Preventing falls

Falls are one of the most common ways older adults get hurt. A fall can break a hip, injure the head, or shake a person's confidence so much that they stop moving. For a person living with dementia, a fall can also bring a hospital stay, more confusion and a sudden loss of independence.

The good news is that many falls can be prevented. This page explains why dementia raises the risk, and what helps most: exercise, a safer home, a medicine review and good eye and foot care. It also covers what to do right after a fall.

How common and serious falls are

More than 1 in 4 older adults fall each year, but fewer than half tell their doctor.¹ Falls lead to about 4.5 million emergency room visits a year in older Americans. Nearly 319,000 older adults are admitted to the hospital each year for a broken hip, and most of those breaks come from falls.¹

Falls are also the most common cause of brain injury in older adults.¹ In 2024, falls caused more than 43,000 deaths among people 65 and older. That makes them the leading cause of injury death in this age group.²

Why dementia raises the risk

Dementia is listed among the long-term conditions that make falls more likely.³ There are several reasons, and they often add up.

• Walking and balance changes. In Alzheimer's disease, problems with walking and balance usually show up in the middle and later stages.⁴ See middle-stage dementia and late-stage dementia.
• Lewy body dementia. In this type, stiff muscles, shuffling steps and drops in blood pressure on standing often appear early, and falls are common.⁴ See Lewy body dementia and Parkinson's disease dementia.
• Seeing the world differently. Some people with dementia have trouble telling apart colors and shades that are close to each other.¹³ A step edge, a dark rug or a shiny floor can be hard to read.
• Memory and judgment. A person may forget to use a walker, forget that they need help to stand, or not notice that they are unsteady.
• Low blood pressure on standing. Some dementias, some medicines and not drinking enough can make blood pressure drop when a person stands up. This can cause dizziness and falls.⁵
• Medicines. Medicines that act on the brain, such as sleep and anxiety medicines, raise the risk of falls.³
• Sudden illness. An infection such as a bladder infection, dehydration or a new medicine can cause delirium (sudden, severe confusion). People with dementia are more likely to get it.¹⁵

Ask for a fall check

The CDC suggests asking the doctor to check fall risk.¹⁰ Tell the doctor about every fall, every near fall, and any fear of falling, even if no one was hurt.⁹

World falls guidelines say every older adult should get advice on preventing falls and staying active. People at high risk should get a full falls assessment. This looks at many causes at once and leads to a plan built for that person.⁸ A falls assessment may look at:^3,8

• Walking, balance and leg strength
• All medicines
• Blood pressure lying down and standing
• Vision, feet and shoes
• Bone strength. Ask about screening and treatment for osteoporosis (thin, weak bones).¹⁰
• The home

Ask whether a physical therapist or occupational therapist can visit. A physical therapist works on strength, balance and walking aids. An occupational therapist looks at how the person does daily tasks at home and suggests changes.

Exercise: the strongest tool

Exercise is the best-studied way to prevent falls. A Cochrane review pooled 108 trials with more than 23,000 older adults living at home.⁶

Source for the table: Cochrane review.⁶

Most of these studies were in older adults living at home. In nursing homes, where many residents have dementia, the benefit of exercise is less clear.⁷ Even so, guidelines say programs should be tailored to the person, led by trained staff, and should build up slowly. They should focus on balance, strength and coordination.³ In care homes, a daily routine with regular chances to stand and walk is recommended.³

For a person with dementia, keep instructions short and show each move. Exercise at the time of day they are most alert. Music and a familiar routine can help. Adult day programs often include group exercise. See adult day care.

Make the home safer

Small changes can remove many hazards. Start with the places the person uses most: the path from bed to bathroom, the stairs and the bathroom.¹¹

Floors and paths

• Remove throw rugs, or hold them down with non-slip backing or double-sided tape.¹¹
• Keep clutter and cords out of walkways. Move furniture that blocks a clear path.¹¹
• Avoid sharp changes from bright to dark rooms. Even lighting is less confusing.¹²

Stairs

• Put sturdy handrails on both sides, running the full length of the stairs.¹¹
• Add light switches at the top and bottom.¹¹
• Mark step edges with tape or paint in a color that stands out.¹³
• Think about a safety gate, or moving daily life to one floor.¹³

Bathroom

• Install grab bars in and next to the tub or shower and beside the toilet.^11,12
• Use non-slip mats or textured strips on wet surfaces.^11,12
• A shower chair lets the person sit while washing. This also helps if blood pressure drops on standing.⁵ See bathing, dressing and grooming.

