Preventing Falls: Home Audit and Simple Exercise Program

title: Fall Prevention at Home: Comprehensive Audit and Practical Exercise Program

description: Comprehensive guide to prevent falls among elderly people at home. Safety audit of the housing, risk factors, necessary adaptations, balance and strength exercise program, effective prevention plan.

keywords: fall prevention, falls elderly people, home audit, home safety, balance exercises, muscle strengthening, housing adaptations, fall prevention seniors

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fall prevention, falls, safety, home audit, balance, muscle strengthening, housing adaptations, elderly people, autonomy, home help

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Reading time: 28 minutes

“Mom fell last night going to the bathroom. Femoral neck fracture, hospitalization, surgery. Everything changed.” “Dad has fallen three times this month. Each time, we were scared. We don’t know what to do anymore.” “The rugs, the lighting, the stairs… I know it’s dangerous, but what can we do differently?” “She refuses to use her cane, says she doesn’t need it. As a result: she falls regularly.”

Falls are the leading cause of accidents among elderly people. One in three people over 65 falls at least once a year. The consequences are dramatic: fractures (femoral neck, wrist, skull), hospitalization, loss of autonomy, fear of falling leading to immobilization and increased dependence, even death in the most severe cases.

However, the vast majority of falls can be prevented. With a rigorous audit of the home, simple adaptations, a regular exercise program, and constant vigilance, it is possible to drastically reduce the risk of falling and preserve autonomy and safety.

This guide provides you with all the tools to prevent falls: complete home audit checklist, identification of risk factors, concrete adaptations, balance and muscle strengthening exercise program, and comprehensive prevention plan.

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Table of Contents

1. Understanding Falls

2. Identifying Risk Factors

3. Safety Audit of the Home

4. Adaptations and Arrangements

5. Fall Prevention Exercise Program

6. Shoes and Technical Aids

7. Medications and Vigilance

8. What to Do After a Fall

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Understanding Falls {#understanding-falls}

Key Figures

1 in 3 people over 65 falls at least once a year.

1 in 2 people over 80 falls each year.

10,000 deaths per year in France related to falls (elderly people).

Leading cause of accidental death among those over 65.

Leading cause of emergency hospitalization (traumatology).

40% of hospitalizations after 65 are due to falls.

Consequences:

• Femoral neck fracture: 50,000/year in France, severe (surgery, long rehabilitation, loss of autonomy)
• Head trauma: Risks of neurological sequelae
• Fear of falling: Post-fall syndrome (loss of confidence, reduced activity, immobilization, increased dependence)
• Death: 10% of serious falls lead to death within the year

Why Do Elderly People Fall More?

Physiological Aging:

• Loss of muscle mass (sarcopenia): Less strength, less ability to catch oneself
• Decreased balance: Proprioception disorders, slowed reflexes
• Visual disorders: Decreased acuity, cataracts, AMD (difficulty seeing obstacles)
• Hearing disorders: Role in balance (inner ear)
• Osteoporosis: Fragile bones, easier fractures

Pathologies:

• Neurological disorders: Parkinson’s, Stroke, neuropathies (impaired gait, unstable balance)
• Dementia, Alzheimer’s’s: Cognitive disorders (forgetting obstacles, impaired judgment)
• Orthostatic hypotension: Drop in blood pressure when standing up = dizziness, falls
• Diabetes: Diabetic neuropathy (reduced foot sensitivity), hypoglycemia (malaise)

Medications:

• Sleeping pills, anxiolytics: Drowsiness, balance disorders
• Antihypertensives: Drop in blood pressure = dizziness
• Polypharmacy: Drug interactions, cumulative side effects

Environment:

• Inadapted home: Rugs, obstacles, insufficient lighting, stairs, slippery floors
• Inappropriate shoes: Slippery slippers, heels, shoes that are too big

Risk Situations

Night: Going to the bathroom in the dark, drowsiness.

