Falls and Balance in Older Adults

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Sources

1. Centers for Disease Control and Prevention. Facts about older adult falls (last reviewed September 8, 2026). Checked October 29, 2026.
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   “More than one out of four older people falls each year, but less than half tell their doctor. Falling once doubles your chances of falling again”; “One out of 10 falls results in an injury that causes the older adult to restrict their activities for a day or more”; nearly 319,000 older people are hospitalized for hip fractures each year; “83% of hip fracture deaths and 88% of emergency department visits and hospitalizations for hip fractures were caused by falls”; falls are the most common cause of traumatic brain injury in older adults; conditions that contribute to falls include lower body weakness, vitamin D deficiency, difficulties with walking and balance, medicines such as tranquilizers, sedatives or antidepressants and some over-the-counter medicines, vision problems, foot pain or poor footwear, and home hazards such as broken steps, throw rugs and clutter; “The more risk factors a person has, the greater their chances of falling”; fear of falling can lead people to cut down their activities.
2. Centers for Disease Control and Prevention. About older adult fall prevention (last reviewed September 8, 2026). Checked October 29, 2026.
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   “Falls among adults 65 and older caused over 43,000 deaths in 2024, making it the leading cause of injury death for that group”; emergency departments recorded about 4.5 million visits for older adult falls in 2024; “Falls can be prevented” and “Falls don’t have to be inevitable as you age.”
3. Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, et al. Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2019;(1):CD012424. doi:10.1002/14651858.CD012424.pub2 (PMID 30703272; full text PMC6360922).
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   Systematic review of 108 randomized controlled trials with 23,407 people aged 60 and over living in the community in 25 countries (average age 76, 77% women); most trials had unclear or high risk of bias for one or more items. Exercise of all types reduces the rate of falls by 23% (rate ratio 0.77, 95% CI 0.71 to 0.83; high-certainty evidence) and the number of people who fall by 15% (high-certainty); “Subgroup analyses showed no evidence of a difference in effect on both falls outcomes according to whether trials selected participants at increased risk of falling or not.” Balance and functional exercises reduce the rate of falls by 24% (rate ratio 0.76, 95% CI 0.70 to 0.81; 39 studies; high-certainty); multiple types of exercise, most often balance and functional plus resistance exercise, probably reduce it by 34% (0.66, 0.50 to 0.88; moderate-certainty); Tai Chi may reduce it by 19% (0.81, 0.67 to 0.99; low-certainty) and reduces the number of people who fall by 20% (risk ratio 0.80, 0.70 to 0.91; high-certainty). “We are uncertain of the effects of programmes that are primarily resistance training, or dance or walking programmes.” Exercise may reduce the number of people with a fall-related fracture (risk ratio 0.73, 95% CI 0.56 to 0.95; low-certainty). A larger effect on the rate of falls in trials where a health professional delivered the exercise (rate ratio 0.69) than where trained instructors who were not health professionals did (0.82); “both approaches resulted in reductions in the rate of falls.” Adverse events, where reported, were “predominantly non-serious.”
4. Sherrington C, Michaleff ZA, Fairhall N, Paul SS, Tiedemann A, Whitney J, et al. Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. British Journal of Sports Medicine. 2017;51(24):1750–1758. doi:10.1136/bjsports-2016-096547 (PMID 27707740).
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   Meta-analysis of 99 comparisons from 88 randomized trials with 19,478 participants. Exercise reduced the rate of falls in community-dwelling older people by 21% (rate ratio 0.79), “with greater effects seen from exercise programmes that challenged balance and involved more than 3 hours/week of exercise. These variables explained 76% of the between-trial heterogeneity and in combination led to a 39% reduction in falls”; “There was no evidence of a fall prevention effect of exercise in residential care settings or among stroke survivors or people recently discharged from hospital.”
5. Montero-Odasso M, van der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age and Ageing. 2022;51(9):afac205. doi:10.1093/ageing/afac205 (PMID 36178003; full text PMC9523684).
