“When families are prepared — physically, emotionally, logistically — they are able to handle these moments a lot differently. There’s less panic, less guilt, and a little bit more empowerment.” Dr. Taylor Rush
One minute, everything’s fine. The next minute, your loved one is on the floor. If fall prevention isn’t on your radar yet, or if you’re waiting until after the first fall happens, you’re not alone. There is a lot you can do right now to be better prepared.
We are Sue Ryan and Nancy Treaster. As caregivers for our loved ones with Alzheimer’s and other types of dementia, we know firsthand how frightening falls can be, and how much the fear of a fall can affect both the person you’re caring for and yourself.
We’re sharing five practical tips drawn from the expertise of Dr. Taylor Rush, clinical health psychologist and Director of Behavioral Sciences and Interdisciplinary programs at the Cleveland Clinic Center for Neurological Restoration. Taylor specializes in chronic neurological conditions including dementia, Parkinson’s and movement disorders, with a deep focus on supporting care partners through the challenges they face every day.
We’re sharing five essential tips for preventing falls, handling them when they happen, and managing the emotional aftermath for both you and your loved one.
Tip 1: Know Your Loved One’s Fall Risk Factors
Many caregivers don’t think about fall risk until something critical happens. It’s often not a dramatic event. Perhaps it’s a rushed moment, a quick turn, an instant when you blink, and your care receiver is on the floor. The more you understand about what contributes to fall risk, the better prepared you’ll be.
Key Physical Risk Factors to Watch For:
- Mobility and balance: As muscle strength declines, your loved one may lose steadiness in their core, back, and legs, making movement less stable.
- Visual changes: Reduced visual acuity, double vision, or conditions including dementia and macular degeneration, can affect depth perception. These make it harder to judge the height of a step or spot something that can be tripped over.
- Medications: Some medications, including those for blood pressure or tremor, can cause dizziness or lightheadedness. Ask your loved one’s prescriber: “Can side effects of this medication cause a fall risk? What should I watch for?”
How Dementia Adds a Layer of Complexity:
Dementia affects executive functioning, the “look before you leap” part of the brain that helps us plan, problem-solve, and anticipate consequences. Your loved one may not think ahead about how their balance or weakness will play out when they try to move quickly, climb a step stool, or rush to the bathroom. Watch for these micro-risk moments:
- Rushing to the bathroom without grabbing an assistive device
- Turning too quickly and losing balance
- Standing up and remaining dizzy even after pausing.
Observing your loved one in everyday situations can reveal patterns. These small moments are often when fall risk is highest.
Tip 2: Reduce Risk with Practical Prevention Strategies
You don’t have to tackle everything at once. The goal is safety, not perfection. Start with the highest-risk areas and build from there.
Home Modifications That Make a Real Difference:
- Lighting: Install motion-sensored night lights or floor-level running lights for nighttime bathroom trips. Add lamps in darker corners throughout the home.
- Grab bars: Install them near toilets, in showers or tubs, and anywhere slippery or requiring movement up and down quickly.
- Threshold lips: The lip where flooring meets a doorway can be just half an inch high and still catch a toe or shoe. Leveling them or creating a gradual slope can prevent falls.
- Footwear: Socks and bare feet on hard floors are fall risks. Comfortable house shoes with good support, kept easily accessible, make a significant difference.
- Area rugs: The curling edges and uneven surfaces of area rugs are a leading trip hazard. Consider removing them, even if there’s an emotional attachment.
Sue learned about area rugs very early in her journeys.
Very early in our diagnosis, our doctor told us to remove all area rugs now, explaining several reasons. One is that these will be more challenging to keep clean as incontinence begins. Another is that even the slightest shuffle makes these rugs tripping and falling hazards. They’re usually around a counter, cabinet, or furniture with edges, that can cause even more significant harm to a loved one if they trip or fall.
Physical Therapy Is Your Ongoing Partner:
Physical therapy helps maintain and rebuild strength, mobility, and balance — all of which directly reduce fall risk. Think of it as a revolving door: go, get what you need, live your life, and go back again. The more consistently your loved one maintains their strength, the less likely falls become. An ounce of prevention truly is worth a pound of cure here.
Tip 3: Start the Conversation Early and Have a Plan
Don’t wait for a crisis to have the conversation about falls. The time to build a plan together is not when you’re in the middle of a crisis, when fear is high, emotions are running over, and everything is reactive. Have the conversation early, while your loved one is still relatively independent and no falls have happened.
Know Your Own Capacity — Both Physical and Emotional:
Be honest with yourself about two things:
- Physical capacity: If there’s a significant weight difference between you and your loved one, trying to lift or support them after a fall could injure you both. What does helping them look like without putting either of you at risk?
- Emotional capacity: Each of us is different, so it’s reasonable that we handle crises differently. Some people stay calm in a crisis. Others become overwhelmed quickly. What’s important is knowing yourself. Anticipate your reaction, plan for it ahead of time, and think through how you’ll manage it.
