Preventing falls at home: a room-by-room check and what to ask the doctor

Many families start worrying about falls after the first one. Falls are common. Over 14 million older adults, about 1 in 4, report falling every year, and falls are the leading cause of injury for adults 65 and older.¹ The CDC is clear that falls aren’t a normal part of aging, and that they can be prevented.² This note walks through what helps most: telling the doctor, checking the medicines, building strength and balance, and fixing the home room by room.

The short answer

• Tell the doctor about any fall, any unsteadiness and any fear of falling, even when nobody was hurt.²
• Ask the doctor or pharmacist to review every medicine for ones that could raise the risk of a fall.²
• Do exercises that make the legs stronger and improve balance, like tai chi.²
• Have the eyes checked at least once a year.²
• Walk through the home with a checklist and fix what you find.³
• When a doctor orders it and the person is homebound, Medicare covers physical and occupational therapy at home.⁵

Tell the doctor, even if nobody was hurt

A fall without an injury is still worth reporting. Less than half of older adults who fall talk to their doctor about it.² The doctor can look for the reasons behind it, such as a health condition that raises the risk, like depression or osteoporosis, or a medicine that makes the person dizzy.²

Say so too if the person feels unsteady when standing or walking, or is afraid of falling.² Fear of falling is worth a conversation on its own.

Questions to bring to the appointment

The National Library of Medicine suggests questions like these for the doctor. Write the answers down.⁴

• Am I taking any medicines that will make me sleepy, dizzy or lightheaded?
• What exercises can I do to build strength or improve my balance?
• Should I use a cane or a walker?
• Do I need a shower chair, a raised toilet seat or grab bars?
• Is my bed the right height, or do I need a bed on the first floor to avoid the stairs?
• Do I need help with cleaning, cooking or laundry?
• What should I do if I fall, and how do I keep my phone within reach?
• Should I get a medical alert system to call for help after a fall?

The medicines

Medicines deserve their own look. Ask the doctor or pharmacist to review all of them, including vitamins and anything bought without a prescription, to see whether any might increase the risk of falling.² A medicine that makes someone sleepy, dizzy or lightheaded is the kind to ask about.⁴

If the person has home health, the nurse reviews every medicine the person is using as part of the first full assessment, looking for side effects, interactions and duplicates.⁶

Floors and stairs

The CDC’s home checklist starts with the floors.³

• If you have to walk around furniture to cross a room, move the furniture so the path is clear.
• Remove throw rugs, or use double-sided tape or a non-slip backing so they won’t slip.
• Keep papers, shoes, books and other objects off the floor.
• Coil or tape cords and wires next to the wall, and have an electrician add an outlet if one is needed.

Stairs, inside and out, get the same attention.³

• Keep objects off the stairs, and fix loose or uneven steps.
• Put a light and a light switch at the top and bottom of the stairs. Light switches that glow help at night.
• Replace a burned-out stairway bulb right away, with help from a friend or family member.
• Make sure carpet is firmly attached to every step, or remove it and attach non-slip rubber treads.
• Fix loose handrails, and put handrails on both sides of the stairs, as long as the stairs.

Kitchen, bedroom and bathroom

The checklist goes on through the rest of the house.³

• Kitchen: keep the things used most on lower shelves, about waist high. If a step stool is needed, get one with a bar to hold on to, and never stand on a chair.
• Bedroom: put a lamp close to the bed where it’s easy to reach, and a nightlight on the path from the bed to the bathroom. Some nightlights turn on by themselves after dark.
• Bathroom: put a non-slip rubber mat or self-stick strips on the floor of the tub or shower, and grab bars next to and inside the tub and next to the toilet.

Give the bathroom, and the walk to it at night, extra care. Wet floors, low light and hurry are a hard combination.

Strength and balance

Exercises that make the legs stronger and improve balance, like tai chi, are one of the CDC’s core recommendations.² The CDC suggests asking a local community or senior center about exercise classes and fall prevention programs.³

For someone recovering from an illness or a hospital stay, a physical therapist can start the work at home, at a safe level, and build from there.

What home health adds

Medicare covers home health when a doctor orders it, the person needs skilled care part time, and leaving home takes a considerable and taxing effort. Covered home health services cost nothing, and they include physical and occupational therapy.⁵

• The physical therapist works on strength, balance and walking, and teaches safe use of a cane or walker.
• The occupational therapist works on everyday tasks like bathing, dressing and using the toilet safely, and looks at how the home is set up.
• The nurse reviews the medicines and teaches the family what to watch for.⁶

If a fall happens

If the person is hurt, hit their head, can’t get up or seems confused, call 911, and don’t try to lift them on your own. If they’re on hospice, call the hospice too.

If the fall caused no injury, still tell the doctor, and the home health nurse if one is visiting.² Then look at what happened: where, when, and what the person was doing. The answer can point to the fix, whether it’s a rug, a dark hallway or a hurried trip to the bathroom.