The short answer
- Check before anybody is liftedHead, hips, legs, and whether they are answering you normally. Nothing here asks you to lift a grown adult by hand, and you should not try.
- Call 999 for a head, back, neck or hipThe NHS also says to call 999 if the person cannot get up. Ring 111 if they are in pain, injured or unwell but none of that applies.
- Time on the floor matters on its ownAn hour or more down there brings cold, pressure damage to the skin and muscle damage, whatever the fall itself did.
- Ask the GP for two thingsA falls assessment, and a review of every medicine they take. Both are free, and a fall is the reason to ask.
This page covers the fall itself and the days after it. Preventing the next one is the subject of the mobility and falls pillar, linked at the top.
The first ten minutes
Do not lift them, and check these things first
It is hard to stand still when a parent is on the floor, and the instinct is to get them back into a chair. That is the one thing to resist until you know what has happened, because a broken hip that is moved hurts far more and heals worse.
The first ten minutes
Work down the left before anybody is moved. What you find on the right decides which number you ring.
Check, in this order
Say their name and wait
Ask them something simple and listen to the answer, rather than to how calm they sound.
Somebody who cannot be woken, cannot keep their eyes open or has had a fit needs an ambulance now.
Ask whether they hit their head
Look for a bump or a cut, blood or clear fluid from an ear or the nose, and bruising behind the ears.
If nobody saw the fall, take it as a possible head injury rather than deciding they probably did not.
Look along both legs before you touch them
Compare the two. A leg that looks shorter than the other, or has turned outwards, is the sign to know.
That, or pain in the hip, upper leg or groin, is how a broken hip looks. It is an ambulance where they are.
Ask what hurts, and let them move themselves
Ask them to move each arm and leg a little on their own. Watch for anything they will not move.
You are looking for pain and weakness you cannot see. Nobody needs to be turned over for this.
Check what they take for their blood
Warfarin, apixaban, rivaroxaban, edoxaban, dabigatran and clopidogrel are the usual names.
With any bang on the head, that changes the answer even when they seem perfectly well.
What you find, and who to ring
Ambulance, and do not move them
- They cannot be woken, cannot stay awake, or have had a fit
- They may have injured their head, back, neck or hip
- They cannot get up, even with somebody helping
- A leg looks shorter or turned outwards, or they cannot put weight on it
- There is heavy bleeding, or a wound with something in it
Ring while you sit with them
- They hit their head and take medicine that thins the blood
- They are being sick, dizzy, in pain or not themselves
- They got up all right but cannot tell you why they went down
- Nothing looks broken and you are still not sure
Ring the surgery this week
- No injury, they are steady again, and the day carries on
- They felt faint or dizzy in the moments before the fall
- This is the second fall in a year, however small
Based on the NHS advice on falls and on head injury. Nothing on this page asks a family to lift anybody by hand.
Kneel down so you are at their level, and keep your hands off them while you ask. You are answering five questions rather than examining them: are they talking normally, did they hit their head, do both legs look the same, does anything hurt when they move it themselves, and do they take anything that thins the blood.
The NHS advice is to call 999 if somebody has fallen and may have injured their head, back, neck or hip, or cannot get up, and to get help from 111 if they may be in pain, injured or unwell. If you are on the fence, ring 111 and let them decide. They can send an ambulance themselves, and they will not think you wasted their time.
If your relative has Parkinson's, the fall may have started with their feet stopping rather than with a trip, and freezing and falls with Parkinson's explains what that looks like. For falls in general, away from this checklist, how to deal with elderly falls covers the causes and what reduces them.
What you find
The things that change the answer, even when somebody seems fine
Four findings are worth knowing in advance, because in each one the person can look perfectly well and still need a hospital.
A bang on the head
Medicine that thins the blood
A leg that looks wrong
A fall nobody can explain
If that leg turns out to be a broken hip, the operation follows within a day or two, and what the weeks after hip fracture surgery take at home sets out the help that comes home with them.
A fall nobody saw deserves the same care as one you watched. If your father was found on the floor and cannot say what happened, you do not know whether he hit his head, so treat it as though he did.
Time on the floor
Why time on the floor is a problem of its own
Ambulance waits are long, and a family sitting on a hallway floor at two in the morning is often told to expect several hours. NHS guidance calls more than an hour on the floor a long lie, and treats it as a problem in its own right, separate from whatever the fall broke.
While you wait with them
- Stay with them and keep talking. Somebody frightened and alone on a cold floor gets worse
- Cover them, legs and feet first. A floor pulls heat out of a person faster than the room does
- Put a cushion under their head, and something soft under a hip or a heel if it slides there
- Let them shift their own weight a little every so often, if they can do it without pain
- Ring 999 back if anything changes: new confusion, worse pain, shivering or drowsiness
- Note the time they went down, so the crew know how long it has been
What not to do
- Do not lift or drag them, alone or with another relative. Backs get hurt and hips get worse
- Do not pull on an arm to help them roll. If they are moving, let them do it in their own time
- Do not reposition somebody with hip, back or neck pain. Comfort them where they are
The harms are the ones you would expect from lying still and cold for hours. Body temperature falls, they get dehydrated, the skin over a hip or a heel is damaged by their own weight, and squashed muscle releases substances that put the kidneys under strain. Confusion and a chest infection can follow. Tell the crew, and later the GP, how long your relative was down there, because it changes what gets checked.
