This course will be updated or discontinued on or before Thursday, November 25, 2027
Nationally Accredited
CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.
Outcomes
≥ 92% of participants will understand how falls impact patient safety across various settings and the safe use of assistive devices.
Objectives
By the end of this course, the participant will be able to:
Compare fall risk factors among patients in community-based settings, hospitals, and nursing homes.
Identify common fall risk assessments
Identify recommendations to ensure safe use of assistive devices.
Outline how to minimize risk factors associated with wheelchair use.
Relate common assistive devices for patients with hearing impairment and low vision.
Examine how technology is being used to address fall prevention.
CEUFast Inc. and the course planning team for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
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$39 Unlimited Access for 1 Year (Includes all state required Nursing CEs)
No Tests Required (Accepted by most states & professions)
Nursing Assistants from California, only. You must read the material on this page before you can take the test. The California Department of Public Health, Training Program Review Unit has determined that is the only way to prove that you actually spent the time to read the course. Less
Patient safety refers to the process of keeping patients free from harm, and it is essential throughout all healthcare settings. It has become an important area of focus due to millions of patients sustaining injuries or deaths annually due to a lack of safety or mediocre health care (World Health Organization [WHO], 2023). The World Health Organization, WHO, estimates that around 1 in every 10 patients is harmed in health care, and more than 3 million deaths occur every year due to unsafe care (WHO, 2023). It’s estimated that patient harm reduces global economic growth by 0.7% annually, with the indirect cost of harm amounting to trillions of US dollars annually (WHO, 2023). Falls are an adverse event that can result in significant harm to patients. In the United States, 700,000 to 1,000,000 patients fall in a hospital every year. Research has found that nearly one-third of those falls were preventable (Agency for Healthcare Research and Quality [AHRQ], 2013).
Whether in the community, hospitals, or nursing homes, patient safety is a concern. A third of community-dwelling adults experience a fall each year (Clemson et al., 2023). Falls among community-dwelling older adults can significantly impact an individual’s participation in their functional daily activities and ability to remain safe in their home. Fall risk factors among community-dwelling older adults include orthostatic hypotension, gait and balance disorders, sensory impairment, medications, and environmental hazards (Colón-Emeric et al., 2024). Fall hazard reductions, including reducing clutter and installing lighting and non-slip steps, are associated with lower fall rates among older adults at high risk for falls (Clemson et al., 2023). However, the use of assistive devices, including canes and walkers, as standalone interventions was limited, and these devices were found to be most effective when used as part of a multifactorial intervention program (Colón-Emeric et al., 2024).
Hospitalization is associated with an increased risk for falls and serious injuries, with falls representing a significant cause of preventable injury and being frequently reported adverse events (Dykes et al., 2020). A 2023 study found that falls are prevalent among older adults with modifiable risk factors, including anxiety about falling, BMI, imbalance, and vertigo, and are associated with increased risk factors for falls in the elderly (Khawaja et al., 2023). Additionally, a 2022 study on factors associated with the severity of falls in hospital patients found that increased age, being female, toileting, and showering were all associated with a more severe fall (Ghosh et al., 2022). The study also found that depression, poor balance, and requiring standby assistance were also associated with an increased severity of falls (Ghosh et al., 2022).
A 2020 nonrandomized study involving 17,948 patients who were included in the preintervention period and 19,283 patients in the postintervention period of similar age, sex, race/ethnicity, primary insurance, and hospital and unit length of stay assessed whether a fall-prevention tool kit used on patients and their families throughout hospitalization was associated with reduced falls and injurious falls. In the study, a nurse-led fall prevention toolkit was developed to connect evidence-based preventive interventions with specific fall risk factors, integrating continuous patient and family engagement in the fall prevention process. The study found that the nurse-led intervention focused on engaging patients and families with care team members was associated with overall reduced rates of falls and fall-related injuries. These nurse-led interventions included a laminated Fall TIPS poster displayed at the bedside, accompanied by color-coded clinical decision support that linked to the Morse Fall Scale risk factors and evidence-based interventions. The use of the Fall TIPS EHR toolkit allowed nurses to identify patient-specific risk factors using the Morse Fall Scale and to utilize clinical decision support linked to risk factors, resulting in appropriate interventions. The completed poster was reviewed with the patient and their family members at admission and during each shift (Dykes et al., 2020).
