good for the heart but barely trains balance. What is needed is a session at least twice a week with chair stands, half squats, heel raises, standing on one leg beside a support and heel-to-toe walking; tai chi and group programmes for older people suit this well. The effect does not appear at once but around the third month, and in exchange it lasts as long as the sessions continue.
The rest supports it. Have your eyes tested once a year, and be aware of the catch with varifocals: on stairs they blur the step edges, so many people find a separate pair for distance easier outdoors. Have your hearing tested too, since the ear does more than hear. Eat enough protein and calcium-rich foods, make sure you are not short of vitamin D, and drink through the day, because dehydration on its own causes weakness and dizziness. And show your feet to a specialist if they hurt, are deformed or have lost sensation.
Fear of falling also floors you
After a first fall many people start being careful: going out less, giving up walks, staying indoors. The logic is understandable and the result is the opposite of what was intended. Within a few months without activity the muscles weaken, balance deteriorates and the risk of falling ends up higher than it was. The circle closes: fear leads to stillness and stillness to the next fall.
It is better broken early. Tell your doctor about the fall even if nothing was injured: most falls are never reported to anyone, and those are precisely the ones that predict the next one, the one with a fracture in it. Start exercising modestly and in safe conditions, and use a stick or a frame set to your height if you need one: a well-chosen support is not a badge of frailty but the way to keep walking further and for longer.
Online consultation
A remote appointment is a good place to go over what usually gets lost in a short visit: the exact circumstances of the fall, what happened in the second beforehand, whether the room spun or the vision dimmed. The doctor will work through your medication list with you and point out which items are worth raising at a face-to-face appointment, explain how to measure blood pressure lying and standing, what to change at home and which exercises to begin with. It is equally useful for deciding whether a fall that left no obvious injury still needs to be looked at in person. The urgent signs in the list above are not assessed remotely — for those you call an ambulance straight away.
This material is for information only and does not replace medical advice.
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