Fall-Proofing Your Home: Sorting the Evidence From the Noise

Key takeaways

• Older adults: about 1 in 4 adults 65 and older reports a fall each year
• Common hazards: loose rugs, clutter, poor lighting and stairs without railings
• Most useful single change: Remove throw rugs or secure them with double-sided tape.
• Commonest mistake: Standing on chairs to reach high shelves.
• See a doctor if any of the signs under "When to speak to a doctor" below apply to you.

What it is

Simple changes to the home that lower the risk of falls for older adults and young children. It sits within Injury Prevention. Here are the numbers, taken from the guidance cited at the end.

The numbers, in one place

What helps

These are worth doing. None of them needs to happen all at once.

• Remove throw rugs or secure them with double-sided tape
• Add nightlights in bedrooms, hallways and bathrooms
• Have your eyes checked at least once a year
• Ask your doctor or pharmacist to review medicines that may cause dizziness or sleepiness
• Do exercises that improve strength and balance

What to avoid

Things that seem reasonable and are not.

• Standing on chairs to reach high shelves
• Walking in socks or loose slippers on hard floors
• Using baby walkers, which the American Academy of Pediatrics advises against

In depth

Falls are not just accidents of bad luck. They usually happen when a person's balance, strength, vision or attention meets a hazard in the environment, such as a loose rug, poor lighting or a step without a railing. Reducing falls means working on both sides of that equation: making the home safer and helping the person become steadier. For older adults, falls are a leading cause of injury, including hip fractures and head injuries, and can lead to a loss of independence.

Many factors that raise fall risk in older adults can be changed. Muscle weakness, especially in the legs, and problems with balance are among the strongest. Certain medicines, such as those for sleep, anxiety, depression and blood pressure, can cause dizziness or drowsiness. Vision problems, foot pain, poorly fitting shoes and drops in blood pressure on standing all contribute. A fall itself is a warning sign, because people who have fallen once are more likely to fall again.

For young children, falls are the most common cause of nonfatal injuries treated in emergency rooms. Babies roll off beds and changing tables, toddlers climb furniture and fall down stairs, and children fall from windows and playground equipment. Their large heads, developing coordination and natural curiosity mean the home needs to be adapted as they grow. Supervision helps, but physical barriers, such as gates and window guards, protect children when attention slips.

Signs and symptoms

• Feeling unsteady when standing or walking
• Holding onto furniture or walls to move around the home
• Worrying about falling or limiting activities because of fear of falling
• Dizziness or light-headedness when standing up
• Tripping or near-misses, even without falling
• In children, climbing furniture or playing near open windows

Causes and risk factors

• Leg weakness and problems with balance or walking
• Medicines that cause dizziness, drowsiness or low blood pressure
• Vision problems, including outdated glasses and cataracts
• Foot pain and unsupportive or poorly fitting footwear
• Home hazards such as clutter, poor lighting and loose rugs
• Conditions such as Parkinson's disease, stroke, arthritis and dementia
• In children, unsecured furniture, open windows and unguarded stairs

How it is checked

Your doctor can assess fall risk as part of a routine visit or the Medicare Annual Wellness Visit. They may ask whether you have fallen in the past year, whether you feel unsteady and whether you worry about falling. Simple tests, such as timing how long it takes you to stand from a chair, walk a short distance and sit back down, or checking how well you balance, help identify problems.

They may also review medicines, check blood pressure lying and standing, examine your feet and refer you for a vision check. If there are concerns, a physical therapist can assess strength and balance, and an occupational therapist can visit your home to identify hazards and recommend changes. Your insurance or Medicare may cover some of these services with a referral.

Treatment and support options

Strength and balance exercise

Exercise programs that improve leg strength and balance are among the most effective ways to prevent falls in older adults. Options include tai chi, physical therapy and community programs designed for fall prevention. Even a few minutes of regular balance exercise at home can help. Your doctor or a physical therapist can recommend a safe program.

Medication review

Ask your doctor or pharmacist to review all your medicines, including over-the-counter sleep aids and allergy medicines. Some can be reduced, changed or taken at a different time of day to lower dizziness or drowsiness. Never stop a medicine without talking to your doctor first.

Home modifications

Simple changes can make a big difference: clear walkways, secure or remove rugs, add bright lighting and nightlights, install grab bars and use non-slip mats in the bath. Keep frequently used items within easy reach. An occupational therapist can suggest more specific changes, such as a raised toilet seat or shower chair.

