Falls Prevention for Older Adults in Hertfordshire

About a third of people over 65 fall at least once a year. Most of those falls do no lasting damage, but they change behaviour: people stop going out, stop doing the things that keep them strong, and so become more likely to fall again. The good news is that falls are one of the few risks in later life that respond well and predictably to the right kind of exercise.

Why do falls happen?

Almost never for one reason. A fall is usually several small things lining up at once, and that is why fixing one of them often is not enough.

• Leg strength — the commonest and the most fixable. Strength declines from around 30 and accelerates after 70, particularly if you have had a spell of illness or hospital.
• Balance and reaction — the reflexes that catch a stumble slow down, so a trip that would once have been a wobble becomes a fall.
• Medication — blood pressure tablets, sedatives, sleeping tablets and antidepressants all raise the risk, and the risk rises again with the number of medicines taken. This is worth a medication review at the GP, not a change you make yourself.
• Blood pressure dropping on standing — a common cause of the fall that happens getting out of a chair or out of bed.
• Eyesight — and specifically varifocals, which distort the edge of a step.
• Feet and footwear — pain, deformity, and slippers with no back to them.
• The house itself — rugs, trailing flexes, poor lighting on the stairs, no rail on one side.
• Fear of falling — which makes people move cautiously and stiffly, and cautious stiff walking is itself less stable.

What actually reduces the risk?

This is one of the better-evidenced areas in physiotherapy, and the answer is fairly specific. Exercise reduces falls, but only certain exercise does.

What works: programmes that challenge balance properly, combined with progressive strength work for the legs, done at least twice a week and continued over months. The balance component has to be genuinely challenging — standing with the feet together or one in front of the other, reaching outside your base, moving your head while standing, stepping in different directions. If it is comfortable, it is not training balance.

What does not: walking on its own. Walking is good for plenty of things but it does not improve balance or build leg strength, and programmes based on walking alone do not reduce falls. Gentle seated exercise has the same problem: it is better than nothing, but it does not train the thing that fails.

The other evidenced components are a medication review, an eyesight check, vitamin D where someone is deficient, and modifying hazards in the home — with the last one working best when a professional does the assessment rather than a leaflet.

What does a home falls assessment involve?

An hour, in your house, and it covers three things.

You. Standard tests that give a number to work from: how many times you can stand from a chair in thirty seconds without using your arms, how long you can hold a tandem or single-leg stance, how long it takes to stand up, walk three metres, turn and sit down. Plus a look at how you actually walk, and your blood pressure sitting and standing if the falls happen on standing up.

Your house. Walked through room by room. Stair rails and whether there is one on both sides, lighting and whether there is a switch at each end, the height of the bed and the chair, rugs, thresholds, flexes, the bathroom, and the route you take at night.

Your life. What you have stopped doing, and what you want to get back to. That is what the programme is built around, because a programme aimed at nothing in particular does not get done.

What does the exercise look like?

Usually a short daily routine rather than a long weekly one, built from things you can do in your own kitchen holding the worktop. Sit-to-stands from your own chair, heel raises at the sink, stepping practice, standing with the feet closer together and then in line, and weight shifting. It progresses by removing hand support, narrowing the base, and adding load — not by adding more repetitions.

Six to twelve weeks in, most people can measurably do more. The chair-stand count is the easiest thing to watch, and it is usually the first to move.

What should I do if I have already fallen?

Tell your GP, even if you were not hurt. A fall is the single best predictor of the next one, and it should trigger a medication review and a look for the cause. If you are struggling to get up from the floor, that is worth practising with a physiotherapist — the technique for getting up via a chair can be learnt, and it removes a good deal of the fear.

Hertfordshire has an NHS falls service, and your GP can refer you. Private home physiotherapy is an alternative where you would rather not wait, or an addition where you want more sessions than the service provides.

Why a home visit suits this particularly well

Falls happen in the house, mostly on the stairs, getting out of a chair, or on the way to the bathroom at night. A clinic cannot assess any of those. Working in the actual rooms, on the actual stairs, with the actual chair, means the programme fits the place the problem lives.

Home visits across Hertfordshire

Falls prevention assessments and strength and balance programmes are available at home across St Albans, Harpenden, Watford, Hemel Hempstead, Stevenage, Hertford and across Hertfordshire.

About Leah Edwards

Leah Edwards is a chartered physiotherapist (MCSP, HCPC PH122795) providing home visit physiotherapy across St Albans, Harpenden, Watford, Hemel Hempstead, Stevenage, Hertford and across Hertfordshire. She qualified with a First from London South Bank University in 2020, spent her early career in the NHS in intensive care, medical rehabilitation and musculoskeletal outpatients, and has worked in private clinics around St Albans and Harpenden since 2022. She also spends one day a week in a private hospital treating people after hip, knee, shoulder and foot or ankle surgery. She assesses and diagnoses directly, so there is no wait for a GP referral before treatment can start.

Read Leah's profile or call 07490 128910.

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