Falls are often dismissed as an inevitable part of getting older. They're not. Most falls have identifiable causes, and many of those causes are modifiable. The evidence for falls prevention is stronger than most people realise, and the payoff is significant: fewer fractures, fewer hospitalisations, less pain, and better independence.
Approximately one quarter of Australians aged 65 and over fall every year. In 2023-24, falls accounted for over 248,000 injury-related hospitalisations. The rate is highest in people aged 85 and over, and it's rising. Falls are now the single most expensive condition for health spending in Australia.
Exercise: the strongest evidence
If there's one thing the research is clear on, it's that exercise reduces falls. A major Cochrane review of 59 studies involving nearly 13,000 participants found that exercise reduces the rate of falls by 23% overall. When programmes combined balance training with resistance exercises, the reduction was even greater: up to 34%.
| Exercise type | Fall reduction | Evidence quality |
|---|---|---|
| Balance + functional exercises | 24% | High |
| Balance + resistance combined | 34% | Moderate |
| Tai Chi | 19% | Low |
| Resistance training alone | Uncertain | Limited |
| Walking alone | Uncertain | Limited |
The most effective programmes shared several features: they challenged balance progressively, were done at least three times a week, and were supervised by a physiotherapist or exercise professional. Both group-based and home-based programmes were effective.
The Otago Exercise Programme
The Otago Exercise Programme is a home-based, physiotherapist-prescribed exercise programme specifically designed for older adults. Developed in New Zealand and widely used in Australia, it has been shown to reduce falls by approximately 35% in people aged 80 and over. It involves a combination of strength and balance exercises done at home, with regular physiotherapist reviews.
It's worth noting that walking on its own, while excellent for general fitness, has not been shown to reduce falls. Swimming and cycling also don't reduce falls risk because they don't challenge balance or load the skeleton through gravity. If falls prevention is a goal, the programme needs to include balance work and resistance exercises.
Want the whole series on one page? I've put every bone-health habit, graded by the evidence, into a free one-page shortlist that comes with the newsletter.
Medications that increase your risk
Several commonly prescribed medication classes increase the risk of falls, usually through effects on balance, alertness, blood pressure, or muscle control. This doesn't mean these medications should never be used, but it does mean the risk should be weighed and monitored, especially in older adults.
- Sedatives and sleeping tablets (benzodiazepines, Z-drugs)
- Opioid pain medications
- Some antidepressants (SSRIs and tricyclics)
- First-generation antihistamines
- Anticholinergic medications (especially when combined)
- Some blood pressure medications (particularly those causing dizziness on standing)
- Antipsychotics
The risk of falls increases significantly when a person is taking four or more medications ("polypharmacy"), with even greater risk at eight or more. A structured medication review can identify opportunities to reduce doses, switch to lower-risk alternatives, or stop medications that are no longer needed.
A Home Medicines Review (HMR) is a Medicare supported service where a pharmacist visits your home, reviews all your medications (including over-the-counter and supplements), and provides a report to your GP with recommendations. If you're taking multiple medications and are concerned about falls, ask your GP about arranging one.
Your home environment
Most falls happen on flat ground, from slipping, tripping, or stumbling. Many of these happen at home, and many are preventable with practical modifications.
- Loose rugs or mats (especially on hard floors)
- Poor lighting (hallways, stairs, bathrooms)
- Wet bathroom surfaces without non-slip mats or grab rails
- Stairs without handrails
- Clutter in walkways
- Uneven flooring or raised transitions between rooms
- Items stored in hard-to-reach places (requiring step ladders or stretching)
- Cords or cables across walking paths
A home safety assessment by an occupational therapist is one of the most practical steps for someone with a history of falls. They can identify hazards you may not have noticed and recommend specific modifications. Your GP can arrange a referral as part of a chronic disease management plan.
Vision, footwear, and balance
Vision
Visual impairment is an independent risk factor for falls. Reduced contrast sensitivity, depth perception, and visual acuity all increase risk. Regular eye checks are important, particularly for people with cataracts, glaucoma, or macular degeneration.
One interesting finding from the research: multifocal glasses can increase fall risk in active older adults when worn outdoors, because the lower lens distorts depth perception when looking at the ground. A study found that switching to single-lens glasses for outdoor activities reduced outdoor falls by approximately 40% in active people. This doesn't apply to everyone, but it's worth discussing with your optometrist if you're active outdoors and wear multifocals.
Footwear
Loose slippers, worn soles, high heels, and open-backed shoes all increase falls risk. The evidence supports low-heeled, well-fitting shoes with good grip. This is a simple change that can make a real difference, especially at home where many falls happen.
Fear of falling
Being afraid of falling can actually increase your risk. Fear leads to avoiding activity, which causes deconditioning and muscle weakness, which in turn makes falls more likely. The most effective way to break this cycle is through a supervised exercise programme that progressively builds confidence, strength, and balance in a safe environment.
Check your falls risk factors
The following checklist covers the most common modifiable risk factors for falls. Tap any that apply to you. This is not a diagnostic tool, but it can help you identify areas worth discussing with your GP.
What your GP can do
Falls prevention works best as a coordinated approach. Your GP can bring together the different elements into a single plan. This typically includes a falls risk assessment, a medication review, a vision check, referrals to allied health professionals (physiotherapy, exercise physiology, occupational therapy), and ongoing monitoring.
If you have a chronic condition such as osteoporosis, your GP can set up a chronic disease management plan (GPCCMP) that gives you access to up to five Medicare supported allied health visits per calendar year. These can be used for physiotherapy or exercise physiology specifically focused on balance and strength training.
Consider talking to your GP about falls prevention if any of the following apply to you.
- You've had a fall in the past 12 months
- You feel unsteady on your feet or worry about falling
- You're taking four or more medications
- You've noticed changes in your balance or coordination
- You have osteoporosis or have had a fracture
- Your vision has changed or you haven't had an eye check recently
Falls prevention is one of the most practical and evidence-based things you can do to protect your independence as you get older. Most of the risk factors are modifiable, and many of the interventions are straightforward. The first step is knowing what to look for.
Concerned about
your falls risk?
Book an appointment and we can assess your risk factors, review your medications, and put together a falls prevention plan.
Common questions about falls prevention
Clinical information in this article is informed by the 2024 RACGP/Healthy Bones Australia guideline, the Cochrane review of exercise for falls prevention (Sherrington et al. 2019), AIHW injury data 2023-24, and Australian falls prevention guidelines. This is general information only. Your GP can advise on what's relevant for your individual situation.
