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Fall prevention when dementia impairs safety awareness

Key points

  • Falls are a leading cause of hospitalization in people with dementia, but many can be prevented with proactive measures.
  • The person may not recognize hazards or ask for help due to brain changes—do not rely on their judgment.
  • Remove clutter, improve lighting, and place frequently used items within reach to reduce the need to stand and reach.
  • Use simple, one-step commands when helping the person stand or walk, and always supervise during transitions.
  • Grab bars, non-slip mats, and proper footwear are low-cost tools that significantly reduce fall risk.
  • Personalize strategies based on the type and stage of dementia, the caregiver’s physical ability, and the living situation.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Step-by-step

  1. 1. Assess the person’s fall risk by noting if they have fallen before. A history of falls is the strongest predictor of future falls. Watch for signs of unsteadiness when they stand or walk, and note any recent changes in their balance or gait.

  2. 2. Remove all clutter from walkways, especially in areas where the person spends most of their time, like the living room, bedroom, and bathroom. This includes loose rugs, cords, and small furniture that could be tripped over. Keep pathways wide and clear.

  3. 3. Improve lighting throughout the home, particularly in hallways and near the bathroom. Use nightlights in the bedroom and bathroom so the person can see clearly if they get up at night. Dim lighting can cause shadows that confuse and disorient, increasing fall risk.

  4. 4. Place frequently used items—like a glass of water, remote control, reading glasses, or phone—within easy reach of where the person sits or lies down. This reduces the need for them to stand up and reach, which can lead to loss of balance.

  5. 5. Use simple, one-step commands when helping the person stand. Instead of saying, ‘Put your hand on the wall so you can hold on and stand up,’ say, ‘Put your hand here,’ and guide them. Break down the task into small, clear steps to reduce confusion.

  6. 6. Provide supervision and assistance during daily activities like getting out of bed, using the bathroom, or walking to the kitchen. Do not assume they can do these tasks safely alone, even if they seem capable. Offer a steady arm or a gait belt for support.

  7. 7. Install grab bars in the bathroom near the toilet and in the shower or tub. Have a handyman secure them properly so they can bear weight. Also, use non-slip mats in the bathroom and kitchen to prevent slipping on wet floors.

  8. 8. Encourage the person to wear shoes with good traction, even indoors. Avoid socks on tile or wood floors, as they can cause slipping. Also, ensure clothing is not too long or loose, which can catch on furniture or the person’s feet.

  9. 9. Consider a home safety evaluation by a physical or occupational therapist. They can recommend specific modifications and exercises to improve strength and balance, tailored to the person’s stage of dementia.

  10. 10. If the person uses a walker or cane, monitor their use carefully. In mid to late stages, assistive devices can actually increase fall risk because the person may forget to use them correctly or lean forward, leading to forward falls. Consult a therapist before introducing or continuing use.

What not to do

  • Do not assume the person will ask for help when they need it. They may not recognize they are unsteady or that standing up is risky. Instead, proactively offer assistance and supervise during transitions.

  • Do not rush the person when they are standing or walking. Hurrying can cause them to lose balance or become anxious. Allow plenty of time and use a calm, reassuring tone.

  • Do not use complex instructions like, ‘Mom, I need you to roll over to the edge of the bed so I can help you sit up.’ This overloads the brain. Instead, say, ‘Roll toward me,’ and then, ‘Now sit up,’ one step at a time.

  • Do not leave the person alone in a new or confusing environment, such as a shopping mall or a friend’s home. Disorientation increases fall risk. Stay with them or have a companion nearby.

  • Do not ignore signs of orthostatic hypotension, such as dizziness when standing up quickly. Encourage the person to sit for a moment before standing, and ensure they are well-hydrated. Discuss any concerns with a clinician.

  • Do not place area rugs or mats in high-traffic areas, even if they are non-slip. They can still be a tripping hazard. Remove them entirely for safety.

Practical tools

  • Simple Verbal Cues for Standing

    When helping someone stand, use short, clear phrases. For example, say, ‘Put your feet flat on the floor,’ then, ‘Push up with your hands,’ and finally, ‘Stand up slowly.’ Avoid saying, ‘Let’s get up now,’ which is too vague. Practice these cues so they become routine.

  • Gait Belt

    A gait belt is a padded belt that goes around the person’s waist, giving you a secure handhold to guide them when walking or standing. It provides stability and reduces the risk of you pulling on their arms, which can cause injury. Always use it with proper training from a therapist.

  • Nightlights and Motion-Sensor Lights

    Place nightlights in the bedroom, bathroom, and hallway. Motion-sensor lights that turn on automatically when someone stands up are especially helpful. This reduces the chance of the person walking in the dark and tripping over unseen objects.

  • Non-Slip Footwear

    Encourage the person to wear shoes with rubber soles, even indoors. Look for shoes that are easy to put on, like slip-ons with elastic laces. Avoid slippers or bare feet, which offer no traction. If they resist, try a pair of comfortable, non-slip socks with grip pads on the bottom.

  • Home Safety Checklist

    Create a simple checklist to review weekly: Are walkways clear? Are grab bars secure? Is lighting adequate? Are frequently used items within reach? This helps you stay proactive and catch hazards before they cause a fall.

  • Hydration Reminder System

    Dehydration can cause dizziness and increase fall risk. Set a timer or use a water bottle with marked times to remind the person to drink small amounts throughout the day. Aim for at least 6-8 cups of water daily, unless a clinician advises otherwise.

Discuss with your clinician

Ask the doctor if the person’s medications could be causing dizziness or low blood pressure, which increases fall risk. Some blood pressure meds, sedatives, or antidepressants can have this effect.

Discuss whether a physical therapy referral is appropriate to assess balance and strength, and to learn safe transfer techniques.

If the person has had a fall, ask about a bone density test to check for osteoporosis, which increases fracture risk.

Inquire about the use of a gait belt or other mobility aids, and whether the person is a candidate for a walker or cane given their dementia stage.

Ask about orthostatic hypotension: how to check for it and whether the person should have their blood pressure measured while lying, sitting, and standing.

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