Falls Aren't Just "Part of Getting Older"

Put This Into Practice

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Every year, 1 in 4 Americans over 65 falls. Falls are the leading cause of fatal and non-fatal injuries for older adults.

But here's what most people don't realize: most falls are preventable.

Falls aren't inevitable. They happen because of identifiable risk factors—and those factors can be addressed.

This guide covers what home care providers, family caregivers, and the individuals themselves can do to prevent falls.

Why Falls Happen

Falls usually result from multiple factors combining:

Medical Factors

Factor	How It Increases Risk
Medication side effects	Dizziness, drowsiness, blood pressure changes
Vision problems	Can't see obstacles or judge distances
Chronic conditions	Diabetes affects nerve sensation; stroke affects balance
Muscle weakness	Can't catch yourself or recover from stumbles
Balance issues	Inner ear problems, neurological conditions
Foot problems	Pain changes how you walk
Cognitive decline	Judgment and reaction time affected

Environmental Factors

Poor lighting
Loose rugs and carpets
Clutter and obstacles
Slippery surfaces
Stairs without handrails
Cords across walking paths
Pets underfoot
Inappropriate footwear

Behavioral Factors

Rushing
Not using assistive devices
Climbing on chairs/stools
Walking in dark
Not asking for help

Most falls happen when multiple factors align: poor lighting + rushing + muscle weakness + loose rug = fall.

The Home Safety Assessment

Walk through the home with fall prevention eyes. Here's what to check:

Entryways

Good lighting (inside and outside doors)
Non-slip welcome mats
Secure handrails on any steps
Clear pathway from door to living area
Place to sit while removing shoes
Light switch reachable from door

Living Rooms

Clear walking paths (at least 3 feet wide)
Cords secured along walls, not across paths
Furniture stable and not wobbly
Chairs have armrests for support when rising
Remote controls/phones within reach from seating
Non-slip backing on all rugs (or remove rugs)
Coffee tables not in walking paths

Kitchens

Non-slip mats at sink and stove
Frequently used items at waist-to-shoulder height
Step stool with handrail (if reaching is necessary)
Spills cleaned immediately
Good lighting over work areas
Non-slip flooring
Chair for sitting while doing tasks

Bathrooms (Highest Fall Risk Area)

Bedrooms

Light switch reachable from bed
Nightlight or motion-activated light
Phone within reach of bed
Clear path from bed to bathroom
Bed at appropriate height (not too high/low)
Shoes/slippers easily accessible
No clutter on floor

Stairs

General

Night lights in hallways
Working smoke and CO detectors
Phone accessible from floor level
Medical alert device if appropriate
Pet feeding areas not in walkways

Home Modifications That Reduce Falls

Low Cost (Under $50)

Night lights: $5-15 each
Non-slip bathtub strips: $10-20
Rubber-backed rugs: $15-30
Grab bar (suction cup): $20-40
Motion-sensor night light: $15-25
Cord organizers: $10-15

Moderate Cost ($50-500)

Professional grab bar installation: $100-200 each
Raised toilet seat: $30-100
Shower bench: $50-150
Handrails for stairs: $100-300
Improved lighting fixtures: $50-200

Higher Cost (May Be Tax Deductible)

Bathroom remodel with accessibility features
Stair lift: $3,000-15,000
Walk-in tub: $5,000-15,000
Ramp installation: $1,000-5,000
Widened doorways

Many modifications for medical necessity are tax-deductible.

Exercise and Strength

The single most effective fall prevention intervention: exercise.

Why Exercise Prevents Falls

Builds muscle strength (especially legs)
Improves balance
Increases flexibility
Improves reaction time
Maintains bone density

Evidence-Based Programs

Tai Chi: Studies show 50%+ reduction in falls. Focuses on balance, slow controlled movements, weight shifting.

Otago Exercise Program: Home-based program designed by physical therapists specifically for fall prevention. Includes leg strengthening and balance exercises.

Matter of Balance: Group program that addresses fear of falling while building strength.

YMCA/Senior Center Programs: Many offer evidence-based fall prevention classes.

Daily Exercises

Simple exercises that help (check with doctor first):

Standing exercises (hold onto counter):

Standing on one foot: 10-30 seconds each side
Heel-to-toe walking: 10 steps
Marching in place: 30 seconds
Side leg raises: 10 each side

Seated exercises:

Ankle circles: 10 each direction
Seated marching: 30 seconds
Toe raises: 10 reps
Knee lifts: 10 each side

Progress gradually. If someone is deconditioned, start with seated exercises and work up.

