Home Health Training
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10.7 Common Diagnoses

Falls and Deconditioning

Why people fall, the medication review that prevents more of them than any equipment, what to do when one happens, and breaking the deconditioning cycle.

Updated Sep 18, 2026

Falls are the most common reason a home health patient ends up in hospital, and the one most open to prevention. A fall is almost never a single cause — it is four or five small things that lined up.

Ask about falls properly

Patients under-report. They minimise, they forget, and they are afraid that admitting a fall means losing their independence.

Ask concretely: "Have you had any falls since I last saw you — including any time you ended up on the floor, even if you were not hurt and got yourself up?"

Then look for what they will not say: new bruising, a rearranged room, furniture being used as handholds, a walker parked in the corner.

Why people fall

Work through all of them; there is rarely one answer.

Medications — the biggest modifiable cause

More falls are prevented by a good medication review than by any piece of equipment.

  • Sedatives, hypnotics, benzodiazepines — the highest-risk group
  • Antihypertensives and diuretics — check for orthostatic drops
  • Opioids
  • Anticholinergics — confusion, blurred vision, dizziness
  • Antidepressants and antipsychotics
  • Hypoglycaemics — see Diabetes
  • Polypharmacy itself — risk climbs with the number of medications, whatever they are

Take an orthostatic blood pressure on anyone who reports dizziness on standing, and report a significant drop. See Medication Reconciliation and the Medication Profile.

Everything else

  • Strength and balance — often the reason a PT referral is the intervention
  • Vision — when was it last checked, are the glasses current, are they wearing bifocals on stairs?
  • Footwear — what they wear indoors, which is often socks or backless slippers
  • Environment — see Home Safety Assessment
  • Continence — rushing to the toilet at night is a classic mechanism
  • Orthostatic hypotension, arrhythmia, anaemia
  • Cognition and poor safety awareness — see Dementia and Cognitive Impairment
  • Fear of falling, which causes a guarded, shuffling gait that makes a fall more likely
  • Alcohol
  • Pain, which changes how someone moves
  • Assistive device — wrong height, wrong device, or one they have quietly stopped using

When a fall happens while you are there

  1. Do not move them until you have assessed
  2. Check for head strike and loss of consciousness
  3. Check for deformity, shortening, rotation, pain on movement
  4. Vital signs
  5. Any head strike on an anticoagulant is a 911 call, regardless of how well they look — see Anticoagulation and INR Management
  6. If uninjured and able to assist, help them up safely — if you cannot do so without risk to either of you, call for help
  7. Notify the physician, and the family
  8. Complete the occurrence report — see Incidents and Occurrence Reporting

Then work out why, and change something. A fall investigated and not acted on is a fall that repeats.

When a fall happened before you arrived

  • How long were they on the floor? Anyone down for a prolonged period needs evaluation for rhabdomyolysis, dehydration, and pressure injury
  • Head strike? Anticoagulated?
  • Same questions about cause
  • Did they call anyone? If not, why not — that is the finding that shapes the plan

A patient who fell and could not summon help needs a plan for next time: a pendant alarm, a phone carried on their person, or an agreed check-in.

Breaking the deconditioning cycle

The cycle is predictable: illness or a fall → less movement → weakness → more difficulty and more fear → less movement still. Each turn makes the next one easier.

It is broken by activity, not rest. Practically:

  • PT for strengthening, balance, and gait — the core intervention
  • OT for ADL retraining and energy conservation
  • Get them out of the chair every day, with a specific target rather than "move more"
  • Sit-to-stands as a home exercise, counted
  • Address the fear explicitly; confidence is part of the treatment
  • Nutrition — protein intake is frequently inadequate, and muscle cannot be rebuilt without it
  • Treat pain so movement is possible

What to teach

  • How to get up from the floor safely — practise it with the PT
  • What to do if they cannot get up: stay warm, move position to protect the skin, summon help
  • A way to call for help carried on their person, not left on the kitchen counter
  • Rise slowly in stages: sit, pause, stand, pause, walk
  • Use the device every time, including the short trip to the bathroom at 3am
  • Clear the route from the bed to the bathroom, and light it
  • Indoor footwear with a back and a grip

When to call

  • Any fall with a head strike, especially on an anticoagulant
  • Suspected fracture
  • A prolonged time on the floor
  • A new pattern of falls
  • Orthostatic drop
  • Dizziness, syncope, or near-syncope
  • Any new deficit after a fall