Falls: What to Do After One, and How to Prevent the Next

Call 911 if someone cannot get up, hit their head and is confused or drowsy,
has obvious deformity, is in severe pain, or has been on the floor for a long
time.

Come in today — even feeling fine — if:

• They hit their head and take a blood thinner. This is the most important
  line on the page.
• They hit their head at all and are over 65, or are on aspirin
• There is pain in the hip, groin or thigh, even if they can walk
• They cannot remember the fall, or lost consciousness however briefly
• They were on the floor for more than an hour
• They fell outdoors in summer — see the burn section below

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Why a head strike on a blood thinner is different

A bleed inside the skull can develop slowly. Someone can hit their head,
feel fine, talk normally, make a cup of tea, and deteriorate hours or even
days later. Blood thinners — including the newer ones, and aspirin — make that
considerably more likely.

So the decision is not "do they seem all right." It is "did they hit their
head, and are they on anything that thins the blood." If yes, that is a CT
scan conversation today rather than a wait-and-see.

And afterwards, for the next week: a new or worsening headache, vomiting,
unusual drowsiness, confusion, weakness on one side, or a change in personality
means come back. Tell whoever is around to watch for it, because the person
themselves may not notice.

An older adult can walk on a broken hip

Pain in the groin or thigh after a fall is worth an X-ray even if they stood
up and walked to the car. Being able to weight-bear is not evidence against a
fracture, and a hip fracture found late is a much worse outcome than one found
the same day.
More on injuries and imaging

A long time on the floor is its own injury

If someone has been down for hours — overnight, or unable to reach a phone —
the time on the floor matters as much as the fall. Dehydration, muscle
damage that can injure the kidneys, pressure injuries, and a body temperature
that has drifted in either direction.

Bring them in even if nothing appears broken. This is one of the situations
where the visible injury is the least of it.

The Arizona version: a fall is often also a burn

Ground temperature in a Phoenix summer is high enough to cause a serious burn
in a short time, and what determines depth is how long the skin stays in
contact with it. Someone who falls on a driveway, a patio, pool decking or a
road and cannot get up quickly is sustaining a burn while they wait for help.

Treat it as both. Cool the burned skin while you are working out whether
anything else is wrong, and mention it when you arrive — it is easy to
overlook next to a possible fracture.
More on burns

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Why the fall itself matters even when nothing breaks

Falls are the leading cause of injury death for adults 65 and over — over
43,000 deaths in 2024 on the CDC's figures, and about 4.5 million emergency
department visits in the same year.

That second number is the one to sit with. The overwhelming majority of
those 4.5 million people went home afterwards. A fall that breaks nothing is
still the most useful warning most people ever get, and it is usually treated as
an embarrassment instead.

A fall is information. Most are not simply bad luck, and the useful question
afterwards is why did this happen, because the answer is often fixable and
usually predicts the next one.

Common and correctable causes:

• Medication. The single biggest lever. Anything sedating, anything for
  blood pressure, sleeping tablets, some antidepressants, and — most of all —
  several of them together. A medication review is the most effective fall
  prevention there is. Do not change anything yourself; ask for the review.
• Blood pressure dropping on standing. Getting up and feeling grey or
  swimmy. Common, easy to test for, often adjustable.
• Vision. An out-of-date prescription, cataracts, or varifocals on stairs.
• Feet and footwear. Pain, numbness, slippers without backs, worn soles.
• Dehydration, which in this climate is a year-round contributor and not
  merely a summer one.
  More on dehydration
• Alcohol, including an amount that was fine ten years ago.
• Strength and balance, which decline quietly and respond to work.

If you have fallen once, your risk of falling again is higher than it was.
That is not a reason for gloom — it is the reason to ask why, once, properly.

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Prevention that is actually worth the effort

Most advice on this is a long list of equal-looking bullet points. These are
not equal. In rough order of what changes outcomes:

1. Get the medications reviewed. Everything else is smaller than this.
2. Do strength and balance work. Not walking — walking is good for other
   things. Balance and leg strength specifically, and it works at any age.
   In this climate that means indoors or early morning for much of the year.
3. Have your eyes checked, and be careful on stairs in varifocals.
4. Stand up in two stages. Sit on the edge of the bed or chair for a
   moment before rising. It costs nothing and prevents a common fall.
5. Fix the floor. Loose rugs, trailing cables, the box in the hallway.
6. Light the route you walk at night, bed to bathroom especially.
7. Wear shoes indoors that fit and have backs.
8. Grab rails where you actually need them — bathroom and stairs — rather
   than wherever they are easiest to fit.

And the one nobody mentions: tell someone you fell. Falls go unreported
because people fear losing independence, and an unreported fall cannot be
investigated. The thing most likely to cost someone their independence is the
fall nobody looked into.

Something you can do in the next ten minutes

Number one on that list — get the medications reviewed — is easy to agree
with and easy to never book. Here is the step that makes it happen.

The National Council on Aging publishes a
Falls Free CheckUp: thirteen
questions, a falls-risk score, and a report you can take to the appointment.
Several of the questions are about exactly the medicines this article puts
first — anything that causes light-headedness, anything for sleep or mood.

That turns "you should get your medications reviewed" into a piece of paper
with your own answers on it, which is a different conversation from arriving
empty-handed. It is free, it takes a few minutes, and it is the tool the CDC
points to.

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What happens when you arrive here

• A physician sees you — board-certified, every visit, at every hour.
• CT and X-ray on site — the two tests this presentation most often needs,
  available at any hour.
• Laboratory work in the building, which matters after a long time on the
  floor.
• A critical care room here for the presentations that need one.
• Monitoring for up to 24 hours, which is useful after a head injury
  specifically, since the point of concern is a change over hours rather than
  anything visible on arrival.

If admission, surgery or specialist care is needed, we stabilise and arrange
the transfer. We are an emergency room, not a hospital.

What helps us most: what happened and whether anyone saw it, whether there
was any loss of consciousness, a full list of medications including blood
thinners and anything bought over the counter, and whether there have been
other falls recently.

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El Mirage ER — open 24 hours a day, 7 days a week, 365 days a year.
12000 N El Mirage Rd, El Mirage, AZ 85335 · (480) 237-4922
Walk in. No appointment, no referral.
If this is a medical emergency, call 911.

This article explains when to seek emergency care. It is not medical advice and
cannot account for your history, your medications, or what has happened. If you
are unsure, call us or call 911.

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Sources

The guidance in this article about when to seek emergency care is drawn
from these public sources. Each one is linked so you can read it yourself.

• Centers for Disease Control and Prevention — About Older Adult Fall Prevention — https://www.cdc.gov/falls/about/index.html
• MedlinePlus (National Library of Medicine) — Falls — https://medlineplus.gov/falls.html
• National Council on Aging — Falls Free CheckUp — https://www.ncoa.org/tools/falls-free-checkup/

This article is general information, not a diagnosis, and it cannot account
for your history or medications. If you are unsure, call us on (480) 237-4922
or come in. If it might be an emergency, treat it as one and call 911.

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