When an older person falls, the most important thing you can do is stay calm and resist the urge to immediately pull them up. More than one in four adults over 65 falls each year, and about 37% of those falls result in an injury that needs medical attention or limits activity for at least a day. What you do in the first few minutes can prevent a minor fall from becoming a serious injury.
Check for Injuries Before Moving Them
Before you try to help someone off the floor, you need to know if they’re hurt. Ask them to stay still and talk to you. Find out where they feel pain, whether they hit their head, and whether they feel dizzy or confused. Look for visible signs of injury: swelling, bruising, bleeding, or any limb that looks bent or positioned abnormally.
Pay special attention to the hips and legs. A hip fracture is one of the most common serious injuries from a fall in older adults, and the signs are fairly distinct. According to Mayo Clinic, symptoms include severe pain in the hip or groin, inability to bear weight, bruising and swelling around the hip, a leg that appears shorter on the injured side, or a foot that turns outward. If you notice any of these, do not attempt to move them. Call 911.
When to Call 911
Some situations call for emergency help, no matter how minor the fall seemed. Call 911 if the person:
- Lost consciousness, even briefly
- Cannot bear weight on a leg or arm
- Has a visible deformity in any limb, with swelling or bruising
- Has severe pain in the hip, back, or head
- Seems confused or is not making sense
- Is on blood thinners and hit their head
Blood-thinning medications make even a seemingly minor head bump potentially dangerous because they increase the risk of bleeding inside the skull. If the person takes blood thinners and struck their head, they need medical evaluation regardless of how they feel in the moment.
How to Safely Help Them Up
If you’ve checked for injuries and the person feels ready to try getting up, don’t grab their arms and pull. That’s the most common mistake, and it can cause shoulder injuries, throw you both off balance, or worsen an injury you didn’t notice. Instead, use the chair method.
Place a sturdy chair directly in front of them, or help them crawl slowly to the nearest stable piece of furniture. Let them use the chair or furniture to first get into a kneeling position, then pull themselves to a partial stand. You can gently guide them, but let the furniture bear their weight, not your body. Once they’re partially upright, help them turn slowly so they can sit down in the chair. Give them time. There is no reason to rush this.
If the person cannot get up on their own, even with a chair for support, don’t force it. Make them as comfortable as possible on the floor with a pillow and blanket, and call for help. Trying to lift a person who can’t assist in the process puts both of you at risk.
Watch for Delayed Head Injury Symptoms
One of the most dangerous consequences of a fall in an older adult is a slow bleed inside the skull. This type of brain bleed typically shows up between 3 and 21 days after a head injury, which means someone can seem perfectly fine right after a fall and develop serious symptoms days or even weeks later.
The symptoms are often subtle in older adults: new or worsening headaches, confusion, difficulty with balance, changes in personality, or increasing drowsiness. In one documented case, a patient presented with headaches and balance problems several weeks after a fall, with no other obvious warning signs in between. This delayed timeline makes it easy to dismiss symptoms or not connect them to the fall.
If the person hit their head, or if you’re not sure whether they did, monitor them closely for the next few weeks. Any new confusion, persistent headache not relieved by over-the-counter medication, unsteadiness, or unusual sleepiness warrants an immediate trip to the emergency room.
Schedule a Medical Follow-Up
Even if the person seems fine after a fall, a visit to their doctor within the next few days is worthwhile. Falls rarely happen for no reason, especially in older adults. A post-fall evaluation typically focuses on figuring out why the fall happened so it doesn’t happen again.
One critical piece is a medication review. Many common prescriptions, particularly blood pressure medications, sedatives, and antidepressants, can cause dizziness or drops in blood pressure when standing. This blood pressure drop, where the systolic reading falls by 20 points or more within three minutes of standing up, is a frequent and treatable cause of falls. A doctor can also check vision, test balance and gait, evaluate leg strength, and screen for neurological issues that might have contributed.
Blood work may be part of the evaluation. Low vitamin D, vitamin B12 deficiency, thyroid problems, and anemia can all affect balance and increase fall risk. These are straightforward to test for and often simple to correct.
Breaking the Fear-of-Falling Cycle
What happens after a fall often matters as much as the fall itself. Many older adults develop a significant fear of falling again, and that fear triggers a cycle that actually makes future falls more likely. The anxiety leads to avoiding physical activity, which weakens muscles and worsens balance, which increases the real risk of another fall.
If you notice the person becoming less active, reluctant to walk, or withdrawing from social activities after a fall, that fear cycle may be taking hold. The solution, counterintuitively, is more movement, not less. For someone with a high level of fear, chair-based exercises are a good starting point. Research shows that chair-based aerobic exercise significantly reduces fear of falling while also improving mobility and daily functioning. The person stays seated, which feels safe, while still building the strength and confidence they need.
As confidence improves, activities like tai chi are particularly effective. Tai chi emphasizes slow, controlled movements that build balance, trunk rotation, and coordination. It has a strong evidence base for reducing both the fear of falling and the actual risk of falling in older adults living at home. The key is matching the activity to the person’s comfort level and gradually progressing from there. Pushing too hard too fast reinforces the fear. Starting gently and building success does the opposite.