Falls Prevention Checklist

Most falls are preventable. A proactive, multifactorial approach — combining environmental safety, medication review, exercise, and individualised care planning — can significantly reduce falls risk.

NICE CG161 recommends: Older people who have fallen or are at risk of falling should be offered a multifactorial assessment and individualised intervention plan. A single intervention is rarely effective on its own — the greatest impact comes from addressing multiple risk factors simultaneously.

Evidence-Based Prevention Strategies

Environmental Safety

Conduct environmental risk assessments on admission and regularly thereafter
Ensure adequate lighting, especially at night (night lights in bedrooms and corridors)
Remove loose rugs, trailing wires, and clutter from walkways
Install handrails in corridors and grab rails in bathrooms and toilets
Use non-slip mats in bathrooms
Ensure beds are at the correct height for safe transfers
Keep call bells within easy reach at all times
Ensure resident's walking aids are accessible and in good repair
Maintain even flooring and repair damage promptly
Ensure wet floor signs are used and wet areas cleaned promptly

Medication Review

Request medication review from GP or pharmacist for all residents at risk
Review psychotropic medication regularly (NICE recommends 3-monthly for antipsychotics in dementia)
Reduce polypharmacy where possible — deprescribe where appropriate
Monitor for side effects of medications that increase fall risk
Ensure 'when required' (PRN) sedating medications are used cautiously
Record and report any new symptoms after medication changes

Exercise and Mobility

Promote regular physical activity appropriate to the resident's ability
Refer to physiotherapy for strength and balance training
Encourage walking with appropriate aids rather than relying on wheelchairs
Include seated exercises for residents with limited mobility
Support occupational therapy input for functional mobility
Ensure continence care to avoid urgent rushes to the toilet
Reduce sedentary time — encourage movement throughout the day

Individual Care Planning

Complete a falls risk assessment on admission and after any fall
Develop an individualised falls prevention care plan
Review the care plan after every fall or near-miss
Ensure all staff are aware of residents at high risk
Use visual identifiers for high-risk residents (e.g., coloured wristband, symbol on door)
Ensure adequate supervision and staffing levels
Consider assistive technology — bed sensors, chair sensors, alarm mats

Environmental Safety Audit

Use this checklist to assess the physical environment for falls hazards. Walk through the home and each resident's room regularly.

Bedroom

Bed at correct height for safe transfers
Call bell within easy reach
Night light available
Non-slip mat beside the bed
Floor free of clutter and trailing wires
Personal items within easy reach

Bathroom / Toilet

Grab rails installed and secure
Non-slip mats in place
Commode available if needed
Toilet seat at appropriate height
Adequate lighting
Call bell accessible from toilet

Corridors / Communal Areas

Even flooring — no loose carpets or mats
No trailing cables
Adequate lighting (especially at night)
Handrails along corridors
Clear pathways — no clutter
Wet floor signs available and used

General

Appropriate footwear available for residents
Walking aids in good repair and correct height
Heating adequate — cold rooms increase stiffness
Spill response kits accessible
Outdoor areas safe and well-lit
Signage clear and visible

Exercise & Mobility Recommendations

NICE CG161 recommends that older people at risk of falls are offered group or home-based exercise programmes that combine strength and balance training. Exercise is one of the most effective single interventions for falls prevention.

Evidence-Based Exercise Programmes

•OSTEO programme: Evidence-based home exercise programme for older people at risk of falls
•Tai Chi: Shown to reduce falls risk in older adults by improving balance and proprioception
•Strength and balance classes: Group-based sessions incorporating chair-based exercises, standing balance, and progressive resistance training
•Walking programmes: For residents who can walk with or without aids — promotes independence and deconditioning prevention
•Seated exercises: For residents with limited mobility — maintains upper body strength and circulation

Key Principles

Any exercise is better than none — even seated exercises reduce deconditioning
Programmes should be at least 12 weeks in duration for maximum benefit
Refer to physiotherapy for individual assessment and programme design
Encourage residents to be active within their capability — reduce sedentary time

Quick Reference: Falls Prevention Summary

1.Assess — Conduct a multifactorial falls risk assessment on admission, after any fall, and regularly.
2.Environment — Conduct regular environmental checks — lighting, flooring, call bells, grab rails.
3.Medication — Request regular medication reviews, especially for psychotropic and polypharmacy.
4.Exercise — Promote regular strength and balance exercise appropriate to ability.
5.Plan — Develop an individualised falls prevention care plan for every resident at risk.
6.Monitor — Review and update the care plan after every fall, change in condition, or near-miss.