A fall is not bad luck, and it is not simply ageing. It is a medical event with causes you can treat.

The circle that does the damage

After a fall — or even a near-miss — something reasonable happens. The person becomes careful. They stop going out alone, they skip the stairs, they sit down more. That caution looks like wisdom, and it is the beginning of the problem.

Muscle is lost surprisingly fast at seventy, and balance is a skill that decays without practice. So a few careful months produce weaker legs and worse balance, which produce a genuine stumble, which produces more caution. Each turn of that circle makes the next fall more likely and more serious. Fear of falling is itself one of the strongest predictors of falling.

Which is why the single most effective thing on this page is not a grab rail. It is exercise that challenges your balance — and it has to be slightly difficult to work. Gentle movement is good for many things; it does not prevent falls. Standing on one leg while you hold a worktop, walking heel-to-toe, sitting down and standing up without using your hands, stepping in different directions: that is the medicine, and the dose is a few hours a week, permanently.

Test your legs: thirty seconds

This is a real clinical screen — the 30-second chair stand. It measures the leg strength that gets you off a toilet, out of a car and up from a fall. It takes half a minute and it will tell you something useful.

What actually works, in order

Falls prevention has been studied heavily, and the findings are unusually clear about the order of importance. Most households do the last item on this list and none of the first.

1. Strength and balance training, ongoing. The strongest single intervention, and the only one that reverses the underlying cause. It must challenge your balance to work, and it must continue — the benefit fades within months of stopping. Group classes, a home programme from a physiotherapist, or tai chi all have good evidence.
2. A medication review. Put every box and bottle in a bag and take it to your doctor or pharmacist, and ask specifically: which of these can make me dizzy, sleepy or unsteady? Sleeping tablets, sedatives, some antidepressants, strong painkillers, and blood-pressure medicines are common culprits, and four or more medicines together is itself a risk factor. Never stop anything on your own.
3. Blood pressure standing up. Ask for it to be measured lying and then standing. A drop when you stand is common, treatable, and a frequent cause of falls that get blamed on carpets.
4. Eyes. A sight test yearly — and see the warning about varifocals below, because it surprises almost everyone.
5. Feet and shoes. Pain, numbness, thick nails and bunions all change how you walk. Wear shoes indoors: firm, thin-soled, closed at the heel, gripping. Slippers without a back, socks on smooth floors and bare feet are all associated with falls.
6. Vitamin D, if you are deficient, on medical advice — not large occasional doses, which can make things worse.
7. The home. Worth doing, and last for a reason: on its own it helps mainly people already at high risk. Clear the routes you walk at night, get rid of loose mats and trailing cables, put a light where you can reach it from the bed, and add grab rails where you already steady yourself with a hand.

Two surprises worth knowing

If you fall: the floor, and the hour after

Two things are worth rehearsing before they are needed, because both go badly when improvised.

Getting up

1. Don't rush. Lie still for a moment and check: any severe pain, especially in a hip, groin or back? Any numbness? Did you hit your head?
2. If you think something is broken or you hit your head, stay put and call for help. Getting up on a fractured hip is how a bad injury becomes worse.
3. If you feel able: roll onto your side, push up onto hands and knees, crawl to a stable chair or the bed, put both hands on it, bring one knee up, and stand slowly. Sit for several minutes before walking.
4. Then tell someone, today. Not because of embarrassment, but because a fall is information: it means something is treatable and hasn't been treated yet.

Why nobody hears about the first fall

Most falls are never mentioned to anyone. The reason is not forgetfulness — it is entirely rational. Older people know what a reported fall can trigger: a conversation about "whether this house is still suitable", a loss of the car, a nudge towards care. Hiding a fall protects independence in the short term, and guarantees the next one.

Which means the way the question is asked decides whether you get an honest answer. "Have you had a fall?" reliably produces "no". These work better:

What "balance training" actually looks like

Prescribing exercise without showing it is most of why nobody does it. Here is a starter set that needs no equipment. Do it near a worktop or a heavy chair — close enough to touch, so you can catch yourself — and aim for most days, ten to fifteen minutes, building up over weeks rather than days.

1. Sit to stand. From a firm chair, stand up without using your hands, then sit down slowly under control. Slow is harder than fast, and the lowering matters more than the rising. Ten, twice.
2. Heel raises. Hands on the worktop, rise onto your toes, hold two seconds, lower slowly. Then the same on one leg when you're ready. Ten to fifteen.
3. One-leg stand. Hold the worktop, lift one foot, aim for ten seconds each side, and work up to thirty. Progress by using fewer fingers rather than by wobbling more dangerously.
4. Heel-to-toe walking. Walk along the length of the kitchen counter placing each heel directly in front of the other toe, hand hovering over the surface. Twenty steps, back and forth.
5. Sideways walking. Step sideways along the counter, ten each way. Simple, and it trains the hip muscles that catch a sideways stumble — which is how hips get broken.
6. Step-ups and reaching. Step up onto the bottom stair and down, holding the rail; then stand and reach slowly to the side and up, which trains recovery at the edge of your balance.

None of this looks impressive, and that is not the point. This is the intervention with the best evidence in the whole subject, and the reason it fails is almost never the exercises — it is stopping after six weeks. A class you attend with someone else survives far longer than a leaflet on the fridge.

The other half: bones

Falls are why people hit the ground. Bone strength is why hitting the ground breaks something. Any serious approach has to address both, and the bone half is routinely missed — including by health systems.

• Ask directly for a fracture-risk assessment. A bone-density scan and a risk calculation are quick, and a large share of people who have already broken one bone are never assessed and never treated — the so-called treatment gap. The next fracture is the one worth preventing.
• Height loss and a rounding upper back can indicate vertebral fractures that happened without a dramatic fall and were never diagnosed. Worth mentioning to a doctor.
• Treatments exist and work. Where osteoporosis is confirmed, medication substantially reduces future fractures. It is also widely stopped early because it produces no felt benefit — which is precisely what successful prevention feels like.
• The basics still matter: enough dietary calcium, vitamin D if you are deficient, not smoking, moderating alcohol, and weight-bearing exercise — the same exercise that improves your balance also loads your bones.
• Certain long-term medicines weaken bone, steroid tablets most notably. If you take them regularly, ask whether your bones should be protected.

The drill: 16 decisions

Sixteen everyday situations — a stumble nobody mentions, a new sleeping tablet, a fall in the night. Most have an instinctive answer that raises the risk. Pick your move; every answer explains why.

The card

Print it for the fridge, or take it to the next doctor's appointment — the questions are the useful part.

🖨️ Print the card