TL;DR. One in four adults aged 65+ falls each year. Falls are the leading cause of injury death and hospitalization in this age group, but they are largely preventable. The CDC’s STEADI initiative identifies four pillars of fall prevention: home modifications, strength and balance exercise, medication review, and vision and hearing checks. This guide walks the home room by room, lists the specific exercises that work, explains the medications that raise fall risk, and outlines when professional caregiver support becomes the right answer.
The numbers families should know
The Centers for Disease Control and Prevention reports more than one in four adults age 65 and older falls each year, more than 3 million older adults are treated in emergency departments for fall injuries annually, and falls are the leading cause of injury death in this age group (CDC, Older Adult Falls Facts). The financial cost is large — CDC estimates total medical costs of falls in older adults exceed $50 billion per year — but the bigger cost is the cascade: hospitalization, deconditioning, loss of independence, and often a one-way move out of the home (CDC, Cost of Older Adult Falls).
Most falls happen at home, and most are preventable. The CDC’s STEADI (Stopping Elderly Accidents, Deaths & Injuries) initiative is the standard reference for healthcare providers and families (CDC, STEADI Resources).
Pillar 1. Make the home itself safer — room by room
Bathroom (where most falls happen)
- Grab bars next to the toilet and inside the shower, mounted into wall studs (never suction cup)
- Walk-in shower or transfer bench rather than a step-over tub
- Non-slip mat inside the tub/shower; textured rug outside
- Handheld showerhead on a 5-foot hose
- Raised toilet seat with arm supports
- Anti-scald valve set to a 120°F maximum at the water heater
- Bright, glare-free lighting
- Nightlight or motion sensor
Bedroom
- Bed at a height where feet rest flat on floor when seated on the edge
- Bedside lamp within easy reach
- Phone or call button at the bed
- Clear path between bed and bathroom
- Plug-in nightlights between bed and bathroom
- Slippers with non-slip soles, kept beside the bed
- No throw rugs (or anchored with double-sided rug tape)
Living room
- Stable, sturdy chairs with arms (avoid low, soft chairs that are hard to rise from)
- Clear walking paths — no clutter, no pet bowls, no extension cords across walkways
- Furniture arranged so the senior can walk from one piece to another for support if needed
- Bright lighting that does not produce glare on TV screens or polished floors
- No loose rugs
Kitchen
- Frequently used items between waist and shoulder height — no climbing
- Sturdy step stool with a handle (replace any chairs being used as stools)
- Lever-handle faucets and door handles
- Non-slip mat in front of the sink (rubber-backed)
- Spills wiped immediately
Stairs and entry
- Handrails on both sides of every staircase, extending past top and bottom step
- Stair tread tape or contrast-edge strips for visibility
- Bright lighting at top and bottom of stairs, with switches in both locations
- No clutter on stairs (laundry baskets, shoes, magazines)
- Ramp at primary entrance if walker or wheelchair is in current or anticipated use
- Stairlift if living areas span multiple floors and stair-climbing is unsafe
- Outdoor walkways well-lit and snow- or leaf-cleared
Hallways and transitions
- Plug-in nightlights along the path between bedroom and bathroom
- Even flooring — no high transitions between rooms
- No piles of mail, magazines, or laundry on the floor
Pillar 2. Build strength and balance through exercise
The NIA reports that exercise programs combining strength and balance training reduce fall rates in older adults by approximately 25–30% (NIA, Four Types of Exercise). The most evidence-supported programs include:
Tai Chi
The single most consistently effective fall-prevention exercise. Slow, weight-shifting movements train balance and proprioception. Many Pennsylvania senior centers, YMCAs, and physical therapy clinics offer “Tai Chi for Arthritis and Falls Prevention” classes specifically.
Otago Exercise Program
An evidence-based home exercise program (5 strength + 12 balance + walking) developed in New Zealand, recognized by the CDC. Available through many PA outpatient PT clinics and through the YMCA’s Healthy Living program.
Daily walking
30 minutes per day, broken into segments if needed. Walking maintains lower-body strength, balance, and circulation.
Specific home exercises
- Sit-to-stand from a sturdy chair, no hands — build up to 10 reps, 2 sets
- Heel-to-toe walking in a hallway, like walking a line, 10 steps
- Single-leg stand holding the back of a chair, 30 seconds each side
- Calf raises at the kitchen counter, 10 reps, 2 sets
- Side leg lifts while holding the counter, 10 reps each side
The American Occupational Therapy Association recommends these as first-line interventions when a senior is at fall risk but ambulatory (AOTA, Aging in Place).
Pillar 3. Review medications
The CDC STEADI program identifies certain medication classes as raising fall risk meaningfully. Ask the primary care doctor or pharmacist for an annual medication review focused on fall risk, especially for:
- Benzodiazepines (Valium, Xanax, Ativan) — sedation, balance impairment
- Sleep aids (Ambien, Lunesta, Restoril) — nighttime falls, confusion
- Opioid pain medications — sedation, dizziness
- Antihistamines with diphenhydramine (Benadryl, ZzzQuil, Tylenol PM) — sedation
- Blood pressure medications — orthostatic hypotension causing dizziness on standing
- Diuretics — hurry to bathroom + dehydration
- Antidepressants — some classes increase fall risk
- Antipsychotics — sedation, gait disturbance
The American Geriatrics Society’s Beers Criteria identifies medications considered high-risk for older adults, and most pharmacists can run a Beers screen on a senior’s medication list. This is one of the highest-yield safety interventions and costs almost nothing.