Childproofing for falls

Install hardware-mounted safety gates at the top of stairs and pressure gates at the bottom. Use window guards or stops that keep windows from opening more than 4 inches, since screens do not stop children from falling. Anchor furniture and TVs to the wall to prevent tip-overs. Always keep a hand on a baby on a changing table.

Prevention

• Stand up slowly, especially after lying down or sitting for a long time
• Wear supportive shoes with non-slip soles inside and outside the home
• Keep a lamp or light switch within reach of your bed
• Use a cane or walker if recommended, fitted by a professional
• Keep outdoor steps and paths clear of ice, leaves and clutter

Day to day

After a fall, many people become afraid of falling again and start doing less. This can lead to weaker muscles and worse balance, which in turn raises fall risk. Staying active, with guidance from a physical therapist if needed, helps break that cycle. Talk to your doctor about your concerns, because addressing fear of falling is part of good fall prevention.

It also helps to plan for what to do if you fall. Learn how to get up safely, or how to stay warm and comfortable while waiting for help if you cannot. Consider a medical alert device, especially if you live alone, and keep a phone within reach. Let family or neighbors check in regularly. These steps provide reassurance and can prevent a fall from becoming a long, dangerous wait.

For specific groups

Older adults

Falls are a leading cause of injury in adults 65 and older. Talking with your doctor about falls, staying active, reviewing medicines and making the home safer can significantly reduce risk and help you stay independent.

Babies and toddlers

Babies can roll off beds, couches and changing tables earlier than parents expect. Toddlers climb furniture and stairs. Use gates, window guards and furniture anchors, and never leave a baby alone on a raised surface.

People with osteoporosis

Weak bones mean a fall is more likely to cause a fracture. Fall prevention is especially important, alongside treatment for bone health. Ask your doctor about bone density testing and how to reduce your fracture risk.

Questions to ask your doctor

• Do any of my medicines increase my risk of falling?
• Could I benefit from physical therapy for strength and balance?
• Should I have my vision or hearing checked?
• Would a home safety assessment by an occupational therapist help?
• Should I have a bone density test?
• What should I do if I fall and cannot get up?

More questions, answered

Is falling just a normal part of getting older?

No. While risk rises with age, many falls can be prevented by improving strength and balance, reviewing medicines, checking vision and making the home safer. Tell your doctor about any fall so the causes can be addressed.

Do window screens stop children from falling?

No. Screens are designed to keep insects out, not to hold a child's weight. Use window guards or stops that limit opening to 4 inches or less, and keep furniture away from windows so children cannot climb up to them.

How do I get up safely after a fall?

Stay still for a moment and check for injury. If you feel able, roll onto your side, get onto your hands and knees and crawl to a sturdy chair. Use it to push up slowly. If you are hurt or cannot get up, call for help and keep warm.

What type of exercise is best for preventing falls?

Exercises that combine strength and balance training, such as tai chi or programs designed by physical therapists, have the strongest evidence. Walking is good for overall health but does not improve balance as much on its own.

Are pets a fall hazard?

Pets can be a tripping hazard, especially small animals that move underfoot. Consider a bell on their collar, keep pet toys picked up and be aware of where your pet is, especially at night.

Should I stop using stairs to avoid falls?

Not necessarily. Using stairs safely can help maintain strength. Make sure there are sturdy railings on both sides, good lighting and no clutter. If stairs feel unsafe, talk to your doctor or a physical therapist.

Related topics

• Falls Prevention: What Published Guidance Supports (Bone and Joint)
• Child Safety at Home: What Published Guidance Supports (Children's Health)
• Strength and Balance in Later Life: What Published Guidance Supports (Healthy Aging)
• Foot Care in Later Life: What the Evidence Actually Says (Foot Health)

Where to go next

• What People Get Wrong About Fall-Proofing Your Home
• Starting Out With Fall-Proofing Your Home
• Fall-Proofing Your Home — the reference entry
• Injury Prevention: The Complete Guide
• The Evidence on Safe Firearm Storage, Without the Hype
• Bike and Helmet Safety: Sorting the Evidence From the Noise

When to speak to a doctor

Tell your doctor about any fall, even if you were not hurt, since it can signal a treatable problem. Call 911 if someone cannot get up, hit their head while taking blood thinners, or has severe pain, confusion or a possible broken bone.

Where this comes from

• CDC — Older Adult Fall Prevention
• National Institute on Aging — Falls and Fractures in Older Adults
• American Academy of Pediatrics — Falls Prevention

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.