After 65, a fall is never trivial: it reveals an imbalance between a person’s abilities and their environment, and it often comes before a loss of independence. Most of its causes can be identified with a few questions and two simple tests, and corrected: medications, vision, strength, footwear, the home. The prevention check-up at ages 70–75 makes it a priority.
Why is fall prevention in older adults a priority?
Because in people aged 65 and over, falls are the most common accident and the one with the most serious consequences. Santé publique France, the French public health agency, reports that more than 20,000 people aged 65 and over died in connection with a fall in 2024 and that about 175,000 were hospitalized for this reason in the same year. The 2022–2024 national fall prevention plan for older people, launched by the French ministry responsible for social affairs (Solidarités), aimed to reduce fatal or disabling falls among people aged 65 and over by 20%.
The French National Authority for Health (HAS) defines a fall as unintentionally ending up on the ground, and speaks of repeated falls from two falls within twelve months. What worries us most is not a one-off fall in a fit person; it is the chain reaction: a fall, fear of falling again, going out less, less muscle, less appetite, another fall, then the hip fracture or hospital stay that tips the person into dependency. Breaking this spiral as early as possible is the goal of fall prevention in older adults.
We also see “harmless” falls that the person has told no one about. So the first question of the check-up is simple: have you fallen in the last twelve months, even without hurting yourself?
What are the risk factors for falls?
The HAS distinguishes predisposing factors, which cause lasting vulnerability, from precipitating factors, which trigger the fall on a given day. Most can be modified, at least in part.
| Predisposing factors (underlying) | Precipitating factors (triggers) |
|---|---|
| Age 80 and over, female sex | Orthostatic hypotension (drop in blood pressure on standing up) |
| Polypharmacy (many medications), sleeping pills and anti-anxiety medications | Dizziness, feeling faint, sudden neurological deficit |
| Gait and balance disorders, muscle weakness | Hyponatremia, hypoglycemia |
| Osteoarthritis, foot abnormalities, sensory disorders | Excessive alcohol consumption |
| Reduced vision | Environmental factors: rugs, lighting, stairs, shoes |
| Depressive syndrome, cognitive decline | Acute illness (infection, dehydration) |
Most people who fall have several factors at once. It is this accumulation that the prevention check-up seeks to break down, topic by topic, to choose the one or two levers that matter most for you.
What simple tests can assess the risk?
Two tests recommended by the HAS can be done in the office, in under five minutes, with no equipment: the Timed Up and Go and the one-leg stance test. They do not make a diagnosis; they identify a risk and guide next steps.
- The Timed Up and Go: stand up from a chair, walk three meters, turn around, come back and sit down. A time of 20 seconds or more signals a risk of falling according to the HAS.
- The one-leg stance test: stand on one foot. Not getting past 5 seconds signals a risk.
- The three questions: have you fallen in the past year, are you afraid of falling, do you feel unsteady when walking.
The check-up adds a blood pressure measurement while standing and lying down (orthostatic hypotension), a look at the feet and shoes, vision, and the list of medications. In case of repeated falls or an abnormal test, the HAS recommends a more complete assessment by the regular doctor (médecin traitant), sometimes in a geriatric clinic, and targeted physiotherapy.
How can you adapt your home?
A large share of falls happen at home, during ordinary movements: getting up at night, stepping out of the shower, reaching for something up high. The national portal pour-les-personnes-agees.gouv.fr recommends planning home adaptations ahead rather than rushing them after a fall.
| Room or situation | What causes falls | What you can do |
|---|---|---|
| Walkways, hallway | Loose rugs, electrical cords, dark areas | Remove or secure rugs, clear passageways, lighting with no dark areas |
| Night | Walking from bedroom to toilet in the dark | Lit path or night-lights, a lamp within reach, getting up in two stages |
| Bathroom, toilet | Slippery floor, high-sided bathtub, low toilet | Non-slip surfaces, grab bars, walk-in shower, raised toilet, shower seat |
| Stairs | Worn steps, no handrail, poor lighting | Handrails on both sides, contrasting stair edges, light switches at the top and bottom |
| Kitchen | Items stored up high, stepladder | Store everyday items at hand height, a stable stool |
| Footwear | Open-backed slippers, smooth soles | Closed shoes that hold the heel, non-slip soles |
Help is available: assistive technology information and advice centers (CICAT) give free, non-commercial advice on equipment, an occupational therapist can assess the home, and MaPrimeAdapt’ (a French government grant for adapting homes to aging) funds adaptation work, subject to eligibility. Telecare (a pendant or wristband alarm) is one of the five pillars of the fall prevention plan: it does not prevent falls, but it keeps people from lying on the floor for hours.
What adapted physical activity after 65?
The fall prevention plan presents physical activity as the best weapon against falls. The HAS recommends walking regularly and, after repeated falls, physiotherapy including balance work and muscle strengthening. International guidelines add, for people aged 65 and over, varied multicomponent activities that emphasize balance and strength, several days a week.
