Statistics on Falls Among Older Adults, the Long Lie, and What Happens Next

The NIHR Long Lies Study protocol defines a long lie as a person being unable to get up and remaining on the floor for over an hour (Kuczawski et al., NIHR Open Research, 2026, citing Blackburn 2022, Kubitza 2022 and Fleming 2008).

The one-hour threshold is older than most of the research that uses it. It comes from a general-practice survey in Birmingham, England, and it is the definition carried by the standard geriatrics textbook and by the UK's current national study. The literature is startlingly thin, and its definitions are not uniform, which is the first thing to know before comparing any two long-lie figures.

• A 2025 systematic review found only six articles on long lies after falls in 45 years of English-language literature and concluded there is no universal definition of a long lie, even though responders are encouraged to convey to hospital anyone on the floor for an hour or more (Holland & Watkins-Webb, Nursing Older People, 2025).
• A 2022 systematic review of long lies in ambulance-attended older people found only four eligible cohort studies out of 70 identified and concluded that long lies were relatively uncommon in that setting because of rapid ambulance response (Blackburn et al., Int Emerg Nurs, 2022).
• Across 22 papers using the term 'long lie', only 8 set a specific time criterion - 5 used one hour or longer, and one each used 5, 10 and 15 minutes - while 7 used vague durations and 5 set no time limit; in total 2,805 people were unable to get up and 1,121 were affected by a long lie (Kubitza et al., Eur Rev Aging Phys Act, 2023).
• The earliest print use of the term 'long lie' that could be verified is Wild, Nayak & Isaacs (BMJ, 24 January 1981), which puts the phrase in quotation marks in Table IV and operationalises it as remaining on the floor unable to rise for more than one hour.
• The standard geriatrics textbook 'Falls in Older People' (Lord, Sherrington & Menz, Cambridge University Press, 2001) defines the long lie as remaining on the ground or floor for more than an hour after a fall and calls it a marker of weakness, illness and social isolation.

Sources: NIHR Open Research; Nursing Older People; International Emergency Nursing; European Review of Aging and Physical Activity; British Medical Journal; Cambridge University Press

Over 14 million, or 1 in 4, U.S. older adults report falling every year (CDC Older Adult Falls Data, reviewed 2026).

Falls are the denominator for everything that follows. Roughly a quarter to a third of people over 65 fall each year in the United States, the United Kingdom and Canada, and about half of those over 80. In the oldest old the rate is higher still: in the Cambridge cohort of people over 90, three in five fell within a single year.

• 60% of a population-based cohort of people aged over 90 (n=110) fell at least once during one year of prospective follow-up (Cambridge City over-75s Cohort; Fleming & Brayne, BMJ, 2008).
• Around a third of people aged 65 and over, and around half of people aged 80 and over, fall at least once a year (NICE NG249, 2025).
• Approximately 30% of people older than 65 fall at least once a year - around 3 million people in England (NICE impact report on falls and fragility fractures, 2018).
• In 2020, 14 million U.S. adults aged 65 and over (27.6%) reported falling in the previous year (CDC, MMWR, 2023; BRFSS 2020).
• In 2020, 28.9% of U.S. women aged 65 and over reported a fall in the past year, versus 26.1% of men (CDC, MMWR, 2023).
• Around a third of people aged 65+ and around half of people aged 80+ fall at least once a year (OHID, Falls: applying All Our Health, 2022).
• Around a third of all people aged 65 and over fall each year, increasing to half of those aged 80 and over (Public Health England consensus statement, 2017).
• Between 20% and 30% of Canadian seniors fall each year (Public Health Agency of Canada, Seniors' Falls in Canada: Second Report).
• 34% of 1,103 community-living people aged 72+ (370 people) experienced 660 falls over a mean 15.9 months of follow-up (Tinetti, Liu & Claus, JAMA, 1993).
• 37.3 million falls severe enough to require medical attention occur worldwide each year (WHO Falls fact sheet, 2021).
• An estimated 684,000 people die from falls globally each year (WHO Falls fact sheet, 2021).
• Adults older than 60 suffer the greatest number of fatal falls (WHO Falls fact sheet, 2021).

Injuries and deaths from falls

In 2024, 43,020 U.S. adults aged 65 and over died from unintentional falls (CDC WISQARS 2024 leading causes chart).

Fall deaths among older Americans have quadrupled this century, and the rate is still climbing: for men over 85 it doubled between 2003 and 2023. The state-by-state range is more than fivefold.

• Between 2003 and 2023 the fall death rate for U.S. men 85+ doubled (178.3 to 373.3 per 100,000) and for women 85+ rose 2.5 times (128.5 to 319.7) (NCHS Data Brief 532).
• In 2023, the unintentional fall death rate for U.S. adults aged 85 and over was 373.3 per 100,000 for men and 319.7 for women (NCHS Data Brief 532).
• In 2023, state unintentional fall death rates for adults 65+ ranged from 29.5 per 100,000 in Alabama to 158.4 in Wisconsin (NCHS Data Brief 532).
• The age-adjusted unintentional fall death rate among U.S. adults 65+ reached 78.4 per 100,000 in 2024, up 21% from 2018 (CDC Older Adult Falls Data, 2026).
• Deaths due to falls among Canadians aged 65+ increased 51% between 2017 and 2022 (Public Health Agency of Canada, 2025).
• In 2022, 7,621 Canadian adults aged 65 and over died of falls (Public Health Agency of Canada, Health Infobase, 2025; CVSD).
• Older-adult falls cause about 4.5 million U.S. emergency department visits each year, of which 3.1 million are treated and released and 1.4 million are hospitalized (CDC Facts About Falls, WISQARS, 2026).
• Falls lead to about 1.4 million hospitalizations of U.S. older adults each year (CDC Facts About Falls, WISQARS, 2026).
• Nearly 319,000 U.S. older adults are hospitalized for hip fractures each year (CDC Facts About Falls, 2026).
• U.S. adults aged 65 and over experienced an estimated 35.6 million falls in 2018 (CDC, MMWR, 2020; BRFSS).
• U.S. adults aged 65 and over had an estimated 8.4 million fall-related injuries in 2018 (CDC, MMWR, 2020; BRFSS).
• In 2018, 10.2% of U.S. adults aged 65 and over reported an injury from a fall in the past year (CDC, MMWR, 2020; BRFSS).
• CDC estimated about nine million fall injuries among U.S. older adults per year (applying 37% injured to 14 million fallers) - sentence present only on the archived CDC data page.
• About 37% of U.S. older adults who fall report an injury that required medical treatment or restricted activity for at least a day (CDC Facts About Falls, 2026).
• One in 10 falls among U.S. older adults results in an injury that restricts activity for a day or more or leads to seeking health care (CDC Facts About Falls, 2026).
• The age-adjusted unintentional fall death rate among U.S. adults 65+ was 78.0 per 100,000 in 2021 (CDC, MMWR, 2023).
• The age-adjusted unintentional fall death rate among U.S. adults 65+ was 64.7 per 100,000 in 2018 (CDC Older Adult Falls Data, 2026).
• The age-adjusted unintentional fall death rate among U.S. adults 65+ was 55.3 per 100,000 in 2012 (CDC Older Adult Falls Data, archived version).
• The unintentional fall death rate among U.S. adults 65+ was 69.9 per 100,000 in 2023; 74.2 for men and 66.3 for women (NCHS Data Brief 532).
• The crude unintentional fall death rate among U.S. adults 65+ was 65.6 per 100,000 in 2020 (NCHS Data Brief 449).
• In 2024, unintentional fall death rates among U.S. adults 65+ were 74.8 per 100,000 for men and 66.6 for women (CDC MMWR QuickStats, 2026; NVSS).
• Between 2019 and 2020 there were around 234,800 emergency hospital admissions in England related to falls among people aged 65 and over; around 157,370 (67%) were aged 80+ (NICE NG249, 2025).
• There were around 220,160 emergency hospital admissions related to falls among patients aged 65 and over in England in 2017 to 2018, 66.6% of them aged 80+ (OHID, 2022).
• PHE cited 255,000 falls-related emergency hospital admissions per year for older people in England (Falls and fracture consensus statement, 2017).
• Emergency admissions due to falls in people aged 65+ in England were 2,114 per 100,000 in 2016/17; 993 per 100,000 at 65-79 and 5,363 at 80+ (NICE impact report, 2018, citing the Public Health Outcomes Framework).
• In 2022 there were 78,076 fall-related hospitalizations among Canadians aged 65 and older; falls cause 89% of injury hospitalizations in this group (PHAC, 2025; CIHI DAD).
• In 2022 there were 200,825 fall-related emergency department visits among adults 65+ reported in Ontario and Alberta alone (PHAC, 2025; NACRS).
• Falls cause over 38 million disability-adjusted life years (DALYs) lost worldwide each year (WHO Falls fact sheet, 2021).
• Over 80% of fall-related deaths occur in low- and middle-income countries (WHO Falls fact sheet, 2021).

