A
While the older person is still clear-headed, designate their future guardian in writing
Value for cost High
In plain termsWhile the older person's mind is still clear, spend a few hundred yuan at a notary office on a written document stating who will be their guardian in the future. Without this document, once the older person can no longer make their own decisions, who signs for them and who manages their money will have to be designated by a court. If family members disagree, it will drag on even longer.
- Cost
- Have one drawn up at a notary office, a few hundred yuan. One conversation with the older person is enough to settle it. The hard part is bringing it up: you have to talk with them face to face about the day when they can no longer take care of themselves
A little money
Done in passing
Some willpower
Benefit size large
- Benefit
- The Civil Code (民法典) provides that an adult who is clear-headed and can make their own decisions (in legal terms, “an adult with full capacity for civil conduct”) may agree with others in advance on who will be their guardian in the future. The other party can be a close relative, or another individual or organization willing to serve as guardian. Once it is agreed, they must “determine their guardian in writing.” When in the future they can no longer make decisions, or can make only some of their decisions (in legal terms, “lose or partially lose capacity for civil conduct”), the person named in writing takes charge. Without this document, who signs for them and who manages their money in the future has to go through designation by a court
- Evidence grade
- A
- Notes
- This document is called voluntary guardianship (意定监护), meaning a person the older person designates themselves in advance. This person ranks ahead of the default order of guardians set by law. Older people who live alone, whose children live in another city, or whose family relationships are complicated have even more need to do this in advance. It is advisable to have it notarized at a notary office
A
Make a will, and remember that a later will overrides an earlier one and a notarized will no longer takes priority
Value for cost High
In plain termsThe law recognizes six kinds of will, but if the form is wrong the whole will is void, and this is the most common way things go wrong. For the kind you write by hand yourself, the person must write it entirely by hand from start to finish, sign it, and clearly write the year, month and day. If several wills were made and their contents conflict, the last one made is the one that counts. Since 2021, a notarized will also no longer automatically comes first.
- Cost
- Writing a will by hand yourself costs nothing. Having it notarized at a notary office costs from a few hundred to a thousand yuan or more. The hard part is bringing it up: you have to talk with the family about what happens after death
No money
Done in passing
Some willpower
Benefit size large
- Benefit
- The Civil Code (民法典) recognizes six forms of will: handwritten by the testator, written by someone else on the testator's behalf, printed, audio or video recorded, oral, and notarized. Each form has its own procedural requirements that must be met (in legal terms, “formal requirements”). If several wills were made and their contents conflict, the last one made prevails. Since 2021, a notarized will no longer automatically comes first
- Evidence grade
- A
- Notes
- A will you write by hand yourself must be written entirely by hand by the person from start to finish, signed, and clearly dated with the year, month and day. A printed will must have two or more witnesses. The testator and the witnesses must sign every page and clearly write the year, month and day. Heirs, people written into the will to receive property, and their close relatives cannot serve as witnesses. If the form is wrong the whole will is void; this is the most common way things go wrong
C
Keep the older person's money in a separate account, and set a two-person confirmation rule for large expenses
Value for cost High
In plain termsScams that get older people to buy health supplements, collectibles or wealth-management products all follow the same script: first spend a few months getting close to them, then harvest everything in one go. Agree on a rule in advance: any expense above a certain amount must first be mentioned to a particular person. This amounts to pushing back the moment of handing over the money, past the most impulsive stretch.
- Cost
- No money. Talk it over with the family once and settle on an amount. The hard part is how to bring it up without making the older person feel you are guarding against them
No money
Done in passing
Some willpower
Benefit size large
- Benefit
- Health-supplement, collectibles and wealth-management scams aimed at older people all follow the script of first spending a few months building up trust, then harvesting everything in one go. Agree in advance that “any expense above a certain amount must first be mentioned to a particular person.” This amounts to putting off the decision to pay, past the most impulsive stretch
- Evidence grade
- C
- Notes
- Don't present this as “I'm afraid you'll be scammed.” Present it as “we keep one set of books for the family's money,” and older people accept it more easily. Also, don't hand all of the older person's money over to the children to keep; that leads to another kind of dispute
- Sources
- 作者经验，无直接文献；防骗通则见第 8 节和第 13 节
C
Give the older person a ready excuse they can say at any time: “I need to go home and talk it over with my family”
Value for cost High
In plain termsSales pitches and scams rely on on-the-spot pressure that makes it awkward to say no right then and there. Agree with the older person in advance on one sentence: “I need to go home and talk it over with my family.” They can say it at any time, and it gives them a way out on the spot. This works better than reasoning with them after the fact.