Bathroom: Wet, slippery floor, entering/exiting shower/bathtub.

Stairs: Going up/down, precarious balance.

Outside : Uneven sidewalks, black ice, rain, crowd.

Sudden rise : Orthostatic hypotension.

After meal : Digestion = decrease in alertness.

Morning : Joint stiffness after night, not yet “warmed up”.

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Identify risk factors {#facteurs-risque}

Fall risk assessment grid

For each criterion, check if present:

Individual factors:

• [ ] Age > 75 years
• [ ] History of falls (1 or more in the year)
• [ ] Fear of falling (avoids certain activities)
• [ ] Balance disorders (instability, dizziness)
• [ ] Gait disorders (limping, dragging feet, slow walking)
• [ ] Muscle weakness (difficulty getting up from a chair without using arms)
• [ ] Visual disorders (cataract, AMD, glaucoma, blurred vision)
• [ ] Cognitive disorders (dementia, Alzheimer’s’s, confusion)
• [ ] Urinary incontinence (toilet urgency at night)
• [ ] Joint pain (osteoarthritis, rheumatism)
• [ ] Diagnosed osteoporosis

Medications:

• [ ] Use of sleeping pills, anxiolytics
• [ ] Use of antihypertensives
• [ ] Polypharmacy (> 4 medications/day)
• [ ] Recent change in treatment

Environment:

• [ ] Rugs on the floor (not secured)
• [ ] Slippery floors (tiles, waxed parquet)
• [ ] Insufficient lighting (dark areas, no night light)
• [ ] Stairs without railing or unstable railing
• [ ] Clutter (wires, objects on the floor)
• [ ] Door thresholds (steps)
• [ ] Absence of grab bars (bathroom, toilet)
• [ ] Inappropriate shoes (slippers, no support)
• [ ] Absence of technical aids (cane, walker) when needed

Score:

• 0-3 factors : Low risk (basic prevention)
• 4-6 factors : Moderate risk (enhanced prevention, home adaptations)
• 7+ factors : High risk (urgent intervention, complete adjustments, close monitoring)

Simple assessment tests

Single-leg stand test:

• Stand on one foot, eyes open, without assistance, for 5 seconds.
• If failure : Balance disorder.

Chair rise test (5 times):

• Stand up from a chair 5 times in a row, without using arms, as quickly as possible.
• If > 15 seconds or impossible : Muscle weakness.

Timed Up and Go (TUG) test:

• Stand up from a chair, walk 3 meters, turn around, return, sit down.
• If > 20 seconds : High fall risk.

Walking test:

• Observe walking over 10 meters: dragging feet? Hesitant walk? Unstable balance?

If one or more abnormal tests : Consult physiotherapist, doctor (in-depth assessment).

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Home safety audit {#audit-domicile}

Room-by-room audit grid

Entrance / Hallways

Floor:

• [ ] Rugs secured or removed (no loose rugs that slide)
• [ ] Non-slip floor (no excessive wax)
• [ ] Clear passage (minimum width 90 cm for walker)
• [ ] No obstacles on the floor (electrical wires, objects)

Lighting:

• [ ] Switch accessible from the entrance
• [ ] Sufficient lighting (no shadowy areas)
• [ ] Night light (if hallway leads to bedroom-toilet)

Thresholds:

• [ ] No door threshold (or ramp installed)
• [ ] Doors of sufficient width (wheelchair if necessary)

Kitchen

Storage:

• [ ] Frequently used utensils within reach (no stool needed)
• [ ] No need to climb on a step stool

Floor:

• [ ] Non-slip floor, no wax
• [ ] No rug in front of sink

Safety:

• [ ] Functional smoke detector
• [ ] Automatic gas/electric cut-off (if cognitive disorders)

Bathroom / Toilet

HIGH RISK AREA

Shower / Bathtub:

• [ ] Non-slip mat in shower/bathtub
• [ ] Grab bar(s) securely fixed (shower entry/exit, near bathtub)
• [ ] Shower seat (avoids prolonged standing)
• [ ] Step-free shower (no ledge to step over) or bath board

