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LONGEVITY LATEST ISSUE 32 · 14 OCTOBER 2026
LONGEVITY LATEST · DEEP DIVE
It’s the Landing, Not Just the Fall
Why fewer falls haven’t yet meant fewer fractures, which landings break hips, and how to get up off the floor safely, or know when not to try.
By Christian Thomsen · Companion to Issue 32 · 14 October 2026 · ~7-minute read
In a Cambridge study of people over 90, eight in ten of those who fell couldn’t get up unaided after at least one of their falls. Three in ten lay on the floor for an hour or more.
It’s the part of a fall people rarely think to practise. It’s also a clue to a puzzle that runs through Issue 32: exercise cuts falls by about a quarter, with high certainty, yet the trials still can’t show it cuts fractures by anything like as much. What happens after you start to go down matters as much as how often you do.
First, the question every reader is really asking: is this about me?
Two minutes at the kitchen counter
These are the screening tests from the US Centers for Disease Control’s STEADI toolkit. Do them beside a counter, with someone standing next to you, ready to steady you.
Timed Up and Go: rise from a chair, walk three metres at your normal pace, turn, walk back and sit. Twelve seconds or more suggests higher risk.
Four-stage balance: feet side by side, then one foot half ahead, then heel to toe, then on one leg, ten seconds each without holding on. Stop at the first stage you can’t hold; don’t go on to the next. Not holding heel-to-toe for ten seconds, or one leg for five, suggests higher risk.
Chair stands: a firm chair without arms, seat about 43 cm high. Sit in the middle, arms folded across your chest, and count full stands in 30 seconds. If you need your arms to get up, stop: the score is zero. CDC treats these as below average, and a sign of higher risk: aged 60–64, fewer than 14 for men and 12 for women; 65–69, 12 and 11; 70–74, 12 and 10; 75–79, 11 and 10; 80–84, 10 and 9; 85–89, 8 for both; 90–94, 7 and 4.
Worry: are you avoiding things because you might fall? Across 53 studies and 75,076 people, high concern about falling went with 60% higher odds of a future fall (odds ratio 1.60). It’s a risk factor, not a weakness, partly because people who fear falling tend to move less.
Add your history. A fall in the past year, especially one that hurt you or left you unable to get up, outranks any test.
A caveat worth keeping: these tests sort groups better than they predict individuals. Passing is reassurance, not a guarantee, and failing one doesn’t mean you will fall. It means the training plan in the newsletter’s Biohacking Corner is aimed at you, ideally with a professional the first few weeks.
MedlinePlus. Fall risk assessment · CDC STEADI. 30-second chair stand · Ellmers et al. Age Ageing (2025)
What turns a fall into a fracture
Most falls break nothing. In US data, about one fall in ten causes an injury serious enough to need medical care or a day of restricted activity. Whether a particular fall breaks a hip depends on things that have little to do with how often you fall.
A 1994 JAMA study compared 149 older people who had fallen, about half of whom had broken a hip. The strongest predictor was the direction of the fall (odds ratio 5.7), in practice whether the person came down on the side of the hip. Next came the energy of the fall, higher for taller and heavier people (2.8 per standard deviation), and lower density at the femoral neck (2.7 per standard deviation). Thinner people did worse too, with less padding over the bone (2.2).
Put those together and the gap in the trials stops looking mysterious. Balance training mainly changes how often you fall. It does much less to change which way you land, how much padding covers the hip, or the density of the bone underneath, which was Issue 30’s subject.
The fall is the trigger. Direction, padding and bone decide the damage.
Why the trials can’t see it yet
Two problems, and they pull in opposite directions.
Too small to count: fractures are rare per fall, so it takes very large trials to count enough of them. Of the 108 trials in the Cochrane exercise review, only ten reported fall-related fractures, covering 4,047 people. The pooled estimate was 27% fewer (risk ratio 0.73), but low certainty. A 2026 meta-analysis of fall-prevention programmes found just two trials with usable hip-fracture data, 132 hip fractures between them, both leaning towards fewer but neither significant. For any fracture, across five studies, there was no clear effect (risk ratio 0.91).
