Skip to main content
    Safer steps for seniors

    Safer steps for seniors: Strong legs, steady steps, more good years.

    In 2020, 14 million older Americans reported a fall in the past year. Exercise cuts the rate of falls by 23%, on high-certainty evidence.

    Try it in the sliderTalk to Ryan

    Ryan K. Hertel · heyitskenton

    The problem

    What we're up against.

    • More than one in four, every year.

      In 2020, 14 million older adults, 27.6% of them, reported falling in the previous year.

    • The leading cause of injury death.

      Falls are the leading cause of injury death for Americans aged sixty-five and older, and the fall death rate rose 21% from 2018 to 2024, even adjusting for age.

    • Broken hips.

      Nearly 319,000 older people are hospitalized for hip fractures each year, and falls cause about 88% of hip fracture emergency visits and hospital stays.

    • A large and growing bill.

      Health care for falls that didn't kill cost $80 billion in 2020, most of it paid by Medicare.

    • More people at risk.

      America now has 61.2 million people aged sixty-five and older.

    What works

    Proven, and ready to grow.

    • Exercise works.

      Across 108 randomized trials, exercise cut the rate of falls by 23% and the number of people who fell by 15%.

    • Tai ji quan, best in a head-to-head trial.

      In a randomized trial with 670 older adults at high risk in Oregon, tai ji quan classes cut falls by 58% compared with stretching, and by 31% compared with a standard exercise program.

    • Strength and balance at home.

      The Otago program, home exercises from a physical therapist, cut falls and fall injuries by 35% across four trials.

    • Safer homes, for those most at risk.

      Fixing home hazards cut falls by 26% overall, and by 38% among people at higher risk.

    • A national recommendation.

      The US Preventive Services Task Force recommends exercise for older adults at increased risk of falling.

    What a family could fund

    Where the money goes furthest.

    • Cheap per person.

      A cost analysis for the CDC priced three proven programs at $104.02, $211.38 and $339.15 a participant, in 2012 dollars.

    • Paid back in care avoided.

      All three saved more in medical costs than they cost, and the tai chi program returned 509% on each dollar.

    • The real-world price.

      Delivering tai ji quan in the Oregon trial cost $906 a participant, travel included, and it was both cheaper and more effective than the other exercise programs.

    • A network ready to grow.

      Federal grants have put over $53 million into falls prevention since 2014, reaching more than 238,000 people from 2014 to 2024, a small share of those who fall.

    • Classes that keep going.

      Tai ji quan runs as two one-hour classes a week for 24 weeks, so a family's money buys teachers, rooms and rides to class.

    Honest limits

    What money can't promise.

    • Fewer falls, not always fewer fractures.

      The evidence that exercise prevents fractures is less certain than for falls, and fixing homes may make little difference to fractures.

    • Big screening programs fell short.

      A nurse-led program in American practices didn't significantly cut serious fall injuries, and screening and treatment in England didn't cut fractures.

    • Tailored plans add little.

      Plans tailored to each person's risks may only slightly reduce falls, with little or no effect on whether people fall at all.

    • People drift away.

      A year on, about half of older people in trials are still sticking with their program.

    • Real life is harder than a trial.

      Open community classes will likely do less than trials did, and the benefit grows when practice continues.

    Hard questions

    Asked and answered.

    1. You might ask

      Isn't falling just part of getting old?

      Ryan

      Risk rises with age, but many risk factors can be changed, and exercise cuts the rate of falls by 23%.

    2. You might ask

      Why not just hand out grab bars?

      Ryan

      Home fixes work best for people already at high risk. When trials didn't pick people at risk, falls didn't drop.

    3. You might ask

      Will older people actually show up?

      Ryan

      In the tai ji quan trial, attendance was 77% and only 13% dropped out, but staying with it is harder: about half are still at it a year later.

    In the slider

    See what your fortune could do here.

    Safer steps for seniors

    The slider prices this cause with these numbers:

    • Delivering a tai ji quan course cost $906 a participant in a randomized trial in Oregon, travel included.
    • The whole need is the older Americans who report a fall each year, 14 million.
    • A course cuts the rate of falls by about 23%, not all of them, and the benefit grows when practice continues.
    Try it in the sliderTalk to Ryan

    More of the Blueprint

    Keep reading.

    5 more chapters on the way

    Back to Keep 100

    Sources

    Every number in this chapter, and where it came from.

    1. Source 1: Nonfatal and Fatal Falls Among Adults Aged 65 Years or Older, United States, 2020-2021 (Kakara and others) (opens in a new tab)

      Morbidity and Mortality Weekly Report, 1 September 2023. Checked 16 October 2026.

