About one in four adults over 65 falls every year, making falls the leading cause of injury and injury-related death in this age group. The good news is that most falls are preventable. Prevention works best as a combination of strategies: strengthening the body, fixing hazards in the home, reviewing medications, and addressing vision and footwear. Here’s what actually works.
Why Falls Are Increasing
Over 14 million older adults report falling each year in the United States. About 37% of those who fall sustain an injury serious enough to need medical treatment or limit their daily activity, adding up to roughly nine million fall injuries annually. The fall death rate among older adults climbed 41% between 2012 and 2021, rising from about 55 to 78 deaths per 100,000 older adults. This increase is partly due to an aging population, but also because many preventable risk factors go unaddressed.
The Two Categories of Risk Factors
Falls rarely have a single cause. Risk factors fall into two broad groups: things happening inside the body and things happening in the environment.
Body-Related Risks
Reduced leg strength is one of the strongest predictors of falling. As muscle mass declines with age, balance and the ability to catch yourself after a stumble both deteriorate. Other physical factors include impaired vision, reduced sensation in the feet and legs, slowed reaction time, arthritis in the hips or knees, and foot problems like bunions or neuropathy. Cognitive changes from conditions like Alzheimer’s disease or after a stroke also raise the risk significantly.
Depression is an often-overlooked contributor. It reduces physical activity, slows reaction time, and can affect attention to surroundings.
Environmental Risks
Poor lighting, cluttered walkways, slippery floors, loose rugs, and lack of grab bars in bathrooms are the most common household hazards. Poorly designed or maintained stairways are particularly dangerous. Among healthier older adults, falls tend to happen during risk-taking activities like climbing ladders, rushing, or carrying heavy loads.
Build Strength and Balance
Exercise is the single most effective fall prevention strategy because it targets multiple risk factors at once: leg strength, balance, reaction time, and coordination. Programs that combine balance training with resistance exercises consistently reduce fall rates in clinical trials.
Practical options include tai chi, which has strong evidence for improving balance; bodyweight exercises like sit-to-stand repetitions and heel raises; and walking on varied terrain. The key is consistency. Even 30 minutes of balance and strength work three times a week makes a measurable difference over several months. If you or your loved one has limited mobility, a physical therapist can design a seated or supported program to start safely.
Review Medications With a Pharmacist or Doctor
Certain drug classes substantially increase fall risk, and many older adults take several of them simultaneously. The American Geriatrics Society maintains a list of medications considered potentially inappropriate for older adults, and several categories stand out for fall risk specifically.
Benzodiazepines (prescribed for anxiety or sleep) increase the risk of cognitive impairment, falls, and fractures. Sleep medications in the “Z-drug” category, like zolpidem, carry similar risks. First-generation antihistamines found in many over-the-counter sleep aids and allergy products, particularly diphenhydramine, impair balance and alertness. Older antidepressants with strong sedating effects, skeletal muscle relaxants, and even some newer antidepressants in the SNRI class have been linked to increased falls.
The risk compounds when multiple medications with overlapping side effects are taken together. Taking two or more drugs with anticholinergic properties, which block a specific nerve signal and are found across allergy medications, bladder drugs, and certain antidepressants, increases the risk of falls, confusion, and cognitive decline. A pharmacist can conduct a medication review to flag these interactions, and dosage adjustments or alternatives often exist.
Optimize Vision
Annual eye exams catch conditions like cataracts, glaucoma, and macular degeneration that develop gradually and may go unnoticed. But the type of glasses you wear matters just as much as the prescription.
Multifocal lenses (bifocals, trifocals, and progressive lenses) blur distant objects in the lower visual field, which is exactly where you need to see curbs, steps, and uneven ground. Studies show that older adults wearing multifocal glasses have impaired depth perception and less accurate foot placement when stepping onto raised surfaces. Trips and contacts with step edges occurred only while participants wore multifocal lenses, not single-vision lenses. Prospective research found that multifocal wearers were significantly more likely to fall over a 12-month period, especially outdoors and on stairs.