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   Expert consensus guideline built on a modified Delphi process with graded recommendations. “Clinicians should routinely ask about falls in their interactions with older adults, as they often will not be spontaneously reported” (1A); the three key questions: “(i) Have you fallen in the past year, (ii) Do you feel unsteady when standing or walking? (iii) Do you have worries about falling”; the CDC’s Stay Independent self-check of 12 questions “can also be used”; gait speed is recommended for predicting falls risk (1A), cut-off “<0.8 m/s”, and the Timed Up and Go, cut-off “>15 seconds,” can be considered, “although evidence for fall risk stratification is mixed” (1B); people at intermediate risk “should be offered targeted exercise or a physiotherapist referral”; high risk includes a fall with injury, “multiple falls (≥2 falls) in the previous 12 months,” frailty, “inability to get up after the fall without help for at least an hour” and suspected transient loss of consciousness, and “Suspicion of a syncopal fall should trigger syncope evaluation and management”; the multifactorial assessment covers gait and balance, strength, medications, cardiovascular disorders including orthostatic hypotension (blood pressure measured lying and on standing), dizziness (screened with history and, on indication, Dix-Hallpike and head impulse tests, with referral to an ENT specialist), walking aids, vision (including multifocal glasses), hearing, foot problems and footwear (with referral to a podiatrist), cognition, concerns about falling and the home; exercise programs that “include balance challenging and functional exercises (e.g. sit-to-stand, stepping), with sessions three times or more weekly which are individualised, progressed in intensity for at least 12 weeks and continued longer for greater effect” (1A), adding Tai Chi and/or progressive resistance training when feasible (1B), delivered by “appropriately trained professionals,” who “could be physiotherapists, exercise physiologists or kinesiologists, trained exercise instructors or other allied health professionals”; “A medication review and appropriate deprescribing of FRIDs [fall-risk-increasing drugs] should be part of multidomain falls prevention interventions” (1B); cataract surgery and “avoiding the wearing of multifocal glasses when outside” by active older adults are effective, while new spectacles “have not yet been shown to reduce the risk of falls”; “We recommend exercise, cognitive behavioural therapy and/or occupational therapy (as part of a multidisciplinary approach) to reduce fear of falling in community-dwelling older adults” (1B); “the oldest old often still lie on the floor for a long time before they use a call alarm”; “Regaining the skill to rise from the floor is most successfully re-learnt through practice of each of the specific movements required (often called backward-chaining)”; “Vitamin D supplementation to prevent falls should be reserved for those at risk of vitamin D deficiency.”
6. National Institute on Aging. Falls and fractures in older adults: causes and prevention (content reviewed September 12, 2022). Checked October 29, 2026.
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   “More than one in four people age 65 years or older fall each year”; fear of falling “may lead them to avoid activities,” but “staying active is important to keeping your body healthy and actually helps to prevent falls”; causes include eyesight, hearing and reflexes; diabetes, heart disease, and problems with the thyroid, nerves, feet or blood vessels; incontinence causing rushed movement to the bathroom; mild cognitive impairment or some types of dementia; sarcopenia, problems with balance and gait, and postural hypotension; “Foot problems that cause pain, and unsafe footwear such as backless shoes or high heels”; “Some medications can increase a person’s risk of falling because they cause side effects such as dizziness or confusion. The more medications you take, the more likely you are to fall”; tips: new glasses (“take time to get used to them”), hearing aids that fit, telling a doctor or pharmacist about a drug that makes you sleepy or dizzy, enough sleep, limiting alcohol, “Stand up slowly” and “Get your blood pressure checked when lying and standing,” using a cane or walker of the right size (“A physical or occupational therapist can help you decide which devices might be helpful and teach you how to use them safely”), keeping hands free, “nonskid, rubber-soled, low-heeled shoes” and not walking on stairs or floors in socks or smooth-soled shoes or slippers; “Always tell your doctor if you have fallen since your last check-up, even if you did not feel pain when you fell”; after a fall: breathe, decide if you are hurt, roll onto your side, get on your hands and knees and crawl to a sturdy chair, put your hands on the seat, slide one foot forward flat on the floor, rise slowly from kneeling and turn to sit; “If you are hurt or cannot get up on your own, ask someone for help or call 911”; keep a charged phone with you and arrange daily contact with family or a friend; “For people with osteoporosis, even a minor fall may be dangerous”; healthy bones “may help prevent serious injury, such as breaking a hip.”
7. Centers for Medicare & Medicaid Services. Physical therapy services (Medicare.gov). Checked October 29, 2026.
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   Part B covers medically necessary outpatient physical therapy; “You can also get this therapy to help improve or maintain your current function, or slow your rate of decline”; your doctor or other provider “must certify that you need it”; “After the Part B deductible, you pay 20% of the Medicare-approved amount”; “There’s no limit on how much Medicare pays for your medically necessary outpatient therapy services in one calendar year.”