Sources: CDC Injury Center (2021, 2026); BMJ; NICE (2018, 2025); CDC (2020, 2023, 2026); Office for Health Improvement and Disparities; Public Health England; Public Health Agency of Canada (2014, 2025); JAMA; World Health Organization; CDC WISQARS (2022, 2023, 2024); NCHS (2022, 2025)

47% of non-injured fallers aged 72+ (148 of 313) reported being unable to get up without help after at least one fall, over a mean 21-month follow-up in New Haven (Tinetti, Liu & Claus, JAMA, 1993).

This is the gateway statistic. A long lie cannot happen to someone who can get back up, and the inability to rise after a fall is far more common than the long lie itself. In the over-90s, four in five fallers needed help off the floor at least once in a year; among people attended by an ambulance, nearly four in five needed help, and about half were still on the floor when the crew arrived.

• 80% of over-90s who fell (53 of 66) were unable to get up after at least one fall during one year of follow-up (Fleming & Brayne, BMJ, 2008).
• A 2023 scoping review on the concept of the long lie states that 78% of people aged 65+ who fall need help to get up from the floor (citing Johnston et al. 2010, an Australian ambulance audit).
• In 66% of falls (176 of 265) reported by people over 90, the person was unable to get up without help (Fleming & Brayne, BMJ, 2008).
• Just over 53% of older people attended by ambulance after a fall in NSW were still on the floor when the ambulance arrived (Simpson et al. 2014, as restated by Blackburn et al., Int Emerg Nurs, 2022).
• A 2022 BMC Geriatrics scoping review states that half of people over 65 who fall are found on the floor by rescue services (citing Simpson 2014 and Tinetti 1993).
• 54% of fall reports (144 of 265) among people over 90 described the participant as being found on the floor (Fleming & Brayne, BMJ, 2008).
• A 2022 BMC Geriatrics scoping review states that after a fall, more than half of older people living alone are unable to get up or get help independently (citing Simpson 2014, Tinetti 1993 and Vellas 1987).
• A 2022 BMC Geriatrics scoping review states that among people in need of care, 70% of those who fell already had problems getting up (citing Vellas et al., Age Ageing, 1987).
• Including falls with serious injury, 50% of all fallers (185 of 370) and 39% of all falls (259 of 660) involved inability to get up without help (Tinetti, Liu & Claus, JAMA, 1993, Table 1).
• Inability to get up without help was reported after 37% of non-injurious falls (220 of 596) among community-living people aged 72+ (Tinetti, Liu & Claus, JAMA, 1993).
• One in ten of 539 falls among 325 community-dwelling previous fallers left the person unable to get up for at least 5 minutes, and one in four falls led to activity limitation (Nevitt, Cummings & Hudes, J Gerontol, 1991).

Sources: JAMA; BMJ; European Review of Aging and Physical Activity; International Emergency Nursing - author manuscript; BMC Geriatrics; Journal of Gerontology

The published protocol of the NIHR Long Lies Study (Kuczawski et al., NIHR Open Research, 2026) states that around one in three adults over 65 fall each year and about one in five of these remain on the floor for over an hour.

There is no single answer, and anyone who gives you one without a denominator is rounding. For older fallers generally, one in eight to one in five is the range quoted; among people attended by an ambulance after a fall, about one in eight. Per fall, the figure runs from a few percent of non-injurious falls in community-living people aged 72 and over to about one in seven falls in the oldest cohort studied. In the original Birmingham survey, four people lay on the floor for more than six hours.

• A 2022 BMC Geriatrics scoping review states that one in eight older people who fall report lying on the floor for more than an hour (citing Simpson 2014 and Vellas 1987).
• Long lies (more than 60 minutes on the ground) occurred in 13% of 1,610 emergency ambulance cases for people aged 65+ who had fallen in New South Wales, with a median response time of 15 minutes (Simpson et al., Prehosp Emerg Care, 2014).
• 4 of 125 home fallers aged 65+ (3.2%) remained on the floor for more than six hours (Wild, Nayak & Isaacs, BMJ, 1981).
• 20 of 125 people aged 65+ who fell at home (16%) remained on the floor unable to rise for more than one hour, in a six-practice Birmingham survey (Wild, Nayak & Isaacs, BMJ, 1981).
• Lord, Sherrington & Menz (2001) report that Vellas (1987) found more than 20% of patients admitted to hospital because of a fall had been on the ground for an hour or more.
• In 41.1% of referred older fallers with a documented fall time (23 of 56), an hour or more had elapsed between the fall and ambulance arrival, in a Northern Ireland ambulance cohort (Scott, Br Paramed J, 2020).
• At baseline, 31% of fallers (8 of 26) in six California memory care facilities spent more than one hour on the ground after a fall; with real-time video fall detection this fell to zero (Bayen et al., JMIR, 2021).
• Only 3% of non-injurious falls among community-living people aged 72+ left the person on the floor for over 60 minutes, and 9% for over 30 minutes (Tinetti, Liu & Claus, JAMA, 1993).
• 30% of over-90s who fell (20 of 66) lay on the floor for an hour or more after at least one fall during one year of follow-up (Fleming & Brayne, BMJ, 2008).
• 15% of all reported falls (40 of 265) among people over 90 resulted in the person lying on the floor for an hour or more (Fleming & Brayne, BMJ, 2008).
• 28% of unwitnessed falls in which the over-90 faller could not get up (40 of 143) led to lying on the floor for an hour or more (Fleming & Brayne, BMJ, 2008).
• Johnston & Grimmer-Somers (2010) note that in the over-90 cohort 30% (n=20) of fallers were on the floor an hour or more and for a further 9% (n=6) the maximum time on the floor was unknown, adding that 'the incidence of long lies is largely unknown'.
• 12% of men and 19% of women aged 65+ who sought medical attention after a fall in Finland lay where they fell for 15 minutes or more (Ryynänen et al., Z Gerontol, 1992).
• Among 322 people with multiple sclerosis aged 55+, 27.6% lay on the floor for 10 minutes or more after their most recent fall and 4.7% (15) had a long lie of more than one hour (Bisson et al., Arch Phys Med Rehabil, 2015).

• Fleming & Brayne (BMJ, 2008) restate the 1981 Birmingham general-practice survey as finding that 16% of home fallers aged over 65 lay on the floor for more than an hour (20 of 125).
• Tinetti et al. (JAMA, 1993) characterise the 1981 British study as reporting that 20% of falls resulted in a lie of more than one hour, noting those falls were reported to physicians and likely over-represent frail or injured fallers.
• Tinetti et al. (JAMA, 1993) summarise two earlier prospective studies (Nevitt 1991; Campbell 1990) as finding that almost half of fallers required help getting up but only 10% of falls resulted in a lie of more than one hour.

Sources: NIHR Open Research; BMC Geriatrics; Prehospital Emergency Care; British Medical Journal; Cambridge University Press; British Paramedic Journal; Journal of Medical Internet Research; JAMA; BMJ; International Journal of General Medicine; Zeitschrift für Gerontologie; Archives of Physical Medicine and Rehabilitation

The median estimated time spent incapacitated was 4.5 hours across all events; 2 hours for those found alive and 18 hours for those found dead (Gurley et al., NEJM, 1996; San Francisco, 1993).

The honest shape of the answer is a long tail. Most people who fall and cannot get up are helped within the hour; a minority wait for hours, and a small group for days, and the people who were found dead had been down the longest. The San Francisco figures above cover people living alone found helpless at home from any cause. The only prospective study that timed every fall in a cohort, the Cambridge over-90s, gives the fall-specific distribution below.