Toilet:

• [ ] Raised toilet seat (eases sitting/standing)
• [ ] Grab bar near the toilet
• [ ] Easy access (wide door, sufficient clearance)

Floor:

• [ ] Non-slip floor (even when wet)
• [ ] No rugs (except secured non-slip mat)

Lighting:

• [ ] Bright light, no shadow
• [ ] Switch accessible before entering

Bedroom

Bed:

• [ ] Suitable height (feet touch the floor when seated, easy to get up)
• [ ] Stable bed (no sliding wheels)
• [ ] Clear path from bed to toilet (sufficient width, no obstacles)

Night lighting:

• [ ] Automatic night light (motion detector) or switch accessible from bed
• [ ] Bedside lamp within reach

Phone:

• [ ] Phone accessible from the bed (in case of emergency)

Floor:

• [ ] No carpet (or non-slip carpet, secured)

Living Room

Armchair:

• [ ] Suitable height (feet on the ground, can get up without difficulty)
• [ ] Sturdy armrests (help to get up)
• [ ] Stable armchair (no wheels)

Circulation:

• [ ] Furniture arranged for clear passage
• [ ] No electrical wires on the floor (extension cords, cables)
• [ ] Carpets secured or removed

Stairs (if present)

HIGH RISK ZONE

Handrail:

• [ ] Solid handrail on BOTH sides (if possible)
• [ ] Suitable height (easy to grasp)
• [ ] Continuous handrail (from the beginning to the end of the steps)

Steps:

• [ ] Visible step edges (contrasting strips, different color)
• [ ] Non-slip steps (anti-slip)
• [ ] Regular step height (no step higher than the others)

Lighting:

• [ ] Strong lighting at the top and bottom of the stairs
• [ ] Switch accessible at the top AND bottom

If stairs impossible to secure:

• [ ] Consider stairlift (significant cost, possible prescription)
• [ ] Or arrange bedroom/bathroom on the ground floor (avoid stairs)

Outside (garden, balcony, building access)

Path:

• [ ] Clear path, no obstacles (branches, tools)
• [ ] Stable, non-slip ground (gravel, dirt = risk)
• [ ] Outdoor lighting (if night movements)

Building access:

• [ ] Functional elevator (avoid stairs)
• [ ] Access ramp (if steps at the entrance)
• [ ] Entrance hall lighting

Audit Summary

Number of non-compliant points: ___

Priorities:

1. Absolute urgency (immediate life risk): Bathroom, stairs

2. High priority (significant risk): Night lighting, carpets, clutter

3. Medium priority (comfort, prevention): Bed height, armchair

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Adaptations and Arrangements {#adaptations}

Priority Arrangements (to be done immediately)

1. Remove ALL carpets

Unless non-slip carpet, very well secured (double-sided adhesive tape, under all surfaces).

Otherwise = deadly danger.

2. Install grab bars in the bathroom

Vertical bar (or angled) at the entrance of the shower (to hold when entering/exiting).

Horizontal bar along the shower or bathtub (to hold during washing).

Bar near the toilet (helps to get up/sit down).

Professional installation: Solid fixing in the wall (no suction cup, insufficient).

Cost: 50-150€ per bar + installation (100-200€) = Partial reimbursement APA, PCH.

3. Install night lights

Automatic night lights (motion detector): Hallway, bedroom, bathroom.

Automatically turn on if the person gets up at night (avoids searching for the switch in the dark).

Cost: 10-30€ each (very low cost, maximum efficiency).

4. Secure stairs

Anti-slip strip on step edges (adhesive, easy to install, 5-10€/meter).

Contrasting strips (yellow, white) to visualize steps.

Reinforced handrail (check stability, add a second handrail if possible).

Secondary Arrangements (comfort/safety improvement)

5. Shower seat

Avoids prolonged standing (fatigue, dizziness).

