Falls are a serious concern for anyone caring for a person with Alzheimer’s disease or another dementia.

But preventing dementia falls isn’t as simple as picking up the rugs.

Dementia can change the way a person walks, sees, judges distance, processes their surroundings, and recognizes danger. Medications, weakness, illness, poor vision, and changes in balance can add even more risk.

That’s why one of the most important things you can do after a fall—or even a near fall—is ask:

WHY did this happen?

A fall can be a clue that something has changed.

Learning to recognize those clues can help you make the home safer and may even help prevent the next fall.

🎥 Prefer to Watch? Dementia Fall Prevention Explained

Falls in dementia are often about more than simply losing balance. Changes in the brain can affect walking, vision, judgment, depth perception, coordination, and how a person understands the environment.

And sometimes, a fall may be a clue that something has changed.

In this video, I’ll walk you through why falls happen, what changes to watch for, how to make the home safer, and how to use my Dementia Detective approach to look for the WHY behind a fall.

NOTICE → LOOK → ASK → TRACK → CONNECT

Watch the full dementia fall prevention lesson below.

Why Are Falls More Common With Dementia?

As dementia progresses, changes in the brain can affect much more than memory.

Your loved one may have trouble with:

• Walking and balance
• Coordination
• Judging distance and depth
• Recognizing obstacles
• Processing what they see
• Remembering to use a walker or cane
• Recognizing that something is unsafe
• Finding their way through familiar surroundings

A floor that looks perfectly normal to you may look very different to a person living with dementia.

A dark rug may look like a hole.

A shiny floor may appear wet.

A change from carpet to tile may look like a step.

Poor lighting can make these problems even worse.

This is why dementia fall prevention needs to include both the person and the environment around them.

Look for Changes in Walking and Balance

Sometimes caregivers notice small changes before a fall happens.

Watch for things such as:

• Shuffling their feet
• Taking smaller steps
• Holding onto furniture
• Leaning to one side
• Having trouble getting out of a chair
• Becoming unsteady when turning
• Hesitating before taking a step
• Walking more slowly
• Suddenly needing more help
• Having difficulty using stairs

Don’t assume these changes are “just the dementia.”

A new change in walking or balance deserves attention.

Weakness, pain, illness, dehydration, blood pressure changes, medication side effects, vision problems, and other medical conditions can also increase fall risk.

Talk with their healthcare provider about new or worsening changes.

Become a Dementia Detective

When someone falls, our first thought is often:

“How do I keep this from happening again?”

Before you can answer that question, you need to know what may have caused the fall.

Think like a Dementia Detective.

NOTICE

What happened?

Did they trip?

Lose their balance?

Slide out of a chair?

Become dizzy when they stood up?

Were they trying to reach something?

LOOK

Look around the area.

Was there:

• A rug?
• A cord?
• Poor lighting?
• A pet underfoot?
• Clutter?
• An uneven floor?
• A piece of furniture in the pathway?
• Water on the floor?

ASK

Ask yourself what may have been happening before the fall.

Were they:

• Trying to get to the bathroom?
• Tired?
• Hungry?
• Weak?
• More confused than usual?
• In pain?
• Getting up too quickly?
• Wearing unsafe shoes?
• Carrying something?
• Trying to do something they can no longer safely do alone?

TRACK

Write the fall down.

Include:

• Date and time
• Where it happened
• What they were doing
• What happened right before the fall
• Any injury
• Changes you noticed that day
• Anything else that might have contributed

One fall may seem random.

Several falls written down may reveal a pattern.

CONNECT

Use what you learned to decide what needs to happen next.

That might mean changing something in the home, talking with the doctor, reviewing medications, having their vision checked, or asking for a physical or occupational therapy evaluation.

Don’t just record that they fell. Look for the WHY.

Walk Through the Home With Fresh Eyes

One of the best ways to prevent falls is to walk through the home and look at it from the viewpoint of someone living with dementia.

Don’t just look for obvious dangers.

Look for things that could become confusing.

Clear the Walkways

Keep frequently used paths as open as possible.

Remove:

• Clutter
• Shoes
• Electrical cords
• Small tables
• Footstools
• Baskets
• Other objects that stick out into walking areas

Pay special attention to the path between the:

Bed → Bathroom

Chair → Bathroom

Bedroom → Kitchen

These are routes your loved one may travel several times each day.

Remove or Secure Rugs

Loose rugs are a common tripping hazard.

Whenever possible, remove throw rugs from areas your loved one frequently walks through.

If a rug must remain, make sure it is firmly secured and does not slide, bunch, or curl at the edges.

Also look at the color and pattern of the rug.

A dark rug or strong pattern may be confusing to someone whose brain is having trouble processing what they see.

Improve the Lighting

A person with dementia may have more trouble seeing obstacles and judging distances when lighting is poor.

Make sure there is good lighting in:

• Hallways
• Bathrooms
• Bedrooms
• Stairways
• Entrances
• Frequently used walking paths

Nightlights and motion-activated lights can be especially helpful.

Try to reduce dark shadows and sudden changes between very bright and very dark areas.

Pay Special Attention to the Bathroom

Bathrooms can be one of the highest-risk areas in the home.

Water, slippery surfaces, getting on and off the toilet, and stepping into or out of a shower can all increase fall risk.

Consider:

• Grab bars near the toilet
• Grab bars in the shower or tub
• Non-slip surfaces
• A shower chair when appropriate
• Good lighting
• Keeping the floor dry
• Keeping commonly used items within easy reach

Don’t rely on towel bars for support. They may not be strong enough to hold someone’s weight.

Make Furniture Easier to Use

Look at the chairs your loved one uses most often.

Very low, soft chairs can make standing more difficult.