• 10% of people found helpless or dead at home had been unable to summon help for more than three days, and only 38% of that group survived (Gurley et al., NEJM, 1996; San Francisco, 1993).
• Among the 90 people found dead at home in the San Francisco study, paramedics estimated 29% had been down for more than 72 hours (median 18 hours), versus a median of 2 hours for those found alive, of whom 31% had been helpless under an hour.
• When over-90s fell alone and could not get off the floor, help to get up arrived within five minutes in only 17% of such falls (25 of 143) (Fleming & Brayne, BMJ, 2008).
• Among 143 falls where an over-90 was alone and unable to get up, time on the floor was under 5 minutes in 17%, 5 minutes to under 1 hour in 48%, 1-2 hours in 10%, over 2 hours in 18% and unknown in 7% (Fleming & Brayne, BMJ, 2008, Table 3).
• Among 265 falls in people over 90, time on the floor was under 5 minutes in 43%, 5 minutes to under 1 hour in 36%, 1-2 hours in 5%, over 2 hours in 10% and unknown in 6% (Fleming & Brayne, BMJ, 2008, Table 3).
• Among non-injured fallers aged 72+ who could not get up, mean time on the floor was 11.7 minutes (SD 22.0; range 1-180 minutes); for seriously injured fallers it was 19.1 minutes (Tinetti, Liu & Claus, JAMA, 1993).

Waiting for an ambulance (England)

In December 2022 one in ten Category 3 ambulance incidents in England waited more than 11 hours 5 minutes 56 seconds (90th centile), per NHS England Ambulance Quality Indicators.

A fall without obvious injury is usually triaged as urgent rather than life-threatening, which in England means a Category 3 response with a national standard of two hours for nine in ten calls. In the winter of 2022 the slowest tenth of those calls waited more than eleven hours, and in one year more than a thousand older fallers waited over twelve. Response times have since recovered to roughly the standard, but a person on the floor who has phoned for help is still on the floor until the crew arrives.

• In 2022/23, 1,411 older patients in England waited more than 12 hours for an ambulance after a fall, a more than tenfold increase on 2019/20, per ambulance-trust FOI responses compiled by the Liberal Democrats (March 2024).
• In 2022/23 there were 19,904 incidents in England where a person aged over 65 who had fallen waited more than four hours for an ambulance, an average of 54 a day, per Freedom of Information responses from ambulance trusts compiled by the Liberal Democrats (March 2024).
• In December 2022, the worst month on record, the mean Category 3 ambulance response time in England was 4 hours 19 minutes 10 seconds, per NHS England Ambulance Quality Indicators (published January 2023).
• The NHS England national standard for Category 3 (urgent) ambulance calls is a response within 120 minutes for 90% of incidents, per NHS England / Nuffield Trust (standard in force since the 2017 Ambulance Response Programme).
• In December 2025 the mean Category 3 ambulance response time in England was 2 hours 1 minute 17 seconds, in the month with the largest ever number of ambulance incidents, per NHS England Ambulance Quality Indicators (published January 2026).
• In December 2025 the 90th-centile Category 3 ambulance response time in England was 4 hours 48 minutes 28 seconds, per NHS England Ambulance Quality Indicators.
• In May 2026 one in ten Category 3 ambulance incidents in England waited more than 4 hours 8 minutes 14 seconds (90th centile), about twice the 120-minute standard, per NHS England Ambulance Quality Indicators.
• In a prospective NSW cohort of 1,610 ambulance responses to fallers aged 65+ (2010-11), the median response time was 15 minutes and 13% of patients had a long lie of more than 60 minutes on the ground; 28% were not transported, per Simpson et al., Prehospital Emergency Care 2014.

Sources: New England Journal of Medicine; BMJ; JAMA; NHS England (2021-2026); Liberal Democrats; Nuffield Trust; Prehospital Emergency Care

Among 50 'long lie trauma' ED patients (median 13.5 h on the ground), associated diagnoses were hypovolaemia 66%, infection 52%, injury 22%, severe rhabdomyolysis (CK >=5000 U/l) 21%, acute kidney injury 20% and severe hypothermia <32 C 20% (Hüser et al., 2023, Cologne).

The damage of a long lie is mostly not the fall. It is hours of unrelieved pressure on skin and muscle, no fluids, a cooling floor, and in many cases a bladder emptied where the person lies. Pressure damage to deep tissue begins within hours; muscle breakdown releases proteins that can shut down the kidneys, and in people over 70 almost every case of that condition is a long lie; hypothermia is common in winter even indoors. How often each complication appears depends heavily on which patients a study counts.

• Integrated evidence from human, animal and cell studies indicates pressure ulcers in deep tissue under bony prominences very likely begin between the first hour and 4 to 6 hours of sustained loading (Gefen, Ostomy/Wound Management, 2008).
• In a French hospital cohort of 343 rhabdomyolysis patients (CK >5x normal), 90% of cases in patients aged 70 and over were explained by prolonged immobilization, principally after a fall (Morin, Somme & Corvol, BMC Geriatrics, 2024).
• In a London case-control study, 79% of patients admitted with hypothermia after being found ill indoors (mean age 80) had been found on the floor, versus 14% of controls; 86% lived alone (vs 43%) (Woodhouse, Keatinge & Coleshaw, The Lancet, 1989).
• In a 10-year Australian regional hospital series of 383 rhabdomyolysis cases (median age 71), the leading cause was prolonged immobility after a fall (71.5%); 50.7% developed acute kidney injury, 9.9% needed kidney replacement therapy and 7.6% died (Choy et al., Renal Society of Australasia Journal, 2020).
• Acute renal failure occurred in 57.7% of 343 rhabdomyolysis cases (median age 75; most older cases due to prolonged immobilization after a fall) at Rennes University Hospital, 2013-2019 (Morin et al., BMC Geriatrics, 2024).
• In 308 emergency-department rhabdomyolysis cases (CPK >=500 U/L) at two Florida community hospitals in 2017-2018, pressure injury / prolonged immobility was the most common cause (53.6%); 90.3% were admitted and 4.3% needed haemodialysis (Alter et al., JACEP Open, 2025).
• Among 370 patients over 80 presenting to a UK tertiary hospital after a fall with long lie and no trauma (Dec 2021-Jul 2022), 65% had a creatine kinase result and 39% of those were elevated; 4% (15 patients) developed acute kidney injury (Walters & Baxter, University Hospital Southampton, World Falls Congress abstract via British Geriatrics Society, 2026).
• Only 4% (15 of 370) of over-80s presenting to a UK hospital after a fall with long lie and no trauma developed acute kidney injury, while 25% were discharged the same day (Walters & Baxter, BGS/World Falls Congress abstract, 2026).
• Dehydration was diagnosed in 42 of 261 people (16%) transported to hospital after being found helpless at home; decubitus ulcers in 10 and aspiration pneumonia in 10 (Gurley et al., NEJM, 1996).
• Among 86 hypothermic elderly patients treated in a UK department between 1980 and 1985, mortality within 48 hours was 36%, and 90% of those who survived the hypothermia died within one year (Gautam et al., Public Health, 1989).
• In Japan's nationwide accidental-hypothermia registry (2018-2020, 1,194 patients, median age 79), 73.4% of cases occurred indoors, 49.3% were caused by acute medical illness, and 30-day mortality was 24.5% (Takauji et al., Acute Medicine & Surgery, 2021).

The psychological aftermath

• In the study that defined the 'post-fall syndrome', 10 of 36 older patients admitted after a fall showed severe clutching/grabbing and could not walk unaided, and 9 of those 10 had died or were still in hospital four months later (Murphy & Isaacs, Gerontology, 1982).
• A 2024 meta-analysis of 153 studies with 200,033 older adults in 38 countries estimated the global prevalence of fear of falling at 49.60% (range 6.96-90.34%), higher among patients than community residents (52.2% vs 48.4%) (Xiong et al., BMC Geriatrics, 2024).
• 32% (70 of 219) of older people who fell during a two-year study reported a fear of falling afterwards; fearful fallers went on to develop greater mobility restriction (Vellas et al., Age and Ageing, 1997; New Mexico, USA).

Sources: Medizinische Klinik - Intensivmedizin und Notfallmedizin; Ostomy/Wound Management; BMC Geriatrics (2024); The Lancet; Renal Society of Australasia Journal; JACEP Open; British Geriatrics Society; New England Journal of Medicine; Public Health; Acute Medicine & Surgery; Gerontology; Age and Ageing

Total mortality was 67% for people estimated to have been helpless for more than 72 hours versus 12% for those helpless for under 1 hour; overall mortality was 28% (Gurley et al., NEJM, 1996).

Time on the floor predicts death in every study that has measured it, and it predicts loss of independence almost as strongly: most survivors of being found helpless at home never returned to independent living. The San Francisco figures cover people living alone found helpless from any cause, so they bound the problem rather than isolate falls; the fall-specific cohorts from Birmingham, New Haven and Cambridge point the same way.

