Of everything that raises a person’s risk of falling, home hazards are the easiest to fix. No referral, no appointment, no copay needed.
Ask most older adults what’s likely to land them in the hospital this year, and falling at home probably isn’t the first answer.
The numbers say otherwise. According to the CDC, falls are the leading cause of injury for adults 65 and older. More than 14 million older adults, about one in four, fall every year. Those falls lead to roughly 3 million emergency department visits and about 1 million hospitalizations annually.
Less than half of older adults who fall tell their provider about it. Falling once also doubles the chance of falling again. So the common pattern is that someone falls once, doesn’t mention it, and then falls again.
Why start with the home
Fall risk comes from several things at once: balance, strength, vision, hearing, medication side effects, and the physical space someone moves through every day.
Most of those take time to address. Improving balance means weeks or months of physical therapy. A medication side effect means a conversation with a prescriber and possibly a dosage change. A vision or hearing problem means an exam and often a device. All of that is worth doing, but none of it can happen quickly.
On the other hand, straightening a loose rug that could pose a tripping hazard is an easy fix.
Most older adult falls happen at home, and researchers estimate that more than 30% of falls are caused by environmental hazards such as throw rugs, loose cords, or dimly lit stairs.
A 2023 Cochrane review, one of the most rigorous types of medical evidence available, pooled 22 randomized controlled trials covering 8,463 older adults living in their own homes. Programs to identify and fix home fall hazards reduced the overall rate of falls by 26% (moderate-certainty evidence). Among people already at higher risk of falling, such as those who’d fallen in the past year or recently left the hospital, the reduction was 38%, rated as high-certainty evidence, the strongest grade Cochrane assigns.
That’s a meaningful effect from something as simple as rearranging furniture and adding lights. The CDC’s own guidance for clinicians makes the same point plainly: remove trip hazards and keep floors clutter-free.
Why these hazards get missed
Home hazards usually don’t look like hazards. They look like a house someone has lived in for twenty years. The rug has always been there. The lamp has always been across the room. Nothing about it looks dangerous until it is.
There’s a second issue worth naming: identifying a hazard and fixing it are two different things. People notice the loose rug or the dark stairwell, and then nothing changes. Sometimes that’s because no one in the household can safely move furniture or install a grab bar. Sometimes it’s cost related. Often a hazard that seemed worth fixing on Saturday just doesn’t feel urgent by Tuesday.
Which is why the goal isn’t only spotting hazards, but actually acting on them. The Cochrane review found something related: education about fall hazards on its own, without follow-through, didn’t show a clear benefit. Knowing about a hazard isn’t the same as removing it.
A room-by-room checklist
Take some time to walk through your home and identify these potential hazards. Start with the route you use most, usually bed to bathroom.
Floors and walkways
- Do anchor any rug you keep with double-sided tape or a non-slip pad
- Do run cords along the wall, secured out of the way
- Do keep main paths clear of shoes, bags, laundry baskets, and pet bowls
- Don’t keep throw rugs in walkways if you can avoid it; they’re the most common tripping hazard in the home
- Don’t run a cord under a rug, since it creates a hidden bump
- Don’t accept a path that requires stepping around something
Lighting
- Do add a nightlight in the hallway and bathroom
- Do keep a lamp or light switch reachable from bed
- Do replace burned-out stairwell bulbs right away
- Don’t walk a dark hallway from memory, even a familiar one
- Don’t rely on a phone flashlight, since it takes up a hand you may need
Bathroom
- Do install grab bars beside the toilet and inside the tub or shower
- Do use a non-slip mat inside the tub
- Do use a shower chair if standing through a full shower is tiring
- Don’t use a towel bar for support; it isn’t built to hold weight and can pull off the wall
- Don’t step onto wet tile in socks
Stairs
- Do install handrails on both sides where possible, and check they’re secure
- Do add contrast tape to the top and bottom step
- Don’t store anything on the steps, even briefly
- Don’t carry a load that blocks your view of your feet
Kitchen
- Do keep everyday items between waist and shoulder height
- Do wipe up spills right away
- Don’t rely on a step stool for daily use; rearrange the cabinet instead
- Don’t stand on a chair
Bedroom
- Do keep a clear path from bed to door
- Do keep a phone within reach of the bed
- Do sit on the edge of the bed for a moment before standing, since blood pressure needs time to adjust
- Don’t use furniture as a handrail across the room
Footwear
The Cochrane review found that specialized footwear on its own did not reduce falls. Shoes alone aren’t a fix, but they matter alongside everything else on this list.