      From the Centers for Disease Control and Prevention.

    2. Source 2: Exercise for preventing falls in older people living in the community (Sherrington and others) (opens in a new tab)

      Cochrane Database of Systematic Reviews, 31 January 2019. Checked 16 October 2026.

    3. Source 3: Older Adult Falls Data (opens in a new tab)

      Centers for Disease Control and Prevention, 4 September 2026. Checked 16 October 2026.

    4. Source 4: Facts About Older Adult Falls (opens in a new tab)

      Centers for Disease Control and Prevention, 4 September 2026. Checked 16 October 2026.

    5. Source 5: Hip Fracture-Related Emergency Department Visits, Hospitalizations and Deaths by Mechanism of Injury among Adults Aged 65 and Older, United States 2019 (Moreland and others) (opens in a new tab)

      Journal of Aging and Health, 10 October 2022. Checked 16 October 2026.

    6. Source 6: Healthcare spending for non-fatal falls among older adults, USA (Haddad and others) (opens in a new tab)

      Injury Prevention, 19 July 2024. Checked 16 October 2026.

    7. Source 7: Older Adults Outnumber Children in 11 States and Nearly Half of U.S. Counties (opens in a new tab)

      US Census Bureau, 26 June 2025. Checked 16 October 2026.

    8. Source 8: Effectiveness of a Therapeutic Tai Ji Quan Intervention vs a Multimodal Exercise Intervention to Prevent Falls Among Older Adults at High Risk of Falling: A Randomized Clinical Trial (Li and others) (opens in a new tab)

      JAMA Internal Medicine, October 2018. Checked 16 October 2026.

      Seven cities in Oregon.

    9. Source 9: Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data (Robertson and others) (opens in a new tab)

      Journal of the American Geriatrics Society, May 2002. Checked 16 October 2026.

      Four trials of the Otago Exercise Program in New Zealand.

    10. Source 10: Environmental interventions for preventing falls in older people living in the community (Clemson and others) (opens in a new tab)

      Cochrane Database of Systematic Reviews, 10 March 2023. Checked 16 October 2026.

    11. Source 11: Interventions to Prevent Falls in Community-Dwelling Older Adults: US Preventive Services Task Force Recommendation Statement (opens in a new tab)

      JAMA, July 2024. Checked 16 October 2026.

    12. Source 12: A cost-benefit analysis of three older adult fall prevention interventions (Carande-Kulis and others) (opens in a new tab)

      Journal of Safety Research, February 2015. Checked 16 October 2026.

      Funded by the Centers for Disease Control and Prevention.

    13. Source 13: Cost-Effectiveness of a Therapeutic Tai Ji Quan Fall Prevention Intervention for Older Adults at High Risk of Falling (Li and others) (opens in a new tab)

      Journals of Gerontology Series A, August 2019. Checked 16 October 2026.

    14. Source 14: Falls Prevention Program (opens in a new tab)

      US Administration for Community Living, 3 September 2026. Checked 16 October 2026.

    15. Source 15: Falls Prevention Program Impact (opens in a new tab)

      US Administration for Community Living, 3 October 2024. Checked 16 October 2026.

      The program's own count.

    16. Source 16: Evidence-Based Falls Prevention Programs (opens in a new tab)

      National Council on Aging, 22 June 2026. Checked 16 October 2026.

    17. Source 17: A Randomized Trial of a Multifactorial Strategy to Prevent Serious Fall Injuries (Bhasin and others) (opens in a new tab)

      New England Journal of Medicine, July 2020. Checked 16 October 2026.

      The STRIDE trial, in 86 primary care practices.

    18. Source 18: Screening and Intervention to Prevent Falls and Fractures in Older People (Lamb and others) (opens in a new tab)

      New England Journal of Medicine, November 2020. Checked 16 October 2026.

      The PreFIT trial, in England.

    19. Source 19: Multifactorial and multiple component interventions for preventing falls in older people living in the community (Swarnalatha and others) (opens in a new tab)

      Cochrane Database of Systematic Reviews, 21 September 2026. Checked 16 October 2026.

    20. Source 20: Older people's participation in and engagement with falls prevention interventions in community settings (Nyman and Victor) (opens in a new tab)

      Age and Ageing, 28 August 2011. Checked 16 October 2026.

    21. Source 21: World guidelines for falls prevention and management for older adults: a global initiative (Montero-Odasso and others) (opens in a new tab)

      Age and Ageing, September 2022. Checked 16 October 2026.