- Cost
- No money. One conversation with the older person; a few minutes is enough
No money
Done in passing
No willpower
Benefit size medium
- Benefit
- Sales pitches and scams both rely on applying pressure on the spot. Agree in advance on the sentence “I need to go home and talk it over with my family,” so the older person has a way out. This is more effective than reasoning after the fact
- Evidence grade
- C
- Notes
- Use this together with Item 3 (keep the older person's money in a separate account). While you are at it, also make the home fall-proof; see Section 1. This sentence is meant to give the older person a way out so they don't have to stand up to people head-on in the moment; it is not for guarding against them. When surrounded by salespeople, the hardest part is saying no in front of a roomful of people, harder even than telling what is true from what is false
- Sources
- 作者经验，无直接文献
A
Stay away from any “investment in old-age care” that has the older person pay first: membership cards, buying beds, buying senior apartments, “travel-and-stay” old-age care and buying senior products are all the same illegal fundraising scheme
Value for cost High
In plain termsOld-age care schemes that have the older person pay first and promise returns are all the same scam: membership cards, buying beds, buying senior apartments, travel-and-stay old-age care, and meetings that sell senior products. Under the rules, losses on this kind of money are yours alone to bear. Someone collected 136 million yuan by taking reservations for beds in senior apartments, cheating more than 2100 people. The only thing that can be stopped is the step of handing over the money.
- Cost
- No money. Read the scheme names below aloud to the older person once; a few minutes. From then on, when they come across one, refuse outright: don't go to the lectures, don't go on the visits, don't leave a phone number. The hard part is that if the older person has already been several times and gotten to know the people, it is hard to talk them back out of it
No money
Done in passing
Some willpower
Benefit size large
- Benefit
- The Ministry of Civil Affairs has listed five forms this takes; recognizing the scheme names is more reliable than judging the people. The first: falsely using the name of an elderly care institution: no real premises, a temporarily rented venue, and a claim to have signed a cooperation agreement with an elderly care institution, in order to “piggyback” on it. The second: in the name of providing “elderly care services”: selling “VIP cards,” “membership cards” and “prepaid cards,” having people pay “elderly care service fees” in advance, and promising services that clearly exceed their own bed capacity. The third: in the name of investing in “elderly care projects.” Common schemes include buying shares in health and elderly care bases and selling fictitious senior apartments. There are also long-term leases of elderly care beds and “time bank” mutual-aid elderly care. The cover they use is sales with the principal returned, leaseback after sale, and agreed buyback. The fourth: in the name of selling “senior products”: product buyback, consignment and resale, consumption rebates, free health checks, free gifts, conference marketing, health lectures, and free consultations by experts. The fifth: in the name of enjoying “travel-and-stay elderly care”: low-cost or free tours, rebates on stored value, and points-based elderly care. The money cannot be recovered; the regulations say so explicitly. Article 25 of the Regulations on Preventing and Handling Illegal Fundraising (防范和处置非法集资条例) provides that “losses suffered from participating in illegal fundraising shall be borne by the fundraising participants themselves,” so money lost is yours alone to bear. Among officially reported cases, Dai Mouping and others illegally raised 136 million yuan in the name of reserving beds in senior apartments, with more than 2100 victims; Dai Mouping was sentenced to 15 years for fundraising fraud and fined 400,000 yuan. Cao Mouming committed fundraising fraud of 13.207 billion yuan in the name of investing in the elderly care industry, involving more than 110,000 people, and was sentenced to life imprisonment, deprived of political rights for life, and had all personal property confiscated. Health-supplement conference sales are prosecuted as fraud. Ni Mourong used free banquets, free gifts and chauffeured pickup to bring older people to lectures. The lecturers used “false personas, false cases, and inflated prices with staged bargaining” to make up cancer-preventing and cancer-fighting effects. Older people were lured into buying “dihydroquercetin” at dozens of times the cost price. Sales came to more than 620,000 yuan. Ni Mourong was sentenced to 10 years and 3 months and fined 120,000 yuan (nationwide; the regulations took effect on May 1, 2021)
- Evidence grade
- A
- Notes
- Judge not by whether “this place looks legitimate,” but by whether “they have you pay first and whether they promise returns.” Elderly care institutions are supposed to sell services; once their pitch brings in investment, rebates or getting your money back, don't believe it. Being taken to lectures, tours or free medical consultations is not illegal in itself, and it is hard to stop. What can be stopped is the step of handing over the money; use this together with the two-person confirmation rule in Item 3. If money has already been paid, immediately follow Section 8, Item 2 and call 110 (police) or 96110 to request a stop-payment, and at the same time report it to the local lead department responsible for handling illegal fundraising. Using your home to fund old age (以房养老) is a separate path; see Item 6 (home reverse-mortgage pension insurance).
