Prevention of falls at home:
the role of the caregiver
Identify risk factors, secure the environment, adopt the right gestures — the complete guide for caregivers and helpers who support an elderly person at home
Falls are the leading cause of fatal accidents among people over 65 in France. However, they are not inevitable. The vast majority of falls at home can be prevented through a rigorous assessment of risks, targeted adjustments, and appropriate support practices. The caregiver, present daily in the home of the elderly person, is on the front line to detect risky situations, secure the environment, and adopt the right support gestures. This comprehensive guide provides you with all the keys to perform this prevention role with method, kindness, and effectiveness.
1. Understanding why seniors fall: risk factors
Preventing falls first requires understanding why they occur. Risk factors are divided into two main categories: intrinsic factors (related to the person themselves) and extrinsic factors (related to the environment). Most falls result from a combination of several simultaneous factors.
1.1 Intrinsic factors
Sarcopenia and muscle weakness
Sarcopenia — progressive loss of muscle mass related to aging — affects 30% of people over 80. It reduces the strength of the lower limbs, the ability to recover from a loss of balance, and reaction speed. It is the most modifiable risk factor through regular physical exercise.
Balance and walking disorders
Balance depends on three systems: visual, vestibular (inner ear), and proprioceptive (sensations from the limbs). With age, each of these systems deteriorates. Walking with small steps, lack of arm swing, and hesitation at the start are early signs of fall risk.
Polypharmacy and medication side effects
Taking more than 4 medications simultaneously doubles the risk of falling. Psychotropic drugs (anxiolytics, sleeping pills, antidepressants), antihypertensives, and diuretics are particularly involved — through effects of drowsiness, orthostatic hypotension, or decreased alertness.
Visual disorders
Cataracts, AMD, glaucoma, or simply inadequate optical correction reduce the perception of obstacles, reliefs, and changes in floor level. Bifocal glasses, often worn by seniors, can disrupt the view of the ground when descending stairs.
Cognitive disorders
People with dementia have a 2 to 3 times higher risk of falling than those without cognitive disorders. Wandering, disconnection between the intention to move and the reality of physical capabilities, and loss of memory of locations significantly increase the risk.
The fear of falling
Paradoxically, the fear of falling is itself a risk factor. It leads to a reduction in activities, progressive physical deconditioning, and a tense posture that increases the risk of imbalance. Breaking this vicious circle is one of the challenges of prevention.
1.2 Extrinsic factors: the home environment
| Home area | Main risk factors | Frequency of falls |
|---|---|---|
| Bathroom / Toilet | Slippery floor, lack of grab bars, high bathtub | 40% of falls |
| Bedroom | Bed too high or too low, cluttered floor, insufficient lighting at night | 25% of falls |
| Stairs | No railing or only on one side, worn steps, no visual contrast | 15% of falls |
| Kitchen | Slippery floor after cleaning, access to high shelves, stools | 10% of falls |
| Hallways / Entrance | Rugs, electrical wires, insufficient lighting, shoes on the floor | 10% of falls |
2. The caregiver: a central actor in prevention
The caregiver is often the person who knows the home and the daily habits of the person being supported best. This intimate knowledge of the place and the person makes them an irreplaceable actor in fall prevention — provided they are trained to perform this role methodically.
🔍 The preventive gaze of the caregiver
Each home intervention is an opportunity for preventive observation. The caregiver trained in fall prevention does not just perform the planned tasks — they simultaneously observe the general condition of the person, changes in their gait or balance, and modifications in the environment that could pose new risks. This constant preventive gaze cannot be replaced by a quarterly medical visit.
2.1 The 5 preventive missions of the caregiver
Regularly assess risks
The caregiver must conduct an informal risk assessment at each intervention, observing the gait, balance during transfers, reactions during position changes, and the general state of alertness of the person. Any notable change must be reported to the family and the sector manager.
Secure the immediate environment
Remove obstacles from pathways, ensure that technical aids are within reach (cane, walker), check that the path to the toilet at night is lit and clear, tidy up cables and wires on the floor — all simple actions that are part of the daily preventive role.
