Falls are the leading cause of injury-related death among adults 65 and older, and the most common cause of traumatic brain injuries in this age group. According to the Centers for Disease Control and Prevention, one in four older Americans falls each year, and falling once doubles the chance of falling again.

The good news: most falls are preventable. This guide covers risk factors, prevention strategies, and what to do when falls occur—whether your loved one lives at home or in an adult family home.

Understanding Fall Risk Factors

Physical Factors

  • Muscle weakness: Especially in legs and core
  • Balance problems: Inner ear issues, neurological conditions
  • Vision impairment: Cataracts, glaucoma, macular degeneration
  • Foot problems: Pain, numbness, improper footwear
  • Chronic conditions: Arthritis, diabetes, Parkinson's, stroke effects
  • Cognitive impairment: Dementia affects judgment and spatial awareness

Medication-Related Factors

Many common medications increase fall risk:

  • Sedatives and sleep medications
  • Antidepressants
  • Blood pressure medications (can cause dizziness)
  • Antihistamines
  • Pain medications, especially opioids
  • Taking 4+ medications (polypharmacy)

The Agency for Healthcare Research and Quality recommends regular medication reviews with a pharmacist to identify fall-risk drugs.

Environmental Factors

  • Poor lighting
  • Slippery or uneven floors
  • Loose rugs and clutter
  • Stairs without handrails
  • Lack of grab bars in bathrooms
  • Pets underfoot

Home Safety Modifications

Bathroom Safety

Bathrooms are the most dangerous room for falls:

  • Grab bars: Install near toilet and in shower/tub
  • Non-slip mats: Inside tub and on bathroom floor
  • Raised toilet seat: Reduces strain when sitting/standing
  • Shower chair or bench: For those unsteady standing
  • Handheld showerhead: Allows seated bathing
  • Night lights: For nighttime bathroom trips

Bedroom Safety

  • Bed at proper height (not too high or low)
  • Clear path to bathroom
  • Light switch or lamp within reach of bed
  • Phone accessible from bed
  • Remove throw rugs

Living Areas

  • Remove or secure loose rugs
  • Keep pathways clear of clutter and cords
  • Ensure adequate lighting throughout
  • Arrange furniture to allow clear walking paths
  • Secure bookshelves and other tall furniture

Stairs and Hallways

  • Handrails on both sides of stairs
  • Non-slip treads on steps
  • Light switches at top and bottom of stairs
  • Night lights in hallways
  • Remove items stored on stairs

Physical Prevention Strategies

Exercise for Fall Prevention

Regular exercise significantly reduces fall risk. Focus on:

  • Strength training: Especially lower body (legs, hips)
  • Balance exercises: Tai Chi is particularly effective
  • Flexibility: Stretching improves mobility
  • Walking: Maintains overall fitness and gait

The CDC's STEADI initiative provides evidence-based fall prevention resources and exercise recommendations.

Vision Care

  • Annual eye exams
  • Keep glasses prescription current
  • Use single-vision glasses for walking (bifocals can distort depth perception)
  • Treat cataracts and other conditions promptly
  • Ensure adequate lighting when reading or moving

Footwear

  • Wear shoes with non-slip soles
  • Avoid walking in socks or loose slippers
  • Ensure proper fit—not too loose or tight
  • Replace worn shoes
  • Consider seeing a podiatrist for foot problems

Fall Prevention in Adult Family Homes

Quality adult family homes implement comprehensive fall prevention programs:

What to Look For

  • Fall risk assessment: Every resident should be assessed upon admission
  • Individualized care plans: Addressing specific risk factors
  • Environmental safety: Grab bars, non-slip flooring, adequate lighting
  • Assistive devices: Walkers, canes, wheelchairs as needed
  • Staff training: In safe transfer techniques and fall response
  • Medication management: Regular review of fall-risk medications

Questions to Ask

  • How do you assess fall risk for residents?
  • What fall prevention measures are in place?
  • How many falls have occurred in the past year?
  • How do you respond when a fall occurs?
  • How will you communicate with me about falls?

What to Do When a Fall Occurs

Immediate Response

  1. Stay calm: Assess the situation before moving
  2. Check for injuries: Ask about pain, look for visible injuries
  3. Don't rush to get up: Wait until pain/dizziness subsides
  4. Call for help if needed: 911 for serious injuries
  5. Get up safely: Roll to side, push up to hands and knees, use stable furniture

When to Seek Medical Attention

  • Hit head during fall
  • Taking blood thinners (even minor falls need evaluation)
  • Visible injury or severe pain
  • Unable to get up or bear weight
  • Confusion or loss of consciousness
  • Any concerning symptoms in hours following fall

After a Fall

  • Report to physician even if no apparent injury
  • Investigate cause—what led to the fall?
  • Address any identified risk factors
  • Consider physical therapy evaluation
  • Monitor for delayed symptoms (especially head injury)

Frequently Asked Questions

Should my parent use a walker even if they don't want to?

If a healthcare provider has recommended a walker, it's for good reason. Pride often prevents seniors from using assistive devices, but falls are far more dangerous than accepting help. Try involving them in choosing the device, getting a physical therapist to demonstrate proper use, and emphasizing that using a walker allows more independence than recovering from a broken hip.

Are bed rails a good idea for preventing falls?

Bed rails are controversial—they can actually cause injuries when seniors try to climb over them. The FDA has reported deaths from entrapment in bed rails. Better alternatives include: beds at proper height, non-slip floor mats beside the bed, motion-sensor alarms, and concave mattresses that reduce rolling. Consult with healthcare providers before using bed rails.

How effective are medical alert systems?

Medical alert systems ("I've fallen and I can't get up") can be lifesaving—they ensure help can be summoned even if the person can't reach a phone. However, they only work if worn consistently. Look for waterproof devices that can be worn in the shower. Automatic fall detection models can alert services even if the wearer can't press the button.

Can exercise really prevent falls?

Yes! Research consistently shows exercise reduces falls by 23-40%. Tai Chi is particularly effective. Even chair-based exercises help those with limited mobility. The key is consistency—regular exercise over time builds the strength and balance that prevent falls. Physical therapists can design safe programs for any ability level.

My parent has fallen several times—does this mean they need a nursing home?

Not necessarily. First, investigate why falls are occurring and address those factors. Many people do very well in adult family homes with appropriate supervision and assistance. The smaller environment can actually be safer than larger facilities or living alone. However, if falls continue despite interventions, higher levels of supervision may be needed.