According to the Centers for Disease Control and Prevention, one third of older adults fall every year (2016) and approximately 10% of falls resulting in serious injury (Albert et al., 2014). Falls are a serious problem that can lead to disability, loss of independence, and fear of falling. Even those who fall and are not injured can experience disability from activity restriction, isolation, deconditioning, and depression (Albert et al.). Risk factors that can lead to falls include medication use, lack of exercise, low vision, neuropathies, hypoglycemia, malnutrition and/or dehydration, and a high-risk home environment.

A medication review is an important preventive intervention to mitigate fall risk. The home healthcare clinician will need to collaborate with the primary care provider for proper medication management and review. All medications should be reviewed to ensure they are necessary, with emphasis on multiple drugs, psychoactive drug use, and cardiac drug use (Avin et al., 2015). Medications that do not have an active indication should be discontinued. Medication dosages may need to be reduced to the lowest effective dose, and medications where the risk of side effects outweighs the benefit should be avoided (e.g., skeletal muscle relaxants). High-risk drugs, such as psychoactive drugs (benzodiazepines especially) should be reduced to lowest effective dose or eliminated. Medications with side effects like drowsiness, sedation, blurred vision, or confusion should also be closely monitored for necessity. Lastly, sedating medications containing diphenhydramine (Benadryl) should be given serious consideration prior to use (American Geriatrics Society [AGS], 2015).

Exercise is an important part of one's daily routine, but especially important for minimizing the fall risk in older adults. Home healthcare clinicians may need to educate the patient regarding exercises that can be done at home (or get a physical therapist on board if the patient's condition warrants). Helpful exercises may include balance exercises, strength training, flexibility training (muscle and joint stretching), tai chi, as well as cardiovascular, endurance, and fitness training (AGS, 2012).

The ability to see clearly is important for fall prevention. Older adults may need corrective lenses to aid vision (AGS, 2012). Home healthcare clinicians can grossly assess for vision deficits and help patients make an appointment for vision testing and proper corrective lenses if needed. Additionally, patients should be educated to not to use bifocals or multifocal lenses when walking (especially on stairs) (AGS, 2015).

Recognition and proper treatment of neuropathies can also play a role in fall reduction. Assess patients for numbness in their feet or hands, as well as the need for assistive devices such as canes, walkers, reachers, handrails, grab bars, and raised toilet seats in the bathroom. A consult to physical or occupational therapy should be made to evaluate need, and to obtain and educate the patient on proper use of equipment (AGS, 2012).

For patients with diabetes, hypoglycemia can be a cause of falls. Tight glycemic control can cause low blood sugars and increase the risk of falling in older adults and generally should be avoided. Home healthcare clinicians can work with the patient, caregiver, and primary care provider to maintain adequate control over blood sugar levels without being too strict and thus increasing the risk of low blood sugar and falls (AGS, 2012).

Malnutrition and dehydration increase the risk of falls and serious injury if a fall does occur. Monitoring of medications that affect appetite, upset a patient's stomach, or decrease absorption should be discussed with the prescriber. Ensuring availability of food and adequate hydration as well as food preparation are important factors to consider during home care management (AGS, 2012).

Diseases and conditions such as heart failure (HF), chronic obstructive pulmonary disease (COPD), anemia, and Parkinson disease can increase fall risks. In HF, the swelling of extremities, potential lightheadedness, and nausea that can accompany the disease can increase the risk of falls (AGS, 2012). COPD reduces the oxygen circulating in the blood and brain, and can cause heart rhythm problems. Patients with COPD are at a high risk of falling due to dizziness or blacking out. Monitoring these diseases and response to treatment is vital for the safety of these patients (AGS, 2012). Anemia can cause lightheadedness, dizziness, and fatigue leading to falls. The cause of the condition needs to be determined and treated (either via supplements, surgery to repair ulcers, medication adjustments, or blood transfusions) to reduce falls in patients with anemia (AGS, 2012). Parkinson disease results in an increased risk of falling due to muscle stiffness and pain, difficulty starting or continuing movement, slower and jerky movements, tremors, and rigid limbs. These patients will need to be monitored frequently for medication effectiveness (due to decreased effectiveness of medications after a period of time) and changes in medication (AGS, 2012).

The home environment needs to be assessed for safety and appropriate modifications. The clinician should assess for adequate lighting, loose carpeting and clutter on the floor, removing or replacing hazardous furniture (wrong bed height, unstable table/chairs), and the use of nonslip bathmats can be beneficial in maintaining safety (AGS, 2015). Patients who get up to urinate frequently throughout the night may need the use of a bedside commode and a night light. The patient should wear footwear that is flat, and has nonskid soles with a large contact area. Fall risk is increased by backless shoes and slippers, high-heeled shoes, and smooth leather soles, all of which should be avoided (AGS, 2015).

Vitamin D supplementation is a controversial topic, and has been both supported and refuted in various studies. Thus, practitioners should use caution and other means of fall prevention if utilizing vitamin D supplementation (Stubbs et al., 2015).

Home healthcare clinicians are in an optimal position to help prevent falls. There are many risk factors involved in fall risk for the community-dwelling patient. Assessing, intervening, and providing education on these issues will help ensure the safety of patients, decrease fall risk, and improve the quality of life by limiting hospitalizations related to falls and injury.

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