A fall is a situation in which a person accidentally and suddenly moves from a higher to a lower position, in which injury may or may not occur (Leahy, Fuzy & Grafe, 2013). Worldwide falls are the second leading cause of accidental injury (WHO, 2012). Each year approximately 424,000 people die from a fall globally, with about 80% of these falls occurring in low- to middle-income countries (WHO). Falls can be caused by many different things. Poor mobility, cognitive impairment, the ingestion of alcohol or drugs, poor balance and coordination, vision loss, and unsafe environments are some of the many possible causes of falls. Side effects from medications, neurological and cardiovascular diseases, and physical disabilities are other reasons why people may fall in the home. Confusion and improperly using assistive devices, such as walkers and canes, also put people at risk for an unintentional injury from a fall.

Developmental changes that occur as children grow and as adults age are also important contributing factors for unintentional injuries from falls. Deaths from falls are highest for adults over the age of 60 years across the globe (WHO, 2012). Adults over 65 years, young adults aged 15–29 years, and children 15 years and younger have the highest morbidity rates across the world (WHO).

Injuries from falls can range from relatively mild (such as a bruise) to life-threatening (such as suffering from a hip fracture or brain injury). Fall prevention strategies are the best way to prevent accidental injury from falls. Health Care Assistants play a crucial role in preventing falls in the home.

Guidelines for Fall Prevention

• Keep walkways free of clutter, throw rugs, and loose cords.
• Wipe or mop up spills immediately. Close off areas with wet floors until dry to prevent people from walking on wet areas.
• Do not use wax or use other floor cleaners which will leave the floor slippery.
• Ensure all carpeting is tacked down securely and all rugs have non-skid backing.
• Use non-skid mats in the tub.
• Ensure handrails and grab bars are installed in the shower. Health Care Assistants should teach clients how to use them.
• Use good lighting in all rooms of the home. Replace light bulbs that have dimmed or are no longer working.
• Ensure stairwells are properly lit and stairs are sturdy.
• Have clients wear non-skid shoes with tied laces.
• Ensure clothing fits and that pant or dress hems are not so long as to possibly cause the client to trip.
• Teach clients how to properly use ambulatory devices, such as walkers and canes.
• Have clients use glasses and hearing aids in order to better see and hear what is going on in their surroundings.
• Check for disorientation frequently and report any concerns to a supervisor immediately.
• Allow the client to slowly rise to a standing position by first sitting at the edge of the bed to prevent falls that result from dizziness due to rapid changes in position. This is called orthostatic hypotension.
• Always lock the wheelchair, chair, and bed brakes before completing transfers.
• Keep beds in their lowest position and ensure side rails are up in proper position.
• Frequently ask the client if they need to use the bathroom and stay close while they are in the restroom to quickly respond to requests for help.
• Assist the client with muscle strengthening exercises and walking as prescribed by the care plan to improve balance, coordination, and strength.
• Keep the home picked up and do not allow shoes, toys, or other items to be left on the floor.
• Keep items such as tissues, the phone, remote controls, and drinks within close reach of the client so they do not have to reach far to retrieve them.

If a fall does happen, Health Care Assistants must report it immediately to their supervisor. The client needs to be checked for medical issues prior to helping them up from the floor. Health Care Assistants should NOT move their client until they have been thoroughly checked for injury and their supervisor has given them permission to move them.

Health Care Assistants may be asked to complete an incident report if their client falls. If this occurs, remember to only report the facts. Report the situation in a matter of fact manner, without being judgmental or emotional. The agency will provide specific training regarding their requirements in the event of a client fall.