Preventing Falls in Dementia

People with dementia fall more often than other older adults because of changes in balance, judgment, eyesight and medications; learn the main causes, what to do after a fall, and practical ways to make falls less likely.

By Jim Pavlish, Editor · Last updated: October 23, 2026 · Editorial policy

Falls are one of the biggest everyday risks for older adults. The National Institute on Aging notes that more than one in four people age 65 or older fall each year, and the risk rises with age. People living with dementia fall more often than their peers, and they are more likely to be hurt, to break a hip, and to end up in the hospital, where confusion often gets worse (see Hospital Stays and Dementia). The good news is that many falls can be prevented.

Why people with dementia fall more

Several things usually combine:

• Changes in balance and walking. Many types of dementia, especially Lewy body, Parkinson's disease dementia and vascular dementia, affect movement, posture and gait.
• Judgment and memory. A person may forget they need a walker, try to stand too quickly, or not recognize a hazard like a wet floor.
• Vision and depth perception. Dementia can change how the brain processes what the eyes see, so a dark rug can look like a hole, or a step can be hard to judge (see Vision Loss and Dementia).
• Medications. Sleeping pills, anxiety medicines, antipsychotics, some antidepressants, blood pressure drugs and "PM" allergy or sleep aids can cause dizziness or drowsiness (see Medications That Can Affect Memory and Antipsychotics and Dementia: Risks).
• Urgency and night-time trips to the bathroom, often in the dark (see Incontinence).
• Restlessness and wandering, especially late in the day (see Sundowning).
• Other health problems: low blood pressure on standing, dehydration, infections such as a UTI, pain, or poor footwear.

Practical ways to lower the risk

Ask for a falls review. The CDC's STEADI program encourages doctors to screen older adults for fall risk. Ask the doctor directly: "Is any of these medicines raising the risk of falls?" Bring every pill bottle, including over-the-counter products. Ask about blood pressure checks lying down and standing, and a vitamin D or bone-health review.

Keep moving safely. Regular exercise that builds strength and balance, such as walking, tai chi, or a program from a physical therapist, is one of the best-proven ways to prevent falls (see Exercise and the Brain). A physical therapist can also fit a cane or walker properly.

Check eyes and feet. Get a yearly eye exam and keep glasses clean and handy. Choose well-fitting shoes with thin, non-slip soles; avoid floppy slippers and walking in socks.

Make the home safer (see Home Safety):

• Remove throw rugs, cords and clutter from walking paths
• Add night lights from bedroom to bathroom, and bright, even lighting elsewhere
• Install grab bars by the toilet and in the shower, and use a shower chair
• Put railings on both sides of stairs; mark step edges with contrasting tape
• Use plain, solid-colored floors where possible, since busy patterns and dark mats can confuse
• Keep things they use daily within easy reach, so they don't climb or stretch

Plan for the bathroom. A regular toileting schedule, a bedside commode at night, and limiting drinks in the last couple of hours before bed (while keeping them well hydrated during the day) can cut down on rushed night-time trips.

Watch for "behavior" that is really discomfort. Restlessness can mean pain, hunger, boredom or needing the toilet (see Recognizing Pain in Dementia). Meeting the need can prevent risky wandering.

About restraints and bed rails

Tying someone down or raising full bed rails might seem safe, but they can cause injuries, including people climbing over rails and falling from higher up, and they increase distress. Safer options include a low bed, a floor mat beside the bed, and motion-sensor lights or alarms. Talk with the care team about what fits.

If a fall happens

• Stay calm and don't rush to lift them. Check for pain, bleeding, or a limb that looks out of position.
• Call 911 if they hit their head, can't get up, seem to be in severe pain, are on blood thinners, or are more confused than usual. A person with dementia may not be able to tell you they're hurt.
• If they seem uninjured, help them roll onto their side, get onto hands and knees, and rise slowly using a sturdy chair.
• Tell the doctor about every fall, even ones without injury. A new fall can be the first sign of an infection, a medication problem or a change in the disease.
• Consider a medical alert device, ideally one with automatic fall detection.

This article is general information, not medical advice. Ask the person's doctor or a physical therapist for a fall-risk assessment.

Sources

1. National Institute on Aging: Falls and Fractures in Older Adults, Causes and Prevention
2. CDC: STEADI, Older Adult Fall Prevention
3. Alzheimer's Association: Home Safety

Not medical advice. This article is general information, not a diagnosis or treatment plan for any individual. Talk with a doctor about your situation.

Related articles

• Home Safety
• Medications That Can Affect Memory
• Exercise and the Brain
• Vision Loss and Dementia
• Incontinence