8. Centers for Medicare & Medicaid Services. Durable medical equipment (DME) coverage, Canes and Walkers (Medicare.gov). Checked October 29, 2026.
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   Covered DME includes canes, walkers (“including rollators”) and commode chairs; Part B covers it “if your doctor or other health care provider orders it for use in your home”; Medicare pays only through suppliers enrolled in Medicare; “After you meet the Part B deductible, you pay 20% of the Medicare-approved amount (if your supplier accepts assignment)”; “Medicare doesn’t cover white canes for the blind.”
9. National Health Service (England). Falls (page last reviewed March 6, 2025). Checked October 29, 2026.
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   Get emergency help if someone has fallen and “may have injured the head, back, neck or hip” or “cannot get up”; if you cannot get up: use a phone or personal alarm, or shout or bang on a wall or the floor, keep warm, “Keep moving your body,” and “Try to change position about every 30 minutes, to help prevent pressure sores”; if someone else has fallen, “do not try to lift them yourself.”
10. Centers for Disease Control and Prevention. Symptoms of mild TBI and concussion. Danger signs in adults that need emergency care include a headache that gets worse and does not go away; weakness, numbness or decreased coordination; repeated vomiting; slurred speech; one pupil larger than the other; confusion; and losing consciousness or being very drowsy. Checked October 29, 2026.
11. National Health Service (England). Head injury and concussion (page last reviewed May 29, 2025). Get urgent medical advice after a recent head injury if you are vomiting, feel dizzy, or “have a condition that thins your blood or take medicine that thins your blood”; “do not drive yourself there if you have hit your head.” Checked October 29, 2026.
12. National Institute on Deafness and Other Communication Disorders. Balance disorders (last updated March 6, 2018). Checked October 29, 2026.
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    “A balance disorder is a condition that makes you feel unsteady or dizzy”; “dizziness” can mean faintness for one person and “an intense sensation of spinning (vertigo)” for another; “About 15 percent of American adults (33 million) had a balance or dizziness problem in 2008”; balance relies on signals from “your eyes, ears, and the muscles and touch sensors in your legs”; “Low blood pressure can lead to dizziness when you stand up too quickly”; “Your risk of having balance problems increases as you get older”; BPPV is “A brief, intense episode of vertigo triggered by a specific change in the position of the head,” treated with movements such as the Epley maneuver; a primary doctor may suggest an otolaryngologist or audiologist; “A vestibular rehabilitation therapist can help you develop an individualized treatment plan”; “Talk to your doctor about whether it’s safe to drive”; “avoid walking in the dark,” and “If necessary, use a cane or walker and modify conditions at your home and workplace, such as adding handrails.”
13. Centers for Medicare & Medicaid Services. Yearly “Wellness” visits (Medicare.gov). A conversation-based visit to create a prevention plan; the provider will “Review your current prescriptions” and give you a written plan; “You pay nothing if your doctor or other health care provider accepts assignment.” Checked October 29, 2026.
14. Centers for Disease Control and Prevention, STEADI. Assessment: Timed Up & Go (TUG) (2017). Checked October 29, 2026.
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    Purpose “To assess mobility”; the person wears regular footwear, can use a walking aid, stands up from a chair, walks to a line 3 meters (10 feet) away at a normal pace, turns, walks back and sits down; “Always stay by the patient for safety”; “An older adult who takes ≥12 seconds to complete the TUG is at risk for falling.”
15. Centers for Disease Control and Prevention, STEADI. Assessment: 30-Second Chair Stand (2017). Checked October 29, 2026.
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    Purpose “To test leg strength and endurance”; a straight-backed chair without armrests (seat 17 inches high); arms crossed at the wrists on the chest; count full stands in 30 seconds; “If the patient must use his/her arms to stand, stop the test”; “A below average score indicates a risk for falls”; below-average scores: ages 60–64, men <14, women <12; 65–69, <12 and <11; 70–74, <12 and <10; 75–79, <11 and <10; 80–84, <10 and <9; 85–89, <8 and <8; 90–94, <7 and <4.
16. Centers for Disease Control and Prevention, STEADI. Assessment: The 4-Stage Balance Test (2017). Checked October 29, 2026.
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    Purpose “To assess static balance”; four positions held for 10 seconds each without a cane or walker, eyes open: feet side by side; the instep of one foot touching the big toe of the other; tandem stand (heel touching toe); standing on one foot; “An older adult who cannot hold the tandem stand for at least 10 seconds is at increased risk of falling,” and referral to physical therapy for gait and balance exercises or to an evidence-based program such as Tai Chi may be considered.