Similar to hospitals, falls are also a regular occurrence in nursing homes. In fact, patients in long-term facilities are at very high risk of falls, with an estimated half of 1.6 million nursing home residents in the United States falling each year (UC Davis PSNet Editorial Team, 2024). A 2023 systematic review and meta-analysis assessing the incidence and risk factors of falls in older people living in nursing homes found that nursing home residents are at a higher risk of falls than individuals living in community-dwelling settings (Shao et al., 2023). The study found that dementia, Parkinson’s disease, insomnia, and vertigo were also risk factors for falls (Shao et al., 2023). The research also found that nursing home residents were at an increased risk for falls when they took multiple medications, including anxiolytics, benzodiazepines, antidepressants, and psychotropic drugs. Additionally, impaired performance of activities of daily living (ADL), unsteady gait, poor balance, and the use of walking aids were also associated with falls. Individuals with hearing loss are at higher risk of falls. Hearing loss due to the lack of auditory input impacts spatial orientation, requiring patients to make a greater effort to gather information, thereby reducing their attention and cognitive resources needed for balance control and increasing their fall risk (Shao et al., 2023).
The Shao et al. (2023) study also examined the use of bed rails. This study found bed rails to be helpful in addressing steadiness and safety for frail older adults when getting in and out of bed. The study found that environmental factors were among the most modifiable factors in nursing homes and recommended creating safe and age-friendly environments to prevent falls. These included:
Floor safety
Lighting
Support equipment
Sensing technology, which includes wearables and smart home sensors. Items such as smart socks or instrumented shirts can be used to detect falls or used as part of a fall risk assessment (Shao et al., 2023).
The Institute of Medicine developed one of the most influential guides for assessing the quality of healthcare. It includes six domains vital to ensuring healthcare quality (AHRQ, 2025).
The six domains of healthcare quality include:
Safe: healthcare should help and not harm patients.
Effective: services should be provided based on research-based methods that are beneficial to patients.
Patient-centered: health care should consider the individual needs of each patient.
Timely: wait times and delays should be decreased as much as possible.
Efficient: waste of all types should be avoided.
Equitable: care should be provided without any type of discrimination (AHRQ, 2025).
A fall refers to an event in which a person experiences an unintentional change in position from one plane to a lower one. Falls represent a significant public health concern worldwide. At around 684,000 fatalities a year, falls represent the second leading cause of accidental injury death. Death rates are the highest in adults 60 years and older throughout all areas of the world. As for non-fatal falls, 37.3 million are severe enough to require medical care of some type (WHO, 2021).
Falls can significantly impact overall quality of life, regardless of whether or not they result in injury. Older adults can become fearful of falling and may begin to limit their participation in activities and decrease their socialization with others. This physical limitation can lead to physical decline, depression, social isolation, and feeling helpless. In addition to the impact on the individual, falls in older adults also create a significant financial toll. By 2030, the cost of falls in older adults may exceed $101 billion. The older adult population is expected to increase by 55% by 2060, leading to higher fall rates and associated healthcare costs (National Council on Aging [NCOA], 2025).
While multifactorial fall prevention programs are common among community-dwelling older adults, there is limited knowledge about their effectiveness in nursing homes. A 2023 study examined the features of effective multifactorial fall prevention programs for older adults in nursing homes and found that successful multifactorial interventions consistently reduced the incidence of falls. These intervention programs assessed residents’ environmental and personal risk factors to engage facility staff and specifically addressed residents’ intrinsic fall factors (Suen et al., 2023). These intrinsic factors included the resident’s cognitive capacity and falls history. For residents with cognitive impairments, interventions should consider providing separate interventions for learning-based components and assessing whether modifying the risk factor could reduce the likelihood of falls (Suen et al., 2023).
