Fall Prevention

Key Points

• Falls are common and can cause severe injury or death, especially in older adults.
• Most falls result from multiple risk factors, so prevention requires combined interventions.
• Priority modifiable risks include weakness, balance impairment, high-risk medications, sensory deficits, and environmental hazards.
• Ongoing reassessment is required at admission, at regular intervals, and after condition or medication changes.

Pathophysiology

Fall events are usually multifactorial failures of mobility, balance, and environmental safety rather than a single isolated cause. The source section identifies lower-body weakness, gait and balance difficulty, sensory problems, and medication effects as major contributors to instability.

Risk increases when reduced activity causes further deconditioning, which then worsens strength and mobility. This cycle can accelerate after a prior fall because fear of falling often reduces activity and increases future fall probability.

Classification

• Intrinsic risk factors: Lower-body weakness, vitamin D deficiency, gait and balance problems, vision impairment, and acute confusion.
• Medication-related risk factors: Tranquilizers, sedatives, antihypertensives, and antidepressants that increase dizziness or impaired alertness.
• Extrinsic risk factors: Environmental hazards such as clutter, poor footwear, and tripping hazards.

Nursing Assessment

NCLEX Focus

Priority questions often ask which findings indicate immediate high fall risk and which intervention should be implemented first.

• Assess mobility baseline, transfer ability, and signs of lower-body weakness during routine care.
• Observe gait stability and balance during ambulation and position changes.
• Identify sensory deficits that increase risk and escalate findings to nursing staff.
• Report new weakness, confusion, or condition changes that increase immediate risk.
• Review environment for tripping hazards and unsafe footwear that can trigger falls.

Nursing Interventions

• Keep residents as strong and mobile as possible through safe, regular activity and supervised movement.
• Apply interventions for sensory deficits and ensure safe use of assistive approaches during care.
• Use proper safe-patient-transfer techniques for bed, chair, and ambulation transitions.
• Remove clutter and other environmental hazards, and maintain clear pathways.
• Encourage adequate nutrition-support and hydration-management to reduce dizziness and weakness.

Escalate Condition Changes

Report new confusion, weakness, or functional decline promptly because delayed communication increases injury risk.

Pharmacology

Drug Class	Examples	Key Nursing Considerations
sedatives	Benzodiazepines, hypnotics	Monitor for sedation, impaired coordination, and delayed reaction time.
antihypertensives	ACE inhibitors, beta blockers	Monitor for orthostatic symptoms and dizziness during transfers.
antidepressants	SSRIs, SNRIs	Monitor for early treatment dizziness or balance changes affecting mobility.

Clinical Judgment Application

Clinical Scenario

An 82-year-old resident with recent weakness and antihypertensive therapy becomes unsteady when standing and reports near-falls during toileting.

Recognize Cues: Weakness, unsteady gait, high-risk medication exposure, and near-fall history. Analyze Cues: Combined intrinsic and medication-related factors increase immediate injury risk. Prioritize Hypotheses: Highest priority is imminent fall during transfers. Generate Solutions: Initiate transfer assistance, remove room hazards, and communicate risk escalation. Take Action: Use assisted transfer methods and reinforce frequent observation during mobility. Evaluate Outcomes: No falls occur, mobility remains supported, and risk indicators are communicated for formal reassessment.

Related Concepts

• falls - Core adverse event prevented by mobility and environment controls.
• safe-patient-transfer - Correct transfer mechanics reduce transition-related injuries.
• orthostatic-hypotension - Medication and volume status can precipitate dizziness and falls.
• sensory-deficits - Vision and other sensory changes increase tripping and balance risk.
• mobility-support - Strength and activity maintenance reduce deconditioning-related fall risk.

Self-Check

1. Which combination of risk factors in an older adult indicates the highest near-term fall risk?
2. Why does reduced activity after a prior fall increase future fall probability?
3. Which transfer-related intervention should be prioritized when dizziness appears during standing?