Fall Prevention — Balance and Strength Training

• Why falls are so dangerous when you have low bone density
• A home safety checklist you can walk through room by room
• How your shoes, vision, medications, and muscles all play a role
• When and how to use walking aids without embarrassment
• Simple balance exercises that make a real difference

Some facts:

• One in three adults over 65 falls at least once a year
• Around 9 in 10 hip fractures happen because of a fall
• 20% of hip fracture patients die within one year
• 50% of hip fracture patients never regain their previous level of independence
• The fear of falling can itself lead to reduced activity, social isolation, and further physical decline

These numbers are here to help you act, not to frighten you. Falls are not an inevitable part of aging. Many of the risk factors can be changed, so you can lower your risk a great deal.

The most effective way to prevent an osteoporotic fracture is to prevent the fall that causes it.

Most falls happen at home, in familiar surroundings. Walk through your home with fresh eyes and deal with these common hazards:

Lighting

• Every room and hallway has enough light, with no dark corners
• Light switches are accessible at the entrance to every room
• Night lights are installed in the bedroom, hallway, and bathroom
• A flashlight or phone is within reach from your bed
• Outdoor walkways and porches are well-lit

Floors and surfaces

• Loose rugs are removed, secured with double-sided tape, or replaced with non-slip mats
• Electrical cords and phone chargers are tucked away from walkways
• Floors are free of clutter (shoes, newspapers, pet toys, bags)
• Spills are cleaned up immediately
• Carpet edges are tacked down and not fraying
• No transitions between floor types that create a tripping edge

Bathroom (the most dangerous room)

• Grab bars installed next to the toilet and inside the shower/tub
• Non-slip mat or adhesive strips in the shower/tub
• Non-slip bath mat outside the shower/tub
• Shower chair or bench available if standing is tiring or unsteady
• Raised toilet seat if getting up and down is difficult
• Towels and toiletries within easy reach (no stretching or bending)

Kitchen

• Frequently used items stored at waist to shoulder height, so you don't need to climb on step stools
• Non-slip mat in front of the sink
• Step stool with a handrail if you must reach high shelves (but rearrange first)
• Spills cleaned up immediately

Stairs

• Sturdy handrails on both sides (or at least one side)
• Good lighting at top and bottom
• No objects stored on stairs
• Non-slip treads if stairs are smooth or polished
• Consider a contrasting color strip on the edge of each step for visibility

Bedroom

• Lamp or light switch within reach from the bed
• Clear path from bed to bathroom
• Phone within reach from the bed (in case of emergency)
• Bed height allows easy getting in and out (not too low, not too high)

Print this checklist and walk through your home room by room. Better still, ask a family member or friend to walk through with you. A fresh pair of eyes often spots hazards you've gotten used to.

What's on your feet matters more than you might think:

Choose shoes that are:

• Low-heeled (1 inch / 2.5 cm or less)
• Firmly fastened (lace-up, Velcro, or buckle, not slip-ons that can come loose)
• Non-slip rubber soles with good tread
• Supportive around the heel
• Well-fitting: not too loose, not too tight

Avoid:

• Walking in socks or stockings on smooth floors (very slippery)
• Flip-flops, backless slippers, and high heels
• Worn-out shoes with smooth soles
• New shoes that haven't been broken in (try them indoors first)

At home: Wear well-fitting slippers with non-slip soles rather than going barefoot or wearing socks.

Poor vision and hearing both increase fall risk:

Vision

• Have your eyes examined every 1-2 years (annually if you have diabetes or glaucoma)
• Keep your glasses prescription up to date
• Be careful with bifocal or progressive lenses on stairs. The lower part (reading zone) can blur the steps. Some people benefit from single-distance glasses for walking
• If you've had cataract surgery, follow up to make sure your prescription is still correct
• Allow your eyes to adjust when moving between bright and dark areas

Hearing

• Have your hearing checked regularly
• Hearing loss affects spatial awareness and balance (your inner ear plays a role in equilibrium)
• If you have hearing aids, wear them consistently

Many common medications can increase fall risk through side effects like dizziness, drowsiness, or low blood pressure:

Medications that may increase fall risk:

• Sleeping pills and sedatives
• Some medicines for depression
• Blood pressure medications (especially if they cause dizziness when standing)
• Antihistamines (some cause drowsiness)
• Strong (narcotic) pain medicines
• Some diabetes medications (if they cause low blood sugar)
• Muscle relaxants

What to do:

• Do NOT stop any medication on your own. Always talk to your doctor first
• Ask your doctor or pharmacist to review ALL your medications (including over-the-counter drugs and supplements) specifically for fall risk
• If you take four or more medications ("polypharmacy"), a medication review is especially important
• Report any dizziness, lightheadedness, or drowsiness to your doctor. The dose or timing may be adjustable

A medication review is one of the most effective single steps for fall prevention. Ask your doctor: "Could any of my medications be increasing my risk of falling?"

