Fall Prevention at Home: Hazard Reduction, Medication Review, Strength and Balance, and Post-Fall Action

Who needs this teaching

Adults aged 65 and older, clients with a history of falls, gait or balance impairment, orthostatic hypotension, or fall-risk medications, and the family. About 1 in 4 adults aged 65 and older falls each year. Falls are the leading cause of injury death in older adults. The CDC STEADI initiative (Stopping Elderly Accidents, Deaths, and Injuries) guides screening, assessment, and intervention.

The priority teaching points

1. Screening. Ask three key questions: Has the client fallen in the past year? Does the client feel unsteady when standing or walking? Does the client worry about falling? A Timed Up and Go test of 12 seconds or more indicates increased fall risk. A decrease of 20 mm Hg systolic or 10 mm Hg diastolic within 3 minutes of standing indicates orthostatic hypotension.
2. Home hazards. Remove throw rugs, cords, and clutter from walkways. Install night lights from the bedroom to the bathroom and light switches at both ends of the stairs. Install grab bars next to the toilet and in the tub or shower. Use nonslip mats and a shower chair. Install handrails on both sides of the stairs.
3. Footwear and devices. Wear sturdy, low-heeled shoes with nonslip soles and closed backs. Avoid backless slippers and walking in socks. Use the prescribed cane or walker every time.
4. Position changes. Sit on the edge of the bed before standing. Pump the ankles, then stand slowly and wait until steady. Report dizziness on standing.
5. Vision and hearing. Have an eye examination every year and update eyeglasses. Have hearing checked and wear prescribed hearing aids.
6. Medication review. Review all medications with the provider at least yearly and after any fall. Fall-risk drugs include sedative-hypnotics, benzodiazepines, opioids, antidepressants, antipsychotics, anticonvulsants, antihypertensives, and diuretics. Avoid nonprescription sleep aids that contain diphenhydramine; anticholinergic effects cause confusion and dizziness.
7. Strength and balance. Exercise for strength, gait, and balance at least 3 times weekly. Tai chi and physical therapy programs reduce falls.
8. After a fall. Keep a phone or medical alert device within reach at all times. After a fall, stay still and check for injury. If uninjured, roll to the side, crawl to a sturdy chair, kneel, place both hands on the seat, bring one foot forward, push up, and turn to sit. If injured or unable to get up, call for help and keep warm while waiting. Report every fall to the provider.

Red flags the client reports

Teach-back questions

• "Which hazards will you remove from your home first?"
• "Show me how you get out of bed."
• "Which of your medicines make you dizzy or sleepy?"
• "Show me how you would get up from the floor."
• "When will you call 911 after a fall?"

Teaching tips

• Walk through the home safety checklist with the family.
• Observe the client rise from a bed and a chair.
• Refer to physical therapy or a community balance program.

Read more on NCLEXPace

• Falls, Restraints, and Seclusion: The Rules
• Bones and Muscles Map: Fractures, Casts, Traction, and Joint Replacement
• Anticoagulants on the NCLEX: Heparin vs Warfarin vs DOACs

Sources

• Montero-Odasso M, et al. World Guidelines for Falls Prevention and Management for Older Adults: A Global Initiative. Age Ageing. 2022;51(9):afac205.
• 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2023;71(7):2052-2081.