Bedroom and night

• Put a lamp within easy reach of the bed, and night lights along the path to the bathroom. Motion-sensor lights turn on by themselves.¹¹
• A chair with armrests near the bed makes standing up and dressing easier.¹²
• Night-time trips to the bathroom are a common time for falls. See bladder and bowel problems and sleep problems in dementia.

Seeing clearly

• Reduce glare with blinds or sheer curtains.¹³
• Use colors that contrast, such as a light switch plate that stands out from the wall.¹³
• Cover mirrors if the person finds them upsetting.¹³

Our making the home safer guide has a full room-by-room checklist.

Review medicines

Some medicines cause sleepiness, dizziness or unsteady walking. Ask the doctor or pharmacist to review every medicine at least once a year, and after any fall. Include over-the-counter pills, vitamins and herbal products.⁹

The American Geriatrics Society lists medicines that older adults should often avoid. These include some sleeping pills, benzodiazepines (a group of calming medicines), older allergy medicines such as diphenhydramine, some muscle relaxants and older antidepressants.¹⁴ Water pills, some antidepressants and blood pressure medicines can lower blood pressure on standing.⁵

Ask the doctor too whether vitamin D is right for the person.⁹ In nursing homes, vitamin D seemed to lower the number of falls in people with low vitamin D levels.⁷

Eyes, feet, shoes and standing up

• Eyes. Get an eye exam every year and update glasses.⁹ Bifocals and progressive lenses can make steps look closer or farther than they are. A separate pair of distance-only glasses for walking outside may help.¹⁰ See hearing, vision and brain health.
• Feet. Have the feet checked once a year.⁹
• Shoes. Wear well-fitting shoes with good support, indoors and out.⁹ Loose slippers and socks without grips are risky.
• Stand up slowly. Sit up, sit on the edge of the bed for a moment, then stand. March in place or move the feet before walking. Do not walk while feeling dizzy.⁵
• Drink enough. Not drinking enough fluid can lower blood pressure. Follow the doctor's advice if fluids are limited.⁵

What to do after a fall

Stay calm. Before moving, take a minute or two to check for pain or injury.¹⁶

If the person is not hurt and can get up, let them do it slowly, with your guidance:¹⁶

1. Roll onto one side.
2. Push up onto hands and knees.
3. Crawl to a sturdy chair or heavy piece of furniture.
4. Put one foot flat on the floor and push up slowly, holding the chair.
5. Turn and sit down to rest.

A person with dementia may not follow these steps. Give one step at a time, in a calm voice, and show them what to do.

If no one can get up, call for help. Keep warm with a blanket or coat. Move the arms and legs gently, and shift position about every 30 minutes if waiting a long time.¹⁶ A medical alert button worn on the body can bring help faster. See technology that helps.

Head injury. Someone should stay with the person for at least the first day after a head injury.¹⁷ If they take a blood thinner, get medical advice the same day, even if they seem fine.¹⁷

In the days after. See the doctor after any fall, even one without injury.¹⁶ Write down when and where it happened, what the person was doing, and whether they felt dizzy. This helps find the cause. A person with dementia may not be able to say they are in pain. Watch for limping, refusing to walk, guarding a body part, or new agitation.

Fear of falling and keeping freedom

After a fall, many people become afraid and move less. Moving less weakens muscles, which makes another fall more likely. Talk with the doctor if fear is holding the person back. See fear of falling.

You cannot prevent every fall. Keeping a person sitting all day to stop falls also weakens them and takes away dignity. Aim for a safer setting and an active day instead. In the hospital, ask staff to help the person get up and walk, and to avoid needless bed rest.³ See hospital stays. For more support, see caring for someone with dementia and the safety hub.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.