Register with Your Local Emergency Medical Services (EMS):
Many communities have local EMS registry programs that allow you to pre-register your loved one. You can provide information about their diagnosis, medications, tendencies toward confusion or agitation – and even their nickname, so that when first responders arrive, they already know how to approach the situation. This keeps the environment calmer for everyone.
Sue explains:
I registered my loved ones with EMS and experienced firsthand how much it helped. When EMS first responders arrived, they already knew the situation and had the answers to many questions they would have had to ask. They came in calmly and handled everything with care. There was no need to escalate. The prior registration made a real difference.
Make sure your plan is collaborative. It’s incredibly helpful for your loved one, you, and other family members to be in agreement about how a fall will be handled, if and when it occurs.
Tip 4: They’ve Fallen — Stay Calm, Assess, and Don’t Panic
When a fall happens, your first job is to manage yourself. If you stay calm, your calm helps become their calm. The instinct to react, to ask “What happened?”, to express frustration, to immediately try to get them up , isn’t helpful in the moment. Pause. Look. Assess.
What to Assess Immediately:
- Did they hit their head?
- Are they bleeding?
- Are they in pain?
- Can they get up or bear weight?
When to Call 911:
Call EMS if your loved one is bleeding, has lost consciousness, or is in significant pain. EMS would rather you call and have everything be okay than not call and have things end badly. They’re not going to accuse you of overreacting. Some caregivers are on a first-name basis with their local EMS team, and that’s perfectly fine. They’re there to help.
If They Don’t Need Emergency Care:
If your loved one isn’t injured and can safely remain on the floor, there’s no rush to get them up immediately. The floor is not lava. Take your time and help them move safely from the floor to their knees and then upright, using the techniques you’ve (hopefully) already learned from your care team and physical therapists. Some caregivers use lift assist devices such as an IndeeLift, a motorized, mobile lifting device, designed to safely lift individuals from the floor to a seated or standing position after a fall.
Important Tip: Save the “Why did you go up on that stepladder?” conversation for later. In the moment, focus on their needs. There will be time to debrief once the immediate situation is resolved.
Tip 5: Manage the Emotional Aftermath of a Fall
The emotional impact of a fall can last far longer than the fall itself. When Sue’s grandmother fell, Sue was able to get her up safely and verifiy she wasn’t injured. Sue then immediately fell into crushing self-judgment.
I let her fall. It was my fault. I should have done something differently.
The thirty seconds before the fall, everything had been fine. But it didn’t matter. The blame came rushing in anyway. This response is incredibly common. It’s important to recognize it for what it is.
Give Yourself Grace:
Just because you feel responsible doesn’t mean you were responsible. You are doing the best you possibly can in a situation no one is ever fully prepared for. Ask yourself: “Would you hold someone else to the same standard you’re holding yourself?” In most cases, you’d be far more compassionate with a friend. Be that friend to yourself.
Watch for These Common Emotional Responses:
- Hypervigilance and hovering: Following your loved one everywhere, trying to prevent any possible fall from ever occurring again.
- Fear that lingers: A heightened anxiety that doesn’t fade even after the immediate situation has resolved
- Guilt: Especially when you did nothing wrong. Accidents will happen.
Know When to Seek Additional Support:
As caregivers, we often move straight to the next task without giving ourselves time to process how we actually feel. If the emotional weight of a fall or the accumulated weight of many falls is becoming too much, it may be time to seek additional support. Talking to a psychologist or joining a caregiver support group can make an enormous difference. You are not alone in this experience. Others are walking the same road. It helps to learn about their experiences and lessons.
Taking Action: You’re Not Alone On This Journey
Falls are a reality of dementia caregiving. They will happen. Being prepared physically, emotionally, and logistically changes everything. When you know the risk factors, have your home set up thoughtfully, have already talked through a plan with your family, and have given yourself permission to be human when things go wrong, you are in a far better position to handle whatever comes.
Take these steps now, before a fall happens:
- Walk through your home and identify the highest-risk areas for falls including bathrooms, threshold lips, dark hallways, area rugs.
- Ask your loved one’s doctor or pharmacist whether any current medications or potential side effects increase fall risk.
- Look into physical therapy to help maintain strength, balance, and mobility.
- Register your loved one with your local EMS, so first responders have their information on hand.
- Don’t wait. Have the conversation now with your loved one and your family about what the plan will be if a fall happens.
- Give yourself permission to feel the emotional weight of caregiving, and seek support when you need it.
You can find more information from Dr. Taylor Rush at:
Have you navigated a fall with your loved one? What strategies helped you prevent falls or handle them when they happened? Share your experiences in the comments below or on our Facebook or Instagram pages.
Using the number for this blog 64, go to thecaregiversjourney.org where you will find additional resources and information. If you find this blog helpful, please share it with other people who you think it might help. Please follow us or subscribe to our updates. We appreciate it.
Connect with us:
This podcast episode
We’re all on this journey together.
