Falls in later life: what can we do to help older people stay steady and independent?
Falls become more common as we get older, but falling is not simply an inevitable part of ageing. In the UK, around one in three people aged 65 and over fall each year, rising to around half of people aged 80 and over. A fall does not always result in a fracture or a trip to hospital, but it can still have a significant impact. Many people become frightened of falling again and consequently start doing less. They may stop going out, avoid the stairs, walk less or become increasingly reliant on family members.
This can create a difficult cycle. A fall can lead to a loss of confidence, which leads to less activity, which can result in weaker muscles and poorer balance, making everyday activities more difficult and potentially increasing the risk of another fall.
The good news is that there is a lot that can be done to help people remain active, confident and independent.
A new article in the BMJ summarising updated NICE recommendations on falls prevention highlights an important change in the way we should think about falls. Rather than simply trying to predict whether someone is likely to fall, the emphasis is on understanding what factors may be contributing to their falls and what can be changed to reduce their risk.
A fall is worth investigating
It is easy to dismiss a fall by saying, “I just tripped” or “I'm getting older.” Sometimes that may be
all there is to it, but a fall can also be a sign that something has changed.
Perhaps your parent has become weaker, is struggling with their balance, has developed dizziness or is becoming less confident when walking. There may have been a change in medication, eyesight or hearing. A long-term condition such as Parkinson's disease, arthritis, diabetes or a previous stroke may be affecting their mobility. Sometimes several relatively small factors combine to make someone less steady.
This is why the updated NICE guidance recommends looking at the individual rather than simply assigning someone a level of falls risk. NICE specifically advises against using falls-risk prediction tools to try to predict whether an individual will fall, because the evidence does not show that these tools can do this accurately. Instead, healthcare professionals are encouraged to ask about previous falls and assess the factors that may be contributing to them.
What does a proper falls assessment involve?
A comprehensive falls assessment is much more than asking someone to walk up and down a corridor.
The BMJ article highlights a wide range of factors that may need to be considered. These include walking, balance, mobility and muscle strength, but also dizziness, blood pressure, medication, vision, hearing, footwear, foot condition, nutrition and fluid intake, cognition and mood, continence, neurological problems and long-term health conditions. The assessment should also consider how confident the person feels about their abilities and whether they have developed concerns about falling.
For example, someone who becomes dizzy when standing up may need a very different approach from someone whose main problem is weak legs. Someone with Parkinson's disease may need to work on turning, stepping and movement strategies, while another person may primarily need to improve their strength and balance.
This is why there isn't one exercise programme or one solution that works for everyone.
When should you seek help?
If an older person has fallen in the last year, it is worth mentioning this to a healthcare professional. NICE recommends a comprehensive falls assessment for people who have fallen and are living with frailty, have needed medical treatment following a fall, have lost consciousness, have been unable to get themselves up independently, or have had two or more falls in the previous year.
Someone who has had a single fall but does not meet these criteria should still have their walking and balance assessed. If an impairment is identified, NICE recommends offering a falls-prevention exercise programme and considering an assessment of hazards within the home.
You also don't necessarily need to wait for a fall. If you notice that your parent is becoming increasingly unsteady, holding onto furniture, struggling to get out of a chair, avoiding stairs or becoming less active because they are worried about falling, these are good reasons to seek advice.
What can exercise do?
Exercise is one of the most important parts of falls prevention.
The evidence reviewed for the updated NICE guidance supports exercise as an important intervention for people at risk of falls. The recommendation is not simply to “do more exercise”, however. Falls-prevention exercise should be progressive and individualised, taking account of the person's abilities, preferences and goals, and should address relevant aspects of balance, coordination, strength and power. Progress should also be reviewed regularly.
This is particularly important for older people who have become less active through fear of falling.
For example, if someone is struggling to get out of their chair, exercises can focus on the strength needed for repeated sit-to-stand movements. If they are struggling on stairs, the programme can work on leg strength and controlled stepping. If turning is difficult, balance and movement exercises can incorporate turning and changing direction.
The aim isn't simply to make someone “fitter”. It is to make them better able to manage the activities that matter to them in everyday life.
What about the home environment?
A person's home can tell us a lot about why they may be falling.
Someone might walk reasonably well in a clinic but struggle in their own home because of narrow spaces, poor lighting, stairs, loose rugs, unsuitable furniture or difficulty getting to the bathroom.
They may have to carry objects while walking, turn in confined spaces or negotiate a step that is not obvious when viewed in isolation.
This is one of the reasons a home-based assessment can be particularly useful. Rather than simply testing someone's walking in a clinical environment, we can see how they actually move around the places where they live.
The updated NICE recommendations specifically include home hazard assessment and intervention. The BMJ article reports evidence from randomised controlled trials showing that home hazard assessment and intervention reduced falls, with a greater benefit in people at higher risk. NICE recommends that this is ideally carried out by an occupational therapist, although appropriately trained healthcare professionals can undertake the assessment where appropriate.
It is important to remember that the purpose isn't to turn someone's home into a hospital or remove everything they enjoy doing. The question is much more practical:
Can we make the things they do every day a little safer and easier?
Don't overlook medication, dizziness, eyesight and nutrition
Falls are often caused by several things coming together rather than one single problem.
Medication can be an important consideration, particularly if someone takes several medicines or has recently had a change in prescription. NICE recommends considering a structured medication review to identify medicines that may increase falls risk and whether adjustments should be considered. Medication should never be stopped without appropriate medical advice.
Dizziness is another important factor. NICE recommends asking about the nature of someone's dizziness and, where symptoms suggest rotational vertigo, considering further assessment such as the Dix–Hallpike manoeuvre.
Vision, hearing, footwear, foot problems, nutrition and hydration can also be relevant. The updated guidance specifically includes these within a comprehensive falls assessment because falls rarely have a single cause.