Types:

• Fixed wall seat (foldable)
• Removable seat (less stable, but cheaper)
• Bath board (for bathtub)

Cost: 30-200€ depending on model.

6. Toilet riser

Facilitates getting up/sitting down (less effort, less risk of falling).

Added height: 5-15 cm.

Cost: 20-80€.

7. Medical bed (if necessary)

Electrically adjustable height (adjusts as needed).

Barriers (prevents falling out of bed at night).

Cost: 500-2000€ (rental possible, partial reimbursement on prescription).

8. Access ramp (if entry threshold)

Eliminates entry step (wheelchair, walker).

Cost: 200-1000€ depending on length, material.

Financial Assistance for Adaptations

APA (Personalized Autonomy Allowance):

• Support plan includes home adaptations
• Partial coverage (depending on resources)

PCH (Disability Compensation Benefit):

• For disabled people under 60 years old
• Housing adaptations, technical aids

ANAH (National Housing Agency):

• “Living Easy” aid (adaptation work)
• Up to 50% of the cost (max 10,000€)

Retirement funds:

• Some offer assistance for fall prevention work

Mutual insurance:

• Prevention package (depending on contracts)

Advice: Consult a social worker, occupational therapist (advice, procedures).

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Exercise Prevention Program {#programme-exercices}

Why do exercises?

Muscle strengthening = Less risk of falling, better ability to recover.

Improvement of balance = Stable standing, less dizziness.

Improvement of proprioception = Body knows where it is in space, improved coordination.

Scientific studies: Regular exercise program reduces the risk of falling by 30 to 40%.

General principles

Frequency: 3 to 5 times a week (regularity is essential).

Duration: 15-30 minutes per session.

Progression: Start easy, gradually increase difficulty.

Safety: Always do exercises with support nearby (chair, wall, bar), never alone if at significant risk.

Support: Physiotherapist prescribes adapted exercises, demonstrates, caregiver can help daily.

Balance exercises

Exercise 1: Standing on one foot

Position: Standing, near a chair (to hold on if unbalanced).

Action: Lift one foot, hold for 10 seconds, rest. Alternate.

Repetitions: 3 times each foot.

Progression: Increase duration (20 sec, 30 sec), then do with eyes closed (more difficult).

Exercise 2: Heel-to-toe walk

Position: Standing, in a hallway (walls on each side for safety).

Action: Walk by placing the heel of one foot against the toe of the other (like on a line).

Distance: 5-10 meters.

Repetitions: 3 times.

Progression: Increase distance, do without hand support.

Exercise 3: Weight shifts

Position: Standing, feet hip-width apart, near a chair.

Action: Shift body weight from one foot to the other (lean slightly to the left, then to the right).

Repetitions: 10 times.

Progression: Slightly lift the unloaded foot.

Exercise 4: Backward walking

Position: Standing, in a secure hallway.

Action: Walk backward, slowly, 5 meters.

Repetitions: 3 times.

Attention: Check for no obstacles behind.

Muscle strengthening exercises

Exercise 5: Chair rise

Position: Sitting on a sturdy chair (without wheels), feet on the ground.

Action: Stand up without using hands (if possible), sit back down slowly.

Repetitions: 10 times.

Progression: Increase speed, or do 20 times.

If too difficult: Light help from hands at first, then gradually reduce.

Exercise 6: Rise on toes

Position: Standing, hands on the back of a chair (for balance).

Action: Rise onto the balls of your feet, hold for 3 seconds, lower back down.

Repetitions: 10 times.

Progression: Hold longer (5 sec, 10 sec), do on one foot.

Exercise 7: Knee bends (mini-squat)

Position: Standing, feet apart, hands on chair.

Action: Slightly bend the knees (as if to sit), hold for 3 sec, rise back up.

Repetitions: 10 times.

Attention: No full bending (risk to knee), just a slight bend.

Exercise 8: Lateral leg lift

Position: Standing, hand on chair (for balance).

