How often do older people fall in Switzerland?
About a third of people aged 65 and over fall at least once a year, and from 80 it is about half. In Switzerland, according to the advisory body for accident prevention, close to 90,000 fall injuries in this age group are treated each year, and around 1,600 older people die of the consequences.
What a single fall sets off is easier to grasp than the statistics. About five in a hundred falls end in a broken bone, one or two in a hundred in a fractured neck of femur, meaning a break of the thigh bone close to the hip joint. After a break of that kind, studies from the German-speaking countries report that around a fifth of people move permanently into a care home.
Around 95 per cent of fatal falls in Switzerland involve people aged 65 and over. The fall itself is rarely the real problem. The problem is the chain that follows: a fracture, hospital, bed rest, loss of strength, fewer outings, still less strength.
Where in the home do most falls happen?
About half of the falls of older people happen at home, and mostly on level ground. In private homes the living room and the bedroom come first, followed by the garden and the stairs inside the house. So the dangerous place is precisely the one where you feel safest and pay least attention.
On the Swiss average for the years 2015 to 2019, around 45,000 people a year were injured in a fall in a private home. Two thirds of all falls happen on the level. The stairs are feared, but people fall more often in the living room on a straight stretch, for instance with the washing in their arms.
The drawing shows an ordinary floor plan seen from above. Five places are numbered because they come up again and again in home assessments: the rug edge in the hallway (1), a cable running across the living room (2), the threshold to the bathroom (3), the way to the bed in the dark (4) and the stool used instead of a ladder (5). Walk through your own home with these five numbers in mind.
Which five places are worth looking at first?
Five places can be dealt with in one afternoon: the edge of the rug in the hallway, the cable running across the living room, the threshold to the bathroom, the way to the bed in the dark and the stool people climb on. None of them needs building work. All five are numbered on the drawing.
The following five places are examples and not a complete list. They occur in many homes, which is why they are here. In your home quite different places may be the more important ones, for instance a steep staircase, a step onto the balcony or the way to the letterbox. What yields most is to walk through your own home once, calmly, with this view.
- The rug edge in the hallway. Small runners and mats go, or get a non-slip underlay. Edges that curl up are fixed down with double-sided carpet tape. The doormat at the entrance belongs flush with the floor too. Most people pass through the hallway many times a day, often with something in both hands.
- The cable running across the living room. No cable may cross a walking line. Run the cables of the standard lamp, the television, the telephone and the charger along the wall and bundle them. If the socket is on the wrong wall, have a second one fitted rather than laying the cable across.
- The threshold to the bathroom. Thresholds you step over rather than walk across are evened out with a flat ramp. The bathroom needs non-slip strips in bath and shower, a non-slip bath mat and a firmly screwed grab rail beside the toilet and the shower. The towel rail is no substitute for a grab rail, because it tears out of the wall under load.
- The way to the bed in the dark. The night-time trip to the toilet needs light you can switch on while lying down, better still a night light with a motion sensor along the whole route. The route stays clear of shoes, bags, laundry baskets and everything else that gets put down there in the evening. Check it once at night and not in daylight.
- The stool instead of the ladder. A kitchen stool, a swivel chair and the edge of the bed are not climbing aids. For anything above head height a stable step with a handrail belongs in the home. Better still: move everything you use weekly to between hip and shoulder height, and then you do not climb at all.
How much this achieves can be quantified, and the answer is more honest than checklists usually admit. A Cochrane review of 2023 with 22 studies and more than 8,000 participants found that removing hazards at home lowered the fall rate by about 26 per cent, and by about 38 per cent in people at high risk of falling. In people without raised risk the same measure showed no benefit. So anyone who fell last year, or who needs help in daily life, gains measurably, while for people who walk safely the changes mainly create order.
What do better light and different shoes achieve?
Light works where you walk at night and where the floor changes colour: the edges of stairs, thresholds, the way to the bathroom. With shoes what counts is a firm heel and a grippy sole. Whether changing shoes alone prevents falls is less well evidenced than the frequency of that advice suggests.
With age the eye needs markedly more light and adjusts more slowly to the change between light and dark. So light is about the transitions, not about brightness everywhere.
- The light switch is where you enter the room, and can be found in the dark.
- Stairs are lit brightly but without glare, with a switch at the top and at the bottom.
- The front edges of steps are marked in contrast, light on dark or the other way round.
- Motion sensors in the hallway stay on long enough for the whole route.
- Strongly patterned or reflective floors make edges harder to recognise.
On shoes the recommendation of the advisory body for accident prevention (fremde Seite, öffnet in einem neuen Fenster) is unambiguous: indoor shoes with a firm heel and a grippy sole, not slippers the foot slides out of while walking. Socks on parquet are the worst choice in the house. A figure for the benefit of changing shoes as a single measure is not available from the Cochrane review, because the studies were too different; the advice is plausible, then, but less well evidenced than training and a tidy home.