17. US Preventive Services Task Force. Falls prevention in community-dwelling older adults: interventions (final recommendation, June 4, 2024). Checked October 29, 2026.
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    “The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls” (grade B); clinicians should “individualize the decision to offer multifactorial interventions” (grade C); exercise gives “a moderate net benefit,” with moderate certainty; a pragmatic way to find people at increased risk is “to assess for a history of falls or for problems in physical functioning and limited mobility”; “Effective exercise interventions include supervised individual physical therapy and group exercise classes”; “The most common frequency and duration for exercise interventions was 2 to 3 sessions per week for 12 months.”
18. National Institute on Aging. Preventing falls at home: room by room (content reviewed September 12, 2022). Checked October 29, 2026.
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    Handrails on both sides of stairs; light switches at the top and bottom of stairs; no throw rugs or small area rugs; no-slip strips on tile and wooden floors; grab bars near toilets and inside and outside the tub and shower; nonskid mats; night lights near the bed and in the bathroom; a phone near the bed; electrical cords away from walking paths; chairs the right height to get in and out of; a “reach stick” instead of standing on a chair; “If you have fallen, your doctor might suggest that an occupational therapist, physical therapist, or nurse visit your home”; an emergency response system has a fee and “it’s usually not covered by insurance”; some smartwatches can call for help; local Area Agencies on Aging (Eldercare Locator, 800-677-1116) may run home modification programs.
19. Thomas S, Mackintosh S, Halbert J. Does the ‘Otago exercise programme’ reduce mortality and falls in older adults?: a systematic review and meta-analysis. Age and Ageing. 2010;39(6):681–687. doi:10.1093/ageing/afq102 (PMID 20817938).
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    Systematic review and meta-analysis of seven trials with 1,503 community-dwelling adults aged 65 and over (mean age 81.6). The Otago program is “a strength and balance retraining programme designed to prevent falls in older people living in the community”; it reduced fall rates (incidence rate ratio 0.68, 95% CI 0.56 to 0.79) and the risk of death over 12 months (risk ratio 0.45), with no significant difference in serious or moderate fall injuries; of 747 people still in the studies at 12 months, 274 (36.7%) were still exercising three or more times a week.
20. Bradley SM, Hernandez CR. Geriatric assistive devices. American Family Physician. 2011;84(4):405–411. aafp.org (PMID 21842786). Clinical review.
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    “Most patients with assistive devices have never been instructed on the proper use and often have devices that are inappropriate, damaged, or are of the incorrect height”; choice “depends on the patient’s strength, endurance, balance, cognitive function, and environmental demands”; “When only one upper extremity is needed for balance or weight bearing, a cane is preferred. If both upper extremities are needed, crutches or a walker is more appropriate”; the top of a cane or walker should be at the wrist crease, standing upright with arms relaxed, with the elbow flexed 15 to 30 degrees; “A cane should be held contralateral to a weak or painful lower extremity and advanced simultaneously with the contralateral leg”; a quad cane has a larger base of support and stands on its own, but all four points must touch the ground; a standard walker is “the most stable walker” but must be lifted with each step; a front-wheeled walker is less stable but keeps a more normal gait; a rollator “is not appropriate for patients with significant balance problems or cognitive impairment because it can roll forward unexpectedly,” and its brakes should be on before sitting; walkers “require greater attentional demands than canes and make using stairs difficult”; people with gait or balance disorders or difficulty using their device “can benefit from a referral to a physical therapist.”
21. National Institute on Aging. Three types of exercise can improve your health and physical ability. Checked October 29, 2026.
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    Balance exercises “help to prevent falls and fall-related injuries. Aim for about three sessions of balance exercises a week”; examples: Tai Chi, yoga, standing on one foot, the heel-to-toe walk, the balance walk, walking backward or sideways, practicing standing from a sitting position, a wobble board; safety: “If you are unsure about doing a particular movement, seek guidance from your doctor or physical therapist” and “Have a sturdy chair, person, or wall nearby to hold onto for support”; build up to at least 150 minutes a week of moderate aerobic activity.
22. National Health Service (England). Balance exercises (page last reviewed November 7, 2023). Checked October 29, 2026.
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    Sideways walking (10 steps each way); simple grapevine (5 cross-steps each side; “The smaller the step, the more you work on your balance”); heel-to-toe walk (at least 5 steps, fingers on a wall if necessary, moving away from the wall as you progress); one-leg stand facing a wall, fingertips touching it (hold 5 to 10 seconds, 3 on each side); step-up on a step with a rail or near a wall (up to 5 with each leg); “at least twice a week.”
