If your loved one has dementia, their fall risk is significantly higher than their peers without cognitive impairment. Older adults with dementia fall two to three times more than cognitively healthy older adults, and 60 to 80% of people with dementia fall annually. But falls aren't inevitable.
Key Takeaway: The most effective fall prevention strategies combine supervised exercise programs, home environment modifications, medication review, proper footwear, and proactive monitoring of warning signs. Falls can cause serious injuries including fractures, head trauma, and hospitalizations that accelerate cognitive decline, but with the right prevention strategies, you can significantly reduce your loved one's fall risk.
For comprehensive guidance on dementia care, see our dementia care guide. Understanding the dementia symptom progression timeline helps you anticipate when fall risk increases. For room-by-room safety modifications, see our guide on home safety room by room for dementia.
Understanding Why People with Dementia Fall More Often
Falls among people with dementia aren't just bad luck or inevitable decline. Dementia creates specific risk factors that compound the normal age-related changes affecting balance and mobility.
How Cognitive Impairment Increases Fall Risk
Cognitive impairment increases an individual's risk of falls due to the role cognition plays in gait control. Walking isn't an automatic process—it requires constant attention, judgment, and coordination between the brain and muscles. Dementia disrupts multiple systems that keep us upright and balanced.
- Impaired judgment and hazard recognition: People with dementia struggle to identify dangerous situations. They may not recognize a wet floor as slippery, stairs as requiring caution, or uneven ground as a hazard.
- Changes in gait and balance: Dementia affects the parts of the brain that control movement and coordination. People with dementia typically walk more slowly, take shorter steps, have reduced coordination, and sway more while standing.
- Visual and spatial processing problems: Your loved one might see a shadow as a hole to step over, misinterpret depth on stairs, or not notice objects in their path.
- Behavioral and psychological symptoms: Wandering, restlessness, agitation, and sundowning often involve moving around when tired or disoriented, creating prime conditions for falls.
- Medication side effects: Drugs used to manage dementia symptoms or other conditions frequently cause dizziness, drowsiness, confusion, or changes in blood pressure.
- Physical deconditioning: People with dementia often become less active, leading to muscle weakness, reduced flexibility, and poorer balance.
Step 1: Start a Targeted Exercise Program
Exercise is the single most effective intervention for reducing falls in people with dementia. Research shows that programs combining strength, balance, and mobility training can reduce fall rates and improve physical functioning.
Why Exercise Works for Fall Prevention
Physical activity helps older people maintain capacities such as muscle strength, balance, postural control, bone mass, and functionality that usually decline with age. Even people with mild to moderate dementia can participate in and benefit from structured exercise programs.
Types of Exercise That Prevent Falls
- Strength training: Building leg strength is crucial for maintaining balance. Effective exercises include chair stands, leg lifts, heel raises, and resistance band work.
- Balance exercises: Standing with feet together, standing on one foot, walking heel-to-toe, and weight shifts. Studies found that balance exercises reduce falls by 24%.
- Endurance and mobility training: Walking, stationary cycling, or other aerobic activities improve overall fitness and reduce fatigue-related falls.
- Multicomponent programs: The most effective programs combine all three types of exercise, addressing multiple fall risk factors simultaneously.
Starting an Exercise Program Safely
Before beginning any exercise routine, consult with your loved one's doctor to identify contraindications or necessary modifications. A physical therapist can conduct an initial assessment and design a personalized program appropriate for your loved one's current abilities and dementia stage. Start where they are—even seated exercises provide benefits if standing exercises aren't safe yet.
Many communities offer dementia-friendly exercise classes through senior centers, adult day programs, or specialized fitness facilities. Physical therapy services through home health agencies can provide individualized programs delivered in your home. Some insurance plans, including Medicare, cover physical therapy for fall risk reduction.
Step 2: Optimize the Home Environment
Environmental hazards contribute significantly to falls. A systematic approach to home modifications reduces risk while supporting your loved one's independence.
High-Priority Environmental Modifications
- Improve lighting throughout the house: Install brighter bulbs in all fixtures. Add nightlights in bedrooms, bathrooms, and hallways. Consider motion-sensor lights in frequently traveled areas.
- Remove or secure all trip hazards: Remove throw rugs or secure them with non-slip backing. Eliminate clutter from walkways. Tape down electrical cords.
