6 Fall Prevention Strategies at Home and Beyond

Occupational therapists and physical therapists focus on fall prevention in daily treatments—often, in patients’ homes. You can prevent injuries, hospitalizations, and even death by reducing someone’s fall risk. Many therapists regularly treat patients older than 60 years old, which automatically puts them at higher risk for life-threatening injuries, including brain injuries.

As clinicians, we must take this responsibility seriously and learn as much as we can to help our patients stay safe and avoid falls.

Highest Fall Risk Areas of the Home

The first step to creating impactful fall prevention strategies at home is understanding the highest fall risk areas. Over half of the falls people experience in the United States happen at home. When creating an occupational profile, identify potentially higher fall risk areas within the home. People most often fall in their living rooms followed (in order) by their bedrooms, kitchens, bathrooms, and hallways. We can take a deeper dive into these areas to ensure we are addressing multiple treatment contexts during our sessions.

How and when are falls more likely to occur?

• 43 percent occur on the main floor
• 14 percent involve stairs
• 11 percent involve curbs/sidewalks
• 9 percent happen when falling off the bed or other furniture
• 4 percent involve the bath, shower, or toilet¹

While thousands of falls occur at home every year, you can also incorporate strategies for fall prevention outside, including areas like the yard and garage as well as the greater community. As practitioners, we can serve our patients more robustly by keeping these additional performance areas in mind within our plans of care and creating goals to address them.

6 Fall Prevention Strategies at Home and Beyond

In order to optimize clinical outcomes, consider some of the following tips for comprehensive fall assessments both in and outside the home.

1. When inside, administer balance and mobility assessments. Repeat the assessments in a variety of settings within the home to determine if the results vary. It is important to administer the assessments outdoors as well to see how the different contexts impact a patient’s performance. These factors not only facilitate quality treatment plans but can become excellent talking points for fall prevention training.
2. Walk through the house when it is bright and illuminated, but also provide treatments and education in areas without bright light in order to mimic more real-life situations. This may be easier for a patient than it is when the lights are off or the sun has set. Consider the following example: Jack pulls into his garage after dropping his wife off at the store. He exits the car, retrieves his cane—and then the overhead light in the garage automatically shuts off. Jack is now left in the dark. Immediately, he feels off balance and is unable to safely ambulate to the door. Jack falls and sustains humerus and hip fractures. This example highlights the importance of providing fall prevention strategies in various contexts within someone’s ADL routines.
3. During home visits, watch for clues that may indicate a higher fall risk. If you recommend a patient use a walker or cane, monitor if the patient is compliant in using their assistive devices. If not, the patient may need more training to correctly use the device or may need a more appropriate piece of equipment for mobility. You may see patients “furniture surfing” around the home, indicating a balance or gait impairment by leaning on walls, couches, chairs, or counters. Keen assessment skills are imperative for a quality, comprehensive plan of care.
4. When assessing falls outside of the home, start with the entrance/exit areas of the home. There may be a need for grab bars, training in position changes, safety education, and more. Once the exit/entrance areas seem safe, progress patients to areas on the property like the mailbox, yard, and garden. This creates opportunities for additional training, adaptive equipment training, and confidence building for patients.
5. Work with patients on various terrains like grass, gravel, and pavement. Balance and mobility can change based on these factors. Take this opportunity to provide education as well as verbal and tactile feedback, and increase your patients’ confidence when venturing out of the home.
6. Depending on the setting you work in, there may be opportunities to work with patients even beyond the home. This can include activity centers, grocery stores, banks, and parks. If a patient visits friends or family nearby, you may be able to set up a visit in the loved ones’ residences too. Simulating these types of visits is also helpful to patients. If you are providing inpatient care, help the patient maneuver to the cafeteria for a cup of coffee. It’s a great way to build the therapeutic relationship, engage a patient in meaningful activities, build fall prevention techniques, and grow patient confidence.

As you expand your treatment areas for fall prevention, you may need additional tools to fill your toolbox! I have a four-part fall prevention course available within the MedBridge Course Catalog to enhance your skills: Occupational Therapy: A Vital Piece of Effective Fall Prevention.