• Half of the home fallers who lay on the floor for more than one hour died within six months of the fall (Wild, Nayak & Isaacs, BMJ, 1981).
• 62% of survivors of being found helpless at home were unable to return to independent living (Gurley et al., NEJM, 1996; San Francisco, 1993).
• Of people hospitalised after being found helpless at home, two thirds either died or did not return to independent living (Gurley et al., NEJM, 1996; San Francisco, 1993).
• Among people aged 90+ who lay on the floor for an hour or more after a fall, 36% (5 of 14) moved into long-term care within one year and 53% (8 of 15) by the end of the study (Fleming & Brayne, BMJ, 2008).
• 60% (12 of 20) of people aged 90+ who had lain on the floor for an hour or more were admitted to hospital for a fall during the follow-up year (adjusted OR 4.0, 95% CI 1.3-12.3) (Fleming & Brayne, BMJ, 2008).
• Among people aged 90+, lying on the floor for an hour or more after a fall was associated with serious injury (adjusted odds ratio 4.2, 95% CI 1.2-14.8) (Fleming & Brayne, BMJ, 2008; Cambridge, UK).
• In Table IV of Wild, Nayak & Isaacs (BMJ, 1981), 11 of 20 fallers with a 'long lie' after the fall (55%) had died within one year, versus 21 of 105 without (20%).
• One quarter of 125 home fallers aged 65+ (32) died within one year, compared with 8 people in an age- and gender-matched control group (Wild, Nayak & Isaacs, BMJ, 1981).
• One-year mortality was 11% (17) among fallers unable to get up vs 5% (9) among fallers able to get up and 6% (47) among non-fallers; the trend was not statistically significant (Tinetti, Liu & Claus, JAMA, 1993, Table 5).
• Fallers who could not get up without help were more likely to suffer lasting decline in activities of daily living than fallers who could get up (35% vs 26%) (Tinetti, Liu & Claus, JAMA, 1993).
• Among community-dwelling people over 71, at least one fall causing serious injury carried an adjusted odds ratio of 10.2 (95% CI 5.8-17.9) for long-term nursing-home admission over three years; one non-injurious fall 3.1; two or more non-injurious falls 5.5 (Tinetti & Williams, NEJM, 1997).
• 12.1% (133 of 1,103) of community-dwelling people over 71 had long-term admissions to nursing homes during three years of follow-up (Tinetti & Williams, NEJM, 1997; New Haven, USA).
• Of 387 episodes of people living alone being found helpless or dead at home in San Francisco in 1993, 23% were found dead and a further 5% died in hospital, a total mortality of 28% (Gurley et al., NEJM, 1996).
• Of people found alive but helpless at home, 62% were admitted to hospital, with an average stay of eight days (Gurley et al., NEJM, 1996; San Francisco, 1993).
• 52% of hospital-admitted people who had been found helpless at home required intensive care, with an average ICU stay of seven days (Gurley et al., NEJM, 1996; San Francisco, 1993).
• In-hospital mortality was 10% overall and 16% among those requiring intensive care, for people admitted after being found helpless at home (Gurley et al., NEJM, 1996; San Francisco, 1993).
• Of survivors discharged to supportive care after being found helpless at home, 77% went to nursing homes, skilled-nursing or rehabilitation facilities and only 4% to live with family or friends (Gurley et al., NEJM, 1996).
• Of 50 'long lie trauma' patients (median age 76, median 13.5 hours on the ground) presenting to a German university emergency department in 2018-2020, 69% were admitted to intensive care and in-hospital mortality was 50% (Hüser et al., Med Klin Intensivmed Notfmed, 2023).
• 30-day in-hospital mortality was 10.5% (23 deaths) among 343 rhabdomyolysis patients, median age 75, at Rennes University Hospital, 2013-2019 (Morin et al., BMC Geriatrics, 2024).

When the fall broke a hip

• In a multicentre cohort of 1,733 surgically treated osteoporotic hip-fracture patients aged 50+, each additional day between fracture and hospital admission raised one-year mortality risk by 6% (adjusted HR 1.06, 95% CI 1.04-1.08), and admission beyond 4 days doubled it (HR 2.01) (Fu et al., BMC Musculoskeletal Disorders, 2026).
• In 78 geriatric hip-fracture patients at a north Indian tertiary centre (2019-2020), 41% presented more than 48 hours after injury; injury-to-admission time was a risk factor for 30-day mortality (OR 1.22 per day, 95% CI 1.03-1.44), with 30-day mortality 19.2% (Ghosh et al., Cureus, 2023).
• Among 567 hip-fracture patients aged 70+ in a Paris orthogeriatric pathway (2009-2015), 12% developed pressure ulcers, and a pressure ulcer was associated with 2.38 times the risk of death at six months (95% CI 1.31-4.32) (Magny et al., Archives of Osteoporosis, 2017).
• In 19,520 US hip-fracture surgery patients (NSQIP, 2016-2019), 2.7% arrived with a pre-existing pressure ulcer; a preoperative pressure ulcer was independently associated with higher 30-day mortality (OR 1.21, 99% CI 1.02-1.43) and pneumonia (OR 1.39) (Porter et al., JAAOS Global Research & Reviews, 2022).

Sources: New England Journal of Medicine (1996, 1997); British Medical Journal; BMJ; JAMA (1993); Medizinische Klinik - Intensivmedizin und Notfallmedizin; BMC Geriatrics; BMC Musculoskeletal Disorders; Cureus; Archives of Osteoporosis; JAAOS Global Research & Reviews

Half of the 125 home fallers aged 65+ lived alone and one fifth lived with an aged spouse only (Wild, Nayak & Isaacs, BMJ, 1981).

A long lie needs two things: a fall the person cannot get up from, and nobody there to notice. The second condition is the one demography is quietly making more common. In the San Francisco study, family found the person in barely one case in ten, and the rate of being found helpless or dead at home climbed almost tenfold between the early sixties and the mid-eighties.

• Only 11% of people found helpless or dead at home in the San Francisco study were found by family; carers, visiting nurses and home aides (76), friends (41), neighbours (36) and landlords (3) found most others, and calls from landlords were linked to the longest time down (median >72 hours).
• 82% of falls (217 of 265) among people over 90 occurred when the person was alone, over one year of prospective follow-up (Fleming & Brayne, BMJ, 2008).
• Among people aged 65 or older living alone, 31.6 per 1,000 per year were found helpless or dead at home (men 42.2, women 27.6 per 1,000) in San Francisco, 1993 (Gurley et al., NEJM, 1996).
• The annual rate of being found helpless or dead at home rose from 3 per 1,000 people aged 60-64 to 27 per 1,000 aged 85 and over, in San Francisco in 1993 (Gurley et al., NEJM, 1996).
• Among men aged 85 or older living alone, the rate of being found helpless or dead at home was 123 per 1,000 per year (women 85+ living alone: 59 per 1,000) in San Francisco, 1993 (Gurley et al., NEJM, 1996).

How many older adults live alone

In 2022, 28.0% of U.S. adults aged 65 and over (15.7 million of 56.1 million) lived alone - 'nearly 3 in 10' (derived from Census P20-587 Table 2).

