5 Fall Prevention and Safe Mobility

Why fall prevention matters

Falls can cause fractures, head injury, loss of independence, and fear of moving. Prevention is most effective when caregivers recognize individual risks, agree on practical precautions with the patient, and support safe activity rather than unnecessarily restricting mobility.

Recognizing and assessing fall risk

Fall risk can change from day to day. Reassess when a person’s health, medicines, mobility, or surroundings change, and follow the screening and assessment procedures for the care setting.

For older adults, STEADI begins by asking whether the person has fallen in the past year, feels unsteady when standing or walking, or worries about falling. A “yes” response calls for further assessment; it does not mean that every person needs the same precautions.

Consider previous falls, especially repeated falls or falls with injury; weakness, impaired gait or balance, dizziness, fainting, or difficulty transferring; and confusion, reduced attention, impulsivity, or unfamiliar surroundings. Other relevant factors include vision or hearing difficulty, pain, acute illness, frequent urgent toileting, and medicines or combinations of medicines that may cause sleepiness, dizziness, low blood pressure, or impaired coordination.

Environmental hazards include clutter, spills, poor lighting, and obstructed routes. Use the person’s history and direct observation as well as any required screening tool. For community-dwelling older adults, clinicians may assess gait, strength, balance, orthostatic blood pressure, vision, feet and footwear, medicines, and home hazards. Share relevant findings with the care team and incorporate them into an individualized plan.

Preventing falls while supporting mobility

Keep routes to the bathroom clear and well lit; clean spills promptly; secure cords and loose rugs; and place needed items, including the call light, within reach. In care facilities, use the bed’s lowest safe position when the patient is resting and lock bed or wheelchair brakes as appropriate. Check that the patient knows how to call for help.

Explain the mobility plan, ask what has worked before, and provide the supervision or hands-on help indicated by assessment and care instructions. Offer toileting assistance when needed. Use appropriate, well-fitting footwear and the person’s prescribed mobility aid. Make sure glasses and hearing aids are available when needed.

Help the patient rise slowly, especially if dizziness or postural blood-pressure changes are possible. Before walking, check alertness, symptoms, footwear, and that the aid is correctly positioned. Use a gait belt or transfer equipment only if trained and allowed by the care plan and facility policy. Do not pull on a person’s arms or attempt a transfer beyond your training or the person’s assessed ability.

If the patient becomes weak, dizzy, or unsteady, stop, help them sit or lie down safely, and call for assistance. Report new dizziness, confusion, weakness, near-falls, or changes in walking to the appropriate clinician. Medication review, treatment of contributing conditions, vision care, physical or occupational therapy, and strength-and-balance exercise may be appropriate. Review and adjust the prevention plan after a fall or near-fall. Do not rely on alarms or restraints as substitutes for individualized care and safe mobility.

Responding to a fall

1. Stay with the person and call for help. Check for immediate danger and assess responsiveness, airway, breathing, and circulation according to your training and local emergency procedures. Activate the emergency response system when indicated.

2. Do not rush to lift the person. Ask what happened and check for pain, bleeding, deformity, head impact, or other signs of injury. If a head, neck, back, hip, or other serious injury is possible, keep the person still and wait for qualified help. Move them only if remaining there presents an immediate danger. Do not raise the head if a neck or back injury is suspected.

3. Arrange clinical assessment. Report the fall promptly to the nurse or appropriate clinician. A qualified clinician should assess the person and decide whether and how they can be moved. Follow emergency, monitoring, and escalation procedures; symptoms of head injury may appear later.

4. Document and reduce the chance of another fall. According to policy, record the time and circumstances, observed condition and injury, actions taken, notifications, and follow-up. Reassess possible causes and revise the prevention and mobility plan with the care team and patient.