23. Kendrick D, Kumar A, Carpenter H, Zijlstra GAR, Skelton DA, Cook JR, et al. Exercise for reducing fear of falling in older people living in the community. Cochrane Database of Systematic Reviews. 2014;(11):CD009848. doi:10.1002/14651858.CD009848.pub2 (PMID 25432016).
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    Review of 30 studies with 2,878 community-dwelling people (mean ages 68 to 85) testing Tai Chi and yoga, balance training, or strength training. “Exercise interventions were associated with a small to moderate reduction in fear of falling immediately post intervention” (low-quality evidence; very low quality at later follow-up).
24. Clemson L, Stark S, Pighills AC, Fairhall NJ, Lamb SE, Ali J, et al. Environmental interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2023;(3):CD013258. doi:10.1002/14651858.CD013258.pub2 (PMID 36893804).
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    Review of 22 studies in 10 countries with 8,463 community-dwelling people (average age 78). Home fall-hazard reduction “probably reduce[s] the overall rate of falls by 26%” (rate ratio 0.74, 95% CI 0.61 to 0.91; moderate-certainty), and by 38% in people selected for a higher risk of falling (0.62, 0.56 to 0.70; high-certainty); “We found no evidence of a reduction in rate of falls when people were not selected for fall risk” (high-certainty).
25. Fleming J, Brayne C; Cambridge City over-75s Cohort (CC75C) study collaboration. Inability to get up after falling, subsequent time on floor, and summoning help: prospective cohort study in people over 90. BMJ. 2008;337:a2227. doi:10.1136/bmj.a2227 (PMID 19015185).
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    Prospective cohort of 110 people over 90 followed for one year. 82% of falls happened when the person was alone; of those who fell, 80% could not get up after at least one fall and 30% lay on the floor for an hour or more; “Lying on the floor for a long time was strongly associated with serious injuries, admission to hospital, and subsequent moves into long term care”; call alarms “were not used in most cases”; “People need training in strategies to get up from the floor.”
26. Centers for Medicare & Medicaid Services. Medicare costs (Medicare.gov). Part B deductible “$283 before Original Medicare starts to pay.” Checked October 29, 2026.
27. Centers for Medicare & Medicaid Services. Therapy services (CMS.gov, page last modified March 10, 2026). Checked October 29, 2026.
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    Claims above the KX threshold “must include the KX modifier as a confirmation that services are medically necessary as justified by appropriate documentation in the medical record”; “Claims for services over the KX modifier threshold amounts without the KX modifier are denied. For CY 2026 this KX modifier threshold amount is: $2,480 for PT and SLP services combined, and $2,480 for OT services”; “the MR threshold is $3,000 for PT and SLP services and $3,000 for OT services,” and “not all claims exceeding the MR threshold amount are subject to review.”
28. Centers for Medicare & Medicaid Services. Jimmo settlement (CMS.gov). Checked October 29, 2026.
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    Medicare covers skilled therapy under the skilled nursing facility, home health and outpatient therapy benefits “when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration”; coverage “does not turn on the presence or absence of a beneficiary’s potential for improvement, but rather on the beneficiary’s need for skilled care.”
29. Centers for Medicare & Medicaid Services. Home health services (Medicare.gov). Checked October 29, 2026.
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    Covers part-time or intermittent skilled care including physical therapy, occupational therapy and speech-language pathology if you are homebound, which includes having “trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person)”; “You pay nothing for covered home health services.”
30. Centers for Medicare & Medicaid Services. Compare Original Medicare & Medicare Advantage (Medicare.gov). Checked October 29, 2026.
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    Medicare Advantage “Plans must cover all medically necessary services that Original Medicare covers”; “You may need to use doctors and other providers who are in the plan’s network”; “You may need to get a referral to see a specialist”; “You may need to get approval (prior authorization) from your plan before it covers certain services or supplies”; “Plans may have different out-of-pocket costs for certain services.”
31. HealthCare.gov. What Marketplace health insurance plans cover. Checked October 29, 2026.
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    “All plans offered in the Marketplace cover these 10 essential health benefits,” including “Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)”; “Specific services covered in each broad benefit category can vary based on your state’s requirements.”

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your individual situation. Seek emergency care for a head injury after a fall with worsening headache, repeated vomiting, confusion or loss of consciousness.