• Around half (51.1%) of all people living alone in the UK in 2024 were aged 65 or over, compared with 45.5% in 2014 (ONS).
• 43% of U.S. women aged 75 and over lived alone in 2022 (U.S. Census Bureau America Counts, 2024; CPS ASEC).
• In 2019, four in ten EU women aged 65 and over (40%) lived alone, compared with 19% of men (Eurostat news, EU-LFS lfst_hhindws).
• Latvia had the EU's highest share of women aged 65+ living alone in 2019 (49%); Estonia the lowest (26%) (Eurostat news, 2020).
• 4.3 million people aged 65 and over lived alone in the UK in 2024, up from 3.5 million in 2014 (ONS, Families and households in the UK: 2024).
• 3.5 million people aged 65 and over lived alone in the UK in 2014 (ONS, Families and households in the UK: 2024).
• In 2024, 40.9% of UK women aged 65 and over lived alone, versus 27.0% of men (ONS).
• In 2022, 33.3% of U.S. women aged 65 and over (10.15 million) lived alone (U.S. Census Bureau, CPS ASEC 2022, P20-587 Table 2).
• In 2022, 21.8% of U.S. men aged 65 and over (5.58 million) lived alone (U.S. Census Bureau, CPS ASEC 2022, P20-587 Table 2).
• About 27% of U.S. women aged 65 to 74 lived alone in 2022 (U.S. Census Bureau America Counts, 2024; CPS ASEC).
• In 2022, 23.8% of U.S. men aged 75 and over lived alone, versus 42.5% of women (U.S. Census Bureau, P20-587 Table 2).
• 27% of U.S. adults aged 60 and older live alone, versus 16% across 130 countries and territories (Pew Research Center, 2020).
• In 2018, 40.2% of EU-27 women aged 65+ and 21.8% of men lived in single-person households (Eurostat, Ageing Europe 2020 edition, EU-SILC ilc_lvps30).
• By 2050, 26.1% of Japanese men and 29.3% of women aged 65 and over are projected to live alone (Cabinet Office FY2025 report, citing IPSS Household Projections 2024).
• Japan's one-person households headed by someone aged 65+ are projected to rise from 7.38 million (2020) to 10.84 million in 2050 (×1.47), from 13.2% to 20.6% of all households.
• In 1980, 4.3% of Japanese men and 11.2% of women aged 65 and over lived alone (Cabinet Office, FY2025 report; MIC Population Census).
• 2.6 million Australians lived alone in 2021; between 3.4 and 4.0 million are projected to live alone in 2046 (ABS Household and Family Projections, 2024).
• Between 31% and 35% of Australians aged 85 and over are projected to be living alone in 2046 (ABS Household and Family Projections, 2024).
• Around 87,000 Singapore residents aged 65 and above were living alone in 2024, according to the Ministry of Health's reply to a parliamentary question on preventing seniors from dying alone.

Living alone rises with age

• 53% of Canadian women aged 85 and older in private households lived alone in 2021, down from 60% in 2001 (Statistics Canada, 2021 Census).
• In 2021, 41.8% of Canadians aged 85 and older in private households lived alone - 'two in five' (Statistics Canada, 2021 Census, The Daily Table 1).
• In 2021, 32.0% of Canadians aged 80 to 84 lived alone (Statistics Canada, 2021 Census, The Daily Table 1).
• In 2021, 26.7% of Canadians aged 75 to 79 lived alone (Statistics Canada, 2021 Census, The Daily Table 1).
• In 2021, 23.1% of Canadians aged 70 to 74 lived alone (Statistics Canada, 2021 Census, The Daily Table 1).
• In 2021, 20.7% of Canadians aged 65 to 69 lived alone - 'one in five' (Statistics Canada, 2021 Census, The Daily Table 1).
• 4.4 million people lived alone in Canada in 2021 (15% of adults 15+), up from 1.7 million in 1981 (Statistics Canada, 2021 Census).

The population behind the numbers

• By 2050 the world's population aged 60 and over will double to 2.1 billion; the 80+ population will triple to 426 million (WHO Ageing and health, 2025).
• By the late 2070s the global population aged 65 and older is projected to reach 2.2 billion, surpassing the number of children under 18 (UN DESA, World Population Prospects 2024).
• By 2050 one in six people in the world will be over 65, up from one in 11 in 2019 (UN DESA, World Population Prospects 2019, cited on UN Ageing page).
• By 2030, 1 in 6 people in the world will be aged 60 or over, rising from 1 billion (2020) to 1.4 billion (WHO Ageing and health fact sheet, 2025).
• Japan's population aged 65 and over was 36.24 million on 1 October 2024, 29.3% of the total; those 75+ (20.78 million, 16.8%) now outnumber those 65-74 (Cabinet Office, Annual Report on the Ageing Society FY2025).
• The U.S. population aged 65 and older reached 61.2 million in 2024, 18.0% of the population, up from 12.4% in 2004 (U.S. Census Bureau, Vintage 2024 estimates).
• People aged 65 and over made up 21.6% of the EU population in 2024, up from 16% in 2004 (Eurostat, Demography of Europe 2025).

Sources: British Medical Journal; New England Journal of Medicine; BMJ; U.S. Census Bureau (2024, 2025); OECD; Eurostat (2020, 2025, 2026); Cabinet Office, Government of Japan; Office for National Statistics; Pew Research Center; National Institute of Population and Social Security Research, Japan; Australian Bureau of Statistics; Ministry of Health, Singapore; Statistics Canada (2022); World Health Organization; United Nations

In 2024 Wisconsin EMS responded to over 140,000 falls, which made up 21% of 911 ambulance runs with patient contact, per the Wisconsin Department of Health Services EMS and Falls Report (September 2025).

Falls are the largest single cause of injury that emergency medical services respond to: more than three and a half million US 911 responses in a year, more than eight hundred thousand UK calls. A growing share of those calls end with no treatment and no transport: the crew lifts the person off the floor and leaves. These "lift assists" are the closest thing we have to a routine count of people who fell and could not get up, and they are rising far faster than call volumes overall.

• Falls were the leading documented cause of injury in US 911 EMS activations with patient contact in 2024: 3,566,186 events, 52.9% of the 6,741,486 injury events with a recorded cause, per the NEMSIS 2024 National EMS Data Report.
• Over 800,000 calls were made to UK ambulance services in 2024 relating to slips, trips and falls, about 91 an hour, per Freedom of Information responses compiled by Spire Healthcare (11 of 13 services responded in full).
• Among Americans aged 65 and over, falls accounted for 17% of all 911 EMS calls in 2012, and 21% of those fall calls did not result in transport, per CDC analysis of NEMSIS data from 42 states (Faul et al., American Journal of Preventive Medicine 2016).
• In 2021 falls were the leading documented cause of injury in US 911 EMS activations with patient contact: 2,667,567 events, 51.5% of 5,176,176 injury events with a recorded cause, per the NEMSIS 2021 National EMS Data Report.
• Falls account for up to 10% of 999 calls to UK ambulance services, per the Association of Ambulance Chief Executives on launching the National Falls Governance Framework (October 2025).
• Approximately 10% of emergency ambulance calls are for adults aged 65 and older who have fallen (Gunson et al., Age and Ageing, 2025).
• Falls account for 8% of 999 calls with over 50,000 on-scene ambulance responses a year in the Yorkshire and Humber ambulance region, per the NIHR-funded Long Lies study protocol (Kuczawski et al., February 2026).
• In 2017/18 the Welsh Ambulance Service received over 62,000 calls relating to falls, half of which resulted in a journey to hospital, and fallers account for over 10% of its emergency calls, per a Welsh Government ministerial written statement (April 2019).
• The Scottish Ambulance Service attended 41,875 falls incidents involving people aged 65 and over in calendar 2024, out of 322,442 incidents attended for that age group, per its FOI response 25-168 (May 2025).
• Ambulance Victoria attended 324,060 falls patients aged 65+ between 2010 and 2017, 9.7% of its attended workload, with 78.8% transported to hospital and only 3.8% receiving a lights-and-sirens transport, per Cox et al., Injury 2018.
• There were 314,041 occasions of fall-related ambulance use by NSW residents aged 65+ between 2006 and 2013, with rates continuing to increase over time, per Paul et al., Public Health Research & Practice 2017.
• The Ambulance Service of New South Wales responded 42,331 times to people aged 65+ who had fallen in 2008/09, 5.1% of total emergency workload, with 76% transported (median age 83), per Simpson et al., Australasian Journal on Ageing 2013.
• Queensland Ambulance Service falls attendances at 54 regional residential aged-care facilities rose from 1,916 in 2021 to 2,528 in 2023 (6,663 attendances for 3,545 residents; 88% transported), per Hughes et al., Australasian Journal on Ageing 2026.
• Falls caused more than 53,700 Hato Hone St John ambulance callouts in New Zealand in the latest year, about 12% of total workload, with a median patient age of 81 and over two-thirds aged 75+, per the Hato Hone St John falls-prevention release (April 2026).
• Hato Hone St John attends approximately 34,000 fall-related incidents nationwide each year and processed 3,970 fall-prevention referrals in 2021, per Reid, Williams & Leonard, New Zealand Medical Journal 2026 (citing Safety Collective Tamaki Makaurau Auckland 2024).
• Sapporo, Japan logged 70,262 fall-related EMS calls for people aged 65+ in 2013-2022, and modelling projects falls to make up about 11% of all EMS calls by 2040 and 13% by 2060, per Uemura et al., International Journal of Emergency Medicine 2024.

