Healthy Ageing & Longevity - Healthspan
Balance and preventing falls
Last updated 30 September 2026. How we write this .
Many falls in later life can be prevented. Exercise that challenges balance cuts the rate of falls by about a quarter, and checking medicines, eyesight and home hazards helps too.
Start here Many falls in later life can be prevented. Exercise that challenges balance cuts the rate of falls by about a quarter, and checking medicines, eyesight and home hazards helps too.
By the end, you will understand Why does balance get harder with age? Does exercise really prevent falls? What else lowers the risk of a fall? Where this information comes from Claim-cited evidence. Central research claims on this lesson are linked to specific studies or official guidance.
This lesson links the specific studies and guidance used for its central claims.
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Many falls in later life can be prevented, and the best-tested way is exercise that challenges your balance. A 2019 Cochrane review of 108 trials found it cut the rate of falls by about a quarter. Reviewing medicines, treating eye problems and fixing hazards at home each add something, especially for people who have already fallen.
Falls are common enough that this is worth knowing early. Around a third of people aged 65 and over, and around half of those aged 80 and over, fall at least once a year, according to the Office for Health Improvement and Disparities (OHID). In 2017 to 2018 there were around 220,160 emergency hospital admissions for falls among people aged 65 and over in England. A broken hip is the injury people fear most, with good reason. OHID reports one-year death rates of between 18% and 33% after a hip fracture, and around 1 in 5 people move into long-term care within a year of one.
Why does balance get harder with age?
Staying upright is an active job. Your brain blends three streams of information: what your eyes see, what the balance organs in your inner ear sense about head movement, and signals from muscles, joints and the soles of your feet about where your body is. It then makes constant small corrections through the muscles of your legs and trunk. Walking is harder still, because each step briefly leaves you on one leg.
Age chips away at every part of that system. Muscles weaken and react more slowly. Eyesight and hearing fade. The NHS lists other common causes: conditions such as arthritis, stroke and Parkinson's disease, low blood pressure, dementia and the side effects of some medicines. Medicines that act on the brain, which doctors call psychotropic medicines, are a particular concern. NICE names antidepressants, antipsychotics, anxiety medicines, mood stabilisers and antiepileptic medicines as linked to a higher risk of falls. Most falls come from several of these at once, which is why good prevention looks at the whole person.
Does exercise really prevent falls?
Yes, and the evidence here is unusually strong. The 2019 Cochrane review led by Cathie Sherrington pooled 108 randomised trials with 23,407 people living at home in 25 countries. Their average age was 76 and 77% were women. Across 59 trials, exercise cut the rate of falls by 23%. Put another way, where 1,000 people would normally have about 850 falls in a year, exercise would prevent about 195 of them. It also cut the number of people who fell at all by 15%. The reviewers rated both findings as high-certainty evidence, the top grade.
The type of exercise made a difference. Programmes built on balance and functional exercises, meaning movements that mimic daily life such as standing up from a chair, stepping and turning, cut the fall rate by 24%. Programmes that mixed balance work with resistance training, which works muscles against a load, probably cut it by 34%. Tai chi may cut it by 19%. For walking, dancing or strength training on its own, the reviewers could not tell whether falls went down. Exercise may also reduce falls that break a bone, though that rests on far fewer trials. Side effects were mostly minor aches and strains.
Exercise does not have to look like a class. In the Australian LiFE trial, published in the BMJ in 2012, 317 people aged 70 or over who had fallen at least twice, or been hurt in a fall, in the past year were split into three groups. One group learnt to build balance and strength moves into everyday routines. Over 12 months they had 1.66 falls per person per year, against 2.28 in a group given gentle exercise, a 31% lower rate. A conventional structured programme also had fewer falls, but not by enough to rule out chance.
NHS advice for older adults is to be active every day and to do activities that improve strength and balance at least twice a week. For people who have already fallen, NICE guideline NG249, published in April 2025, says programmes should be run by trained professionals, tailored to the person and made gradually harder, focusing on balance, coordination, strength and power.
