If an elderly person has just fallen, the first priority is staying calm and checking for injuries before attempting to move. Falls are the leading cause of injury in adults over 65, and how you respond in the minutes and hours afterward can prevent further harm. Here’s what to do, step by step.
Check for Injuries Before Moving
Whether you’re the person who fell or you’re helping someone else, resist the urge to get up immediately. Lie still for a moment and scan the body for pain. Try gently moving each limb, one at a time. Sharp pain, an inability to move a limb, or dizziness when lifting the head are all signs that something may be wrong.
Hip fractures are one of the most common serious injuries from falls in older adults. Signs include severe pain in the hip or groin, inability to bear weight on the affected leg, visible bruising or swelling around the hip, and the leg on the injured side appearing shorter or turned outward. If any of these are present, do not try to stand. Call 911 and keep the person still and warm until help arrives.
A head strike during a fall is especially concerning. Watch for confusion, repeated vomiting, severe headache, slurred speech, unequal pupil size, or loss of consciousness. If the person takes a blood thinner, the stakes are higher. Data from the National Trauma Databank shows that falling while on an anticoagulant raises the likelihood of death by 180% compared to falling without one. UK clinical guidelines recommend that anyone on a blood thinner who hits their head should receive a CT scan within eight hours. If there’s any doubt about a head injury and the person takes blood thinners, go to the emergency room.
How to Get Up Safely From the Floor
If no serious injury is apparent, getting up should be slow and deliberate. Rushing increases the risk of a second fall or aggravating an injury you haven’t noticed yet.
- Roll onto your side. From your back, slowly turn to one side and pause there.
- Push up onto hands and knees. Use your arms to push yourself into a crawling position.
- Crawl to a sturdy piece of furniture. A heavy chair, couch, or coffee table works well. Avoid anything with wheels or that could tip.
- Place both hands on the furniture. Bring your stronger leg forward into a half-lunge position, foot flat on the floor.
- Push up to standing. Use the furniture and your leg strength to rise slowly. Sit down in the chair once you’re up, and rest before walking.
If crawling isn’t possible because of knee pain or limited mobility, scooting across the floor on your backside or rolling toward the furniture are both reasonable alternatives. The goal is reaching something stable enough to support your weight as you rise.
If the person cannot get up at all, keep them comfortable on the floor with a blanket and pillow, and call for help. Lying on a hard floor for an extended period can cause pressure injuries and dangerously lower body temperature, so don’t leave them there indefinitely while waiting for a convenient time to assist.
What to Watch for in the Next 48 Hours
Some injuries from falls don’t show symptoms right away, particularly internal bleeding in the brain. Even if the person seemed fine initially, caregivers should monitor closely for at least 48 hours. The signs that warrant immediate medical attention include:
- New or worsening confusion, or behavior that seems out of character
- Increasing headache that doesn’t respond to normal pain relief
- Vomiting, especially repeated episodes
- Difficulty with speech, vision, or eye movements
- Unusual drowsiness or difficulty waking from sleep
- Memory gaps about the fall itself or events since
- New difficulty walking, or pain that worsens rather than improves
In the first four hours after a fall, check in frequently. Ask simple questions to gauge alertness and watch for any changes in how the person moves or speaks. After that initial window, continue checking every few hours. If anything changes for the worse at any point, seek medical care.
Schedule a Follow-Up Appointment
Even when a fall doesn’t result in an obvious injury, it’s worth seeing a doctor within a week or two. A fall is often a signal that something has shifted: balance, muscle strength, blood pressure regulation, medication side effects, or vision. The CDC’s fall risk screening program recommends several specific assessments that a doctor can perform.
The Timed Up and Go test measures how long it takes to stand from a chair, walk a short distance, turn around, and sit back down. The 30-Second Chair Stand test checks leg strength by counting how many times a person can rise from a seated position in half a minute. The 4-Stage Balance Test evaluates stability in progressively harder standing positions. These take just minutes and give a clear picture of fall risk going forward.
Your doctor should also check blood pressure in both lying and standing positions. A significant drop when standing, called orthostatic hypotension, is a common and treatable cause of falls and dizziness in older adults. Medications for blood pressure, heart conditions, sleep, or mood can all contribute to fall risk, and a post-fall visit is a good time to review everything being taken.
Make the Home Safer to Prevent the Next Fall
About half of falls in older adults happen at home, and many of the causes are fixable. The National Institute on Aging recommends a room-by-room approach to fall-proofing.
Lighting is one of the simplest and most impactful changes. Install light switches at the top and bottom of every staircase and at both ends of long hallways. Motion-activated plug-in lights can illuminate paths to the bathroom at night. Keep a flashlight by the bed for power outages, and leave a bathroom night light on around the clock.
Floors are the next priority. Remove all throw rugs and small area rugs entirely. Fix any carpet that isn’t firmly secured to the floor. Apply no-slip adhesive strips to tile and hardwood surfaces, especially in kitchens and entryways. Move electrical cords against walls and out of walking paths, and rearrange furniture so there’s a clear route through every room. Low coffee tables are a common tripping hazard.
Bathrooms deserve special attention because wet surfaces and the physical demands of getting in and out of a tub create a high-risk combination. Mount grab bars near the toilet and on both the inside and outside of the tub or shower. Place nonskid mats or strips on any surface that gets wet.
Stairs need secure handrails on both sides, not just one. Outdoors, add non-slip material to exterior steps, install a grab bar near the front door for balance while handling keys, and keep the porch light on at night. In winter, treat walkways with ice melt or sand before they become slippery.
A few smaller adjustments also matter: keep frequently used items at waist height so there’s no need to reach overhead or bend low, make sure chairs and sofas are at a height that’s easy to get into and out of, and if a step stool is necessary, choose one with a top handrail and a wide, stable base.
Building Strength to Reduce Future Risk
Home modifications reduce hazards, but the most effective long-term fall prevention targets the body itself. Muscle weakness and poor balance are the most consistent predictors of future falls, and both respond well to exercise at any age.
Balance training and lower-body strengthening exercises are the foundation. Tai chi programs have some of the strongest evidence for reducing falls in older adults. Even simple exercises like standing on one foot while holding a counter, repeated sit-to-stand movements from a chair, or heel-to-toe walking down a hallway build the specific strength and reflexes that prevent falls. A physical therapist can design a program matched to current ability, which is especially valuable after a fall has shaken someone’s confidence.
Vision checks matter too. Outdated prescriptions, cataracts, and bifocals that distort depth perception on stairs all contribute to falls. An annual eye exam is a straightforward step that’s easy to overlook.