Assist with high-risk transfers
Transfers (getting up from bed, using the toilet, entering/exiting the shower) are the most at-risk moments. The caregiver must master safe assistance techniques — without lifting but by guiding, positioning support points, and anticipating imbalances.
Maintain physical activity in daily life
Encourage daily walking even if short, suggest simple balance exercises integrated into activities (getting up from the chair alone, walking to the window), avoid excessive assistance that promotes deconditioning — all postures that maintain motor abilities.
Communicate and coordinate
Report any change in condition (more hesitant gait, new medication, episode of dizziness, mentioned visual disturbance) to the family and the coordination team. Fall prevention is multidisciplinary — the caregiver is the linchpin of this coordination.
DYNSEO session tracking sheet
The session tracking sheet allows the caregiver to record observations made at each intervention: general condition, incidents or near-falls, environmental modifications, changes in behavior. An essential traceability tool for multidisciplinary coordination and early detection of changes in condition.
Download the sheet3. Home audit: the caregiver's checklist
A systematic home audit is the first step of any prevention program. It should be conducted at the first appointment, re-evaluated every six months, and immediately after a fall or a significant change in the person's health status.
Bathroom
- Non-slip mat in the shower
- Grab bar fixed to the wall
- Shower seat available
- Toilet riser if necessary
- Sufficient lighting
- Lever faucets
Bedroom
- Bed height suitable (knees at 90°)
- Automatic night light
- Clear floor (no rugs)
- Slippers with non-slip soles
- Emergency alarm or bell within reach
- Bed rail if necessary
Hallways
- Rugs removed or secured
- Cables stored or covered
- Automatic lighting (sensor)
- Handles or bars in passages
- Non-slip floor
- Sufficient width for walker
Kitchen
- Frequently used items at accessible height
- No stool or step ladder
- Non-slip floor after cleaning
- Stable chair to sit
- Lightweight utensils within reach
- Accessible timer
Entrance / Stairs
- Handrail on both sides if possible
- Non-slip stair nosing
- Shoes stored out of the way
- Sufficient lighting
- Visual contrast between steps
- Stairlift if condition requires
Garden / Outdoor
- Flat and clear pathways
- No gravel or loose soil
- Access ramp if there are steps
- Outdoor lighting
- Bench to rest
- Shoes suitable for outdoors
4. Secure support techniques: the right actions
The physical support of the person during movements is one of the riskiest moments — and the one where the techniques learned in training make the most difference. A wrong move by the caregiver can cause a fall or injure the caregiver themselves.
4.1 Walking support technique
The caregiver positions themselves slightly back and on the side of the person's motor deficit (weak side). The hand is placed on the forearm or shoulder — never gripping the wrist. We guide, we support, we anticipate — but we do not carry. Allowing the person to use their own resources preserves their abilities and maintains their dignity.
4.2 Getting up from bed
Getting up is a critical moment, particularly after a night of sleep where orthostatic hypotension (drop in blood pressure upon standing) is common. The correct technique: first have the person sit at the edge of the bed for 30 seconds before getting up, check that they do not experience dizziness, ensure their feet are flat before proceeding to get up.
4.3 Entering and exiting the shower
The wet floor, steam, and fatigue make showering one of the most dangerous moments. The caregiver prepares the space before bringing the person (dry floor, seat in place, accessible bars), remains present throughout the bathing process, and assists with exiting by stabilizing the person before they place their foot on the floor outside the shower.
The two-point support rule: A person at risk of falling must always have two stable points of support before moving a third. This simple rule, borrowed from climbing techniques, transforms the approach to all transfers and risky movements.
DYNSEO Communication Notebook
The communication notebook is the tool for communication between the caregiver, the family, and healthcare professionals. It allows sharing observations on mobility, near-falls, changes in condition, and adaptations made to the environment — ensuring the continuity of preventive support among all involved parties.
