Fall Risk Assessment

Not all clients carry the same fall risk — and knowing who is at highest risk allows you to calibrate your level of supervision and intervention. Fall risk assessment is not a one-time event — it is an ongoing clinical skill that you apply every shift.

Section 01

The Major Fall Risk Factors

History of falls: The single strongest predictor of future falls. A person who fell in the past year is at significantly higher risk than one who has not. Always ask about fall history at the start of care.
Age 65 and older: Risk increases with age due to accumulated changes in strength, balance, vision, and medication use. Risk roughly doubles each decade after 65.
Gait or balance problems: Unsteady walking, wide-based gait, shuffling, or any observable balance difficulty significantly increases risk.
Use of assistive devices: Counterintuitively, cane or walker use indicates pre-existing balance problems — not protection. Assistive device users are at higher risk than non-users, but would be at even higher risk without the device.
Cognitive impairment: Dementia, delirium, or any cognitive condition that impairs judgment, safety awareness, and the ability to follow safety instructions dramatically increases fall risk.
Urinary incontinence or urgency: The rush to the bathroom is one of the most common fall scenarios. Nocturia (nighttime urination) is especially high risk.

Section 02

The Timed Up and Go Test

💡 A simple fall risk screen you can observe

The Timed Up and Go (TUG) test is a clinically validated fall risk screen. Observe the client: stand from a chair, walk 10 feet, turn around, walk back, and sit down.

Under 12 seconds: Low fall risk
12-20 seconds: Moderate fall risk — increased supervision needed
Over 20 seconds: High fall risk — significant intervention required

You are not administering a formal test — but observing these movements and noting concerns to the supervising nurse is within your scope and valuable.

Section 03

Environmental Risk Factors

Environmental factors contribute to approximately half of all falls. These are the most directly actionable risk factors in home care.

High-risk indoor locations

Bathroom — wet surfaces, transitions
Bedroom — night navigation, bed height
Kitchen — reaching, wet floors
Stairs — step height, lighting, railings
Doorway thresholds — tripping hazard

High-risk environmental conditions

Poor or uneven lighting
Loose rugs or carpeting
Clutter in walking paths
Wet or slippery floors
Inappropriate footwear

Section 04

Time-of-Day Risk Patterns

⚠ When falls are most likely

Early morning: Getting out of bed — orthostatic hypotension, morning stiffness, and urgency to use the bathroom combine
Afternoon: Post-meal fatigue and peak medication effects (particularly sedatives and blood pressure medications)
Evening: Accumulated fatigue degrades balance, attention, and reaction time
Nighttime: The highest-risk period — darkness, partial sleep state, no assistive device, rushing to bathroom

Increase vigilance at these known high-risk times.

Section 05

Communicating Risk to the Care Team

✓ What to observe and report

New unsteadiness or gait changes compared to previous visits
Complaints of dizziness, lightheadedness, or "feeling off"
Near-miss events — the client almost fell but caught themselves
New environmental hazards you've observed
Refusal to use prescribed assistive devices
Any actual fall, even if no injury occurred

Near-misses and new risk factors are as important to report as actual falls.