Lift assists: found on the floor, not taken to hospital

About 42.8% of Falls Protocol 911 calls across three US agencies were lift assists (6,701 of 15,666), derived from the Annals of Emergency Dispatch & Response (2020).

• In Maplewood, Minnesota, EMS fall calls for people aged 60+ rose 268% between 2007 and 2017, lift assists nearly doubled, and non-transport fall calls cost the community an estimated US$1.5 million over the decade at about US$825 per untreated run, per Quatman et al., Geriatric Orthopaedic Surgery & Rehabilitation 2018.
• Non-transport (lift-assist and similar) EMS runs for falls at private residences in Wisconsin have risen by 16,000 a year since 2018, an 86% increase, and at nursing homes by 2,933 a year (285%), per the Wisconsin DHS EMS and Falls Report (September 2025).
• Colorado Springs Fire Department lift-assist calls rose from 1,567 in 2020 to 3,051 in 2025, roughly doubling in five years, per CSFD figures reported by KOAA News5.
• Decatur (Illinois) Fire Department lift-assist calls grew from 430 in 2014 to more than 1,000 in 2023; after a $500 fee for non-medical lift assists at care facilities, such calls fell about 60% against the prior two-year average, per EMS1 (April 2025).
• Chattanooga Fire Department non-emergency 'citizen assist' calls (including lift assists) roughly tripled, to 1,320 in 2018 from 435 in 2013, per the Chattanooga Times Free Press via FireRescue1 (May 2019).
• Lift-assist 911 responses to assisted living and other senior-care settings in the US rose 30% between 2019 and 2022, three times the growth in overall 911 volume, and in Illinois lift assists were 1 in 20 of all fire-department 911 calls, per a Washington Post analysis reported by Senior Housing News (May 2024).
• Wisconsin EMS responded to 35,564 more falls in 2024 than in 2019, an average rise of 6.1% a year (nearly 10,000 extra falls a year), per the Wisconsin DHS EMS and Falls Report (September 2025).
• In a suburban US fire-based EMS system, 1,087 lift-assist responses made up 4.8% of all EMS incidents from 2004 to 2009, and two-thirds of them went to one-third of the 535 addresses involved, per Cone et al., Prehospital Emergency Care 2013.
• After a lift-assist call, 563 return EMS visits to the same address occurred within 30 days; where patients could be matched, 47.3% were for medical complaints and 55.5% ended in hospital transport, per Cone et al., Prehospital Emergency Care 2013.
• In London, Ontario in 2013, 804 of 42,055 EMS calls (1.9%) were lift assists for 414 people; within 14 days 21% had an emergency department visit, 11.6% a hospital admission and 1.1% died, per Leggatt et al., Prehospital Emergency Care 2017.
• Middlesex-London EMS handled 1,121 lift-assist calls for 611 people aged 65+ in 2015; 32% called more than once, calls averaged 43 minutes (6 minutes to 2 hours 23 minutes), and paramedics spent 801 hours (33 full days) solely on older-adult lift assists, per Schierholtz et al., Prehospital Emergency Care 2019.
• In a suburban Midwest fire-based EMS agency (2008-2017), 1,169 of 21,760 calls (5.4%) were older-adult falls, and lift assists were transported only 7% of the time versus 78% for falls, per Archives of Gerontology and Geriatrics Plus (2024).
• In the Newcastle study, 165 of 1,504 falls attended in people over 65 (11%) required assistance only, with no conveyance to A&E, per Newton et al., Emergency Medicine Journal 2006.
• Across 12 studies, non-transport rates for older people attended by ambulance after a fall ranged from 11% to 56%, and up to 49% of non-transported fallers had unplanned health-care contact within 28 days, per a systematic review by Mikolaizak et al., Australasian Journal on Ageing 2013.
• In a one-month South Australian audit, 379 of 1,700 ambulance callers after a fall (22%) used a personal alarm to summon help, and 58% of alarm-activated calls were false alarms (Johnston et al. 2010, as restated by Blackburn et al., 2022).

The same people call again

A 2023 scoping review reports that 78.8% of older fallers who had a long lie later re-contacted the ambulance service, versus 60.6% of fallers without a long lie, citing Simpson et al. 2014 (Kubitza et al., European Review of Aging and Physical Activity, 2023).

• Among patients who refused EMS transport after a fall in Camden County, New Jersey (July 2021-July 2022), 37.9% were repeat callers and 21.8% 'super-users', with repeat callers having 17-fold higher odds of a 30-day ED visit, per Barr et al., Western Journal of Emergency Medicine 2025.
• In one US urban EMS service (year to October 2024), 433 of 7,329 geriatric calls were refusals of transport after a fall; 32.8% of those patients had a repeat EMS call in the same month, 71.1% of whom were transported and 65.9% of those admitted, per Moore et al., American Journal of Emergency Medicine 2025.
• 32% of older adults who received a Middlesex-London EMS lift assist in 2015 called more than once that year, per Schierholtz et al., Prehospital Emergency Care 2019.
• Over ten years in one suburban US community, 11% of 37,324 EMS calls were fall-related calls for people aged 60+, 29% of those fallers called again, and the 15% who called five or more times were transported only 21% of the time versus 75% for first-time callers, per Quatman et al., Journal of the American Geriatrics Society 2018.
• In a suburban US EMS system with about 120,000 dispatches a year, most repeat EMS encounters after a non-transported lift assist in patients aged 60+ occurred within 72 hours, 76% resulted in transport and 61% had a medical cause, per Dorsett et al., Prehospital Emergency Care (2026; 2022 data).
• Of 1,079 falls attended by the Northern Ireland Ambulance Service in people aged 65+ over three months in 2017, 7% were referred to a falls prevention service; of those, 37.3% re-contacted the ambulance service within a month and 70.7% within six months, per Scott, British Paramedic Journal 2020.
• Among older fallers attended by Ambulance Victoria, 13.2% had a repeat fall attendance within 12 months, with a median of 98 days between the first and second fall, per Cox et al., Injury 2018.
• Across three US emergency dispatch/EMS agencies, 6,701 of 15,666 Falls Protocol calls (January 2017-July 2018) were lift assists, and 3.82% of lift assists generated a repeat 911 call within 24 hours, per the Annals of Emergency Dispatch & Response (2020).

What services are doing about it

• After 600 Welsh care homes received lifting cushions and the ISTUMBLE assessment app in 2018, falls needing an ambulance fell from 379 to 75 (an 80% reduction) and 87% of falls were managed in-house, per NHS England's falls-response guidance (2022).
• In the Welsh Ambulance Service Falls Assistants pilot (Oct 2018-Mar 2019), 65% of 1,776 fallers attended did not need to attend hospital and the average response was 24 minutes after allocation, per the Welsh Government (April 2019).
• East of England Ambulance Service Community Wellbeing Officers helped 443 people who had fallen between November 2023 and September 2024, with 40% discharged without further ambulance attendance, per EEAST (September 2024).
• About 6,000 Community First Responders in England responded to 236,000 incidents in 2021/22, and most ambulance trusts already use them for falls, per NHS England's community-based falls response guidance (October 2022).
• A multifactorial fall-prevention intervention delivered by community EMS clinicians would save US$964 per patient over one year versus no intervention and remain cost-saving up to a programme cost of $1,634 per patient, per a decision-tree model in Injury Prevention (Ordoobadi et al., 2025).

Sources: Wisconsin Department of Health Services; NEMSIS Technical Assistance Center (2022, 2025); Spire Healthcare; American Journal of Preventive Medicine; Association of Ambulance Chief Executives; Age and Ageing; NIHR Open Research; Welsh Government; Scottish Ambulance Service; Injury; Public Health Research & Practice; Australasian Journal on Ageing (2013, 2026); Hato Hone St John; New Zealand Medical Journal; International Journal of Emergency Medicine; Annals of Emergency Dispatch & Response; Geriatric Orthopaedic Surgery & Rehabilitation; KOAA News5; EMS1, reporting Decatur Fire Department data; FireRescue1; Senior Housing News; Prehospital Emergency Care (2013-2025); Archives of Gerontology and Geriatrics Plus; Emergency Medicine Journal; Australasian Journal of Paramedicine; European Review of Aging and Physical Activity; Western Journal of Emergency Medicine; The American Journal of Emergency Medicine; Journal of the American Geriatrics Society; British Paramedic Journal; NHS England; East of England Ambulance Service NHS Trust; Injury Prevention

After falls, the PERS was not activated by 83% of subscribers who fell alone and lay on the floor for more than 5 minutes.

