A fall is a frequent and serious event for older adults, with approximately one in four adults over age 65 experiencing a fall each year. These incidents are the leading cause of both fatal and nonfatal injuries in this age group, underscoring the need for a prepared and structured response. Knowing what to do in the moments following a fall can prevent further injury.
Immediate Triage and Injury Assessment
Once a fall occurs, the helper must remain calm and approach the fallen person slowly, speaking in a reassuring tone. Attempting to move the person immediately is a common mistake that can worsen unseen injuries, such as fractures or spinal trauma. The first step in triage is to determine the person’s level of consciousness by checking if they are responsive and can answer basic questions.
Next, perform a visual sweep for obvious signs of severe injury while the person remains still on the floor. Look for profuse bleeding, limbs lying at unnatural angles, visible bone fragments, or signs of head trauma, such as fluid draining from the ears or nose. If the person is conscious, ask specific questions about their pain, such as where it hurts and if the pain is sharp or dull. Ask them to gently wiggle their fingers and toes to check for basic sensation and movement in the extremities.
If the assessment suggests a severe injury, particularly to the head, neck, or spine, the person must be told to remain exactly where they are. While waiting for professional medical assistance, keep the person warm with a blanket and offer a drink of water, provided they are not nauseous or showing signs of a head injury.
Determining When to Call Emergency Services
Call the local emergency number, such as 911, if the initial assessment reveals high-risk indicators. Mandatory reasons for an immediate emergency call include any loss of consciousness, even if momentary, or signs suggestive of a head injury, such as severe headache, repeated vomiting, or significant confusion. Additionally, if the person reports severe, unrelenting pain, or is unable to move a limb or bear any weight on a leg, a fracture, such as a broken hip, must be suspected.
A suspected hip fracture often presents with pain in the groin or an inability to rotate the leg. An emergency call is also necessary if there is uncontrolled bleeding or symptoms of internal injury, like severe abdominal pain. Even if the person appears uninjured but is unable to get up on their own, emergency medical services should be contacted for a safe lift assist. When speaking to the dispatcher, provide the exact location, the person’s age, known medical conditions, and a concise description of the fall and the current injuries.
Step-by-Step Guide for Safe Assistance
If the person is conscious, confirms they are not in severe pain, and can move their limbs without difficulty, a safe, step-by-step method can be used to assist them up. The helper should provide guidance and stability, allowing the person to do as much work as possible. First, encourage the person to roll onto their side, which helps adjust blood pressure and prevents dizziness upon rising.
They should then push up onto their hands and knees, resting briefly to regain stability. The person should then crawl toward the nearest sturdy piece of furniture, such as a heavy chair or sofa. Once at the furniture, they should place their hands on the seat for support, bring the strongest foot forward, and push up into a kneeling lunge position. The helper can steady the furniture or offer a steadying hand, but must avoid lifting with their back.
After a brief rest in the lunge position, the person uses their arms and legs to push themselves up to a standing position, pivoting to sit immediately on the chair. Allow the person to rest for several minutes after each stage to prevent orthostatic hypotension, a sudden drop in blood pressure that can cause dizziness and lead to a second fall. The helper must confirm the person feels completely steady before allowing them to attempt walking.
Post-Fall Monitoring and Follow-Up Care
Even if a fall seems minor and the person is able to get up, a period of close observation is necessary, especially for signs of a delayed concussion. The person should be monitored for at least 24 to 72 hours for symptoms like increasing confusion, unusual drowsiness, persistent headache, or repeated vomiting, all of which warrant immediate medical attention. Delayed bruising and swelling can also appear, indicating a deeper injury.
Schedule a doctor’s appointment soon after any fall, regardless of injury severity. This visit allows a healthcare professional to perform a full post-fall assessment to rule out subtle injuries, such as hairline fractures. The doctor can investigate the underlying cause of the fall, which may include reviewing medications for side effects, checking for orthostatic hypotension, or assessing gait and balance issues. Identifying and addressing the root cause is essential, as the risk of falling again significantly increases after a first incident.