A sturdy chair with armrests can give them something to push against when standing and provide support when sitting down.

Also make sure furniture isn’t being used as an unsafe substitute for a walker.

If your loved one is constantly “furniture walking”—moving through the room while holding onto tables, counters, and chairs—that can be an important clue that their balance or strength needs to be evaluated.

Check Their Shoes and Clothing

What your loved one wears can affect their safety.

Choose shoes that:

• Fit properly
• Provide good support
• Have non-slip soles
• Stay securely on their feet

Avoid clothing that drags on the floor.

Long pajama bottoms, robes, nightgowns, loose belts, or other dangling clothing can become tripping hazards.

Don’t Forget Vision and Hearing

Changes in vision can make falls more likely.

Someone who cannot clearly see a step, obstacle, or change in flooring may not be able to avoid it.

Regular vision checks are important, and hearing should also be checked.

If your loved one wears glasses or hearing aids, make sure they are using them as recommended and that they are working properly.

Ask for a Medication Review

Some medications can cause:

• Dizziness
• Sleepiness
• Weakness
• Changes in blood pressure
• Problems with balance

Ask the doctor or pharmacist to review all medications your loved one takes.

That includes prescription medications, over-the-counter medicines, and supplements.

Never stop a prescribed medication on your own. Ask whether any of them could be contributing to falls or unsteadiness.

Strength and Balance Matter Too

The environment is only part of fall prevention.

Muscle weakness and poor balance can also increase fall risk.

Ask your loved one’s healthcare provider whether physical therapy or an appropriate strength and balance program could help.

A physical therapist may be able to evaluate:

• Walking
• Strength
• Balance
• Transfers
• Need for a cane or walker
• Safe use of mobility equipment

An occupational therapist can also help identify safety problems in the home and recommend ways to make daily activities safer.

Nighttime Falls Need Special Attention

Nighttime can be especially difficult for someone living with dementia.

They may wake confused, forget where the bathroom is, get up before they are fully awake, or have difficulty seeing in the dark.

Create a simple, well-lit path from the bed to the bathroom.

You may want to use:

• Nightlights
• Motion-activated lights
• A clear pathway
• An open bathroom door
• Easy-to-see bathroom cues

If nighttime toileting is becoming difficult, start tracking when your loved one gets up.

You may discover a pattern that helps you plan ahead.

What About Bed and Chair Alarms?

Alarms can be helpful for some families because they alert the caregiver that someone is getting up.

Options may include:

• Motion sensors
• Chair alarms
• Bed pressure alarms
• Other caregiver alert systems

But remember:

An alarm doesn’t prevent the fall by itself.

It simply tells you that your loved one is moving.

Think of an alarm as one possible part of a larger safety plan rather than the entire solution.

When a Fall May Be Telling You Something Medical

Pay close attention when falls suddenly begin or become more frequent.

A sudden change may be connected to something besides the progression of dementia.

Possible contributors can include:

• Illness
• Dehydration
• Pain
• Weakness
• Medication changes or side effects
• Dizziness
• Blood pressure changes
• Vision problems
• Changes in mobility

If your loved one suddenly becomes much more unsteady, begins falling repeatedly, or has a noticeable change in walking, contact their healthcare provider.

The important question isn’t only:

“How do I stop the falls?”

It’s also:

“What changed?”

What Should You Do If Your Loved One Falls?

Even with a good prevention plan, falls can still happen.

Your first instinct may be to immediately help your loved one off the floor.

Don’t rush.

First, make sure they aren’t seriously injured.

If you suspect a head, neck, back, or hip injury, or they have severe pain, significant bleeding, loss of consciousness, trouble breathing, new weakness, or another serious change, get emergency medical help.

I’ve created a separate guide that walks caregivers through what to check and what to do after a dementia fall.

👉 Read: How to Handle a Dementia Fall at Home

One Fall Can Help You Prevent the Next One

After your loved one is safe, go back and investigate what happened.

Write it down while the details are fresh.

You may not find the answer every time.

That’s okay.

The goal isn’t to blame your loved one—or yourself.

The goal is to find clues.

Over time, you may discover that falls happen:

• At a certain time of day
• On the way to the bathroom
• After taking a medication
• When they’re tired
• When they’re getting out of a certain chair
• When they’re wearing certain shoes
• When they’re more confused
• In one particular area of the home

Those patterns give you something you can work with.

🔎 Free After Fall Investigation Form

One fall may seem random. Several falls written down may reveal a pattern.

My free After Fall Investigation Form helps you use the Dementia Detective process to record what happened, look for possible causes, notice changes after the fall, and watch for patterns over time.

NOTICE → LOOK → ASK → TRACK → CONNECT

👉 Download the Free After Fall Investigation Form

Keep Track of Changes

When you’re caring for someone with dementia, it can be difficult to remember exactly when something changed.

That’s why I encourage caregivers to write things down.

Tracking falls along with changes in walking, balance, medications, sleep, toileting, behaviors, and other symptoms can help you see patterns that are easy to miss from day to day.

It can also give the healthcare team much better information than simply saying:

“They’re falling more.”

Instead, you can show them when, where, and how often the falls are happening—and what else has changed.

👉 Learn more about the Dementia Caregiver’s Notebook

The Bottom Line

You won’t be able to prevent every fall.

But there is a lot you can do to lower the risk.

Make the environment easier to navigate.

Watch for changes in walking and balance.

Review medications.

Pay attention to vision and hearing.

Keep nighttime pathways safe.

And when a fall or near fall happens, don’t stop at:

“They fell.”

Become a Dementia Detective.

Look for the clue.

Write it down.

Watch for the pattern.

Find the WHY.

Because sometimes a fall is more than an accident.

It may be your first clue that something has changed.