B
Apart from insurers' home reverse-mortgage pension insurance, stay away from every other “use your home to fund old age” scheme, and never mortgage the home to buy wealth-management products
Value for cost High
In plain termsThere is only one legitimate way of using your home to fund old age: insurers' home reverse-mortgage pension insurance, which is still being piloted. The kind sold door to door has nothing to do with it; it tricks older people into mortgaging their homes and then using the borrowed money to buy the wealth-management products it recommends. Some people don't even know their home has been mortgaged, and in the end they lose the home and are still left carrying the loan.
- Cost
- No money. Don't hand the family's property certificate to anyone who comes to the door in the name of “using your home to fund old age.” Before signing any mortgage, guarantee or loan agreement, have the children look it over first. The hard part is that the people who come to the door are often very warm and have made many trips, and the older person finds it awkward to turn them down
No money
Done in passing
Some willpower
Benefit size large
- Benefit
- The Consumer Protection Bureau of the China Banking and Insurance Regulatory Commission has spelled out the difference between the real and the fake. There is only one legitimate way of using your home to fund old age, called “reverse-mortgage pension insurance on older people's housing.” Older people who hold full legal property rights to a home mortgage it to an insurance company. The home still belongs to them to live in, use and collect rent from. To sell or otherwise dispose of it, they need the consent of the mortgagee (the insurance company). The older person receives a pension under the agreed conditions, all the way until death. This business is still in the pilot stage, and relatively few are doing it. The “using your home to fund old age” that criminals talk about is “completely unrelated” to the home reverse-mortgage pension insurance the state is piloting; it is “a means of falsely invoking state policy to drum up publicity for illegal fundraising.” The way it works is to lure older people into mortgaging their homes and then put the borrowed money into the wealth-management products it recommends, “often a Ponzi scheme of ‘paying old investors with new money.’” On the consequences, the original text says “some participants did not even know their home had been mortgaged, and in the end lost the home and were still saddled with the loan.” The warning also gives a line for judging rates of return. The original words are “if a wealth-management product promises a return above 6%, put a question mark on it; above 8% is very dangerous; at 10% or more, be prepared to lose your entire principal; ‘guaranteed principal with high returns’ is financial fraud.” The same warning also asks people to “treat the contract-signing stage with caution and not sign blank contracts” (nationwide, June 2021)
- Evidence grade
- B
- Notes
- It gets a B because these statements come from regulators' risk warnings and experience-based judgment, not from research data. The three lines of 6%, 8% and 10% are reference lines the regulator gives consumers, not standards set by law. The China Banking and Insurance Regulatory Commission has been merged into the National Financial Regulatory Administration and the original page no longer opens; what is cited here is the page reposted by a provincial financial regulator. Losing money on the investment is the lesser problem; once the home has been mortgaged, the older person still owes a loan, and the loss is far larger than the principal. For the general rules on signing and blank contracts, see Section 8, Item 17; for how to stop a payment after being scammed, see Section 8, Item 2.