Action: Lift leg to the side (not too high), hold for 3 sec, lower.

Repetitions: 10 times each leg.

Progression: Hold longer, add ankle weights (0.5-1 kg).

Flexibility exercises

Exercise 9: Calf stretch

Position: Standing, hands on wall, one foot in front, one foot behind.

Action: Push back heel into the ground, feel calf stretch, hold for 20 sec.

Repetitions: 3 times each leg.

Exercise 10: Ankle rotations

Position: Sitting on a chair.

Action: Lift one foot, make circles with the ankle (10 in one direction, 10 in the other).

Repetitions: 3 times each ankle.

Typical program (3 times/week)

Warm-up (5 min):

• Marching in place
• Ankle rotations
• Knee flexion/extension (sitting)

Balance exercises (10 min):

• Standing on one foot (Ex. 1)
• Heel-to-toe walk (Ex. 2)
• Weight shifts (Ex. 3)

Strengthening exercises (10 min):

• Chair rise (Ex. 5)
• Rise on toes (Ex. 6)
• Knee bends (Ex. 7)

Cool down (5 min):

• Calf stretch (Ex. 9)
• Deep breathing

Total: 30 minutes.

Integration into daily life

Caregiver: Can accompany exercises (supervision, encouragement, correction).

Physiotherapist: 2-3 sessions/week (evaluation, progression).

SCARLETT Program : Hand-eye coordination games, reflexes, can complement (cognitive + motor stimulation).

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Shoes and Technical Aids {#chaussures-aides}

Suitable Shoes

Slippers = number 1 enemy of falls.

Safe shoe characteristics:

• Non-slip sole (rubber, grooves)
• Heel support (no mules, no open shoes)
• Secure closure (laces, Velcro, no slip-on shoes that slide)
• Lightweight (no heavy shoes, tiring)
• Proper size (not too big = tripping, not too small = pain, imbalance)

Absolutely avoid:

• Slippers without support
• Socks alone (slip on hardwood)
• Heels (even small ones, imbalance)
• Worn shoes (smooth sole)

Walking Aids

Single cane:

• Light balance aid
• Choose appropriate height (hand at wrist level when arm relaxed)
• Rubber tip (non-slip)

Tripod or quad cane:

• More stable (3 or 4 feet)
• For moderate balance disorders

Walker (rollator):

• Frame with 4 wheels, brakes, seat
• Very stable, secure
• Ideal for outdoor walking (fatigue, need to sit)

Wheelchair:

• If walking is impossible or very limited
• Manual (pushed by caregiver) or electric (independence)

Medical prescription : Necessary for reimbursement (partial or total depending on situation).

Training: Physiotherapist teaches proper use (cane, walker).

Acceptance: Often initial refusal (“I don’t want a cane, it makes me look old”). Explain: cane = preserved autonomy, safety, no shame.

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Medications and Vigilance {#medicaments}

Risky Medications

Sleeping pills, anxiolytics (benzodiazepines):

• Daytime drowsiness
• Balance, coordination disorders
• Increases fall risk by 40%

Antihypertensives:

• Lower blood pressure = dizziness, discomfort
• Especially upon standing (orthostatic hypotension)

Antidepressants:

• Some cause drowsiness, balance disorders

Polypharmacy (> 4 medications):

• Drug interactions
• Cumulative side effects
• Confusion, drowsiness

Actions

Regular review of treatments (primary care physician, every 6 months):

• Are medications still necessary?
• Are doses appropriate?
• Are there less risky alternatives?

Supervised medication intake (nurse, caregiver): Avoid forgetfulness, overdoses.

Vigilance after treatment change : Adjustment period (possible side effects).

Advice:

• Get up slowly (avoid orthostatic hypotension)
• Wait 30 seconds sitting at the edge of the bed before standing

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What to Do After a Fall {#apres-chute}

If You Find the Person on the Ground

1. Don’t panic, stay calm.

2. Talk, reassure:

“I’m here, everything is fine, we will help you.”