Too light to show it: the trials big enough to count fractures delivered lighter programmes to broader groups. PreFIT (9,803 people) cut falls by 21% between months four and eight; over 18 months there was no difference, and fractures didn’t fall (rate ratio 1.20, not significant). Its delivery was thin: 697 of the 3,279 people in the exercise arm took up the classes, starting a median 14 weeks after randomisation and averaging 5.5 sessions against the seven planned. Whether the benefit faded because people stopped or because so few began, the trial can’t say. In STRIDE (5,451 people), serious fall injuries barely moved.
So we have small, intense trials that work on falls but can’t count fractures, and big, light ones that can count fractures but barely change falls. The trial that would settle it, large and intense and long, hasn’t reported.
None of this means exercise fails to prevent fractures. The estimate is simply soft.
Sherrington et al. Cochrane (2019) · Alalwani et al. Clin Pract (2026) · Lamb et al. PreFIT. NEJM (2020)
The landing
If direction and padding decide the damage, two strategies try to change the landing rather than the fall.
Hip protectors, padded shells sewn into underwear, work where they’re worn. Across 14 care-home trials and nearly 12,000 residents, they prevented about 11 hip fractures per 1,000 (risk ratio 0.82, with the interval just touching no effect). In five trials of people living at home: no effect. Adherence was poor, especially over time, which caps what the device can do.
Then there’s learning to fall. In a small Kansas study published as a conference abstract last December, 24 adults aged around 72 spent four weeks either practising safe-falling techniques or doing Otago balance work, then were made to fall onto padding in the lab. The safe-falling group became far less likely to hit their heads (odds ratio 0.10). Twenty-four people, lab falls, no peer-reviewed paper yet. A promising idea, nowhere near a recommendation.
The floor
Back to Cambridge. The 110 people in that study, all over 90, reported 265 falls in a year, 82% of them while alone. Long lies were strongly associated with serious injury, admission to hospital and moving into long-term care. Call alarms were widely available, but most falls that led to a long lie didn’t involve their use.
Those were people over 90, the far end of the curve. But getting up from the floor is a skill, and it helps to know the order of things before you need it. This follows NHS guidance.
First, check: stay where you are for a minute or two and notice any pain. If you might have hurt your head, neck, back or hip, or you can’t get up, don’t try. Use your phone or alarm and call for help (999 in the UK); if you can’t reach either, shout or bang on the floor.
If you’re unhurt: roll onto your side, push up onto hands and knees, crawl to something sturdy such as a heavy chair, put one foot flat on the floor and push up slowly while holding on. Then sit and rest.
If you’re waiting: cover yourself with anything to hand to keep warm, keep moving your arms and legs gently, and change position about every 30 minutes.
A phone or alarm only helps if it’s on you, not on the hall table. If you’re steady on your feet and your doctor or physiotherapist agrees, practise the getting-up sequence once with someone present, while you don’t need it.
What this means for you
The training plan lives in the newsletter, and I won’t repeat it here. If you do one thing after reading this, run the two-minute check and write the numbers down. Repeat it every six months, so you can see a slide before it becomes a fall.
Two smaller things. Learn the getting-up sequence above before you need it. And if you’ve had a fall that hurt you, or more than one this year, ask for a falls assessment and expect something specific from it: a medicine review, an eye test, a home visit, a referral to a class.
Train so you fall less. Practise so a fall costs less.
Sources and further reading
Evidence reviewed through 9 October 2026. Fracture estimates for fall prevention are low or very low certainty; the hip-fracture risk factors come from a 1994 case-control study; the long-lie data come from people over 90; and the safe-falling study is a 24-person conference abstract. Educational content only; if you’ve fallen recently or feel unsteady, get professional advice before starting balance training or practising getting up from the floor.
© 2026 FrontWave Media Ltd · Longevity Latest