A
If an older person in the family is bedridden long term or severely disabled, apply for long-term care insurance at the medical insurance (医保) department where they are insured; it is not only for older people
Value for cost High
In plain termsLong-term care insurance helps pay for hiring someone to provide care. If someone in the family is severely disabled and it has lasted half a year or more, apply at the medical insurance department where they are insured. You don't have to advance the care fees yourself first; for those insured as employees about 70% is reimbursed, for those insured as urban and rural residents about 50%, and bed fees and meal fees are not reimbursed. It has no age threshold; young people who are severely disabled can apply too.
- Cost
- Submit an application once at the medical insurance department where the person is insured. Then do a disability-level assessment once. If the first assessment is passed, the assessment fee is paid by the fund, not out of your own pocket
No money
A few hours
No willpower
Benefit size large
- Benefit
- Eligible long-term care service costs have no deductible threshold. A deductible threshold means you first pay up to a certain amount yourself before reimbursement starts; here you don't have to. For those insured under the policy for employees of employers, the fund reimburses about 70%. For those insured under the policy for non-employed urban and rural residents, about 50%. The most that can be reimbursed in a year (the annual maximum payment limit) does not exceed 50% of the previous year's per capita disposable income of urban and rural residents in the local pooling area
- Evidence grade
- A
- Notes
- The disability must be “long-term and continuous (generally 6 months or more)”; a few weeks in hospital does not yet meet the condition for applying. There is also a 6-month waiting period before benefits begin. Long-term care insurance does not pay for costs that are not care, such as bed fees and meal fees. Nor does it pay for medical costs that medical insurance should cover. Those already receiving the work-injury living-care allowance do not receive both. This money and the care subsidy within the two subsidies for people with disabilities are two separate procedures and two separate payments, and they do not conflict; see Section 7, Item 8 (the two subsidies). Care received at home and in the community is favored in reimbursement rates, so you don't necessarily have to move into an institution. This system is being rolled out in batches in different places, and disability assessment standards also differ. First call 12393 or the phone line of the medical insurance agency where the person is insured, and ask whether it has started locally and how to book an assessment. If the assessment is not passed, don't give up; once the disability gets worse you can apply again.
B
If someone in the family is bedridden long term, treat pressure sores as enemy number one: get an electric air mattress, turn them on a schedule, and check the bony areas once a day
Value for cost Standard
In plain termsOlder people who already had pressure sores before hip-fracture surgery are about 20% more likely to die within 30 days. Switching to an electric air mattress means about 60% fewer new pressure sores. Turning on time, if it is really done properly, means about 70% fewer. Don't let the person lie face down for long periods. Once a day, check the sacrum and tailbone, heels, hips, and shoulders and back; if you find redness that does not fade when pressed, contact a nurse or doctor that same day.
- Cost
- A home electric alternating-pressure air mattress starts at a few hundred yuan. Each turn takes only a few minutes. The hard part is that it has to be done every two to three hours, through the night as well, and one person cannot carry it alone
A little money
Time every day
Lots of willpower
Benefit size large
- Benefit