3. Assess the condition:

• Conscious? Responding?
• Pain? Where?
• Can move arms, legs?
• Bleeding? Wound?

4. Do NOT lift immediately if:

• Suspected fracture (femur neck, wrist, skull)
• Intense pain
• Inability to move a limb
• Head trauma (head impact)

5. Call for help:

• 15 (Emergency Medical Services): If serious injury, unconsciousness, intense pain
• 18 (Firefighters): If difficulty lifting, need for technical assistance
• Primary care physician : If fall without apparent severity (evaluation still necessary)

6. If no serious injury, help to get up:

• Roll onto the side
• Position on all fours
• Support on chair, sturdy armchair
• Get up gradually
• Assist, do not pull abruptly

7. Monitor for 24-48 hours:

Even if seems okay, monitor (delayed pain, internal bruise).

After the Fall: Analysis and Prevention

Always analyze:

• Why did they fall? (rug? dizziness? loss of balance?)
• Where? (bathroom? stairs? bedroom?)
• When? (night? after getting up?)

Immediately correct the cause:

• Rug = remove
• Insufficient lighting = install nightlight
• Slippery shoes = change
• Suspect medication = consult doctor

Post-fall syndrome:

After a fall, fear of falling again = reduces activity, remains seated/lying down.

Consequences: Muscle loss, balance further degraded, risk of falling increases.

Solutions:

• Reassure, accompany
• Progressive exercises (physiotherapy rehabilitation)
• Further secure home (bars, nightlights)
• Teleassistance (reassures, knows help is available)

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Testimonials

Mrs. Dupont, 79 years old

“I fell three times in two months. The last time, wrist fracture. The occupational therapist came, we changed everything: removed the rugs, installed bars in the shower, night lights everywhere. And I do my balance exercises every day. It’s been six months, not a fall. I feel safe now.”

Julien, son of Mr. Leclerc

“Dad refused to use a cane. ‘I’m not old,’ he said. Then he fell, femur neck, surgery, six months of rehabilitation. Now, he uses a walker. If we had insisted earlier… We could have avoided all this.”

Sophie, AVS

“I see so many dangerous homes. Rugs everywhere, no light at night, slippery shoes. I always do an audit on my first visit. I report, I explain the risks. Sometimes families don’t realize. A support bar at €50 can prevent a fracture costing €50,000.”

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Conclusion: Prevention is Protection

Falls are not inevitable. With a rigorous home audit, simple adaptations, a regular exercise program, and constant vigilance, it is possible to drastically reduce the risk of falling and preserve autonomy, safety, and quality of life.

The keys to success:

1. ✅ Complete home audit (point-by-point checklist)

2. ✅ Immediate priority adaptations (bars, night lights, rug removal)

3. ✅ Regular exercise program (minimum 3 times/week, balance + strengthening)

4. ✅ Suitable shoes (non-slip soles, heel support)

5. ✅ Medication review (avoid sleeping pills, antihypertensives if possible)

6. ✅ Accepted technical aids (cane, walker = safety, no shame)

7. ✅ Continuous vigilance (communicate observations, adjust prevention)

You are not alone. Our home care toolkit contains a complete audit checklist, illustrated exercise program, checklists. DYNSEO Training: Fall prevention, safe accompaniment. SCARLETT Program: Cognitive and motor stimulation (coordination, reflexes, visual balance).

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DYNSEO resources for fall prevention:

• Complete toolkit: audit, exercises, checklists
• Training: Safe accompaniment and prevention
• SCARLETT Program: Cognitive stimulation and motor coordination

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Preventing falls means offering the freedom to age at home safely. It allows one to walk without fear, to get up at night without anxiety, to stand with dignity. A few bars, a few exercises, a few adaptations: and life resumes, serene, autonomous, peaceful. Let us not allow falls to steal this freedom. Let’s act, now.