The uncomfortable finding, in every study that has looked, is not that alarms are missing. They are within reach in almost every fall. They are not pressed: because the person is confused, cannot reach the pendant, is not wearing it, or does not want to be a bother. When an alarm is pressed, a long lie almost never follows. The gap between "having" and "using" is where most of the long-lie problem lives, and it starts with wearing: fewer than one in five alert users say they wear the device at all times.

• In 97% of 'long lies' (an hour or more on the floor) that occurred despite an installed alarm, the person who fell alone did not use their alarm to summon help.
• In 80% of falls in which a person aged over 90 fell alone, could not get up, and had a call alarm available, the alarm was not used to summon help.
• Some form of call alarm was available in 99% of falls in which a person over 90 fell alone and could not get up.
• When a call alarm was activated after a fall alone by someone unable to rise, lying on the floor for an hour or more occurred in only one, or perhaps two, of 28 such falls.
• Only one of the 367 people found helpless or dead at home in the San Francisco study possessed a commercially available device to summon help (Gurley et al., NEJM, 1996).
• Only 18% of current medical-alert users say they wear or carry their device at all times (industry survey).
• 64% of medical-alert users report not wearing the device in the shower (industry survey).
• 24% of community-dwelling PERS subscribers reported that they never wear the alarm button.
• Only 14% of PERS subscribers wear the alarm button 24 hours a day.
• Two of the 33 reviewed PERS studies found that about 25% of respondents never wore the pendant.
• In a six-month pilot of older adults at risk of falls given a PERS pendant, the median share of days the pendant was worn was 68.0% (IQR 56.1-84.4%).
• In institutional (care-home) settings, 94% of falls where the person was alone, could not get up and had an alarm did not involve alarm use.
• Among people over 90 living in the community (own homes), 78% of falls where the person was alone, could not get up and had an alarm did not involve alarm use.
• Only 10 of 125 home fallers had an alarm system; of nine with a call system, two used it successfully, one tried and failed and six made no attempt; no faller used the telephone after falling (Wild, Nayak & Isaacs, BMJ, 1981).
• Of 31 older people interviewed after calling an ambulance following a fall, 20 owned a personal alarm; the study identified a group who owned an alarm but did not use it effectively.
• In a 12-month prospective cohort of 295 community-dwelling older adults, outcomes after an emergency were similar for personal-alarm purchasers and non-purchasers, with no difference in time spent on the floor or hospitalisations.
• An integrative review of research on personal emergency response systems from the users' perspective identified 33 peer-reviewed studies published 1987-2014.

How reliable is automatic fall detection?

A pendant-worn automatic fall-detection device detected 17 of 89 falls recorded by nursing-home staff (sensitivity 19%) over six months.

• In a real-world trial of a wearable automatic fall-detection device with community-dwelling older adults, 83 of 84 fall alarms recorded were false alarms.
• Only one genuine fall was automatically detected; three further falls occurred while the device was worn but were not identified as falls.
• Of 128 fall events the automatic fall-detection pendant recorded, 111 (87%) were false positives.
• Apple Watch Series 5 Fall Detection recognised only 14 of 300 intentional falls from a wheelchair by able-bodied young adults (sensitivity 4.7%).
• Thirteen published accelerometer fall-detection algorithms re-tested on 29 real-world falls achieved an average sensitivity of only 57.0% (SD 27.3; best 82.8%).
• During one day of monitoring three representative fallers, the number of false alarms generated by the 13 fall-detection algorithms ranged from 3 to 85.
• Of 57 wearable fall-detection projects in a systematic review, only 7.1% reported monitoring older adults in a real-world setting.
• A threshold-based smartwatch fall-detection app detected 77% of 226 induced falls (specificity 99%) in healthy adults aged 18-52.
• One early PERS service evaluation cited in the review found that 40% of all alarm calls were false alarms.
• Apple states that Apple Watch cannot detect all falls, and that high-impact activity can trigger Fall Detection in error.
• Lifeline (formerly Philips Lifeline) states that its AutoAlert fall detection does not detect 100% of falls and that users should press their button when they need help.
• Apple Watch Fall Detection is turned on automatically for users aged 55 and over (if their age is set up in Medical ID / Health Profile).
• If Apple Watch senses immobility for 60 seconds after a fall notification, it automatically calls emergency services.

What older adults actually have

9% of US adults aged 65+ currently use a medical alert system / PERS, unchanged from the same survey in 2023 (industry online-panel survey).

• 95% of US adults aged 65 and older own a cellphone of any kind (2025).
• 78% of US adults aged 65 and older own a smartphone (2025).
• Only 6% of community-dwelling adults aged 65+ with mobility or daily-living difficulties in England reported using a personal call alarm.
• Among US adults 50+ who have provided caregiving, 12% currently use an emergency response system (physically or voice-activated) for the person they care for; 36% are interested.
• In 2025, 12% of Medicare Advantage enrollees were in plans offering a personal emergency response system (PERS) benefit, up from 7% in 2018.
• 36% of US adults aged 50+ own a wearable device (2025), up from 11% in 2016; wearables are the one device category still owned more by adults 18-49.
• 36% of US Baby Boomers (ages 65-74) own a smartwatch or connected health device (2024), versus 66% of Millennials.
• 90% of US adults aged 50+ own a smartphone in 2025, up from 55% in 2016.

Sources: Zeitschrift für Gerontologie und Geriatrie; BMJ; New England Journal of Medicine; TheSeniorList.com; Journal of Medical Internet Research; Innovation in Aging; British Medical Journal; International Journal of General Medicine; Home Health Care Services Quarterly; Journal of the American Geriatrics Society (2015, 2016); Assistive Technology; PLOS ONE; Journal of Geriatric Physical Therapy; JMIR Formative Research; Apple Inc. (2018, 2026); Lifeline Systems; Ageing & Society; AARP Research (2025); Pew Research Center; Medicare Payment Advisory Commission; Rock Health

In 2025, 76,941 people in Japan who lived alone died at home and were handled by police, 37.6% of 204,562 police-handled bodies, up from 76,020 in 2024.

No country counts long lies directly. The closest official series are the counts of people who lived alone and died at home, published by Japan's National Police Agency and South Korea's welfare ministry, and the forensic studies of bodies found days or weeks after death in European and American cities. These are deaths from any cause, so they bound the "nobody noticed" problem rather than measure falls. They are also the only numbers of their kind, and they show how long discovery can take: in Japan, more than seven thousand people in a single year were not found for a month or more.

• In 2025, 7,148 people who died alone at home in Japan (9.3%) were not found for a month or more.
• In 2024, 4,538 people aged 65+ who lived alone in Japan (7.8%) were found a month or more after dying at home; across all ages the figure was 6,945 (9.1%).
• In 2024, 15,630 people aged 65+ who lived alone in Japan were found 8 or more days after dying at home, 26.9% of all such elderly deaths.
• Japan's Cabinet Office estimate of 'isolated deaths' rose to 22,222 in 2025 (from 21,856 in 2024): people living alone found 8 or more days after dying at home, 17,620 men, 4,598 women and 4 whose gender was not recorded.
• Japan's Cabinet Office estimates 21,856 'isolated deaths' (孤立死) in 2024, people living alone who died at home and were found 8 or more days after death (men 17,364; women 4,466).
• Of the 76,941 people who died alone at home in Japan in 2025, 58,919 (76.6%) were aged 65 or over.
• In 2024, 76,020 people in Japan who lived alone died at home and were handled by police, 37.2% of all 204,184 police-handled bodies that year (first full-year national count).
• Of the 76,020 people who died alone at home in Japan in 2024, 58,044 (76.4%) were aged 65 or over.
• Of the 76,020 people who died alone at home in Japan in 2024, 28,756 (37.8%) were found within a day; 15,421 (20.3%) in 2-3 days; 9,987 (13.1%) in 4-7 days; 7,515 (9.9%) in 8-14 days; 7,396 (9.7%) in 15-30 days; 5,138 (6.8%) in 31-90 days; 1,165 (1.5%) in 91-180 days; 389 (0.5%) in 181-365 days; 253 (0.3%) after a year or more.
• Of 58,044 people aged 65+ who lived alone and were found dead at home in Japan in 2024, 22,734 (39.2%) were found within one day of death, while 4,538 (7.8%) were not found for more than 30 days (National Police Agency of Japan, 2025).
• The single largest age band among Japan's 76,020 solitary at-home deaths in 2024 was people aged 85 and over: 14,658.
• In Tokyo's 23 wards in 2021, 41.8% of men and 26.2% of women who lived alone and died at home (ME-examined cases) were found 8 or more days after death; only 14.9% of men and 24.1% of women were found within a day, versus about 81% of people who lived with others.
• In Tokyo's 23 wards, 4,957 people aged 65+ who lived alone died at home in 2023 (unnatural-death cases examined by the Tokyo Medical Examiner's Office), up from 2,878 in 2013.
• Japan's official working definition: an 'isolated death' (孤立死) is 'dying without anyone at one's side, with the body found after a certain period'; for statistics it is operationalised as a police-handled body of a person living alone who died at home (including suicide) and was found 8 or more days after death.
• As a reference figure, 31,843 people living alone in Japan were found 4 or more days after dying at home in 2024, the point at which the Cabinet Office notes visible decomposition typically begins.
• In January-June 2024, 37,227 people living alone died at home in Japan (36.2% of 102,965 police-handled bodies); 28,330 were aged 65+ (provisional).
• In January-June 2025, 40,913 people living alone died at home in Japan (36.8% of 111,036 police-handled bodies); 31,525 were aged 65+ (provisional).

