Preventing Falls and What to Do When They Happen

Falls are something every CNA wishes they could avoid.  No one likes to see their patient fall and injure themselves, and it is heartbreaking when that injury leads to your patient’s death.

But why is it important to talk about falls?  Falls are very common. Every year 1 in 3 older adults have a fall.  These falls can cause severe injuries and may even lead to death. Falls put your patients at risk for significant deterioration in their functional status, leading to decreased mobility and an increase in nursing home placements.  Falls are also often the first symptom of a more serious medical problem. To understand how to prevent falls we must first understand why they happen.

Risk Factors for Falls

There many factors that increase the risk of your patients suffering a fall.

Mobility issues are an obvious risk factor for falls.  People who have gait and balance problems, such as people with Parkinson’s Disease, are more likely to trip and fall.  Also, people who are very weak and frail are at risk of suffering a debilitating fall.

People with confusion, dementia, or other changes in their cognition are more likely to fall as they may get disoriented, or may try to get up unassisted forgetting that they require assistance or need to use their cane or walker.

People who are experiencing an acute illness may be weaker and are also at risk for falls.  In addition to that, often a fall or loss of balance is the first sign of a health problem such as a UTI or a heart condition. Likewise, certain medical conditions may make your patients more likely to fall such as vertigo, numbness in the feet, joint pain, seizures, an irregular heartbeat, incontinence or urgency, and depression. Some medication may likewise increase the risk of your patient falling. People who are taking narcotic painkillers, sedatives, or sleeping pills may fall due to dizziness, drowsiness or vertigo.

Finally, the people who are at the highest risk of falling of those who have fallen before.

Strategies to Reduce Falls

Now that you know who is at risk of falling, how we prevent a fall from happening?

Keep Moving

Since weakness and gait difficulties can put your patients at an increased risk of falling it is crucial to maintain or even improve your patient’s strength and flexibility by encouraging walking and other physical activities.  Many times, older people are reluctant to walk due to pain from joint issues, or from fear – especially if they have fallen before.  If you encourage your patients to mobilize as much as possible, you not only increase their strength but decrease their risk of suffering a potentially catastrophic injury from falling.

Good Shoes

Shoes that are damaged or have slippery treads or soles may put your patients at risk of slipping and falling.  Carefully inspect your patient’s shoes for tread wear regularly and be sure to inform their family when they become too worn.  Many elderly people attempt to walk in shoes that have a heel or a slippery sole.  Encourage them to use running shoes or shoes with grippy, slip-resistant soles as much as possible to reduce falls.

Remove Hazards

Cluttered rooms and hallways or unsafe equipment can cause a patient to fall accidentally.  Make sure your patient’s rooms are clear of obstructions or tripping hazards and ensure any moving equipment such as hospital beds or wheelchairs have the breaks applied when not in use.  Also, be aware of unsafe clothing such as long skirts or trailing sweaters and jackets as your patient could become tangled up in them.  Ensure that any power cords are tucked away and will not trip your patient, and make sure that hospital beds are kept at their lowest position.

Light it up

Older people need 2 to 3 times more light to see then younger people.  Ensure your patient’s rooms are adequately lit so they can clearly see any obstacles in their path. Too much light may be treacherous as well as it can cause glare, impeding an elderly person’s vision. Also, always make sure that they are wearing their glasses.

Use Assistive Devices

Always make sure to have canes or walkers close at hand to make sure that if you patients need to get up quickly they will be safe.  Also, make sure they have adequate supports in the bathroom including appropriately placed handrails and a raised toilet seat.

Be Mindful of Meds

Try to be aware of any patients who are taking sedatives or narcotics.  If they are using sleeping pills, ensure to be extra careful and assist them when getting up at night as their gait may be unsteady, or they may become dizzy on standing.

Don’t Rush

Due to changes in an elderly person’s circulation and equilibrium they may become dizzy when changing positions, such as going from laying to sitting.  Make sure to give them enough time to adjust before standing and ambulating.

Regular Toileting

Many times, people fall because they are rushing to the bathroom.  Perhaps they rang their bell, but you were unable to answer it right away.  Rushing to the bathroom will make a patient more likely to forget their cane or walker in their desperation and may not be as aware of their surroundings, and may make them more likely to trip and fall.  This situation can be easily prevented by establishing a regular toileting routine.  Also, every time you are in a patient’s room, offer to help them to the bathroom.

Avoid Restraints

Often people use restraints to try and keep a patient from getting up on their own and potentially hurting themselves.  However, restraints do not prevent falls and may even cause injuries themselves by trapping the elderly person in an unsafe position.  Bed or chair alarms, if available at your facility are a much better way of preventing a fall.  You are not restricting the patient, but are alerted if they try to get out of bed or their chair unassisted.

Safety Rounds

Doing regular hourly safety rounds is a great way to prevent falls.  On these rounds, you are not only making sure the elderly patients are in a safe position, but you are checking their environment for potential safety hazards.  For example, you may notice that a cup of water has fallen on the floor, causing a slippery surface that could potentially cause someone to slip and fall.

Change in Condition

It is essential to be very alert to any changes in your patient’s condition.  Often infections or small changes in cognition may cause a patient to become weak and fall.  As a CNA you are the person that spends the most time with the patient and thus may recognize any subtle changes in their condition first.

All Behavior Has Meaning

Finally, it is essential to recognize that all behaviors have meaning.  This means that if you notice someone is trying to climb out of bed or trying to walk unassisted, there is often a reason for this.  Instead of resorting to restraints, try to meet that patient’s needs that are causing the restlessness.  Try taking them to the bathroom or getting them a snack or a drink of water.  People with dementia are often unable to express their needs to you so it can become a guessing game of sorts.

What do I do if my patient falls?

If you happen upon a patient that has fallen to the floor, what should you do?

The first thing you must do is call for help.  Take that first moment of finding the patient to alert someone else to go get the nurse or doctor so they can assess the patient right away.

Stay with the patient.  Often people are scared when they fall, and a kind and familiar face goes a long way.  Reassure them that everything is fine and keep them warm by applying a blanket or covering them up.

Be sure not to move them until the nurse or doctor arrives.  Some injuries, such as spinal injuries, could worsen if the patient is moved around.

Ask them for details about the fall – did they trip? Were they dizzy?  Ask about pain level or discomfort.  Provide emergency care by applying pressure to any areas that are bleeding or stabilizing a fractured limb.


Be sure to always document a fall according to your institution’s policies.  Be sure to record any pain, injuries, change in mental status, or changes in sensations.

Closely monitor the patient for any functional decline.  Also support and encourage them to continue walking and moving around to prevent muscle weakness, which would increase their likelihood of falling again.  Look for fear of falling and any loss of confidence.  Many times, a fear of falling may lead to a loss of independence, social isolation, and depression.

Falling is an unfortunate event that occurs far too often in elderly people.  It is a dangerous event that may lead to injury, disability or even death.  Your role as a CNA is incredibly important in preventing falls.  The care you provide, your ongoing observations and communications with your elderly patients and their families, and your monitoring of the patient’s environment give critical information to help prevent falls.