How to Reduce Fall Risk After 65

Key takeaways

• Strength and balance training, tai chi and home safety modifications can reduce the rate of falls by up to 50%, proving that proactive steps make a difference.
• Gait and balance disorders, orthostatic hypotension, sensory impairment, certain medications, and environmental hazards are modifiable risks. Understanding these factors allows you to take targeted action.
  
• Comprehensive programs that combine exercise, medication review, vision care and home modifications significantly reduce fall rates among high‑risk older adults.
  
  

Most adults over 65 enjoy active lifestyles, but falls remain a leading cause of injury and loss of independence. The reassuring news is that falls are largely preventable. Approximately 25% of older adults fall each year, but systematic exercise programs and environmental adjustments can dramatically reduce this risk (R). 

By understanding the factors that contribute to falls and adopting evidence‑based strategies, you can stay steady on your feet and continue enjoying the activities you love.

Understanding risk factors

Falls are multifactorial events. Age‑related changes in vision, hearing and proprioception can increase sway and affect balance (R). However, these changes alone rarely cause falls. Modifiable risk factors include gait and balance disorders, orthostatic hypotension, sensory impairment, medications and environmental hazards. 

In fact, walking barefoot or in stockings markedly increases fall risk (odds ratio 11.2), whereas wearing supportive athletic shoes reduces it (R). Simple situational activities like rushing to the bathroom or being distracted by multitasking also raise fall risk (R).

 

Medication effects are often overlooked. Psychoactive, anticholinergic, cardiovascular and analgesic drugs can cause dizziness, sedation or orthostatic hypotension (R). For example, sedative‑hypnotic medications have a pooled odds ratio of 2.05 for increasing falls (R). A medication review with your health professional can identify alternatives and adjust dosages to reduce risk.

Strength and balance

Among all interventions, exercise stands out as the most effective way to prevent falls. A meta‑analysis of 59 randomised controlled trials found that exercise programs focusing on balance and functional exercises reduced falls by 23 % compared with usual care (R). 

Strength, balance and aerobic exercises improve lower‑limb strength, mobility and proprioception, reducing fall risk by up to 50% (R). Guidelines recommend at least 150 minutes of moderate‑intensity activity per week for older adults (R). 

 

Practical activities include:

• Balance training: single‑leg stands, heel‑to‑toe walking and safe and supported standing on unstable surfaces.
  
  
• Strength exercises: chair rises, squats and resistance band workouts to build lower‑limb muscles.
  
  
• Aerobic activities: brisk walking, swimming or cycling to maintain cardiovascular fitness and endurance.
  

 

Tai chi deserves special mention. A meta‑analysis of 24 randomised trials showed that tai chi reduces fall risk by 24 % (risk ratio 0.76) and improves balance measures such as timed up‑and‑go and functional reach tests (R). The gentle, flowing movements of tai chi enhance proprioception and core strength, making it an excellent option for older adults seeking a low‑impact exercise.

 

Keeping home safe: environmental modifications

Because most falls occur at home, simple home modifications can have a profound impact. A meta‑analysis of environmental interventions showed a 21% reduction in falls (RR 0.79) among individuals who undertook thorough, tailored home modifications (R). In one trial, hazard reduction led to a 39 % reduction in falls (R).

 

Key strategies include:

• Improving lighting: ensure bright, even lighting, especially in stairways and bathrooms.
  
  
• Removing tripping hazards: secure rugs, tidy electrical cords, and keep walkways clear.
  
  
• Installing grab rails and non‑slip mats: particularly in bathrooms and on stairs.
  
  
• Choosing appropriate footwear: wear well‑fitting, supportive shoes with non‑slip soles; avoid walking barefoot or in stockings.
  

 

Multifactorial interventions: combining forces

For individuals at higher risk (previous falls, fear of falling or slow gait speed), a tailored multifactorial program can further reduce falls. A meta‑analysis of 43 randomised trials showed that interventions addressing multiple risk factors – exercise, medication review, vision correction, podiatry care and environmental modifications – reduced falls by 23 % (rate ratio 0.77) (R). 

Such programs may involve healthcare professionals like physiotherapists, occupational therapists and pharmacists working together to assess and mitigate risks. For example, surgery to remove cataracts reduces fall risk (RR 0.68) (R), and multicomponent podiatry interventions (footwear assessment, orthotics and foot care) provide additional benefit (R).

Building your fall‑prevention plan

• Assess your risk: talk to your healthcare provider if you’ve had a fall in the past year or notice changes in balance. Simple tests like gait speed (< 0.8–1 m/s) or the timed up‑and‑go can indicate when interventions are needed.
  
  
• Engage in regular exercise: incorporate balance, strength and tai chi into your routine, aiming for at least 150 minutes of activity each week.
  
  
• Review medications: work with your doctor or pharmacist to identify medications that may increase fall risk.
  
  
• Optimise vision and hearing: regular eye and ear exams can identify impairments that contribute to falls.
  
  
• Create a safe home: clear clutter, improve lighting, use grab rails and wear supportive shoes.
  
  
• Stay socially engaged: maintain social connections through community classes and group exercise; research shows that fear of falling decreases when people feel supported.
  
  

Moving forward with confidence

Ageing brings many joys, and maintaining independence is at the top of the list. By understanding and addressing modifiable risk factors, you can significantly reduce your chances of falling and continue to enjoy an active lifestyle. Invest in strength and balance training, make your home safer, and speak to your healthcare team about medications and vision care.

You deserve to walk confidently into the next chapter of your life. Next up? Discover how toe strength can prevent falls.