Strong muscles and good balance protect you from falls. See our exercise article for a complete routine: Exercise for Stronger Bones.

Key exercises for fall prevention:

• Single-leg stance: practice standing on one foot (with support nearby) for 10-30 seconds per leg, several times a day
• Chair squats: sit-to-stand practice strengthens the thigh muscles that catch you when you stumble
• Heel raises: strengthen calves and ankles for better stability
• Heel-toe walking: improves balance while moving

Tai chi: proven fall prevention

Several large studies have shown that tai chi reduces fall risk by up to 50% in older adults. It combines slow, flowing movements with weight shifting, gentle turning, and focused balance, and it is low-impact and calming.

Many community centers, senior centers, and YMCAs offer tai chi classes specifically designed for older adults. Online videos can also help, but in a class you get guidance from an instructor and the company of other people.

Many people resist using a cane or walker because they feel it makes them look old or frail. That is understandable, but there is another way to look at it:

• A walking aid is a safety tool that protects you, like a seatbelt in a car
• Using a cane or walker allows you to stay active and independent rather than staying home out of fear
• A well-fitted walking aid can increase your confidence and help you participate in activities you might otherwise avoid
• Improper use of a walking aid (wrong height, wrong type) can increase fall risk, so get properly fitted

When to consider a walking aid:

• You feel unsteady on your feet
• You've had one or more falls in the past year
• You hold onto furniture or walls when walking at home
• You avoid going out because you're afraid of falling
• Your doctor or physical therapist recommends one

Getting started:

• Ask your doctor for a referral to a physical therapist for a walking aid assessment
• A PT will recommend the right type (cane, quad cane, rolling walker, standard walker) and adjust it to your height
• Practice using it at home before taking it out in public

• Get up slowly. When rising from bed or a chair, pause for a moment before walking. Blood pressure can drop temporarily when you stand (orthostatic hypotension), causing dizziness.
• Drink enough fluids. Dehydration can cause dizziness and confusion
• Limit alcohol. Even one or two drinks can impair balance and judgment
• Keep your phone with you. If you do fall, you can call for help
• Consider a medical alert device if you live alone
• Keep walkways clear in winter. Ice and snow are major fall hazards. Use salt or sand, and stay inside on icy days if possible
• Use handrails on all stairs, even if you feel steady
• Don't rush. Give yourself extra time

• Walk through your home with the checklist above and fix at least three hazards this week
• Check your shoes. Are they supportive, with non-slip soles?
• Schedule eye and hearing exams if you haven't had them in the past year
• Ask your doctor to review your medications for fall risk
• Practice single-leg stance for 10 seconds on each side (hold a chair). Do it every day while waiting for the kettle to boil
• Look into tai chi classes in your community
• If you've fallen in the past year, tell your doctor. A fall risk assessment can find specific factors to work on

Q. I've never fallen. Do I still need to worry about fall prevention? Yes. Many of the risk factors for falls develop gradually. Weaker vision, medication side effects, muscle weakness, and home hazards build up over time. Prevention is most effective before the first fall, not after.

Q. I fell once but wasn't hurt. Should I be concerned? A fall without injury is a warning sign. People who fall once are much more likely to fall again. Use it as a reason to work on the risk factors in this article: check your home, review your medications, and start balance exercises.

Q. My parent is resistant to making changes at home. How can I help? Come at it from care, not control. Focus on specific, practical changes rather than redoing the whole house. Grab bars in the bathroom and better lighting are good places to start because they're hardly noticeable. You might also suggest a home safety assessment by an occupational therapist. Sometimes advice from a professional is easier to accept than from a family member.

Q. Are hip protectors effective? Hip protectors are padded undergarments designed to absorb the impact of a fall. Research results are mixed. They can reduce hip fracture risk, but only if worn consistently, and many people find them uncomfortable. They may be worth considering for people at very high fall risk, especially in care facilities.

Q. I'm afraid of falling, so I've been staying home more. Is that okay? This is a very common reaction, but it makes things worse. Moving less leads to weaker muscles, poorer balance, and lower confidence, which raises fall risk further. A better approach is to address the specific factors that worry you (home safety, footwear, balance exercises, walking aid) so you can stay active safely. Talk to your doctor about your fears. Help is available.

• Centers for Disease Control and Prevention (CDC). STEADI — Stopping Elderly Accidents, Deaths, and Injuries. https://www.cdc.gov/steadi/
• International Osteoporosis Foundation (IOF). Fall Prevention. https://www.osteoporosis.foundation/patients/prevention/fall-prevention
• World Health Organization (WHO). WHO Global Report on Falls Prevention in Older Age. 2007.
• Sherrington C, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019.
• Gillespie LD, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012.
• Lomas-Vega R, et al. Tai Chi for risk of falls: a meta-analysis. J Am Geriatr Soc. 2017;65(9):2037-2043.