What does strength and balance training really achieve?
Training lowers the fall rate by about a quarter, which is a great deal for a single measure. What works is balance and functional training, meaning practice in standing and walking at your own limit of stability. Strength training alone, walking training and dance are not sufficiently evidenced. Staying with it is what counts.
The figures come from the Cochrane review of 2019 on exercise and fall prevention in older people living at home. Exercise of any kind lowered the fall rate by 23 per cent compared with no exercise. For balance and functional training alone it was 24 per cent with high trustworthiness of the evidence, for programmes combining balance and strength 34 per cent, and for tai chi 19 per cent with low trustworthiness.
- Stand up from the chair and sit down again without using your hands, several times in a row.
- Tandem stance: one foot directly in front of the other, heel to toes, one hand on the worktop.
- Stand on one leg while brushing your teeth, with the basin within reach, and change sides.
- March on the spot and turn your head to the left and to the right while doing it.
- Walk along an imagined line, slowly, looking ahead rather than at your feet.
Practice happens where things go wrong in daily life, for instance at the kitchen cupboard or on your own stairs. The challenge has to be great enough that you wobble a little. How many hours a week are needed cannot be derived reliably from the review; what is best evidenced is the character of the training, less so the dose. Where your limit lies is measured by the Timed Up and Go, a short test in which you stand up from a chair, walk three metres, turn round and sit down again while the time is taken. Occupational therapy in geriatrics carries it out as well.
Why do medicines and glasses belong to fall prevention?
Fourteen groups of medicines raise the risk of falling measurably, among them sleeping tablets and sedatives, antidepressants, antipsychotics, opioids, water tablets and some blood pressure drugs. Anyone taking more than four medicines counts as at risk for that reason alone. Remedies bought without a prescription belong on that list too, and so does the eyesight check.
The grouping comes from a European expert consensus of geriatric societies. It also names antiepileptic drugs, antihistamines, medicines for an overactive bladder, alpha blockers and blood-sugar-lowering tablets that carry a risk of hypoglycaemia, and for some of them it recommends tapering off in steps rather than stopping abruptly.
From that follows one concrete step: take all the packets to your next appointment, including those from the chemist and the drops you take to fall asleep, and say that you have fallen or that you feel unsteady. Whether a medicine is reduced, replaced or tapered is decided by your doctor alone. Do not stop anything yourself.
With eyesight the case is less clear-cut than guides suggest. An annual check of vision and treatment of a cataract make sense, because both improve daily life. The Cochrane review mentioned above found, however, that correcting vision as a single measure barely affected the fall rate. So it replaces neither training nor a tidy home.
What does the fear of falling do?
Twenty to fifty per cent of older people are afraid of falling, many of them without ever having fallen. The fear leads to walking less and doing less. Strength and balance decline, and with them rises exactly the risk that is feared.
When this cycle follows an actual fall, geriatrics calls it post-fall syndrome; it can begin without a fall as well. It rarely starts dramatically. More often it starts with someone skipping the walk when it is wet, then the visit on the first floor. Six months later the radius has shrunk to the flat, and walking really has become less steady.
Families reinforce this with the best of intentions by taking outings over. It helps more to practise the feared activity again in small steps and with company, rather than to replace it.
A Cochrane review concludes that cognitive behavioural therapy probably reduces the fear of falling in older people living independently, and that the effect lasts at least six months. The effect is small, though, and whether it is noticeable in daily life remains open. Something else helps in a very practical way: practising how to get up from the floor while you do not yet need it.
What does occupational therapy do in a home assessment?
An occupational therapist comes to your home and goes through the day with you: standing up, walking, stairs, bathroom, kitchen, night. From what becomes visible, a list of concrete changes emerges, together with a training plan practised at your own furniture.
The difference from a checklist: what is assessed is not the home but you in your home. A threshold is not a hazard in itself; it becomes one when you take it with the washing in your arms and in half-light, which is why the work is observation rather than measurement alone.
- The history of falls: when, where, doing what, how often, and what you have avoided since.
- Walking, standing up, turning and climbing stairs under observation, with the Timed Up and Go where useful.
- A walk through every room including cellar, balcony and the way into the building.
- A check of grab rails, seat heights, bed edges, lighting and floor coverings, each in the place where you use them.
- An exercise programme for balance and strength including getting up from the floor, plus a written list of changes by urgency.
Occupational therapy in Switzerland requires a doctor’s prescription. It is billed to the insurer responsible, and the deductible (Franchise) and the retention fee (Selbstbehalt) run through that insurer; after an accident, accident insurance usually takes over. On amounts, the insurer responsible gives information. A home assessment sensibly takes place where you live; we carry it out in Thalwil and the neighbouring municipalities as treatment at home, where the prescription provides for it. For that, treatment at home has to be ticked on the prescription. You can then arrange an appointment directly or write to us with your questions.