- Do wear supportive shoes with backs, indoors and out
- Don’t walk on hardwood or tile in socks
- Don’t wear loose slippers that can slide off mid-step
When to check again
A few situations call for a closer look:
- After a medication change. Dizziness and fatigue are common side effects, and they combine badly with a dark hallway or unlit stairwell.
- After a fall, even a minor one. Most falls are never reported to a provider. A near-miss usually points to a specific spot in a specific room.
- After a change in vision or hearing. Hearing loss is strongly linked to falls: research cited by the National Council on Aging finds people with hearing loss are nearly three times as likely to fall, and that hearing aids cut that risk by about half.
- When someone avoids part of their own home. If a person has quietly stopped using the basement stairs or back door, that’s a hazard being avoided instead of fixed.
Ask for a home safety referral
If you’ve found problems in your home that you can’t fix on your own, that’s not a dead end. It’s a reason to ask for a referral.
A home safety assessment is a standard, established service. In most of the studies Cochrane reviewed, this meant an occupational therapist visiting the home, identifying hazards specific to how that person moves through the space, and recommending changes, sometimes including equipment. It’s more thorough than any checklist because it accounts for someone’s actual balance, vision, strength, and routines.
It’s also worth knowing who benefits most. The same review found no measurable benefit when hazard-reduction programs were given to people not specifically at risk, but a 38% reduction in falls for people who were. So if you’ve already fallen, been hospitalized after a fall, or need help with things like dressing or using stairs, this is the kind of support the evidence points to. It’s worth asking for by name.
The cost is worth asking about directly. Nationally, Medicare covers about 67% of fall-related costs and Medicaid about 4%, with the rest falling to individuals and families. Finding out what your plan covers before a fall, rather than after, is worth the extra step.
Questions worth bringing to a provider:
- “Can you refer me for a home safety evaluation?”
- “Would an occupational therapy assessment make sense for me?”
- “Should I also consider a physical therapy referral for balance?”
- “Would my plan help cover grab bars, a shower chair, or a raised toilet seat?”
- “Can we review my medications for anything affecting my balance?”
If you’re enrolled in a managed care plan, your care team can help you figure out what’s available. Area Agencies on Aging are another resource, since many run home modification programs and can connect people with local help for the physical work.
Start with one room
You don’t need to fix your whole house this weekend. Pick the route you walk most, walk it tonight, and fix the first thing you notice.
Then tell someone: a family member, a caregiver, or your provider. Since fewer than half of falls get mentioned to a provider, saying something out loud is itself a useful step. Noticing a hazard and fixing it are two different things, and the second one is what actually prevents a fall.
Where daily monitoring fits
Fixing hazards addresses what’s visible. Catching gradual changes, like swelling, a new sore, or a shift in how someone stands, is harder to do on your own, and that’s where the SmartMat+ comes in.
Members step on the mat each day, which takes about twenty seconds. The data goes to the Podimetrics care team, who watch for changes over time and follow up when something looks different. These are the kinds of changes that rarely come up at a visit three months away but show up in daily data right away.
Sources: Clemson L, Stark S, Pighills AC, Fairhall NJ, Lamb SE, Ali J, Sherrington C. Environmental interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2023, Issue 1. Art. No.: CD013258. DOI: 10.1002/14651858.CD013258.pub2. CDC, Older Adult Falls Data and Facts About Falls (2026). CDC STEADI clinician materials. National Council on Aging, Get the Facts on Falls Prevention.