Getting up safely
How somebody gets themselves up when nothing is hurt
If they are not injured, are answering you normally and want to try, they can get up in stages using the furniture and their own strength. Your job is to clear the route, steady the chair and talk them through it. These are the stages the NHS sets out.
- 1
Let them lie still for a minute
No rushGetting up too quickly is how the second fall happens, especially if they felt faint before the first. Ask again what hurts once the shock has worn off. - 2
Roll onto their side, then onto hands and knees
Their own movementThey roll towards the stronger side and push up with their arms. If it hurts anywhere, stop here and ring 111. Do not turn them yourself. - 3
Crawl to something solid
A heavy chair or the bathA dining chair with its back to a wall, a heavy armchair, the side of the bath or a fixed sink. Move a rug or a light chair out of the way first. - 4
One foot flat, stand slowly, then sit
Hands on the furnitureThey bring one foot flat on the floor in front, hold the furniture and push up through that leg, then turn and sit. Stand at their side rather than in front, and let them rest.
If they cannot manage a stage, that is the end of the attempt. Two people hauling a parent up by the arms is how shoulders are hurt and how family carers injure their backs, and moving elderly parents safely is worth reading before the next time rather than during it.
Once they are in the chair, look again: bruising, a wrist they are holding oddly, a graze to clean, and how steady they are when they next stand. A fall that seemed like nothing at nine in the evening can look different the next morning. If they are working their way round the room on the furniture, that is the point to ask about which walking aid fits and who should set its height, rather than ordering one online.
What to write down
The note for the GP, and the two things to ask for
Whether or not an ambulance came, the surgery should hear about a fall. What you can give them that nobody else can is the detail of what happened, and that detail is what turns a fall into a referral. Write it down while it is fresh.
Before you ring the surgery
0 of 9 ticked
What to write down
What to ask for
Say the word falls when you ring. A fall recorded as a bruised hip goes nowhere, while a fall recorded as a fall is what gets a referral written. The care needs assessment explains how to ask the council, and local authority funding covers what happens to the money afterwards. If tablets are part of the picture, medicines in later life is a plainer read than the leaflets in the boxes.
The week after
What to watch for, and whether help at home is needed
Two things happen at once in the days after a fall. Injuries that were not obvious on the night show themselves, and confidence goes. The second does more long-term harm than the bruises, because somebody who is afraid to walk to the kitchen loses the strength that was keeping them upright.
- That night
Somebody stays, or somebody rings
If they hit their head, they should not be alone overnight. If nobody can stay, agree who is ringing and when, and leave a phone and a light within reach of the bed.
- Days one to three
Watch for what did not show on the night
New or worsening pain in a hip, a wrist or the ribs. A headache that will not settle, being sick or drowsy after a head injury. Confusion that is new. Any of those means ringing 111, or 999 if it comes on suddenly.
- The first week
The GP, the referral and the medicines
Ring the surgery with your note. Ask for the falls assessment and the medicine review, and ask how long the wait will be, so you know what has to be covered meanwhile.
- Weeks two to six
Getting moving again
Strength and balance work lowers the risk rather than managing it, and it has to happen most days to count. Sitting still because it feels safer is what makes the next fall more likely.
Help at home in those weeks is usually about the two ends of the day: getting washed and dressed in the morning, and getting to bed safely at night. Carers on PrimeCarers charge £18 to £25 an hour with our fee included, about £20 typically, so an hour every morning for a fortnight is around £280. An agency charges £28 to £35 for the same hour, and what an hour of care costs sets the routes side by side.
If the fall ended in A&E and your relative came home the same day, after a fall and a trip to A&E covers the first three days at home. When you are ready to see who could do those mornings, you can search for carers near them and compare rates, experience and reviews yourself.
Questions
Questions families ask after a fall
The NHS says to call 999 if somebody has fallen and may have injured their head, back, neck or hip, or cannot get up. Call 111 if they may be in pain, injured or unwell but none of that applies, and also if they banged their head and take medicine that thins the blood. If you cannot decide, ring 111. They will send an ambulance themselves if that is what is needed.
You can talk him through getting himself up, and you can move furniture and steady a chair. You should not lift him. If he is not injured and wants to try, the NHS stages are to roll onto his side, push up onto hands and knees, crawl to something solid, bring one foot flat on the floor and stand slowly holding on. If he cannot manage a stage, stop and ring 111.
Take it seriously anyway, particularly if they take anything that thins the blood, because the NHS advice is to contact 111 for a head injury in that case. Hospital guidance is that a scan should be considered within eight hours for somebody on those medicines. They should not be alone overnight, and a headache that will not settle, being sick or new confusion afterwards all mean ringing again.
NHS guidance uses more than an hour on the floor as the definition of a long lie, and treats it as a problem separate from the fall itself. Cold, dehydration, pressure damage to the skin and muscle damage that puts the kidneys under strain all start while somebody is lying there. Tell the ambulance crew and the GP how long it was, because it changes what they check.
Ring the GP surgery, say there has been a fall, and ask to be referred to the local falls service. In some areas you can refer yourself without seeing a GP first. The assessment looks at strength and balance, blood pressure lying and standing, eyesight, feet, medicines and the home.
Not always, and the answer depends on why they fell and how they are a fortnight later. What a fall does usually mean is that getting up and getting to bed are worth covering while confidence comes back. If your relative has been in hospital they may be offered free reablement first. Carers on PrimeCarers charge £18 to £25 an hour with our fee included, and you can book an hour a day and stop when it is no longer needed, with 48 hours' notice for hourly care.