- 19520 hip-fracture surgery patients (US NSQIP, 2016 to 2019). Among those who already had pressure sores before surgery, the proportion who died within 30 days was higher. After other factors were taken into account, this association still held (OR 1.2, odds 21% higher, P=0.004). These people were also more likely to have other problems: deep vein thrombosis (OR 1.59), pneumonia (OR 1.39), unplanned readmission (OR 1.43), and on average 0.4 more days in hospital. 324 hospitalized older people (average age 86) were followed for a median of 18 months. Pressure sores independently predicted long-term death (HR 1.500, 95% CI 1.059 to 2.126, P=0.020). Independently predicting means that after other factors are ruled out, it still predicts on its own. 65 randomized trials were combined in one analysis (a network meta-analysis). It compared powered active air-flow support surfaces with standard hospital mattresses (standard hospital support surfaces). Powered active air-flow support surfaces are the electric air mattress category. People using them had a lower incidence of pressure sores (RR 0.42, 95% CI 0.29 to 0.63, moderate certainty). For powered hybrid air-flow support surfaces it was RR 0.22 (0.07 to 0.66). A Cochrane review of 11 trials with 4462 people (updated 2026). Comparing turning every 2 hours with turning every 4 hours, the difference is unclear (RR 1.05, 95% CI 0.79 to 1.39, very low certainty). Comparisons between other turning intervals are likewise very uncertain. In a trial of 1226 ICU patients, wearable sensors gave real-time reminders and visual alerts so that turning every 2 hours was actually carried out. The incidence of pressure sores was lower than with usual care (RR 0.28, 95% CI 0.10 to 0.75, moderate certainty). In a trial of 116 people, the incidence of pressure sores in the prone (lying face down) group was higher than in the supine (lying flat on the back) group (RR 4.55, 95% CI 2.31 to 8.98)
- Evidence grade
- B
- Notes
- There are three reasons for the B. First, the two mortality studies only saw that “people with pressure sores later fared worse,” and this is not the same as “preventing pressure sores brings mortality down.” Second, the conclusions of the randomized trials on turning intervals are very shaky. Third, the evidence on air mattresses is firmer, but the studies compared hospital bed mattresses, and applying it to home mattresses is an extrapolation. Checking the sacrum and tailbone, heels, hips, and shoulders and back every day for “redness that does not fade when pressed” is routine nursing practice and has no separate literature. For the care services long-term care insurance can reimburse, see Item 7 of this section. If one leg suddenly swells up, treat it as deep vein thrombosis; see Section 13, Item 11. For the stretch of long-term bed rest after a fall or serious injury, see Section 1, Item 34
- Sources
- Porter SB, Pla R, Chow JH, et al. (2022). Preoperative Pressure Ulcers, Mortality, and Complications in Older Hip Fracture Surgery Patients. JAAOS Global Research & Reviews, 6(11). https://doi.org/10.5435/JAAOSGlobal-D-22-00117；Ottaviani S, Rondanina E, Longo E, 等 (2026). Impact of pressure ulcers and frailty on long-term mortality: a prospective cohort study of hospitalized older adults. European Geriatric Medicine, 17(2), 665-672. https://doi.org/10.1007/s41999-025-01331-8；Shi C, Dumville JC, Cullum N (2018). Support surfaces for pressure ulcer prevention: A network meta-analysis. PLoS ONE, 13(2), e0192707. https://doi.org/10.1371/journal.pone.0192707；Latimer SL, Chaboyer WP, Probst S, 等 (2026). Repositioning for pressure injury prevention in adults. Cochrane Database of Systematic Reviews, 6, CD009958. https://doi.org/10.1002/14651858.CD009958.pub4
B
When an older person's cataracts already affect seeing where they are walking, go to an eye department for an assessment for surgery; if both eyes have cataracts, don't put off the second eye too long
Contested Value for cost Standard
In plain termsFor women aged 70 or over, having cataract surgery on the first eye as soon as possible meant about 34% fewer falls over a year, and fewer people with fractures too. But the number of people who fell did not go down. Whether or not the second eye was done, no clear difference in falls was seen. Older people who had the surgery had hip fractures about 16% less often within a year.
- Cost
- First take the older person to an eye department for an examination, and let the doctor judge whether surgery is warranted. Each eye is one operation; many hospitals do it as day surgery, and the person can go home the same day. If both eyes have cataracts, they are done in two separate operations. How much you pay out of pocket depends on which intraocular lens (an artificial lens) is put into the eye and how local medical insurance reimburses it; ask clearly before surgery.
