Falls prevention for older adults: what the NHS, NICE and Age UK advise

Why do older people fall?

A fall rarely has one cause. The NHS says falls are more likely if you are older or have problems moving about, and it lists weaker muscles, conditions that affect balance or movement (such as arthritis, stroke or Parkinson’s disease), low blood pressure, some medicines, eyesight or hearing problems and dementia.¹ The NHS adds that not eating and drinking enough can leave you lightheaded or faint.¹

NICE reaches the same picture from the clinical side. Its guideline NG249, published on 29 April 2025, covers people aged 65 or over, and people aged 50 to 64 who have a factor that could raise their risk of falling.² It names increasing age, certain medicines, low blood pressure and cataracts as examples of individual risk factors, and says some can be changed, for instance through exercise, a medication review or cataract surgery.²

That last point is the useful one. Several of the causes are not fixed. You cannot change your age, but you can change your shoes, your lighting, your eye test dates and how often you move.

How common are falls in the UK?

RoSPA reports that in 2023 falls were responsible for almost 450,000 A&E attendances in England, and that about 340,000 of the people who attended with fall-related injuries were aged over 65.⁸ RoSPA also says falls account for four out of five accident-related hospital admissions among people over 65.⁷

A quick calculation shows how much of the burden sits in later life: 340,000 divided by 450,000 is about 0.76, so roughly three in four of those attendances involved someone over 65. This is arithmetic on two published figures, not a separate statistic, and the two figures may not describe exactly the same group.

Age UK puts the point more gently: falls become more of a concern as we get older, but they are not inevitable, and there is a lot you can do to reduce your chance of one, even after a previous fall.⁶

Which exercises does the NHS recommend for balance?

The NHS says adults aged 65 and over should do activities that build strength, balance and flexibility on at least 2 days a week, and should aim to be active every day, even if only lightly.⁴ The UK Chief Medical Officers give the same twice-weekly minimum and name standing on one leg and backwards walking as balance examples.⁹

The NHS balance exercises page gives five simple moves you can do at home. It advises doing them near a wall or a stable chair in case you lose your balance, building up slowly, and aiming for at least twice a week.³

A worked example of one session

Say you do the one-leg stand with the longest hold the NHS gives. Three holds of 10 seconds on each leg is 3 × 10 × 2 = 60 seconds of actual balance work, and at the shortest hold it is 3 × 5 × 2 = 30 seconds.³ The whole five-exercise routine is short, which is the point: it fits beside the kettle.

The NHS also lists the wider activities that help leg strength and co-ordination, including tai chi, yoga, dance, climbing stairs and lifting weights.⁵ The CMOs add dance and tai chi, and, for frailer adults, sit-to-stand exercise and short walks.⁹

What does NICE say about falls prevention?

NICE guideline NG249 is written for professionals, but its logic is worth knowing because it tells you what to ask for. NICE says not to use falls risk prediction tools to predict whether a person will fall, and instead to ask about falls in the last year.²

The criteria for a comprehensive assessment are a fall in the last year plus any of these: living with frailty, an injury that needed medical treatment, a loss of consciousness, being unable to get up independently, or 2 or more falls in the last year.² A comprehensive assessment looks at things such as lying and standing blood pressure, footwear, vision, hearing, medicines, continence and osteoporosis risk.²

For exercise, NICE says programmes should be delivered by appropriately trained professionals, be progressive and tailored, and focus on balance, coordination, strength and power with regular progress reviews.² It also says to offer a home hazard assessment and intervention using a validated tool where comprehensive management is needed, and to consider having an occupational therapist carry it out.²

NICE adds that there is insufficient evidence to support vitamin D supplements specifically to lower falls risk, though people should follow NHS advice on vitamin D for bone and muscle health.²

How can you make your home safer?

RoSPA says falls at home are often caused by hazards that are easy to overlook and simple to fix, and it offers a four-step approach: spot the hazard, find out how to reduce the risk, make the changes, and keep up the good work.⁷

If you want changes made, Age UK suggests contacting the adult social services department of your local council, and asking your local Age UK about handyperson schemes.⁶ The NHS notes that a falls service may check your home is safe and suggest adaptations.¹

A simple weekly plan

Only a clinician can tell you what suits your own health, so treat this as a starting frame built from the NHS pages above, not a prescription.

1. Set up a safe space. Stand near a wall or a stable chair, wear loose clothing and shoes that fit well, and keep water handy.³¹
2. Pick two days. The NHS asks for strength and balance work on at least 2 days a week, and it suggests doing the balance moves at least twice a week.³⁴
3. Start with the easiest move. Begin with sideways walking or the heel-to-toe walk, using the wall for support.³
4. Build up slowly. The NHS says to increase the repetitions gradually over time.³ Move away from the wall only as the move gets easier.³
5. Add strength. The NHS says to do muscle-strengthening activities that work the major muscle groups on at least 2 days a week, to the point where another repetition would be difficult.⁵
6. Keep moving between sessions. Age UK says that moving more is the best way to stay mobile, and that this need not be vigorous.⁶
7. Stop and get advice if something is wrong. A new fall, or a worry about your balance, is a reason to see your GP.¹

The CMOs note that for people with frailty, moderate-to-severe dementia, a history of vertebral fractures or regular falls, it may be more appropriate for new exercises to be supervised at first by a trained professional.⁹ If that sounds like you, ask your GP or a physiotherapist about a local class.

Alarms, telecare and protective equipment: what each one does

Age UK describes ‘telecare’ as simple technology such as a bed or chair sensor that can alert a carer or a call centre, and it describes personal alarms, worn as a pendant or wristband, as a way to call a 24-hour response centre.⁶ The NHS suggests keeping a way to call for help, such as a personal alarm or a mobile phone.¹ These services are about getting help quickly after a fall.

Neither exercise nor an alarm cushions the moment of impact. Wearable protective equipment is a separate category, and it is a different job: it is meant to reduce the force of a landing, not to stop the fall and not to call anyone. If you are comparing options, see the airbag vest guide for how that equipment works and what it does not do.

Frequently asked questions