# Fall Prevention ## Health New Zealand | Te Whatu Ora **Source:** [https://www.healthnz.govt.nz/health-topics/keeping-healthy/healthy-homes-environments/fall-prevention](https://www.healthnz.govt.nz/health-topics/keeping-healthy/healthy-homes-environments/fall-prevention) **Capture Date:** 2026-06-07 --- ## Overview Falls are a leading cause of injury and hospitalisation among older people in New Zealand. Many falls are preventable. This page provides practical advice on identifying risk factors, improving strength and balance, making the home safer, and knowing when to seek professional help. --- ## Why Fall Prevention Matters - Falls are the **most common cause of injury** for people aged 65 and over. - One in three people over 65 falls each year; this rises to one in two for those over 80. - Falls can lead to **fractures** (especially hip, wrist, and spine), **head injuries**, and **loss of independence**. - After a fall, many older people develop a **fear of falling**, which leads to reduced activity, muscle weakness, and an even higher risk of falling again (a vicious cycle). - Falls prevention is cost-effective and keeps people living independently for longer. --- ## Risk Factors for Falls ### 1. Balance and Mobility Problems - Poor balance (e.g., unable to stand on one foot for 10 seconds) - Muscle weakness, especially in legs and core - Reduced flexibility and joint range of motion - Gait problems (shuffling, unsteady walk, difficulty navigating stairs or kerbs) - Use of walking aids (a poorly fitted walking stick or walker can actually increase risk) ### 2. Medications - **Taking 4 or more medications** (polypharmacy) is a major risk factor — the more medications, the higher the fall risk. - Sedatives, sleeping pills, and tranquillisers (benzodiazepines, zopiclone) — significantly increase fall risk due to dizziness and drowsiness. - Blood pressure medications (antihypertensives) — can cause dizziness upon standing (postural hypotension). - Antidepressants, antipsychotics, and diuretics are also associated with higher fall risk. - Any medication change (new, stopped, or dose change) can temporarily increase fall risk. ### 3. Vision Problems - Reduced visual acuity (can't see clearly) - Cataracts — cause blurred/dim vision and glare sensitivity - Glaucoma — loss of peripheral vision - Age-related macular degeneration — loss of central vision - Wearing incorrect prescription glasses, bifocals, or varifocals (can distort depth perception when walking) - Not wearing glasses when they are needed, or wearing them when they are dirty or scratched ### 4. Past Falls - **Having fallen before is the strongest predictor of falling again.** - Even if not injured, a previous fall means there is an underlying risk factor that needs to be addressed. - Fear of falling after a fall is itself a risk factor — it leads to reduced activity and muscle weakness. ### 5. Health Conditions - **Chronic conditions:** Arthritis, Parkinson's disease, dementia, stroke, diabetes (peripheral neuropathy), heart disease, osteoporosis - **Postural hypotension:** Drop in blood pressure when standing up — causes dizziness, light-headedness, fainting - **Urinary incontinence:** Rushing to the toilet, especially at night, increases fall risk - **Dizziness and vertigo:** Inner ear problems (benign paroxysmal positional vertigo — BPPV) - **Foot problems:** Bunions, calluses, ulcers, ill-fitting shoes, numbness ### 6. Environmental Hazards (Home and Community) - **Inside the home:** - Loose rugs and mats that slip or curl at edges - Cluttered walkways (cords, furniture, clutter) - Poor lighting — especially hallways, bathrooms, and stairs - No handrails on stairs or grab bars in bathroom - Slippery floors (especially wet bathroom tiles) - High bed or low chair that is difficult to get in/out of - Steps or uneven surfaces between rooms - **Outside:** - Uneven footpaths, cracked concrete - Loose gravel on driveways - Garden hoses, tools, or pots in walking paths - Steps without railings - Poor outdoor lighting ### 7. Footwear and Clothing - Shoes with slippery soles or high heels - Wearing loose slippers or flip-flops that don't stay on the foot - Walking in socks or stockings on smooth floors - Long trousers or robes that drag on the floor ### 8. Alcohol - Even small amounts of alcohol affect balance and