My older parent is afraid of falling. How can we help?

If your older parent is afraid of falling, take the worry seriously and turn it into a plan rather than telling them not to worry. Fear of falling is common among older Thai people, even in those who have never fallen: in a study near Bangkok, 21.7% of older people who had never fallen were afraid of it. The US CDC explains that this fear can make people cut down on everyday activities, and being less active makes them weaker, which raises the chance of falling. The steps that help are practical: check the home, especially the bathroom, lighting and steps, keep your parent doing strength and balance exercises, have medicines, eyes and hearing checked, agree on what to do if a fall happens, and tell a doctor about any fall.

This article is about the fear of falling and falls. If your parent finds it hard to get up from a chair, see My parent struggles to get up from a chair. What can we do?

Is it common for older parents to be afraid of falling?

What Thai studies found

Two Thai studies asked older people directly about their fear of falling.

• In Sitdhiraksa and colleagues' study at Siriraj Hospital, Mahidol University (2021), 210 people aged 60 to 85 in four suburban communities near Bangkok were interviewed and examined. A quarter (25.2%) had fallen before. Fear of falling was found in 35.8% of those who had fallen and 21.7% of those who had not.
• In Silangirn and colleagues' survey in northern Thailand, 369 people aged 60 and over answered a standard fear-of-falling questionnaire in April and May 2024. Only 12.7% had fallen in the previous year, yet 38.2% had a high level of concern about falling and 22.5% a moderate level.

Fear does not depend only on past falls

In the study near Bangkok, fear of falling went together with being a woman, being 80 or older, living alone, poorer balance and having difficulty with daily activities, but not with having fallen before. In other words, a parent who has never fallen may still be very worried. In that study, fear went together with poorer balance and difficulty with daily activities, though the study cannot say which came first.

Why the fear is worth acting on

The CDC describes a loop: many people who fall, even without injury, become afraid of falling; the fear makes them cut down on everyday activities; and being less active makes them weaker, which raises the chance of falling again. The CDC also notes that falling once doubles the chance of falling again. Taking the fear seriously, and dealing with the reasons behind it, helps your parent stay active.

How often do older Thai people fall, and where?

Findings from Thai studies

What these numbers can and cannot tell us

The studies used different time periods (6 months, 1 year or since age 60), different places and different groups, and falls were remembered and reported by the people themselves, so small falls are easily forgotten. They show links, not proof of cause. The national survey by Jitapunkul and colleagues was published in 1998, so it reflects older data. But across studies, roughly 1 in 5 to 1 in 4 older people had fallen, and the area around the house and the bathroom come up again and again.

Most falls cause bruises, but they still count

In the Surat Thani study, almost everyone who fell (97.2%) reported some health problem afterwards, though most were relatively minor: swelling or bruising, pain and scrapes made up 85.7% of them. A fall that "only" causes a bruise is still worth telling a doctor about: the NHS advises seeing a GP if you have had a fall.

Which places in a Thai home should we check?

The CDC's Check for Safety checklist goes room by room. Use the examples below as a list of things to look at, not a score.

What Thai studies add

Thai homes have their own risks. The national survey analysed by Sophonratanapokin and colleagues found that slippery floors on the ground floor, a slippery bathroom floor and a toilet outside the house were each linked with more falls. A study of rural homes in Ubon Ratchathani by Boonkhao and colleagues, surveyed in August to October 2023, linked falls with poor lighting in the living room, bathroom, bedroom and parking area, with wires and other obstacles in the path, and with stairs whose steps were uneven in height or slippery.

Based on these findings, in many Thai homes it may be worth looking closely at wet bathroom floors, steps down to an outdoor toilet and a dark yard at night.

For night-time trips to the bathroom, see also Older parents waking up at night: how can family help?

What else helps my parent feel steadier on their feet?

England's NHS falls page lists things people at risk of falls can do. Besides making the home safer, they include the following.

Strength and balance exercises

The NHS physical activity guidelines for older adults say that if you have fallen or are worried about falling, exercises to improve strength, balance and flexibility will help make you stronger and feel more confident on your feet, and list tai chi among the muscle-strengthening activities. The NHS falls page advises people at risk of falls to stay active, being active every day and doing activities that improve strength and balance at least twice a week. For simple exercises to do at home, see My parent struggles to get up from a chair. What can we do? Ask a doctor which kind of exercise suits your parent.

A medicine review

The NHS lists side effects of some medicines among the causes of falls, and advises speaking to a GP or pharmacist if you think your medicines could be affecting your balance. Take all medicines, including those bought without a prescription, to that appointment. In the Bangkok clinic study, people using medicines that cause sleepiness were more likely to have fallen. Do not stop or change a medicine on your own.

Eyes and hearing

The NHS advises regular eye tests, and having the ears and hearing checked, as ear problems can affect balance. It lists problems with eyesight or hearing among the causes of falls.

Shoes and slippers

In the Surat Thani study, 71 people who fell named their footwear or clothing as a factor, and most of them (71.8%) mentioned slippery shoes. The NHS advises shoes or slippers that fit well, do not slip off and have a good grip.

How can I talk with my parent about the fear?

Listen first

Ask what exactly worries them: the bathroom, the stairs, walking to the market, or getting up at night. The answer tells you where to start. Rather than only reassuring them, you can begin with the place that worries them, such as the bathroom floor or a dark path.

Make a plan for what to do after a fall

The NHS advises people at risk of falls to make a plan in case they do fall, and to wear a personal alarm or carry a mobile phone. It also describes how to get up if you feel able to: take your time, roll onto your side, get onto your hands and knees, crawl to something stable such as a heavy piece of furniture, put one foot flat on the floor and stand up slowly, then sit down and rest. If they cannot get up, they should call for help, keep warm and change position about every 30 minutes. Talking this through ahead of time can make the fear feel more manageable.

Encourage your parent to tell the doctor

In a Thai study of 305 older people who had fallen in the past year by Boongird and Ross, only 39% had told their doctor about the fall. Pain after the fall (84%) was the main reason people did tell, and some believed that falling is an unavoidable part of life. A fall without pain is still worth mentioning.

When should we see a doctor, and when should we call 1669?

See a doctor if

• your parent has had a fall, even a small one
• they or you are worried about their balance, or they feel unsteady when walking
• they feel dizzy or light-headed, especially when getting up
• they take regular medicines and seem sleepier or less steady than before

The NHS advises seeing a GP if you are worried about your balance or mobility, or if you have had a fall, and says a doctor may check balance by asking you to get up and move around.

Call 1669 straight away if

• your parent has fallen and may have hurt their head, neck, back or hip
• they cannot get up

If someone else has fallen, the NHS advises keeping them comfortable and warm and helping them up carefully only if they can do it, rather than trying to lift them yourself.