What else lowers the risk of a fall?
A 2012 Cochrane review led by Lesley Gillespie covered 159 trials with 79,193 people and found several other measures that work. Home safety assessments and changes, such as clearing trip hazards and fitting grab rails, cut the rate of falls by 19%. They worked best in people at higher risk and when an occupational therapist did the assessment. Surgery on the first eye with a cataract cut falls by 34% in one trial of 306 women. In a small trial of 93 people, gradually coming off psychotropic medicines cut the fall rate by about two thirds. That is a change to plan with a doctor, never one to make alone. People with a heart rhythm problem called carotid sinus hypersensitivity fell less after a pacemaker was fitted.
Some popular ideas did less than hoped. Vitamin D did not reduce falls overall, although it may help people whose levels were low to start with. NICE now says there is not enough evidence to take vitamin D specifically to prevent falls, while still pointing people to NHS advice on vitamin D for bone and muscle health. Leaflets and education on their own did not cut falls. Glasses had a twist: when regular wearers of multifocal lenses were given single-lens glasses, falls dropped in people who spent a lot of time outdoors, but outdoor falls rose in those who rarely went out.
Why don't falls programmes always work in real life?
Trials recruit willing volunteers and support them closely. Real services often look different. The UK PreFIT trial tested a screen-and-treat approach across 63 GP practices in England, with 9,803 people aged 70 and over. Practices posted a short questionnaire, then invited those at higher risk to an exercise programme or a full falls assessment. Only 65% of those invited took up the exercise. After 18 months, neither approach reduced fractures or falls compared with advice alone. The exercise group did fall less at 8 months, but the gap then closed. Exercise still came out as the most cost-effective option.
The likely lesson is that exercise protects you for as long as you keep doing it, and that a single invitation reaches too few of the people who need it. NICE's 2025 guideline leans on this, asking services to agree changes with each person, offer a choice of group or one-to-one sessions and build in social contact. It also tells professionals not to use falls risk prediction tools, and instead to ask people directly whether they have fallen in the past year.
What should I do if I fall, or keep falling?
Call 999 if someone has fallen and may have hurt their head, neck, back or hip, or cannot get up. Contact NHS 111 if they are in pain, injured or unwell after a fall. If you are on the floor and cannot get up, the NHS advises keeping warm with whatever you can reach and changing position about every 30 minutes to protect your skin.
Tell your GP about any fall, even one that did no harm, and about any worries over your balance. Under NICE guidance, people who have had two or more falls in a year, were injured, could not get up alone, blacked out or are living with frailty should be offered a full falls assessment. That covers a lying and standing blood pressure check, a medicines review, eyesight, hearing, feet and footwear, continence, bone health, and how well you walk and balance. Many areas let you refer yourself to a falls service, and anyone can ask their local council for a free care needs assessment, which can include changes to make a home safer.
This lesson is general education about balance and falls, not medical advice. If you have fallen or are worried about your balance, speak to your GP, a pharmacist or a physiotherapist.
Related in this classroom Related in other classrooms The studies behind this page Falls: assessment and prevention in older people and in people 50 and over at higher risk. Recommendations - NICE guideline NG249, 2025Falls - NHSFalls: applying All Our Health - Office for Health Improvement and Disparities, 2022Exercise for preventing falls in older people living in the community - Cochrane Database of Systematic Reviews, 2019Interventions for preventing falls in older people living in the community - Cochrane Database of Systematic Reviews, 2012Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial - BMJ, 2012Fall prevention interventions in primary care to reduce fractures and falls in people aged 70 years and over: the PreFIT three-arm cluster RCT - Health Technology Assessment, 2021Sources for this classroom
Educational content only. Not medical advice, diagnosis or treatment. Always consult a qualified healthcare professional before changing your health regimen.