Download the notebook5. Cognitive and emotional factors: an often-overlooked dimension
Fall prevention is not limited to physical and environmental aspects. Cognitive and emotional factors play a major role that the trained caregiver must know how to identify and take into account.
5.1 The link between cognitive disorders and fall risk
A person with dementia may forget that they can no longer walk alone, get up at night without calling, or overestimate their abilities. The caregiver must adapt the level of supervision and arrangements to the person's actual cognitive state — and not just their physical state. Implementing a telealarm, a night lift detector, or additional safety measures in risky areas is particularly important for people with cognitive disorders.
Training — Alzheimer's: understanding the disease and finding solutions for daily life
For caregivers who support people with Alzheimer's or related dementias: understanding how cognitive disorders increase the risk of falling and adapting support practices accordingly. Qualiopi certified, fundable by OPCO.
Access the training →5.2 The role of motivation and self-esteem
A demotivated, depressed person or someone with low self-esteem will be less attentive to their movements, less inclined to use their technical aids, and less vigilant about risks. The caregiver who maintains a quality connection, values successes, and encourages autonomy directly contributes to fall prevention.
DYNSEO Motivation Chart
The motivation chart helps the caregiver identify activities that generate the most engagement from the person being supported, to build a tailored activity program that maintains mobility and self-confidence — two key factors in fall prevention.
Access the chartTraining — Behavioral changes related to illness: practical guide for relatives
Understanding how behavioral changes related to illness influence fall risk: apathy, agitation, nighttime wandering, refusal of help. Concrete strategies to adapt home support.
Access the training →6. What to do after a fall? The caregiver's protocol
🚨 Immediate protocol after a fall
⚠️ Never force the lifting of a person who has fallen before ruling out a fracture or internal injury. A poorly lifted femoral neck fracture can significantly worsen the damage. In case of doubt, call 15. The rule: secure the person on the ground (blanket, pillow under the head), stay by their side, and call for help.
6.1 The autonomous lifting technique
If the person is not injured and wishes to get up alone, the caregiver guides them verbally and physically according to the autonomous lifting technique: roll onto the side, get onto hands and knees, move towards a stable object (chair, bed), raise one knee, lean on the stable object to stand up. This technique preserves autonomy and reduces the risk of injury for the caregiver.
6.2 After the fall: analyzing the causes
Each fall is valuable information. Where exactly? At what time? Under what circumstances? What was the person's general condition and level of fatigue? Was there a new medication recently prescribed? This systematic analysis helps identify modifiable factors and prevent the next fall.
7. Cognitive stimulation and fall prevention: the unknown link
Recent studies establish a clear link between maintaining cognitive functions and preventing falls. People whose executive functions (planning, attention, dual task) are better preserved have a significantly reduced risk of falling. Regular cognitive stimulation is therefore an integral part of a comprehensive fall prevention program.
The SCARLETT app from DYNSEO offers cognitive stimulation activities specifically calibrated for seniors at home — with attention, working memory, and dual task exercises (the ability to do two things simultaneously) that precisely strengthen the cognitive functions involved in walking and balance control. DYNSEO's cognitive tests allow for the assessment of these functions and the adaptation of the stimulation program to the specific needs of each person.
DYNSEO Emotion Thermometer
Emotional distress — anxiety, depression, fear of falling — is often an underestimated risk factor for falls. The emotion thermometer allows the accompanied person to communicate their emotional state of the day, helping the caregiver to adapt their support and quickly report any notable changes to the care team.
Access the tool8. Multidisciplinary coordination: the caregiver in the team
Fall prevention cannot rely on a single intervenor. It requires active coordination among all professionals surrounding the person at home.