In practice, here is what we suggest in the personalized plan:
- Walk every day, even for fifteen minutes, outdoors if possible, with a relative at first if fear of falling has set in.
- Work on balance: stand on one foot while holding on to the kitchen counter, walk heel-to-toe along a hallway, stand up from a chair without using your hands, ten times.
- Strengthen your legs: climbing stairs, half-squats while holding a chair, exercises with a resistance band.
- Join a group: “balance” or “fall prevention” workshops offered by many towns, pension funds, and associations, gentle exercise classes, tai chi, water aerobics.
After a chronic illness or a loss of independence, the doctor can prescribe supervised adapted physical activity. The goal is not performance: it is to keep the strength to get up from a chair and the balance to turn around without wobbling.
Why review medications?
Because medications are one of the most common fall factors and one of the easiest to correct. Sleeping pills, anti-anxiety medications, some antidepressants, blood pressure medications and diuretics (which lower blood pressure on standing up), diabetes treatments (hypoglycemia), and more generally polypharmacy increase the risk. The HAS lists prescription review among the recommended interventions after a fall.
The prevention check-up at ages 70–75 is the right time: bring all your prescriptions and all your medication boxes, including over-the-counter products, “occasional” sleeping pills, and supplements. For each treatment, the review checks that it is still indicated, that the dose is suited to your age and kidney function, and that it does not duplicate another. The pharmacist plays a key role, at the pharmacy or as part of the prevention check-up carried out by a pharmacist; any changes are up to the prescribing doctor. A sleeping pill taken for twenty years is not stopped overnight, but it can be tapered, gradually, with support.
Vision, hearing, feet, and bones: the forgotten checks
Four quick checks prevent falls and tend to be forgotten because they fall under different professionals.
- Vision: cataracts, glaucoma, ill-suited glasses, progressive lenses poorly tolerated on stairs. A recent eye exam is part of the check-up; the HAS recommends checking visual acuity when assessing people who fall.
- Hearing: uncorrected hearing loss impairs balance, attention, and social life. A hearing test and, if needed, hearing aids available with no out-of-pocket cost under the “100% Santé” scheme.
- Feet: pain, deformities, nails, loss of sensation (diabetes). Closed shoes that hold the heel and a podiatrist if needed.
- Bones: so that a fall does not become a fracture. For people who fall, the HAS recommends a calcium intake of 1 to 1.5 g per day and a vitamin D intake of at least 800 IU per day, plus osteoporosis treatment if needed. Osteoporosis affects 39% of women around age 65 and 70% at 80 and over, according to French National Health Insurance (Assurance Maladie); we explain how it is detected in menopause and bone health prevention.
What role for caregivers and the prevention check-up?
Fall prevention in older adults is the first topic of the prevention check-up at ages 70–75, a 30- to 45-minute consultation fully covered (100%) by French National Health Insurance, with no upfront payment, once within the age range. It can be done at home by a nurse, who can then look around the home with you; see the prevention check-up carried out by a nurse. The topic can be anticipated as early as the prevention check-up at ages 60–65, when work on strength and balance begins.
Caregivers — spouse, children, neighbors — see what the consultation does not: the gait that is changing, the rug the person refuses to remove, the evening sleeping pill, the fear of going out. With the person’s consent, they can take part in the check-up, help fill out the self-assessment questionnaire, bring the prescriptions, and then bring the plan to life: accompanied walks, the first balance workshop, replacing light bulbs. We also encourage them not to carry everything alone: a fall isolates the person who falls as much as the one who watches over them, and social isolation in older adults is itself a risk factor.
The Personalized Prevention Plan sets one or two goals, not ten: “review the sleeping pill with the pharmacist, then the doctor,” “sign up for the town’s balance workshop,” “grab bars installed before the end of the month.” It is sent to the regular doctor unless the person objects.
Key takeaways
- A fall after 65 is never trivial: report it, look for its cause, and avoid the spiral of fear, inactivity, and another fall.
- Risk factors add up and can be corrected: medications, vision, strength and balance, feet and footwear, the home.
- Two simple tests in the office (Timed Up and Go, one-leg stance) and three questions identify the risk.
- Regular physical activity with balance and strengthening, adapting the home ahead of time, reviewing prescriptions: the three most effective levers.
- The prevention check-up at ages 70–75, which can be done at home with a nurse, makes it a priority; caregivers can take part with the person’s consent.
What Sokrate lets you do
The Sokrate service offers an online preparation questionnaire, to fill out alone or with a relative, that reviews falls in the past year, fear of falling, medications, vision, hearing, and the home. You arrive at the check-up with your priorities identified; the personalized plan is signed by a doctor, a letter is sent to your regular doctor unless you object, and a care coordination nurse provides follow-up. You can prepare a loved one’s prevention check-up or your own today; the general framework is described in the prevention check-up.