Real money
A few hours
No willpower
Benefit size medium
- Benefit
- One randomized trial enrolled 306 women aged 70 or over with cataracts. Half had surgery on the first eye within about 4 weeks; the other half waited the usual 12 months. Over a year, those who had surgery quickly had about 34% fewer falls. The original figure is a rate ratio of falls of 0.66, confidence interval 95% CI 0.45 to 0.96. People who fell at least once: 49% in the surgery group and 45% in the waiting group, so no fewer. People who fell two or more times: 18% in the surgery group and 25% in the waiting group. In the surgery group 4 people had fractures (3%), in the waiting group 12 (8%). A Cochrane review included this trial and concluded that first-eye surgery in women reduced the number of falls and second-eye surgery did not. The randomized trial on the second eye enrolled 239 women aged 70 or over. The surgery group's rate of falls was 32% lower, but the difference may have been due to chance (rate ratio of falls 0.68, 95% CI 0.39 to 1.19). In a 5% sample of US Medicare there were 1113640 cataract patients aged 65 or over (2002 to 2009). This study only followed and recorded, without randomized comparison groups. Those who had surgery had about 16% lower odds of hip fracture within a year (OR 0.84, 95% CI 0.81 to 0.87). The absolute difference is 0.20 percentage points, about 2 fewer cases per 1000 people
- Evidence grade
- B
- Notes
- Contested: when the two randomized trials are combined, the number of people who fell did not clearly go down (OR 0.81, 95% CI 0.55 to 1.17). In whole-population hospital records from Western Australia, in the year after the first eye was done, hospital admissions for fall injuries actually rose by 27%. In the period between the two operations, such admissions were 2.14 times the pre-surgery level. Before-and-after comparisons like this cannot separate the effect of the surgery from the effect of getting older. In another Australian follow-up study, falls dropped the most after the second eye was done. So if both eyes have cataracts, don't put off the second eye too long. In the period between the two operations, take extra care when walking and going up and down stairs. Cochrane also included a trial of helping older people deal with vision problems, in which falls actually increased by about 57%. Surgery takes care of whether you can see clearly; falling less still depends on Section 1, Item 13 (balance and leg strength). For whether bones can withstand a fall, see Section 1, Item 39 (bone density testing) and Section 1, Item 40 (take medication if osteoporosis is found). The national eye health plan states that cataract surgery to restore sight is now widely available at the county level, so you don't necessarily have to go to a big-city hospital. The beneficiaries are mainly your parents and grandparents.
- Sources
- Harwood RH, Foss AJ, Osborn F, Gregson RM, Zaman A, Masud T (2005). Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial. British Journal of Ophthalmology, 89(1), 53-59. https://doi.org/10.1136/bjo.2004.049478 ; Foss AJ, Harwood RH, Osborn F, Gregson RM, Zaman A, Masud T (2006). Falls and health status in elderly women following second eye cataract surgery: a randomised controlled trial. Age and Ageing, 35(1), 66-71. https://doi.org/10.1093/ageing/afj005 ; Gillespie LD, Robertson MC, Gillespie WJ, et al. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 9, CD007146. https://doi.org/10.1002/14651858.CD007146.pub3 ; Tseng VL, Yu F, Lum F, Coleman AL (2012). Risk of fractures following cataract surgery in Medicare beneficiaries. JAMA, 308(5), 493-501. https://doi.org/10.1001/jama.2012.9014 ; Desapriya E, Subzwari S, Scime-Beltrano G, et al. (2010). Vision improvement and reduction in falls after expedited cataract surgery: systematic review and metaanalysis. Journal of Cataract and Refractive Surgery, 36(1), 13-19. https://doi.org/10.1016/j.jcrs.2009.07.032 ; Meuleners LB, Lee AH, Ng JQ, Morlet N, Fraser ML (2012). First eye cataract surgery and hospitalization from injuries due to a fall: a population-based study. Journal of the American Geriatrics Society, 60(9), 1730-1733. https://doi.org/10.1111/j.1532-5415.2012.04098.x ; Meuleners LB, Fraser ML, Ng J, Morlet N (2014). The impact of first- and second-eye cataract surgery on injurious falls that require hospitalisation: a whole-population study. Age and Ageing, 43(3), 341-346. https://doi.org/10.1093/ageing/aft177 ; Keay L, Ho KC, Rogers K, et al. (2022). The incidence of falls after first and second eye cataract surgery: a longitudinal cohort study. Medical Journal of Australia, 217(2), 94-99. https://doi.org/10.5694/mja2.51611 ; 国家卫生健康委 (2022). 「十四五」全国眼健康规划（2021-2025年）. https://www.gov.cn/zhengce/zhengceku/2022-01/17/content_5668951.htm
B
If an older person in the family walks a dog, have them hold the leash in the palm and not wrap it around the hand, keep the leash short, and first train the dog not to lunge forward on the leash
Value for cost Standard
In plain termsIn the US, fractures in people 65 and over from falls while walking a dog on a leash rose from about 1700 to about 4400 a year, and eight in ten were women. The hip is the most common fracture site, and nearly three in ten needed hospitalization. Of hand injuries from dog leashes, about three quarters happened when the leash was wrapped around the hand and the dog pulled. So hold the leash in the palm, keep it short, and train the dog not to lunge.
