How to fall safely if you’re over 65

Dr Katrina McDonald is on a mission to bring the “F” word back. “We have a real problem confronting, or even just talking about, falling,” says the sport and exercise scientist. A senior lecturer at Anglia Ruskin University, she is also a dedicated judo coach and has just co-written a new programme for British Judo, aimed at teaching the over-65s how to do something that most strenuously try to avoid – taking a tumble. 

One third of people aged 65 and over will fall at least once a year. For those over 80, that proportion rises to 50 per cent, and bad falls can have nasty consequences. They are the second biggest cause of death by accidental injury (after only road accidents). An estimated 255,000 annual hospital admissions are related to falls in England alone. Charities, government policy and even the World Health Organisation therefore channel serious energy into preventing them. 

But there is a problem with these statistics and prevention programmes, suggests McDonald: “The fear of falling means you don’t want to risk it, so you stay at home more. Maybe you become isolated and lonely, which is bad enough. But you also reduce your mobility, so you lose muscle strength. Your gait changes. You become a bit less stable. Suddenly, you’re at greater risk of falling.” It’s a vicious cycle, and one that the new “Finding your Feet” programme aims to break. 

Judo might seem an unlikely hobby for retirees to take up, but the martial art embraces the practice of ukemi, or safe falling, says McDonald. The new programme will train judo coaches across the country to harness and adapt these techniques for use in special classes for older students. Di Cocksedge can already attest to their efficacy. “I’m a retired critical care nurse, so I’ve witnessed a lot of damage caused by elderly folk falling,” explains the 71-year-old from Suffolk. “When Katrina told me about her programme I was intrigued, and asked if I could be involved.” 

A month after learning the basic “safer falling” skills, a puppy darted between her feet and she toppled. “Somehow muscle memory kicked in. I rolled onto my side, tucking my head in and increasing my surface area by stretching my arm out. The only thing I damaged was my glasses and thank goodness for superglue.” 

She is not the only witness to the positive impact of such classes. Safer falling programmes are launching from Australia to Sweden. So what can McDonald and other experts in falling teach us about looking after ourselves when we lurch?

Protect your head

The first rule of falling is to protect your head. “If you’re falling onto your back, tuck your chin to your chest, to stop it from hitting the floor first,” says McDonald. If you are falling forwards, you also want to turn your head to the side, to protect your nose, she explains. Andreas Petrides – another expert in falling safely – seconds this advice. 

Founder of the British Action Academy, he teaches stunt artists and was himself Ewan McGregor’s stunt double in Star Wars: Episode I – The Phantom Menace. Tucking your chin to your chest can also prevent violent jolts to the head, and protect you from whiplash, he explains.  

Spread your surface area

“When I teach students how to fall, they learn to do it without using their hands, as these are the first parts of the body to get injured when hitting the ground,” says Petrides. Repeated training means he now does the same, instinctively: “On one occasion I was going to dinner with friends and walking along a road when I suddenly tripped on a broken slab and fell forwards. I rolled over and stood back up without taking my hands from my pockets, so that was my proof that it works!”

While most of us could not, and should not, be following in Petrides’s footsteps, we could benefit from developing alternative strategies to the most commonly adopted protection mechanism – thrusting our arms out. 

The instinctive gesture protects our heads, but channels the impact of a fall into our wrists, risking fracture. The bad habit even has its own acronym – “foosh” or “falling on outstretched hands”. So what should we do instead? Spread the impact of your fall over the biggest surface area possible, suggests McDonald. 

Falling backwards? As soon as your bottom hits the ground, roll backwards with the momentum. When your waistband touches the floor, you should bring your arms down, so that their full lengths make contact with the ground, and the shock is spread along them. “Bottom, lower back, arms,” summarises McDonald. “You’re making a big surface area and dissipating the energy of the fall across it.”

Falling forwards? You want the length of your forearm – “from your fingertips to your elbow” – to meet the ground flat, not just your hands. These techniques, along with the timing and order in which you implement them, are covered in the new Finding your Feet programme, McDonald explains. The best thing to do, she suggests, is to get in touch with your local judo club, see if they are offering it yet, and learn from an expert. 

Fall on your side

Another way to limit your risk of injury is to try to land on your side, says Petrides. His advice is echoed by leading physiotherapist Sam Bhide, who works both within the NHS and privately, and is also a pilates instructor. 

“If you realise you are losing your balance and can’t correct it, then falling on your side will mean you land more on the soft tissues, rather than joints and bones,” she says. Aim for the side of your thigh, buttock and upper arm. The ideal is to end up in the recovery position: “Swing your arms to the side as you fall, and bring them up to protect your face and cover your head.”

Relax downwards

The higher the position from which you fall, the greater the risk of injury, explains Bhide. So if you cannot correct your balance: “Try to fall almost as if in slow motion, lowering your centre of gravity intentionally.” Bend your knees and elbows, keeping your feet on the floor if possible. While your instinct might be to tense and brace for impact, “try to relax and release to the ground, almost like a waterfall or a sack of beans. It will lessen the impact of the fall,” suggests Bhide. 

Supplements to support safer falls

A 2020 meta-analysis of randomised controlled trials found that taking vitamin D supplements, especially if it is vitamin D3, can reduce the incidence of falls. But when falls did occur, taking the vitamin in combination with calcium reduced the risk of fracture, it found. Bhide recommends Adcal D3, which combines vitamin D and calcium in a chewable pill. It is, she suggests, especially beneficial for post-menopausal women, since a lack of oestrogen weakens bones. 

Exercises that can help too

“One good study showed that, for people in their 50s and 60s, not doing strengthening exercises not only puts them at greatest risk of a fall, but also heightens their risk of a poorer prognosis and recovery when they do have falls,” says Bhide.

The latest guidelines from the Royal Osteoporosis Society suggest we should do some weight-bearing exercise on most days (with the duration depending on your fitness and frailty) in order to maintain bone strength, and strengthening exercises to build muscle two or three times a week. This really will make a difference to how well you can control your fall, suggests Bhide, “because when you fall, you’re going to trust your knees, and the larger muscle groups in the body, to bring you down in a safer manner and protect you”.

Taking the stairs regularly is a good start, she suggests. A simple “sit to stand” exercise is also highly beneficial and involves gently raising and lowering yourself into and out of a chair “in a controlled manner”, using the muscles in your lower body, like quadriceps, hamstrings, glutes and calves. 

“Raising yourself up and down onto your tiptoes is also a good simple exercise to do at home,” suggests Bhide. “Try it while you’re brushing your teeth, or filling the kettle. It will improve your calf muscle strength, and so your balance and control.”

McDonald also suggests making use of your tea breaks. “Build up your neck strength by putting your chin to your chest a few times while you wait for the kettle,” she advises. “Then, if you fall, you’ll be more able to tuck your chin and protect your head.”

“I’m not suggesting we can eliminate all injuries from falling by teaching these techniques,” she explains. “But when we try to cut incidents of drowning, we don’t just tell people to avoid the water. We teach them to swim. The same should apply to cutting back the worst consequences of falling. Let’s teach people techniques to keep them safer when it does happen, so that they can get more out of life, for longer.”