Rethinking falls prevention: giving people the confidence to keep moving

Falls are one of those topics that gets covered again and again in health and social care- and for good reason. They're a genuine global problem, and the numbers behind them are hard to ignore. But in our recent Accora Academy webinar, host Nicky Phillips, one of our clinical specialist Occupational Therapists, took a different angle. Rather than adding to the list of warnings about what people shouldn't do, she reframed falls prevention around what people can do to keep moving safely¹.

Read on for the key insights from the session, and some practical takeaways you can bring straight into practice.

Just how big a problem are falls?

According to the World Health Organization, falls are a genuine global health issue, not something that only affects older adults, although they remain most at risk. The scale is striking:

• 684,000 fatal falls occur every year²
• 37.3 million falls require medical attention²
• Falls are responsible for 38 million DALYs (disability-adjusted life years)- a measure of healthy life lost to death or disability²
• Globally, men are most likely to die from a fall, while older women and younger children are especially prone to falling²

With an ageing population, urbanisation, more sedentary lifestyles, and unequal access to healthcare all playing a part, this is a problem that's likely to grow rather than shrink.

What do the guidelines actually say?

Much of the session was grounded in the World Falls Guidelines (2022), developed by over 90 international experts from 39 countries and published in the Age and Ageing journal, led by the World Falls Task Force³.

The clinical recommendations won't surprise most OTs, but they're a helpful checkpoint:

• Multifactorial assessments- never look at one risk factor in isolation
• Individualised interventions- there's no one-size-fits-all solution
• Medical evaluation for balance and gait
• Medication review, since being on four or more medications increases fall risk
• Vision correction- interestingly, photochromic lenses and bifocals can sometimes increase risk due to the time it takes eyes to adjust
• Environmental safety modifications

Proactive and reactive: two sides of the same approach

Nicky highlighted that falls prevention isn't only about stopping falls before they happen. It's also about being prepared for when they do.

Having a fall action plan matters. This can be as simple as:

• Keeping emergency contact numbers visible
• Having your address clearly written down somewhere accessible
• Carrying a mobile phone or wearing a pendant alarm, so help is a single button press away

If someone can't get up after a fall, the advice is to seek help, keep warm, and avoid panicking or exhausting themselves trying to get up unaided. Learning safe techniques for getting up off the floor (with support from a carer, using a nearby chair for leverage) can also reduce the fear of falling, which in itself is a known risk factor.⁴

Where do falls happen, and what can reduce the risk?

The most common locations for falls are the bathroom, the stairs, and around furniture, including getting in and out of beds and chairs. The good news is that many of the highest-impact changes are simple:

• Bed and grab rails, better lighting, and clutter-free walkways in bedrooms
• Handrails, improved lighting, and anti-skid strips on stairs
• Grab bars, shower seats, and non-slip mats in bathrooms⁵

A validated self-assessment tool developed by Finding Balance Alberta gives people a simple way to check their own risk, scoring items like unsteadiness while walking, needing to push up from a chair with their hands, or previous falls. A score of four or more indicates high risk- and because the tool is framed without blame, people tend to be more honest about their answers, which means risks are more likely to be identified and addressed early.⁶

Getting equipment right: beds and chairs

Because we use them daily, beds and chairs are two of the most common places for falls to happen- which makes getting them right one of the simplest, highest-impact interventions available.

The principle is the same for both: fit the equipment to the person, not the person to the equipment.

• A bed or chair that's too low makes standing up harder work
• One that's too high can leave someone unsteady when getting up
• For some people at higher risk of falling at night, lowering the bed towards the floor changes a fall into more of a roll
• A bed lever can support the lying-to-sitting transfer without the twisting movement that often leads to a fall

Further reading: Reducing fall risks in elderly care: The role of floor-level beds

Exercise and lifestyle interventions that actually work

Evidence-based interventions covered in the session included:

• Gait, balance, and functional training
• Tai Chi, which has a strong evidence base for improving balance
• Home assessments and modifications
• Medication review
• Vitamin D, eyesight, and nutrition checks

The Otago exercise programme was highlighted specifically, showing a 30-35% reduction in falls among people with a history of falling, when the exercises are done consistently. As Nicky pointed out, consistency is often the hardest part; without a clear prompt or routine, it's easy for people to let exercises slip.

Footwear matters more than people expect. Look for a high heel collar, a firm midsole, and a textured sole for grip- and be cautious of very thin-soled shoes or slippers, which reduce the feedback people get from the ground beneath them.

It's a community responsibility too

The World Health Organization frames falls prevention around three pillars: safer people, safer environments, and safer policies. This plays out at different levels, from small everyday habits to wider system change:

• Everyday awareness matters more than people realise. Something as small as parking a car half over a kerb can block a pavement, making the space far harder to navigate for someone using a walking frame or wheelchair. Being mindful of how our own actions affect accessibility for others is a simple, practical starting point.
• At a service level, adequate staff-to-resident ratios in care facilities make a difference, since rigid routines tied to shift changes can affect how much residents are able to move throughout the day.
• At a policy level, councils and local authorities can adjust environmental controls to reflect the people actually using a space, such as extending pedestrian crossing timings in areas with older populations who may need more time to cross safely.
• Underpinning all of this is universal design, the principle of designing spaces that work for everyone from the outset, rather than retrofitting for accessibility later.

Technology as an enabler, not a replacement

From GPS watches with fall detection to AI monitoring systems, motion sensors, gait analysis tools, and even online falls prevention classes, technology has a genuine role to play in keeping people safe and independent, particularly for those who can't easily attend in-person sessions.⁷

The "Stepping On" mentality

Nicky closed with a nod to the Stepping On falls prevention programme, and the mindset behind it: promote movement, don't limit it, and don't over-prescribe.⁸ It's a fitting summary of the whole session. Falls prevention isn't about restricting people's lives out of caution. It's about giving them the confidence, the right equipment, and the right environment to keep doing the things they want to do, safely.