Falls in older adults: how exercise and physical therapy help prevent them

Falls are not just a normal part of getting older, and most of them can be prevented. That matters, because they are common and they can change a person’s life. More than 14 million US adults 65 and older, about 1 in 4, report falling every year [1]. In 2024, falls in this age group led to about 4.5 million emergency department visits and more than 43,000 deaths, making them the leading cause of injury death for older adults [2].

Falls also cause most hip fractures in older people, and they are the most common cause of traumatic brain injuries in this age group [3]. Yet fewer than half of older adults who fall tell their doctor, and falling once doubles your chances of falling again [3].

The risk rises sharply with age

• Age 65–7419.0
• Age 75–8475.3
• Age 85 and older338.0

Source: National Center for Health Statistics, MMWR QuickStats, 2026 [4]. Crude rates from 2024 death certificate data.

Nationally, the age-adjusted fall death rate for older adults rose 21% between 2018 and 2024 [1].

Falls in Utah

Utah’s numbers are higher than the national average. In 2023, unintentional falls caused 386 deaths in Utah, and 85.5% of them were adults 65 and older [5]. In 2022, the fall death rate among Utahns 65 and older was 9.7 per 10,000, compared with 7.7 per 10,000 nationally [5].

Exercise is the best-proven way to prevent falls

A Cochrane review pooled 59 trials with nearly 13,000 older adults living in the community. Exercise reduced the rate of falls by 23% and reduced the number of people who fell by 15%, with high-certainty evidence [6]. The type of exercise matters:

Type of exercise	Effect on the rate of falls	Certainty of evidence
Balance and functional exercises	24% fewer falls	High
Several types combined, usually balance and functional plus strength	About 34% fewer falls	Moderate
Tai chi	About 19% fewer falls	Low
Strength training alone, dance or walking alone	Effect unclear	Too few studies

Source: Sherrington et al., Cochrane review, 2019 [6].

In other words, walking is great for your health, but on its own it has not been shown to prevent falls. What works is exercise that challenges your balance.

What the guidelines recommend

The World Falls Guidelines recommend exercise that includes balance-challenging and functional movements, such as standing up from a chair and stepping, done three or more times a week, individualized and progressed in intensity for at least 12 weeks, and continued longer for greater benefit [7]. Tai chi and progressive strength training can be added when possible [7].

The US Preventive Services Task Force recommends exercise to prevent falls in adults 65 and older who are at increased risk, and lists supervised individual physical therapy and group exercise classes among the effective options [8].

Three questions to ask yourself

The CDC’s STEADI program suggests that older adults be asked three questions every year [9]:

1. Have you fallen in the past year?
2. Do you feel unsteady when standing or walking?
3. Do you worry about falling?

If the answer to any of them is yes, you are considered at higher risk, and it is worth getting a fall risk assessment [9]. When gait, strength or balance problems are found, CDC guidance includes referring to physical therapy or to an evidence-based exercise program such as tai chi [9].

What a physical therapist does

A physical therapist can:

• Test your balance, walking speed and leg strength with simple, standard tests, such as how long it takes to stand up, walk a short distance and sit back down
• Build a progressive program of balance, functional and strength exercises matched to your level
• Teach you how to get up safely if you do fall
• Help you keep exercising at home so the benefit lasts

The takeaway

• About 1 in 4 adults 65 and older falls each year, and the risk climbs steeply after 75.
• Utah’s fall death rate for older adults is higher than the national rate.
• Exercise that challenges balance reduces falls by about a quarter, and combining it with strength work may do even more.
• If you have fallen, feel unsteady or worry about falling, a physical therapy assessment is a practical first step.

You can start physical therapy in Utah without a referral. If you or a parent have had a fall or a near miss, an evaluation can show where the risk is and how to lower it.