If you wear multifocals, consider keeping a pair of single-vision distance glasses for walking, outdoor activities, and navigating stairs. Save the multifocals for reading or desk work.
Choose the Right Footwear
Shoes play a bigger role in stability than most people realize. The CDC recommends footwear with these features:
- Low, broad heel: no higher than one inch, with a flared base that maximizes ground contact
- Textured sole: provides grip on wet or smooth surfaces
- Thin, firm midsole: lets you feel the ground beneath you, improving balance feedback
- Firm heel collar: the rigid cup around the back of the heel that holds your foot in place
- Laces or straps: secure the shoe to the foot so it doesn’t slide or shift during walking
Shoes to avoid include high heels, anything with a smooth or worn sole, backless styles like mules or clogs, and slingbacks. Slippers are a common culprit in household falls because they typically lack traction, support, and a secure fit. If you prefer slippers at home, choose ones with rubber soles and a closed back.
Make the Home Safer
A room-by-room walkthrough can eliminate many of the environmental hazards that contribute to falls.
In the bathroom, install grab bars near the toilet and inside the shower or tub. Use nonskid mats or adhesive strips on wet surfaces. In the bedroom, keep a lamp or light switch within arm’s reach of the bed so you never walk in the dark. Throughout the house, secure or remove loose rugs, clear clutter from walkways, and ensure every room and hallway has adequate lighting. On stairs, check that handrails are sturdy and run the full length of the stairway. Tack down any loose carpet on steps.
Good lighting deserves special emphasis. Age-related changes to the eye mean older adults need two to three times more light than younger people to see the same level of detail. Nightlights in hallways, bathrooms, and between the bedroom and kitchen are inexpensive and effective.
Get Enough Vitamin D and Calcium
Vitamin D plays a direct role in muscle function, not just bone health. Older adults with very low vitamin D levels (below 10 ng/ml in blood tests) have a 78% higher risk of falling. Supplementation has been shown to improve muscle function and reduce falls, particularly in less active older women. One study found that combining 700 IU of daily vitamin D with 500 mg of calcium reduced falls by as much as 65% over three years in this group.
The National Osteoporosis Foundation recommends 800 to 1,000 IU of vitamin D3 daily for adults over 50. Since many older adults get limited sun exposure and absorb vitamin D less efficiently, supplementation is often necessary to reach adequate levels. A simple blood test can check your current status.
Screen for Fall Risk Early
One widely used screening tool is the Timed Up and Go test. You sit in a standard chair, stand up, walk about 10 feet, turn around, walk back, and sit down again while being timed. Taking longer than 13.5 seconds is generally considered a sign of increased fall risk. People with balance disorders who exceeded this threshold were 3.7 times more likely to have fallen in the previous six months. Some clinicians use a 12-second cutoff for community-dwelling older adults, while fall clinics sometimes apply a 15-second threshold.
This is a test you can do at home with a stopwatch to get a rough baseline. If the time is creeping up, it signals that strength and balance work should be a priority.
Consider Wearable Fall Detection
For older adults who live alone or have already fallen, wearable fall detection devices offer an added layer of safety. These devices use motion sensors and pressure sensors to detect the sudden impact and change in body position that characterize a fall. When a fall is detected, the device can automatically alert emergency contacts or a monitoring service.
Accuracy varies by device and sensor placement. Devices worn on the trunk (chest or waist) tend to perform best, with studies reporting sensitivity around 97.5% and specificity around 97%. Systems using multiple sensors achieve even higher specificity, approaching 100% in some reviews. Wrist-worn devices are more convenient but generally less accurate. These devices do not prevent falls, but they significantly reduce the time spent on the ground after a fall, which is itself a major risk factor for complications like dehydration, pressure injuries, and hypothermia.