- Cost
- Holding the leash this way and shortening it cost nothing; walk with the older person once and show them. Training the dog not to lunge takes time; you can teach it yourself or hire a dog trainer, and hiring costs money, with prices varying a lot from place to place. The hard part is that the older person is used to a retractable leash and to wrapping the leash around the wrist, and you have to get them to change.
A little money
A few hours
Some willpower
Benefit size small
- Benefit
- By national estimates from US emergency department surveillance data, fractures in people 65 and over from falls while walking a leashed dog numbered about 1671 in 2004 and about 4396 in 2017, a statistically significant increase. Of those with fractures, 78.6% were women and 28.7% needed hospitalization. By single site, the hip was the most common, at 17.3%. By broad category, the upper limbs were the most common, at 52.1%. In another set of nationwide US emergency department data (2001 to 2018), dog-leash-related injuries were estimated at about 360,000 (exact figure 356746). Of these, 193483 were from being pulled by the dog and 136767 from tripping or getting tangled in the leash. Injuries per million people rose from 25.4 to 105.5. A hand surgery clinic saw 443 patients with dog-leash hand injuries over 5 years. About three quarters were injured when the hand or fingers were caught in the leash and the dog pulled (the abstract says 337 people, 75.9%). About one fifth needed surgery (96 people, 21.6%). The US CDC counted about 86629 fall injuries a year related to cats and dogs from 2001 to 2006, 88.0% of them related to dogs. Of dog-related falls, 26% happened while walking the dog, and 21.2% were from being pushed or pulled over by the dog
- Evidence grade
- B
- Notes
- Holding the leash in the palm rather than wrapping it around the hand is the advice of the doctors at that hand surgery clinic. They state that this protects the fingers and wrist but does not prevent the person from being pulled over when the dog lunges. They also advise keeping the leash short: on a short leash the dog cannot build up speed, so the pull is lighter; a long leash also tends to wrap around things and trip people. A retractable leash let out long is a long leash. But no study has specifically compared whether retractable or ordinary leashes lead to more falls; a 2024 review states that there is no data on which leash was being used at the time of injury. Training the dog not to lunge on the leash was mentioned both by the US CDC and by the authors of the fracture paper. The fracture paper also suggests that older people who are thinking of getting a dog choose a smaller one. No study has calculated how many falls these practices prevent, so the size of the benefit is rated small by judgment. For whether bones can withstand a fall, see Section 1, Item 39 (bone density testing) and Section 1, Item 40 (take medication if osteoporosis is found). For practicing balance day to day, see Section 1, Item 13 (balance and leg strength). For whether dog walking can count as exercise, see Section 2, Item 44 (count dog walks toward your walking). The beneficiaries are mainly your parents and grandparents.
- Sources
- Pirruccio K, Yoon YM, Ahn J (2019). Fractures in Elderly Americans Associated With Walking Leashed Dogs. JAMA Surgery, 154(5), 458-459. https://doi.org/10.1001/jamasurg.2019.0061；Forrester MB (2020). Dog leash-related injuries treated at emergency departments. American Journal of Emergency Medicine, 38(9), 1782-1786. https://doi.org/10.1016/j.ajem.2020.05.082；Plusch K, Givner D, Wiafe B, Lutsky K, Beredjiklian P (2026). Hand and Wrist Dog-Leash Injuries in the Outpatient Setting: A Review of 443 Cases. Hand, 21(4), 582-586. https://doi.org/10.1177/15589447241299128；CDC (2009). Nonfatal fall-related injuries associated with dogs and cats — United States, 2001-2006. MMWR, 58(11), 277-281. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5811a1.htm；Rosa R, Buckley RE (2024). Leash-related injuries associated with dog walking: an understudied risk for dog owners? Journal of the American Veterinary Medical Association, 262(7), 973-978. https://doi.org/10.2460/javma.23.11.0608