🤝 Key stakeholders
- General practitioner — review of high-risk medications
- Physiotherapist — rehabilitation of balance and walking
- Occupational therapist — home assessment and technical aids
- Independent nurse — monitoring general condition
- Orthoptist — adapted visual correction
- Pharmacist — advice on high-risk medications
📋 The role of the assistant in coordination
- Observe and report any changes in condition
- Connect information between all stakeholders
- Ensure that physiotherapy prescriptions are followed
- Alert in case of non-compliance with treatments
- Report changes in the environment
- Participate in coordination meetings if invited
Training — Cognitive stimulation for seniors: practical ideas and implementation
For life assistants who wish to integrate cognitive stimulation into their home interventions: what activities to propose, how to adapt to the person's capabilities, and how to maintain motivation over time. Qualiopi certified, fundable through OPCO.
Access the training →The DYNSEO home care toolkit brings together all practical resources for home caregivers: practical sheets, tracking tools, educational resources, and coordination supports. It is accessible directly from the website and downloadable for use during interventions.
“Fall prevention is 20% material adjustments and 80% attentive human observation. The life assistant who arrives every morning and observes, listens, anticipates — that’s the one who makes the real difference between a person who stays upright and a person who ends up in the emergency room.”
— Perspective of home care service coordinators9. Financial assistance for home adaptation
Securing a home has a cost, and many seniors cannot afford the necessary adjustments on their own. The life assistant can play a valuable information role by guiding the family towards available aids.
- MaPrimeAdapt' (since 2024) — state aid for adapting housing for elderly or disabled people. Rate of 50 to 70% depending on income.
- APA at home — can finance small adjustments in the aid plan (grab bars, toilet risers, automatic lighting).
- Tax credit for equipment expenses — 25% of equipment expenses for autonomy in the main residence.
- ANAH (National Housing Agency) — grants for housing adaptation work for low-income households.
- Retirement funds (CARSAT, AGIRC-ARRCO) — can finance small adjustments as part of their social action.
- Mutual insurance — some contracts include "home care" packages covering fall prevention equipment.
Preventing falls: a daily mission, a vital impact
Fall prevention at home is not a secondary mission for the caregiver — it is at the heart of their role. Each intervention is an opportunity to observe, secure, support, and communicate. Training for this mission is giving oneself the means to make a real difference in the life and safety of the people being supported.
Discover the home care toolkit →FAQ — Fall Prevention at Home
Q1 Should every fall be reported even without apparent injury?
Absolutely. A fall without apparent injury is still a significant medical event. It may reveal a deterioration in balance, a new medication side effect, a hypoglycemic episode, or a small transient ischemic attack. The attending physician should be informed of any fall, even minor, to reassess treatment and management. The caregiver should systematically note the fall in the communication log and inform the family and the sector manager.
Q2 How to convince a senior who refuses grab bars or technical aids?
The refusal of technical aids is very common and understandable: they symbolize the loss of autonomy. Several approaches can overcome this refusal: framing the technical aid as a tool for freedom ("this bar allows you to get up alone without waiting for help"), integrating it gradually, choosing aesthetic models, and having it validated by the attending physician or physiotherapist as medically recommended. The argument of the previous fall is often the most convincing.
Q3 What is the difference between an accidental fall and a symptomatic fall?
An accidental fall results from a clearly identifiable external factor (rug, slippery floor, bad shoe). A symptomatic fall has no obvious external cause and may reveal an underlying health problem: balance disorder, vagal discomfort, hypoglycemia, Stroke, medication effect. The rule of caution: always report to the doctor, even if the cause seems obvious, to ensure there is no associated medical cause.
Q4 Is physical exercise really effective in preventing falls?
This is the most effective preventive measure proven by research. Exercise programs targeting balance and lower limb strength (tai chi, physiotherapy exercises, adapted yoga) reduce the risk of falling by 23 to 40% in seniors. Even 30 minutes of daily walking have a measurable protective effect. The caregiver can encourage and facilitate this physical activity integrated into daily life.
Q5 What DYNSEO resources are useful for fall prevention at home?
DYNSEO offers several suitable resources: the Home Care Toolkit for home caregivers, the session tracking sheet to record observations, the communication log for coordination among caregivers, the motivation chart to maintain engagement in physical activities, and the SCARLETT application for cognitive stimulation that contributes to balance and coordination.
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