What should I do if I'm worried about my mum or dad?
If you are concerned about an older parent, it can sometimes be difficult to know how to raise the subject. Many people understandably don't want to feel that their independence is being taken away.
Rather than saying, “You're becoming unsafe and you need to stop doing that,” it can be more helpful to ask what they are finding difficult. Have they noticed that they are less steady? Are they worried about the stairs? Are they avoiding going out? Are they struggling to get out of their chair?
Have they had any near misses that they haven't mentioned?
Sometimes a family member notices these changes before the older person does.
The aim of getting help should not be to restrict someone's independence. In fact, it should be the opposite. Identifying problems early can give someone the opportunity to improve their strength, balance and confidence while they are still able to do many things for themselves.
What can a physiotherapist assess at home?
A physiotherapy assessment in someone's own home can be particularly useful when mobility has changed or someone is becoming concerned about falling.
During a home assessment, we can look at how someone walks around their actual environment, how they get up from their chair, how they manage stairs and turns, how they use a walking aid and how confident they feel when moving around.
We can assess strength, balance, mobility and functional ability and then develop an exercise programme that is appropriate for that individual. We can also identify situations within the home that may be making movement unnecessarily difficult and, where appropriate, recommend further assessment or referral.
A home visit also gives the older person the opportunity to be assessed in a familiar environment, rather than having to travel to a clinic when travelling itself may be difficult or intimidating.
For some people, the most useful outcome isn't simply being told which exercises to do. It is understanding why they are struggling and what they can realistically do to improve things.
What about someone who is frightened of falling?
Fear of falling deserves to be taken seriously.
Someone may physically be capable of walking outside, using the stairs or going shopping, but fear can gradually cause them to stop doing these things. NICE recognises that concerns about falling may persist even when someone is undertaking strength and balance exercises. Where these concerns are not adequately helped by exercise, cognitive behavioural interventions can be
considered.
This is another reason why falls prevention should be about more than simply preventing a fall. It should also be about maintaining confidence, activity and quality of life.
Staying active is part of falls prevention
It is tempting to think that the safest thing for an unsteady older person is to sit down and avoid anything that might cause a fall.
In reality, becoming increasingly inactive can create its own problems.
NICE recommends encouraging people to remain active and, where appropriate, to undertake activities addressing balance, coordination, strength and power. Programmes should be tailored to the person's abilities and preferences, with regular opportunities to review and progress them.
That might mean a structured exercise programme, walking, gardening, swimming, dancing, strength exercises or simply finding ways to incorporate more movement into the day.
The important thing is that activity should be appropriate and progressive rather than avoided altogether.
So, what should we do for our older parents?
If your parent has had a fall, or you have noticed that they are becoming less steady, don't simply assume that it is part of getting older.
Start by talking to them. Find out what they are struggling with and whether they have noticed a change. If they have fallen, particularly more than once, have been injured, couldn't get themselves up, lost consciousness or are living with frailty, a more comprehensive falls assessment is recommended. If they have had a single fall, an assessment of their walking and balance can still identify whether they would benefit from specific falls-prevention exercise.
Think about the whole picture rather than just their balance. Could medication be contributing? Are they dizzy? Are they eating and drinking adequately? Can they see properly? Are their shoes appropriate? Has a long-term condition affected their mobility? Are they becoming frightened of falling? Is there something about their home that is making everyday activities unnecessarily difficult?
And importantly, don't wait until a serious fall happens before doing something.
Early assessment can identify problems while there is still an opportunity to address them.
Falls prevention is really about independence
The updated NICE recommendations provide a useful reminder that falls prevention isn't simply about stopping someone from falling.
It is about understanding the person, identifying the factors that can be changed and helping them remain as active and independent as possible.
For some people that will mean improving strength and balance. For others it may mean addressing dizziness, reviewing medication, improving vision or hearing, changing something within the home or rebuilding confidence after a fall.
Often it will be a combination of several things.
Ultimately, the goal is simple: to help older people feel safer and more confident while continuing to do the things that matter to them.
Worried about an older parent or relative?
If someone you care about has had a fall, is becoming less steady or is losing confidence with everyday activities, a physiotherapy assessment at home can be a useful starting point.
At Physio at Home, we can assess mobility, balance, strength and functional ability within the person's own home. We can look at how they manage everyday activities, identify areas that may be contributing to their difficulties and develop an individual programme to help improve strength, balance and confidence.
Where another professional is better placed to address a particular issue, we can also recommend appropriate onward assessment.
The aim isn't simply to prevent falls. It's to help people remain active, independent and confident in their own home.
Further information and practical advice
The BMJ article on which this blog is based
This article summarises the updated evidence and NICE recommendations relating to comprehensive falls assessment, exercise and physical activity, and home hazard assessment and intervention.
Full reference:Neilson J, MacIntyre D, Whitney J, Aung T, Lally M, on behalf of the Guideline Committee and co-opted GC members. Assessment and prevention of falls in older people and in people 50 and over at higher risk—summary of updated NICE guidance. BMJ. 2026;392:s223. doi:10.1136/bmj.s223. Published 23 March 2026.
Current NICE guidance
The NICE guidance was published on 29 April 2025 and applies to people aged 65 and over, and to people aged 50–64 with factors that may increase their risk of falling.
Practical NICE resources
The NICE resources include information on falls-prevention exercise, home assessment and implementation resources, including the Falls Management Exercise (FaME) implementation toolkit, Otago exercise programme and HomeFAST OT home assessment tool.
Please also check out our other blogs for more falls related content. Thank you for your time and interest.
This article is intended as general information for older people, families and carers. It does not replace an individual clinical assessment. Falls can have many different causes, and advice should be tailored to the individual.
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