Falls
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Last reviewed: 23/06/2026
Falls
Falls and fractures in older people are a costly and often preventable health issue. Find out about the falls-related project the RCN is involved in and the guidance and resources available to you on preventing falls in the community and in hospital.
Falls are the number one reason older people are taken to the emergency department in a hospital.
Falls and fractures in older people are a costly and often preventable health issue. Reducing falls and fractures is important for maintaining health, wellbeing and independence among older people.
A fall is defined as an event that causes a person to, unintentionally, rest on the ground or lower level and is not a result of a major intrinsic event (such as a stroke) or overwhelming hazard.
Risk factors of having a fall
Having a fall can happen to anyone; it can be as a result of an accident, but can also be an unfortunate but normal result of human anatomy. However, as people get older, they are more likely to fall over. Falls can become recurrent and result in injuries including head injuries and hip fractures.
Falls are events resulting from the presence of risk factors. The likelihood and severity of injury from an event is often related to bone health. People with low bone mineral density are more likely to experience a fracture following a fall. One of the main reasons why people have low bone mineral density is osteoporosis.
Over 3.5 million people in the UK have osteoporosis (3,775,000) (PDF). People with this condition are at much greater risk of fragility fractures.
In its 2024 Annual Report, the National Hip Fracture Database (NHFD) reported that more than 70,000 individuals in England, Wales, and Northern Ireland experience hip fractures annually. Read the NHFD report in full.
Causes of falls
There are multiple causes and risk factors when it comes to having a fall. These include:
- having a history of falls
- muscle weakness
- poor balance
- visual impairment
- polypharmacy (taking multiple medicines)
- the use of certain medicines
- environmental hazards
- poor footwear and/or foot care
- medical conditions.
Please see Public Health England's Falls: applying All Our Health.
Integrating AI into older people’s care to prevent falls
Some health and social care settings are beginning to use artificial intelligence (AI) to help prevent falls and keep older people safe. This technology aims to allow residents to stay independent and live in their homes for longer. For example, in southwest London, a pilot scheme led by the local NHS is installing AI-powered monitors in residents' rooms, with their consent. These monitors analyse movement patterns to detect potential fall risks, enabling carers/nurses to respond quickly, and as a result, reducing hospital visits.
Additionally, the NHS has introduced an AI tool capable of predicting a patient's risk of falling with 97% accuracy by monitoring vital signs during home care visits. This tool helps prevent up to 2,000 falls daily by detecting early warning signs such as changes in heart rate, blood pressure, and mobility.
AI-powered virtual assistants are also being developed to remind people to take their medication, help with exercises, and warn carers if they show signs of confusion or unsteadiness . However, these developments raise important privacy and ethical concerns. Some elderly residents may not fully understand or be able to consent to how their personal data is collected and used.
Balancing safety with privacy
AI-powered monitoring systems, such as cameras and health-tracking devices, can improve safety but may also feel intrusive, especially if they monitor private moments. This highlights the need for informed consent and respect for the person’s dignity.
Where it is not possible to gain the person’s consent, due diligence must be paid to following the legislative framework within the Mental Capacity Act process in terms of assessment, documentation and making a decision using the principles of best interests.
In addition to the Mental Capacity Act, care homes must follow data protection laws (GDPR). This means handling personal data responsibly, being transparent about how it is used, and ensuring residents and families are fully informed. While AI can help prevent falls and improve care, it is important to balance these benefits with strong privacy protections and ethical safeguards.
Falls resources
National Institute for Health and Care Excellence (NICE) guidance
- NICE (2019) Surveillance of falls in older people: assessing risk and prevention (NICE guideline CG161) (PDF).
- NICE (2017) Falls in older people. This updated quality standard covers assessment after a fall and preventing further falls (secondary prevention) in older people living in the community and during a hospital stay.
- NICE (2017) Falls in older people pathway.This pathway covers the assessment and prevention of falls in older people both in the community and during a hospital stay.
- NICE. Falls: assessment and prevention in older people and people 50 and over at higher risk - In development. This updated guidance will fully update NICE (2013) Falls in older people: assessing risk and prevention.
Further resources
- British Geriatrics Society (2022) Falls in older people.
- NHS England. The National Patient Safety Improvement Programmes.
- NIHR. Falls Management Exercise (FaME) Implementation Toolkit. This toolkit provides a suite of resources that commissioners can use to plan, implement and monitor the FaME programme.
- Public Health England. Falls: applying All Our Health. Updated information on preventing falls and fractures. See also: NHSE - All Our Health: Falls and Fractures.
- Public Health England and Centre for Ageing Better (2018) Muscle and bone strengthening and balance activities for general health benefits in adults and older adults (PDF). Summary of a rapid evidence review for the UK Chief Medical Officers’ update of the physical activity guidelines.
- Royal College of Physicians. Falls and Fragility Fracture Audit Programme (FFFAP). The Falls and Fragility Fracture Audit Programme is a national clinical audit designed to audit the care that patients with fragility fractures and inpatient falls receive in hospital and to facilitate quality improvement initiatives.
- Royal College of Physicians (2017) Bedside vision check for falls prevention: assessment tool. The National Audit of Inpatient Falls (NAIF) has collaborated with partners to produce a new vision assessment tool which enables ward staff to quickly assess a patient’s eyesight in order to help prevent them falling or tripping while in hospital.
- Royal College of Physicians (2017) National Audit of Inpatient Falls Audit report 2017. Although prevention of inpatient falls across hospitals in England and Wales has improved slightly many patients are not receiving the required assessments which can help prevent falls in hospitals.
- Royal College of Physicians (2016) Falls Prevention in Hospital: a Guide for Patients, their Families and Carers. This guide is designed to help prevent serious injury and unnecessary cost to the NHS caused by older people tripping or falling when they are in hospital.
- Royal College of Physicians (2015) FallSafe resources. FallSafe was a quality improvement project that helped frontline staff to deliver evidence-based falls prevention.
Scotland
- Scottish Patient Safety Programme. Acute Adults - Falls. This resource supports NHS boards with falls improvement work.
- SIGN (2020). Management of osteoporosis and the prevention of fragility fractures. This guideline provides recommendations based on current evidence for best practice in the management of osteoporosis and prevention of fractures.
Wales
- Age Cymru. Falls prevention. Resources include Staying steady - an information guide on how to reduce falls. See also: Falls awareness education resource pack.
- NHS Wales. Putting the citizen first. Standard 2.3: Falls Prevention. This standard is about minimising the risk of people falling.
- NHS Wales. Steady on stay safe.This campaign has been developed by health boards, public bodies and the third sector that have expertise in falls prevention, led by the National Falls Prevention Task Force.
- Public Health Wales. Steady on… Stay SAFE. Public Health Wales is encouraging people aged 50 plus to ‘Steady on.. and stay safe’ to reduce their risk of falling.
Resource lead(s)
Contact details for the resource lead:
