Every year a third of people aged 65 and over fall. Some falls result in a broken bone or other serious injuries, which could mean a stay in hospital. If you have had a fall you may feel afraid of having another, however, there may be steps you can take to help stop it happening again.

Diet plays an important role in maintaining healthy bones, muscles and general health. Making sure you follow a healthy balanced diet and maintain a healthy weight can reduce the risk of falling and of suffering more serious injuries.

Maintaining a healthy body weight

It is important to maintain a healthy, stable body weight. Losing weight without trying, being underweight or overweight can increase your risk of falling. To maintain a healthy body weight, you need to eat a healthy balanced diet. The Eatwell Guide shows how much each of the food groups should contribute to your diet.

Eat regularly and avoid long periods during the day without food, especially if you have diabetes. If you have a small appetite, you should eat more often than usual, for example three small meals and three small snacks every day.

You can find an interactive Eatwell Guide at www.nhs.uk/live-well/eat-well/the-eatwell-guide

Keeping hydrated

It is important to make sure you drink enough fluid every day. Dehydration can increase your risk of falling as a result of dizziness, confusion and tiredness.

Signs of being dehydrated include:

• feeling thirsty - your body is telling you that you are becoming dehydrated. Listen to your body and have a drink. As we get older our thirst mechanism is reduced, which means we may not feel thirsty as often. It is important to drink, even if you don’t feel thirsty
• dark urine - your urine should be pale or straw coloured. The darker your urine is, the more likely it is that you need to increase your fluid intake.

Your body needs fluid to function properly. Aim to drink six to eight glasses of fluid every day. Good choices include water, tea, coffee, milk, juices and squash.

Osteoporosis

Osteoporosis is a condition where bones become fragile and break easily. It happens as part of a natural ageing process and causes no pain or other symptoms until a bone breaks, usually as a result of a fall. Some people with osteoporosis may notice that they become shorter or their spine becomes more curved over the years.

Calcium

Calcium plays an important role in maintaining strong, healthy bones. It is vital to make sure that you are getting enough calcium to minimise age-related bone loss and the risks of osteoporosis. Most adults need 14 calcium points every day. Each point is 60mg of calcium.

You can improve the calcium content of your diet by:

• including more of the foods listed below in your diet
• snacking on dried fruit and nuts, or adding these to breakfast cereals
• adding cheese to mashed potatoes, soups, sauces and eggs
• adding dried skimmed milk powder to your usual milk
• adding peas, beans and lentils to soups, stews and salads.

Seven to eight points:

• 25g of Horlicks Traditional/ Ovaltine Original powder made with milk or other similar drinks.

Four points:

• 30g of hard cheese
• half a tin of sardines (with bones)
• 200ml of milk or calcium enriched soya milk
• one 150g pot of plain or fruit yoghurt.

Three points:

• half a tin of rice pudding
• one 125g pot of calcium enriched soya yoghurt
• half a tin of pilchards
• q small tin of baked beans
• one scoop of diary ice cream
• 120g of dark green leafy vegetables
• three dried figs
• 60g of tofu.

Two points:

• two large slices of white bread
• a small bar of milk chocolate
• one 100g pot of fromage frais
• half a large tin of kidney beans
• a small tub of cottage cheese
• one cheese triangle.

One point:

• two large slices of wholemeal bread
• half a small tin of canned salmon
• one orange
• eight dried apricots
• nine brazil nuts or almonds
• two sprigs of broccoli.

If you find it difficult to get the recommended amount of calcium through your diet, it may be necessary to take a calcium supplement. For more information on calcium supplementation, please speak to a healthcare professional or your GP.

Vitamin D

Vitamin D plays an essential role in the way our bodies use calcium. If we do not have enough vitamin D, our bodies cannot use calcium. Our body makes vitamin D when our skin is exposed to sunlight and this is our main source of vitamin D. However, this process becomes less efficient as we get older. Low levels of sunshine in winter can also make it difficult to absorb vitamin D through our skin. Those who are housebound, obese, have darker skin or keep their skin covered are more at risk of vitamin D deficiency.

Because it's difficult for people to get enough vitamin D from sunshine and food alone, everyone – including pregnant and breastfeeding women – should consider taking a daily supplement containing 10 micrograms of vitamin D during the autumn and winter.

The Department of Health and Social Care recommends that you take a daily supplement containing 10 micrograms of vitamin D throughout the year if you:

• are not often outdoors – for example, if you're frail or housebound
• are in a care home
• usually wear clothes that cover up most of your skin when outdoors.

If you have dark skin – for example you have an African, African-Caribbean or south Asian background – you may also not get enough vitamin D from sunlight. You should consider taking a daily supplement containing 10 micrograms of vitamin D throughout the year.

COVID-19 and vitamin D

As you may have been indoors more than usual during the pandemic, this makes it more important to take a vitamin D supplement. You should take 10 micrograms (400 IU) of vitamin D daily between October and early March to keep your bones and muscles healthy.

There have been some reports about vitamin D reducing the risk of coronavirus (COVID-19), however, there is not enough evidence to support taking vitamin D to prevent or treat COVID-19 at the moment.

Dietary sources of vitamin D

Diet does contribute to a small proportion of our daily vitamin D requirements.

Good food sources of vitamin D include:

• oily fish such as mackerel, salmon, sardines and pilchards
• cod liver oil
• offal such as liver
• eggs
• breakfast cereals and margarines (these have added vitamin D).

Alcohol

Drinking alcohol may also increase your risk of falling by affecting your balance, reducing your reaction times and/or interacting with any medication you are taking.

In the UK, men and women are advised not to drink more than 14 units of alcohol per week on a regular basis, to spread drinking over three or more days, aim to include at least one or two alcohol-free days per week and to include more alcohol free days per week if aiming to reduce alcohol intake.

Raise any concerns you have about alcohol with your pharmacist or GP.

One unit of alcohol is:

• half a pint of beer or cider
• one small glass of wine
• one single pub measure of spirits.

Falls and diabetes

Having diabetes that is not controlled as well as it could be, puts you at a higher risk of falling. If your blood glucose levels drop too low, symptoms of dizziness, weakness and disorientation can cause you to fall.

It is important to eat regularly and avoid long periods without food. Make sure you have foods from the carbohydrate section of the Eatwell Guide at every meal. These include bread, pasta and potatoes. If you feel that your diabetes may be contributing to your risk of falling, please speak to your GP, practice nurse or dietitian.

Exercise

Regular activity helps to reduce the risk of falling by improving balance, co-ordination, and bone and muscle strength. Thirty minutes of exercise is recommended five times per week. If you have other health issues, please discuss suitable types of activity with your physiotherapist or GP.

If you are less mobile or feel that issues with your balance are contributing to your risk of falling, you can ask your GP to refer you to a physiotherapist.