What actually prevents a second fall?

Why is the second fall the one that matters?

A first fall changes the odds. It marks out the people whose balance, strength, medication or blood pressure has already crossed a line, and international falls guidance uses it as the trigger for a full multifactorial assessment rather than reassurance.

It also changes behaviour. Most people respond by moving less, which reduces strength and balance further, which raises the risk of the next fall. That cycle does more damage over a year than the fall itself did.

Which exercise works, and how much?

The Cochrane review of exercise for preventing falls found the effect is carried by programmes that genuinely challenge balance — standing with a reduced base, moving the centre of mass, reducing hand support — delivered consistently and kept up over time. Walking alone does not do it, and general fitness classes do not reliably do it.

Resistance training is added because balance depends on being able to produce force quickly enough to catch yourself. Sitting-only exercise programmes have not shown the same effect.

What else is in a proper falls assessment?

Medication review, because sedatives, some antidepressants and blood pressure drugs are among the most modifiable causes. Lying and standing blood pressure. Vision, including whether varifocals are being worn on stairs. Feet and footwear. Vitamin D and bone health, because the fall and the fracture are separate problems.

Then the home: lighting, thresholds, loose rugs, the route to the bathroom at night. Each item is small. The combination is what the guidelines show reduces falls, and no single item substitutes for the exercise.

How is progress measured?

With timed, repeatable tests rather than impressions: how long it takes to rise from a chair and walk a set distance, how far someone can reach without stepping, how steady they are with a narrowed base, and gait speed. Those figures are recorded at the start and end of a programme and belong in the discharge document.

Fear of falling is measured too, with a short scale. It predicts activity restriction independently of the physical findings and is treatable in its own right.

Frequently asked questions