Medication Review

Medications are a major fall risk factor. Some to watch:

High-Risk Medications

Category	Examples	Fall Risk
Sedatives	Ambien, Xanax, Ativan	Drowsiness, confusion
Blood pressure meds	Various	Dizziness on standing
Pain medications	Opioids, muscle relaxants	Drowsiness, confusion
Antihistamines	Benadryl, Dramamine	Drowsiness, confusion
Diabetes medications	Insulin, sulfonylureas	Low blood sugar, dizziness
Antidepressants	Various	Dizziness, confusion
Diuretics	Lasix, HCTZ	Dehydration, low blood pressure

What to Do

List all medications (including OTC and supplements)
Ask the doctor to review for fall-risk medications
Request alternatives if high-risk medications aren't essential
Understand timing (some meds cause dizziness right after taking)
Never stop medications without doctor guidance

Vision and Hearing

Vision

Regular eye exams: At least annually after age 65.

Address these issues:

Outdated prescription
Cataracts
Glaucoma
Macular degeneration
Poor contrast sensitivity

Eyeglass considerations:

Bifocals can distort floor perception—some people do better with single-vision glasses for walking
Keep glasses clean
Have a spare pair accessible
Use appropriate glasses (not reading glasses for walking)

Hearing

Why hearing matters for fall prevention:

Spatial awareness
Detection of obstacles
Processing environmental cues

If hearing aids are prescribed, use them. Untreated hearing loss increases fall risk.

Footwear

The right shoes matter more than most people realize.

What to Look For

Non-slip soles
Low heel (or flat)
Supportive back (not backless)
Snug fit (not too loose)
Velcro or slip-on if tying is difficult
Good arch support

What to Avoid

Walking barefoot
Socks without grip
High heels
Worn-out shoes
Backless slippers
Flip flops
Shoes that are too big

In-Home Shoes

Many falls happen at home in socks or bare feet. Keep supportive, non-slip shoes for indoor use only.

What Caregivers Should Do

During Visits

Observe and report:

Does the client seem unsteady?
Are they holding onto furniture?
Have they mentioned near-falls?
Are there new obstacles or hazards?
Do they seem drowsy or confused (medication issue)?

Provide support:

Stand on weaker side during transfers
Don't rush transitions
Use proper transfer techniques
Ensure assistive devices are within reach
Keep walkways clear after activities

Communicate: Report fall risks to the care team. A small observation ("she's been unsteady this week") can prompt intervention.

After a Fall

Even if the person seems fine:

Don't rush them up - Check for injury first
Ask what happened - Understanding the cause prevents recurrence
Check for pain - Even minor falls can cause fractures
Monitor for delayed symptoms - Head injuries may show symptoms hours later
Document everything - Time, circumstances, injuries, response
Report to supervisor/family - All falls should be reported

Fear of Falling

After a fall (or near-fall), people often become afraid of falling again. This fear leads to:

Moving less
Losing strength
Actually increasing fall risk

Address fear directly:

Acknowledge it's normal
Focus on what they CAN do safely
Build confidence gradually
Consider occupational therapy evaluation

When to Get Professional Help

Physical Therapy

Consider PT evaluation if:

History of falls
Visible balance problems
Recent decline in mobility
Post-surgery or hospitalization
Fear of falling limiting activity

PT can assess fall risk, prescribe specific exercises, and recommend assistive devices.

Occupational Therapy

OT focuses on daily activities:

Home safety assessment
Training on safe transfers
Adaptive equipment recommendations
Energy conservation techniques

Medical Evaluation

See a doctor after any fall, especially if:

Hit head
Loss of consciousness
Visible injury
Pain or swelling
Confusion
Repeat falls

Request a "falls assessment" if falls are recurring.

Technology for Fall Prevention

Wearable Devices

Medical alert systems:

Pendant or wristband with button
Automatic fall detection (some models)
GPS-enabled for outside use

Smart watches:

Apple Watch and Samsung have fall detection
Can call emergency services automatically
Also track activity and heart rhythm

Home Sensors

Motion sensors that detect changes in activity patterns
Bed sensors that detect when someone gets up
Smart lighting that turns on automatically
Video monitoring (with consent)

Smart Home Features

Voice-activated lights ("Alexa, turn on hall light")
Smart thermostats (reduce getting up to adjust)
Video doorbells (don't rush to door)
Voice-activated emergency calls

See our guide on voice assistants for seniors.

The Bottom Line

Falls are not inevitable. Most can be prevented through:

Home modifications - Remove hazards, add supports
Exercise - Build strength and balance
Medication review - Identify high-risk medications
Vision/hearing care - Keep senses sharp
Appropriate footwear - Supportive, non-slip shoes
Caregiver vigilance - Observe, support, report
Professional evaluation - PT, OT, medical assessment as needed

Every fall prevented is a potential hospitalization avoided, an independent life preserved, and a family's worry reduced.

Start with one thing from this list today.

Learn how CareCade helps track care activities →

Fall Prevention at Home: A Practical Guide for Caregivers and Families