South Korea's lonely deaths

South Korea's lonely deaths rose 7.2% to 3,924 in 2024 (from 3,661 in 2023), 1.09% of all deaths and 7.7 per 100,000 population.

• Men accounted for 84.1% of South Korea's lonely deaths in 2023 (3,053 of 3,632 with known gender), more than five times the number of women (579).
• In South Korea in 2024, lonely-death bodies were most often found by a landlord, security guard or building manager (43.1%), then family (26.6%), neighbours (12.0%) and health/welfare workers (7.7%); in 2023 the shares were 34.5%, 26.2%, 19.3% and 7.0%.
• South Korea recorded 3,661 'lonely deaths' (고독사) in 2023, up from 3,559 in 2022 and 2,412 in 2017; they equalled 1.04 of every 100 deaths in 2023.
• South Korea's statutory definition of a lonely death: 'a person who lived in social isolation, cut off from family, relatives and others around them, dying by suicide, illness or other cause', with no minimum days-to-discovery.

Forensic and public-health signals elsewhere

• In a 12-week population-based study in San Francisco (1993), paramedics found 367 people living alone helpless or dead at home (387 events); 23% were found dead and a further 5% died in hospital, total mortality 28%.
• San Francisco paramedics identified 387 events in which 367 people were found helpless or dead in their homes over 12 weeks (Gurley et al., NEJM, 1996).
• At a central London mortuary, markedly decomposed bodies among coronial autopsies rose 70.5% in the year after the first UK lockdown (23 March 2020) versus the year before, alongside a 38% rise in home deaths and a 52.4% fall in hospital deaths coming to autopsy.
• In Amsterdam, bodies lying unnoticed at home for two weeks or more occurred at 5.3 per 100,000 person-years (379 cases) versus 1.4 per 100,000 in surrounding municipalities (58 cases); all but three of the 437 people lived alone, and among people living alone the rate was 2.7 times higher in the city.
• Among 420 at-home deaths autopsied at Okayama University, 244 (58.1%) were found three or more days after death; delayed discovery was associated with being male, older, living alone, single, retired or not employed, and lacking long-term-care certification, while regular visits from relatives living elsewhere led to early detection.
• Of 88 decomposed bodies from non-traumatic in-home deaths of older people examined in Turkey, 85.2% had lived alone, 83.0% were men and the mean age was 70.9.
• In England and Wales, age-standardised rates of deaths coded R98/R99 ('unattended' / 'ill-defined and unknown cause', a proxy for bodies found too decomposed to ascertain cause) rose from 1979 to 2020 while all other mortality fell; by the 2000s the male rate was more than double the female rate.
• Across the four largest Dutch cities, the incidence of single-household bodies found 14+ days after death was similar in Amsterdam, The Hague and Rotterdam and almost twice that of Utrecht (IRR 1.9, 95% CI 1.1-3.0).
• In eastern Attica (Greece), 217 decomposing bodies were found indoors over 2012-2021; the typical case was a Greek man over 65, single, childless and living alone, found by relatives or neighbours within a month of death, with a natural cause.
• In Vienna, 320 people were found decomposed or mummified at home in 1993-1997 (versus 412 in 1963-1967), with a significantly higher share aged over 64 in the 1990s and a suicide rate nearly three times higher.
• A review of 1,714 decomposition cases at the Allegheny County (Pittsburgh) Medical Examiner's Office over 2007-2016 found reported post-mortem intervals ranging from 1 to 2,920 days, with 'last known social contact' the main basis for the interval in 82% of US cases.

Sources: National Police Agency of Japan (2024, 2025, 2026); Cabinet Office, Japan (2025, 2026); Tokyo Metropolitan Medical Examiner's Office; Ministry of Health and Welfare, Republic of Korea (2024, 2025); New England Journal of Medicine; Journal of Clinical Pathology; Journal of Forensic and Legal Medicine (2018, 2020); Legal Medicine; BMC Geriatrics; Journal of the Royal Society of Medicine; Forensic Science International; Journal of Forensic Sciences; Science & Justice

The estimated average cost of care for each person found helpless at home was $9,985 (70% of 1993 charges for paramedic, hospital and ICU days) in San Francisco (Gurley et al., NEJM, 1996).

The only per-patient cost of being found helpless at home is three decades old and in 1993 dollars; nobody has repeated it. What exists instead are the national cost of falls as a whole, which sets the scale, and the unit costs of the ambulance response.

• Medical costs attributable to fatal and nonfatal falls among U.S. adults 65+ were approximately $50.0 billion in 2015 (Florence et al., J Am Geriatr Soc, 2018).
• Falls in people aged 65 and over have an estimated cost to the NHS of GBP 2.3 billion per year (NICE impact report, 2018; figure originates in NICE CG161, 2013).
• The direct cost of fall-related injuries among Canadians aged 65+ was estimated at CAD 5.6 billion in 2018 (PHAC, 2025).
• Hip fractures alone account for 1.8 million hospital bed days and GBP 1.1 billion in hospital costs every year in the UK; fragility fractures cost GBP 4.4 billion (OHID, 2022).
• Medical spending for fatal falls among U.S. adults 65+ was an estimated $754 million in 2015 (Florence et al., 2018).
• The total cost of an EMS run that did not result in treatment (e.g., a lift assist) was approximately US$825 in Maplewood, Minnesota, per Quatman et al., Geriatric Orthopaedic Surgery & Rehabilitation 2018.
• NHS England's falls-response guidance costs an ambulance call-out at £252, so 92 avoided call-outs in a six-week care-home lifting-equipment pilot in Mid and South Essex saved £23,184 (October 2022).
• Attending fallers in the community cost the North East Ambulance Service £145.83 per fall and £376,018 a year in Newcastle (based on 1,504 falls in people over 65 across 7 months), per Newton et al., Emergency Medicine Journal 2006.

Sources: New England Journal of Medicine; Florence CS et al., Journal of the American Geriatrics Society; NICE; Public Health Agency of Canada; Office for Health Improvement and Disparities; Geriatric Orthopaedic Surgery & Rehabilitation; NHS England; Emergency Medicine Journal

The Long Lies study expects about 16,000 documented long lies among roughly 115,000 Yorkshire Ambulance Service fall calls (April 2019-March 2023), per the NIHR study protocol (2026).

The largest study of long lies ever attempted is under way at the University of Sheffield, funded by the UK's National Institute for Health and Care Research. It links four years of Yorkshire Ambulance Service fall records to hospital and death data, which will give the first population-scale estimate of how many long lies occur, how long they last, and what happens afterwards. Results are expected from late 2026. We will add them here when they are published.

• Around one in five falls among adults over 65 results in a long lie of over one hour on the floor, per the University of Sheffield CURE Long Lies Study page (NIHR158676).
• 30% of people over 65 and 50% of those over 80 experience at least one fall annually (UK framing cited to NICE CG161 and Rubenstein 2006 in Kuczawski et al., NIHR Open Research, 2026).
• Among over-90-year-olds, 58% were reported to have fallen in the previous year and 60% fell during 1-year prospective follow-up, at a prospectively measured rate of 2.8 falls per person-year (Fleming et al., BMC Geriatrics, 2008).

Sources: NIHR Open Research; University of Sheffield, Centre for Urgent and Emergency Care Research; BMC Geriatrics