Repeated falls in an older adult are not a normal part of aging, and they signal that something specific needs attention. About one in four adults over 65 falls each year, but when falls start happening more than once, the risk of serious injury climbs sharply. The good news is that most repeat falls have identifiable, treatable causes. Here’s what to do, starting with the most important steps.
Get a Fall Risk Assessment
The single most useful step is scheduling a fall risk assessment with a doctor. This isn’t a routine checkup. It’s a focused evaluation that looks at strength, balance, gait, medications, vision, blood pressure, and cognitive function all at once. Most primary care providers can do one, and some physical therapy clinics specialize in them.
During the assessment, your loved one will likely go through a few standardized physical tests. The Timed Up-and-Go test, for example, measures how long it takes to stand from a chair, walk about 10 feet, and sit back down. Taking 12 seconds or more signals elevated fall risk. A 30-Second Chair Stand test counts how many times someone can stand and sit in half a minute, which reveals leg strength. A 4-Stage Balance Test checks whether they can hold progressively harder stances, like standing on one foot for five seconds.
Beyond the physical tests, expect the provider to measure blood pressure while lying down and again while standing, check vision, examine their feet and shoes, run a cognitive screening, and review every medication they take. This comprehensive picture is what makes the assessment so valuable. Falls rarely have a single cause, and this process catches the combination of factors that’s actually responsible.
Review Their Medications
Medications are one of the most common and most fixable causes of repeat falls. Many drugs prescribed to older adults cause dizziness, drowsiness, or drops in blood pressure that make falls far more likely. The risk rises with the total number of medications someone takes, especially when the count hits four or more.
Several categories of drugs are well-known culprits: sleep aids, certain antidepressants (including newer types like SNRIs), blood pressure medications, anti-anxiety drugs, opioid pain relievers, and even over-the-counter antihistamines. Some cough suppressants also carry fall risk. The key is not to stop any medication without medical guidance, but to ask the prescribing doctor explicitly: “Could any of these be contributing to falls?” Doctors can often adjust doses, switch to safer alternatives, or eliminate medications that are no longer necessary.
Check for Blood Pressure Drops
One of the most overlooked causes of falls is orthostatic hypotension, a sudden drop in blood pressure when standing up. It causes lightheadedness or a brief blackout right at the moment someone gets out of bed, rises from a chair, or stands up after bending over. A drop of 20 points or more in systolic pressure (the top number), or 10 points in diastolic pressure, when moving from lying to standing is considered abnormal.
This is easy to test at home with a basic blood pressure cuff. Take a reading while your family member is lying down, then have them stand and take another reading within a minute or two. If there’s a significant drop, or if they feel dizzy, bring those numbers to their doctor. Blood pressure medications, dehydration, and prolonged bed rest are common triggers. Simple changes like standing up in stages, staying hydrated, and adjusting medication timing can make a real difference.
Look at Their Eyewear
Vision problems contribute to falls in ways that aren’t always obvious. An outdated prescription is one issue, but the type of lenses matters just as much. Bifocals and progressive lenses blur the view of the ground at exactly the distance where you need to spot obstacles. The lower segment of multifocal lenses focuses at roughly one foot, but when walking, you’re seeing the ground from five to six feet away. That mismatch makes everything underfoot look fuzzy.
Progressive lenses also distort peripheral vision, and bifocals can cause a jarring image jump at the line between the two segments. Several studies have confirmed that wearing multifocal lenses increases trip and fall risk in older adults. For someone who falls frequently, switching to single-distance glasses for walking and outdoor activities (and keeping reading glasses separate) can meaningfully reduce risk, especially on stairs and uneven surfaces.
Start a Balance and Strength Program
Exercise is the single most effective intervention for preventing future falls. Not general exercise like walking, but targeted programs that build leg strength and challenge balance. The Otago Exercise Program, originally developed in New Zealand and now widely used, is one of the best studied. It involves a set of leg-strengthening and balance exercises done at home, three times a week, along with regular walking. In research, participants cut their average falls from 1.4 per person per year down to 0.5.
A physical therapist can tailor a program to your family member’s current ability level. Even people who use walkers or have significant weakness can start with modified exercises and build from there. The key is consistency over weeks and months. Twelve weeks of structured balance training has been shown to dramatically reduce fall frequency in some studies, bringing repeat fallers down to zero falls during the intervention period.
Break the Fear-of-Falling Cycle
After a fall, many older adults develop a fear of falling again. That fear leads them to move less, avoid activities, and spend more time sitting. The resulting muscle loss and deconditioning then makes the next fall more likely, not less. This vicious cycle is well documented: fear leads to avoidance, avoidance leads to weakness, weakness leads to falls, and falls deepen the fear.
Fear of falling also changes the way people move in the moment. It triggers stiff, cautious walking patterns, slower speeds, and increased ankle rigidity, all of which paradoxically reduce stability. If your loved one has started avoiding activities they used to do, or seems anxious about moving around, that avoidance itself is a risk factor. Gentle encouragement, supervised exercise, and physical therapy can rebuild both confidence and physical capacity at the same time.
Make the Home Safer
Home modifications won’t fix the underlying causes of falls, but they remove the triggers that turn a moment of unsteadiness into a trip to the emergency room. Walk through each room with fall prevention in mind.
- Lighting: Install light switches at the top and bottom of every staircase and at both ends of hallways. Use motion-activated plug-in lights along nighttime paths to the bathroom. Keep a night light in the bathroom that turns on automatically, and put light switches and a lamp within reach of the bed.
- Grab bars: Mount them next to the toilet, on both the inside and outside of the tub or shower, and consider one near the front door where balance can waver while fumbling with keys or locks.
- Floor hazards: Remove throw rugs or secure them with non-slip backing. Clear clutter from walkways, tape down loose cords, and make sure nothing requires stepping over to get through a room.
- Bathroom: Use a non-slip mat in the tub or shower. A shower chair and handheld showerhead let someone bathe without standing on a wet, slippery surface.
- Stairs: Make sure handrails are on both sides and firmly attached. Mark the edges of steps with contrasting tape if they’re hard to see.
Know When a Fall Is an Emergency
Most falls in older adults don’t cause serious injury, but some require immediate medical attention. This is especially true for anyone taking blood thinners, because even a minor head bump can lead to slow internal bleeding in the brain that doesn’t show symptoms right away.
After any fall, watch for these warning signs: any loss of consciousness even for a few seconds, confusion or unusual behavior, visible injury to the head or neck (cuts, bruises, swelling), severe or worsening headache, vomiting, difficulty walking that’s worse than usual, or any new weakness on one side of the body. For someone on blood thinners who hits their head, medical evaluation is important even if they feel fine initially, since bleeding can develop hours later.
If your family member falls and can’t get up, don’t pull them up by the arms. Help them roll to their side, get onto hands and knees, and use a sturdy chair to pull themselves up gradually. If they’re in pain or can’t move a limb, call for help rather than risking further injury.