- Install grab bars and handrails: Place grab bars beside toilets and in showers or tubs. Install handrails on both sides of all stairways.
- Address flooring issues: Remove uneven flooring, curling carpet edges, or loose tiles. Choose lighter, solid colors without busy patterns.
Bathroom-Specific Modifications
Bathrooms present particularly high fall risks due to water, hard surfaces, and transitions between sitting and standing. Install a shower chair or bath seat. Use non-slip mats or strips in tubs and showers. Consider a raised toilet seat with armrests. Keep floors dry and wipe up spills immediately. Set your water heater to 120°F or below to prevent scalding.
Bedroom, Stairway, and Furniture Safety
Position the bed at an appropriate height. Keep a clear, well-lit path from bed to bathroom. Mark stair edges with brightly colored tape. Keep stairways well-lit. Arrange furniture to create clear pathways. Ensure furniture is stable and won't shift if someone leans on it for support.
For a complete room-by-room safety assessment, our detailed guide on home safety checklist for dementia provides comprehensive modifications for every area of your home.
Step 3: Address Footwear and Clothing Factors
What your loved one wears, particularly on their feet, significantly affects fall risk. Proper footwear is one of the simplest yet most overlooked fall prevention measures.
Characteristics of Safe Shoes
- Low heels (one inch or less)
- Non-slip rubber soles with good tread
- Backs that hold the heel securely in place
- Adequate arch support
- Secure closures (Velcro is often ideal)
What to Avoid
- Never allow walking in just socks, even on carpet
- Avoid backless shoes, slippers, or sandals
- No high heels or shoes with smooth leather soles
- Pants or robes that are too long can cause trips
Step 4: Review and Manage Medications Carefully
Medications represent one of the most significant yet modifiable fall risk factors. Many drugs commonly prescribed for older adults can cause dizziness, drowsiness, confusion, or changes in blood pressure that increase fall likelihood.
Medications That Commonly Increase Fall Risk
- Sedatives and sleep medications
- Antipsychotics and antidepressants
- Blood pressure medications
- Pain medications, especially opioids
- Anti-anxiety medications
- Medications for urinary incontinence
Regular Medication Reviews
Schedule comprehensive medication reviews with your loved one's physician at least every six months. Bring a complete list of all medications including over-the-counter drugs, vitamins, and supplements. Ask: Is each medication still necessary? Could any be reduced or eliminated? Are there alternatives with fewer fall-risk side effects?
Step 5: Address Physical and Personal Care Needs
Many falls occur when people with dementia attempt to meet basic physical needs independently despite impaired judgment and mobility. Proactive attention to these needs prevents falls before they happen.
- Bathroom and toileting: Establish regular bathroom schedules, typically every two to three hours. Don't wait for your loved one to request assistance.
- Nutrition and hydration: Ensure regular access to food and drinks. Dehydration affects balance and cognition. Offer fluids regularly throughout the day.
- Pain management: Unrecognized or undertreated pain can cause unstable gait, rushing to change positions, and impaired concentration.
- Fatigue management: Tired people fall more. Ensure adequate sleep at night and rest periods during the day.
Frequently Asked Questions About Fall Prevention in Dementia
How quickly can exercise programs reduce fall risk?
Research shows that exercise programs typically need 8-12 weeks of consistent participation before significant improvements in strength and balance occur. However, some benefits begin earlier. The key is starting now and maintaining regular activity rather than waiting for dramatic immediate results.
Should I restrict my loved one's activity to prevent falls?
No. Restricting activity actually increases fall risk by causing muscle weakness, reduced balance, and physical deconditioning. The goal is supervised activity, not inactivity. People need to move regularly to maintain the strength and balance that prevent falls.
When should we consider moving to memory care due to fall risk?
Consider residential memory care when falls occur frequently despite comprehensive home modifications and supervision, injuries from falls are becoming serious or recurring, 24-hour supervision is needed but family cannot sustainably provide it, or your loved one requires a level of care beyond what home supports can provide. For guidance, see our article on how to know when it's time for memory care.
Disclaimer: This article provides general information about fall prevention for people with dementia and is not a substitute for professional medical advice, physical therapy assessment, or occupational therapy evaluation. Every person's fall risk factors and abilities are different. Always consult with qualified healthcare providers, including physicians and physical therapists, for personalized fall prevention recommendations based on your loved one's specific situation. In emergency situations following falls, call 911 immediately.