Despite decades of fall-prevention efforts, falls remain common and consequential for older adults. We know there are modifiable risk factors such as vision and hearing changes, environmental hazards, reduced strength and balance, medication effects, and other contributors. Addressing these factors matters. We can’t prevent every fall.
Some falls happen because of circumstances that could not have been anticipated or controlled. Others occur while people are doing the very activities that help them remain active and connected. An avid pickleball player might step on a loose ball and fall. Someone who rarely leaves their room may have fewer opportunities to fall, but that does not necessarily mean they are healthier, safer, or living well. Perhaps our fall-prevention conversation needs to expand.
Rather than focusing exclusively on preventing falls, we can also prepare people for the possibility of losing their balance. Fall preparedness is about prevention, protection, recovery, psychological and social readiness, and continued participation in meaningful activities. It shifts the goal from simply avoiding falls to building capability, confidence, connection, and resilience.
Context Matters
We often assess fall risk by looking at physical measures such as gait speed, balance, strength, and mobility. Those things matter, but they aren’t the whole picture.
There is also research showing a connection between social isolation, loneliness, and falls in older adults. When people become less socially connected, they may have fewer opportunities or less motivation to get out, move and participate. Over time, doing less can lead to declines in strength, balance, and mobility, along with less confidence in their ability to move. It can become a cycle: less connection can lead to less movement, less movement can lead to less physical capacity and confidence, and that can lead to even more withdrawal.
Is staying home really safer if the cost is losing movement, connection, and participation? Supporting social connection and helping people stay engaged in activities that matter to them can be part of fall resilience, too. Instead of only asking, “How do we reduce this person’s fall risk?” we can also ask, “What matters to this person, and what can we do to help them keep doing it with confidence?” That feels much more consistent with healthy aging and with the lives people actually want to live.
There is another reason to think carefully about how we communicate fall risk: Fear of falling is itself associated with increased fall risk. Fear can lead people to restrict their activity, move less, and avoid situations they perceive as risky.
When Prevention Messaging Creates Fear
Much of the messaging around fall prevention begins with the data: The increased risk of falls among older adults and the serious consequences, including injury and mortality. While these statistics are important, they can also create an unintended message that falling is an inevitable part of growing older and that older adults need to be increasingly cautious because of their age.
There is another reason to think carefully about how we communicate fall risk: Fear of falling is itself associated with increased fall risk. Fear can lead people to restrict their activity, move less, and avoid situations they perceive as risky. Over time, that can contribute to declines in strength, balance, mobility and confidence, the very things that help people stay capable and resilient. In emphasizing how common and dangerous falls are, could we also be reinforcing the idea that falling is simply part of growing older?
We can tell a different story. Instead of focusing primarily on what might go wrong, our messaging can emphasize what people can do. People can stay strong and steady even when they notice changes in balance, strength, or vision. They can develop skills and confidence that help them navigate the challenges of everyday movement. Falling doesn’t have to be a part of aging. And aging doesn’t have to mean becoming afraid of movement. The goal is to make sure risk doesn’t become the entire story.
Positive, capability-based messaging can help people see that there are things they can do to maintain and build their physical capacity, confidence, and participation.
Asking Better Questions
The way we ask about falls matters, too. If people believe that reporting a fall could lead to being tracked, having their activities restricted, or losing some of their freedom and independence, they may not feel comfortable being completely honest. A question such as “Have you fallen recently?” may not tell us the whole story if the person is worried about what might happen as a result of answering yes.
Instead, we can ask questions that invite conversation and help us understand the context: What was happening when you fell? What do you think contributed to it? What were you able to do afterward? Has it changed how you feel about moving or participating in activities you enjoy?
These questions can give us a better understanding of the person without immediately turning a fall into a reason to restrict activity. The goal isn’t to ignore risk. It is to understand the person well enough to help them make informed choices about how they want to keep moving and participating.
If we acknowledge that we cannot prevent every fall, another question emerges: Can we teach people how to respond when they lose their balance? There are techniques for falling that can be learned and practiced. Adaptive Judo, for example, has been used as an approach for teaching older adults how to fall more safely, incorporating
techniques that help people learn how to manage their bodies when they lose balance. The FAST study also explored whether older adults could learn falling techniques.
Participants who received fall training demonstrated decreased head and hip acceleration when falling to the ground, suggesting that learning how to fall may help reduce the force experienced during a fall. This doesn’t mean we should stop working to prevent falls. Rather, it adds another layer to the conversation. Instead of asking only, “How do we stop this from happening?” we can also ask, “If something unexpected happens, can we give people the skills, strategies and confidence to respond?”
The way we ask about falls matters, too. If people believe that reporting a fall could lead to being tracked, having their activities restricted, or losing some of their freedom and independence, they may not feel comfortable being completely honest.
That is the shift from fall prevention to fall preparedness: preventing what we can, preparing for what we can’t, and giving people more tools to remain confident and engaged in life. These changes fit especially well with the original article’s argument that the goal is not simply avoiding falls, but building the capacity and confidence to continue participating in meaningful activities.
A Fall-Resiliency Framework
A fall-resiliency approach can encompass several interconnected areas:
● Prevention: Understanding environmental and physical factors that may increase fall risk.
● Protection: Developing strength, balance, mobility, speed and movement skills that may reduce injury.
● Recovery: Building the ability and confidence to get up from the ground.
● Psychological preparedness: Addressing fear, self-efficacy and confidence in movement.
● Social preparedness: Maintaining relationships, community participation and meaningful activities.
● Continued participation: Helping people continue doing the things that give their lives meaning. This framework expands the fall prevention conversation.
A narrow definition of safety can unintentionally lead us toward restriction: avoid the stairs, don’t dance, don’t go outside alone, don’t participate in activities that might result in a fall. Avoiding every possible risk is not necessarily the goal of healthy aging. The goal should be informed participation, helping people understand risk while developing the capacity and confidence to make decisions about the activities and experiences that matter to them.
For professionals working across aging services, healthcare, physical activity and senior living, this requires us to look beyond physical risk assessments. We can ask about social connection, confidence, meaningful activities, and the context of previous falls. We can create opportunities to practice real-world movement challenges. We can use language and imagery that portray older adults as capable rather than fragile.
Most importantly, we can change the question. Instead of asking: How do we prevent this person from falling? We can also ask: What would help this person move with greater confidence? Instead of: What activities should they avoid? Ask: What matters to them that they want to keep doing? Instead of: How do we make them safer? Ask: How can we build their capacity to respond to challenges?
We should prevent falls whenever we can. We should also prepare people for what we cannot prevent and help them maintain the confidence, connections and capabilities that allow them to keep participating in life.
Erin Eleu, BS, ACSM-CPT, is the founder of AGEnts of Movement and an older adult movement educator who helps leaders create experiences that build confidence, capability, and connection. Her work challenges ageist assumptions and reframes fall prevention through a broader lens of resilience, preparedness, and continued participation.
Photo credit: A participant in a How to Fall Safely class by Bryan DePhillip/Ukemi Health
