If an elderly person falls, your first priority is to stay calm and assess whether they’re injured before trying to move them. Moving someone too quickly after a fall can worsen a fracture or spinal injury. More than one in four adults over 65 falls each year, leading to roughly 3 million emergency department visits and 1 million hospitalizations annually. Knowing what to do in the moment, and what to address afterward, can prevent a bad situation from becoming a dangerous one.
Check for Injuries Before Moving Them
If you find someone on the floor, resist the urge to immediately pull them up. Ask them to stay still for a moment and talk to you. Find out what happened: did they trip, feel dizzy, or lose consciousness? Whether they blacked out matters a great deal for what comes next.
While they’re still on the ground, look for these signs:
- Head injury: Any bump, cut, or bruise on the head or neck, confusion, slurred speech, or a report that they hit their head.
- Hip fracture: Severe pain in the hip or groin, one leg appearing shorter than the other, or the foot on the injured side turning outward.
- Spinal pain: Pain in the back or neck, tingling, or numbness in the arms or legs.
- Obvious fractures: Swelling, deformity, or inability to bear weight on a limb.
If any of these are present, call 911 and do not try to move them. Keep them warm with a blanket and stay with them until help arrives.
When to Call 911 Immediately
Some situations require emergency care without hesitation. Call 911 if the person lost consciousness at any point, even briefly. Call if they hit their head, especially if they take blood thinners. Head injuries in people on anticoagulant or antiplatelet medications are time-sensitive emergencies. Even a minor bump can cause internal bleeding in the skull that worsens rapidly, and there is no safe “wait and see” window. Someone who initially seems fine can deteriorate within hours.
Also call 911 if the person has severe pain and cannot move, is confused or behaving unusually, has difficulty breathing, or is having a seizure. If you’re unsure whether the situation is serious, err on the side of calling.
How to Help Them Get Up Safely
If the person is alert, not in significant pain, and doesn’t show signs of a fracture or head injury, you can help them get up. Don’t yank them by the arms. Instead, use a slow, staged approach:
Have them roll onto their side, then get onto their hands and knees. Place a sturdy chair nearby. They should use the chair to pull themselves up, first getting one foot flat on the floor in a kneeling lunge position, then pushing up to standing. Stay close to steady them but let the chair bear most of the effort. If they can’t get up on their own with the chair’s support, or if pain increases during the attempt, stop and call for help.
If they need to stay on the floor while waiting for help, make them as comfortable as possible. Place a pillow under their head, cover them with a blanket, and stay with them. The longer someone lies on a hard floor, the greater the risk of serious complications.
Why Time on the Floor Matters
When an older person lies on the floor for an extended period, sometimes called a “long lie,” the health consequences go well beyond the original fall. Prolonged pressure on the same muscles can cause a condition where muscle tissue breaks down and releases harmful proteins into the bloodstream, potentially damaging the kidneys. Hypothermia is common, even indoors, because older adults lose body heat quickly when lying on a cold surface. Dehydration, pressure wounds, and infections are also well-documented risks.
This is one reason falls are especially dangerous for people who live alone. If no one discovers them for hours, the complications from lying on the floor can become more life-threatening than the fall itself.
What to Watch for in the Hours After
Even if the person seems fine immediately after a fall, monitor them closely for the next 24 to 48 hours. Delayed symptoms can include worsening headache, increased confusion, dizziness, nausea or vomiting, new bruising, or difficulty walking that wasn’t there right after the fall. Any of these warrant a call to their doctor or a trip to the emergency room.
This monitoring period is particularly important for people on blood thinners. Bleeding inside the skull can develop slowly, and someone who appeared completely normal after the fall may show symptoms hours later.
Getting a Medical Evaluation
Less than half of older adults who fall mention it to their doctor. That’s a problem, because a fall is often a symptom of something treatable. A post-fall medical visit typically includes checking blood pressure while sitting and standing (a significant drop when standing up suggests a circulation issue that causes dizziness), reviewing blood sugar levels for diabetics, and assessing vision and walking stability.
One of the most important parts of the visit is a medication review. Several common drug categories increase fall risk by causing dizziness, sedation, confusion, or drops in blood pressure. These include sleep aids, anti-anxiety medications like benzodiazepines, antidepressants (including SSRIs), opioid pain medications, anticonvulsants, antihistamines, blood pressure medications, and muscle relaxants. Sometimes adjusting a dose or switching to an alternative is enough to significantly reduce fall risk.
Preventing the Next Fall
A first fall roughly doubles the chance of falling again, so prevention after a fall is just as important as the immediate response. Start with the home environment. Remove throw rugs, secure loose cords, and install grab bars in the bathroom near the toilet and in the shower. Make sure hallways, stairs, and nighttime paths to the bathroom are well lit. Non-slip mats in the tub and supportive, low-heeled shoes with rubber soles make a meaningful difference.
Footwear matters more than most people realize. Walking in socks, loose slippers, or worn-out shoes with smooth soles is a common contributor to indoor falls. Properly fitted shoes with good traction are one of the simplest fixes available.
Strength and balance exercises reduce fall risk substantially in older adults. Programs that include standing on one foot, heel-to-toe walking, and lower body strengthening (like chair squats or leg raises) improve stability over time. Many communities offer group classes specifically designed for fall prevention, and physical therapists can create individualized programs for people with mobility limitations. Even modest improvements in leg strength and balance can be the difference between catching yourself and going down.