Pillar 4. Vision and hearing
- Annual eye exam with cataract screening — cataracts double fall risk
- Glasses with current prescription
- Bifocal users: a separate pair for stairs and walking outdoors (bifocals distort depth perception)
- Annual hearing check — untreated hearing loss is associated with increased fall risk through reduced spatial awareness
Foot care and footwear
Often overlooked. Untreated foot pain, untrimmed nails, and loose or worn footwear are major contributors to falls.
- Annual podiatry visit (often Medicare-covered for diabetic patients)
- Shoes with low, broad heels and rubber soles
- Avoid loose slippers and stocking feet on hard floors
- Replace shoes with worn soles
Vitamin D, hydration, and nutrition
The NIA notes that vitamin D deficiency is associated with reduced muscle strength and increased fall risk. Most adults over 65 benefit from 800–1,000 IU per day with the doctor’s approval. Dehydration causes orthostatic hypotension — a common cause of “I just got dizzy and went down.” Aim for 6–8 cups of water per day.
The Timed Up and Go (TUG) test
A simple at-home screen any family can do:
- Have your parent sit in a sturdy chair with arms.
- Time how long it takes to stand up, walk 10 feet, turn around, walk back, and sit down.
- Under 10 seconds: low fall risk.
- 10–13 seconds: moderate fall risk — start a balance program.
- 14+ seconds: high fall risk — talk to the doctor and consider professional support.
Repeat every 6 months to track trends.
If your parent has already fallen
One fall — even without injury — is the strongest predictor of another fall. Action steps:
- Schedule a primary care visit within 1 week. Ask for a fall workup — orthostatic vitals, vision check, medication review, gait assessment.
- Request a physical therapy evaluation. Medicare covers PT after a fall when ordered by a doctor.
- Repeat the home safety walkthrough — the previous setup did not catch the cause.
- Consider a medical alert system with fall detection (Apple Watch, Life Alert, Bay Alarm).
- Add in-home support if any task that contributed to the fall (bathing, getting up at night, navigating stairs) is now risky to do alone.
When fall prevention requires professional care
Bring in professional support when:
- Your parent has fallen more than once in the past year
- Bathing, dressing, or getting to the toilet have become unsafe to do alone
- Nighttime trips to the bathroom are when falls happen
- The senior gets up at unpredictable times (sundowning, dementia, anxiety)
- You as the caregiver are sleep-deprived from monitoring
A-Team Home Care’s personal care covers bathing, dressing, transfer assistance, and toileting with RN-supervised, ACHC-accredited caregivers. For overnight or around-the-clock fall prevention, 24-hour home care uses awake caregivers in shifts so falls are stopped before they happen.
Free in-home assessment within 48 hours for Philadelphia, Bucks County, and Montgomery County. Call (215) 490-9994 or email service@ateampa.com.
Frequently asked questions
What is the most important fall prevention strategy?
No single strategy is most important — falls are multi-factor. The four pillars matter together: home modifications (bathroom + stairs first), strength and balance exercise (Tai Chi or Otago), medication review (especially benzodiazepines and sleep aids), and annual vision check. Doing all four reduces fall rates by roughly half in published studies.
Should I get my parent a medical alert device?
Yes, if they live alone or are home alone for any portion of the day. Devices with automatic fall detection (Apple Watch, Life Alert, Bay Alarm Medical) call for help even if the senior cannot press a button. The most common reason elderly fall victims have poor outcomes is lying on the floor for hours before being found.
Are walkers or canes safe?
When fitted correctly by a physical therapist, yes — they reduce fall risk. When the wrong height or used incorrectly (leaning too far forward, lifting the walker too high), they increase risk. Always have an OT or PT fit and train use.
Does Medicare cover fall prevention services?
Medicare covers physical therapy, occupational therapy, and home safety evaluation when ordered by a doctor (often after a fall or for a fall risk assessment). Medicare also covers an annual wellness visit that includes fall risk screening. Medicare does not cover home modifications themselves, long-term personal care, or medical alert devices.
Will my parent regain confidence after a fall?
Often yes, with structured support. Fear of falling itself increases fall risk — seniors reduce activity, lose strength, and fall more often. Physical therapy, gradual return to activity, and a supportive caregiver presence rebuild confidence. The first weeks after a fall are when the trajectory is set.
Can A-Team caregivers help with fall prevention exercises?
Yes. Personal care and companion care caregivers can encourage and assist with the daily exercises a physical therapist has prescribed, accompany the senior on walks, and ensure the home stays clear of new fall hazards. Caregivers do not replace PT — they extend its impact between sessions.
How often should home safety be reassessed?
At minimum annually, and immediately after any of: a fall, a hospitalization, a new medication that affects balance, a new diagnosis (dementia, Parkinson’s, stroke), or a change in mobility. New equipment (walker, oxygen, hospital bed) usually changes traffic patterns and requires re-evaluation.
Sources & further reading
- CDC STEADI — Stopping Elderly Accidents, Deaths & Injuries
- CDC — Older Adult Falls Facts
- CDC — Cost of Older Adult Falls
- National Institute on Aging — Falls and Fractures in Older Adults
- National Institute on Aging — Four Types of Exercise
- American Occupational Therapy Association — Aging in Place
Disclaimer
This article is for general educational purposes and does not replace medical advice. Talk to your physician about fall risk, exercise programs, and any new symptoms. A-Team Home Care is an ACHC-accredited home care agency serving Pennsylvania.
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