reaction time. - Alcohol interacts with many medications to increase dizziness and drowsiness. --- ## Strength and Balance Exercises Regular exercise is one of the most effective ways to prevent falls. The following types of exercise are particularly beneficial: ### Strength Exercises (Legs and Core) - **Sit-to-stand:** From a chair — stand up without using your hands, then sit down slowly. Repeat 10 times. - **Squats (supported):** Hold the back of a chair, bend knees (as if sitting on a chair), keeping knees behind toes. - **Heel raises:** Stand behind a chair, rise up on tiptoes, hold for 5 seconds, lower slowly. - **Step-ups:** Step up onto a low stool or bottom step (hold rail or support), alternate legs. - **Wall push-ups:** Stand arms-length from a wall, lean forward and push back. ### Balance Exercises - **Single leg stand:** Hold a sturdy chair, stand on one foot for 10–30 seconds. Repeat on other side. - **Tandem stand:** Stand with one foot directly in front of the other (heel to toe). Hold for 30 seconds. - **Tandem walk:** Walk in a straight line, placing one foot directly in front of the other (like on a tightrope). - **Weight shifts:** Stand with feet hip-width apart, shift weight to one side, hold, then to the other. - **Heel-to-toe walking:** Walk forward placing heel of front foot against toe of back foot. ### Flexibility / Stretching - Calf stretches, hamstring stretches, hip and back stretches. - Hold stretches gently — do not bounce. ### Recommended Programmes - **Otago Exercise Programme** — an evidence-based falls prevention programme prescribed by physiotherapists, focusing on strength and balance. - **Tai Chi** — excellent for balance, flexibility, and confidence. - **Stepping On** — group programme that builds strength, balance, and falls prevention strategies. - **Pilates, yoga, or gentle exercise classes** — look for classes designed for older adults. ### Exercise Tips - Aim for at least **30 minutes of moderate activity** on most days (can be broken into 10-minute sessions). - Include **strength and balance exercises at least 2–3 times per week**. - Always use a support (chair, wall, rail) when doing balance exercises until confident. - If new to exercise, start slowly and build up gradually. - Check with a GP or physiotherapist before starting a new exercise programme. --- ## Home Safety Checklist Use this checklist to identify and fix fall hazards in and around the home. ### Lighting - [ ] Hallways, stairs, and entrances are well-lit (bright enough to see clearly) - [ ] Light switches are accessible at room entrances and at top and bottom of stairs - [ ] Nightlights are installed in bedroom, bathroom, and hallway - [ ] You can turn on a light from your bed without getting up - [ ] Curtains and blinds do not create glare or deep shadows - [ ] All light bulbs are bright enough and working ### Floors and Flooring - [ ] All rugs and mats have non-slip backing, or are removed - [ ] No loose carpets, torn linoleum, or uneven flooring - [ ] Walkways are clear of clutter, cords, furniture, and pet bowls - [ ] No electrical cords crossing walkways - [ ] Floor surfaces are not highly polished or slippery ### Stairs and Steps - [ ] Handrails are on both sides of the stairs - [ ] Handrails are secure and easy to grip (not loose or wobbly) - [ ] Stairs have non-slip treads or are not slippery - [ ] Items are not stored on stairs - [ ] The top and bottom of the stairs are well-lit ### Bathroom / Toilet - [ ] Grab bars are installed in the shower, by the bath, and next to the toilet - [ ] A non-slip mat or strips are in the shower/bath - [ ] A shower chair or stool is available if needed - [ ] Toilet is at a comfortable height (a raised toilet seat may help) - [ ] Towel racks and soap dishes are not used as grab bars (they may not support weight) - [ ] Nightlight in bathroom ### Kitchen - [ ] Frequently used items are within easy reach (no bending or reaching to high shelves) - [ ] A sturdy step stool with a handle is available if reaching is necessary (avoid chairs or boxes) - [ ] Spills are cleaned up immediately - [ ] Floor is non-slip (especially if there is water or grease) - [ ] Kitchen towels are not left on the floor ### Bedroom - [ ] A lamp or torch is within reach of the bed - [ ] A clear path from bed to bathroom (no clutter on the floor) - [ ] Bed is at a comfortable height — easy to get in and out of - [ ] Phone or emergency call system is within reach of the bed ### Outside - [ ] Paths and driveways are in good condition — no cracks, uneven surfaces, or loose stones - [ ] Outdoor steps have railings - [ ] Outdoor areas are well-lit (motion sensor lights are useful) - [ ] Garden hoses, tools, and pots are stored safely - [ ] Moss, ice, or wet leaves are cleared from paths quickly ### Footwear - [ ] Shoes have non-slip soles (rubber or textured) - [ ] Shoes are supportive (closed back, low heel, wide toe box) - [ ] No loose slippers, flip-flops, or walking in socks - [ ] Laces/straps are fastened securely --- ## When to See a Health Professional Seek help from a healthcare provider if: - **You have had a fall** (even if not injured) — this is the single biggest risk factor for another fall. - **You feel unsteady** when walking or standing. - **You have dizziness or light-headedness** — especially when standing up from sitting or lying. - **You have had a near-fall** (stumbled, tripped, needed to grab something to stop falling). - **You have a fear of falling** and it is affecting your daily activities. - **You take 4 or more medications** — ask your GP or pharmacist for a medication review. - **Your medications have recently changed** (new, stopped, or dose change). - **You have a health condition** that affects your balance, strength, or mobility. - **You need a walking aid** — get professionally fitted (don't buy from a shop without guidance). - **Your vision has changed** — have your eyes tested regularly (every 1–2 years). ### Who Can Help | Professional | Role | | --------------------------------- | ----------------------------------------------------------------------------------------- | | **GP** | Medication review, check blood pressure, identify underlying conditions, referrals | | **Pharmacist** | Medication review — can advise on medications that increase fall risk | | **Physiotherapist** | Assess balance and gait, prescribe strength and balance exercises (e.g., Otago Programme) | | **Occupational therapist (OT)** | Home safety assessment, recommend equipment (grab bars, raised toilet seat, shower chair) | | **Optometrist / Ophthalmologist** | Eye test, update prescription, check for cataracts or other eye conditions | | **Podiatrist** | Foot care, recommend appropriate footwear, address foot problems | | **District nurse** | Home visit, health monitoring, can coordinate referrals | | **NASC (Needs Assessment)** | Arrange home support services, equipment, and home modifications | --- ## If You Do Fall ### What to Do Immediately 1. **Stay calm** — take deep breaths and assess how you feel. 2. **Do not try to get up right away** unless you are sure you are not injured. 3. **If injured** — call for help (shout, use your personal alarm, phone). Stay warm and still until help arrives. 4. **If not injured** — roll onto your side and rest, then try to get up using a sturdy piece of furniture: - Roll onto your hands and knees. - Crawl to a sturdy chair or sofa. - Place your hands on the seat and lift one knee forward so your foot is flat on the floor. - Push up with your arms and legs, turn around, and sit in the chair. 5. **Tell someone** — even if you got up OK, tell your doctor, family, or a friend. A fall needs to be investigated. ### Personal Alarm / Medical Alert - Consider a personal alarm (e.g., Medical Alarm, St John Alarm, SmartFall) that can be worn as a pendant or watch. - These allow you to call for help at the push of a button. - Some have automatic fall detection. --- ## Summary of Key Facts | Topic | Detail | | ---------------------- | ----------------------------------------------------------------------- | | **1 in 3** | People over 65 fall each year | | **Major risk factors** | Poor balance, 4+ medications, vision problems, past falls, home hazards | | **Medications** | 4+ meds, sedatives, blood pressure drugs significantly increase risk | | **Strength/balance** | Exercises 2–3 times per week cut fall risk by 30–40% | | **Home safety** | Lighting, grab bars, non-slip mats, clear walkways, handrails on stairs | | **When to seek help** | After any fall, if unsteady, dizzy, taking 4+ meds, or vision changes | | **Key professionals** | GP, physio, OT, pharmacist, optometrist, podiatrist |