Patients are at risk for falls regardless of their settings. A 2023 systematic review and meta-analysis found that among community-dwelling older adults, risk factors for falls included the fear of falling, age, being female, a history of falls, depression, visual impairment, dementia, and balance disorders (Li et al., 2023).
Hospitalized patients are also at an increased risk of falls (Heinzmann et al., 2025). While fall risk screening tools have been used in hospital settings, they are no longer recommended due to their ineffectiveness in reducing falls and their time-consuming nature (Montero-Odasso et al., 2022). It is recommended that they be replaced by multifactorial risk assessments. These multifactorial risk assessments are more detailed and help identify risk factors, as well as inform the patient’s care plan to reduce the likelihood of falls and injuries. Persons are considered at high risk for falls in a hospital setting if they:
Are older than 65 years
Have a history of falling
Experience gait instability
Have cognitive or physical issues such as
Confusion
Dizziness
Gait instability
Muscle weakness
Urinary incontinence, urgency, or increased frequency
Have a chronic illness
Use multiple medications
Older adults admitted to the hospital with a history of falls are considered high risk and should undergo a multifactorial fall risk assessment. The patient’s cognitive status should also be considered, as well as the mode of education, which may include handouts, videotapes, or face-to-face discussions. While bed and chair alarms, grip socks, and physical restraints are sometimes used, there is insufficient evidence to recommend their use. However, all hospitals should have policies, procedures, and protocols to prevent falls (Montero-Odasso et al., 2022).
A 2025 systematic review found that among hospitalized patients, there was strong evidence and large effect sizes for associations between falls and older adults 65 to 79 years old (Heinzmann et al., 2025). Comorbidities for this group included diabetes mellitus, hyponatremia, Parkinson’s disease, the use of certain medications, including antidepressants, benzodiazepines, hypnotics, antipsychotics, nonspecified psychotropics, and anticonvulsants, and functional limitations that included cognitive impairments, mobility disorders, and a history of falls. (Heinzmann et al., 2025).
A systematic review and meta-analysis found that among older adults in nursing homes, strong risk factors associated with falls included impaired ADL performance, a history of falls, insomnia, and depression (Shao et al., 2023). The study also noted that low to moderate risk factors associated with falls included the use of walking aids, poor balance, vertigo, the use of antidepressants, polypharmacy, dementia, and unsteady gait (Shao et al., 2023). In nursing homes, fall risk screenings are not recommended to identify residents at risk for falls, as all residents should be considered at high risk for falls (Montero-Odasso et al., 2022). A multifactorial assessment should be performed upon admission to identify fall risk factors and should be repeated annually or if the resident’s condition changes (Montero-Odasso et al., 2022).
The purpose of a fall risk assessment is for the healthcare provider to determine the likelihood that a patient will fall. The CDC and the American Geriatric Society recommend annual fall assessment screens for all adults aged 65 and older. In many outpatient facilities, a fall risk screening is a mandatory part of an initial evaluation. The assessment typically includes an initial screening to determine overall health and identify any previous issues with balance, walking, or a history of falls. If the screening shows that a patient is at risk of falls, the healthcare provider will utilize fall assessment tools to test the patient's strength, balance, and gait. Many healthcare providers utilize the STEADI approach, which the CDC developed. STEADI stands for Stopping Elderly Accidents, Deaths, and Injuries. It includes screening, assessment, and intervention. The screening questions will inquire about falls within the last year, whether or not the patient feels unsteady when standing or walking, and if the patient is fearful of falling.
Fall assessment tools may include (MedlinePlus, 2020):
The Timed Up-and-Go (TUG)
30-second Chair Stand Test
4-stage Balance Test
The Morse Fall Scale (MFS) is also a commonly used fall assessment tool because it addresses all six common predictors of falls when it is used properly. These include the history of falls, secondary diagnoses, ambulatory aids, intravenous therapy, gait/transfers, and mental status. It was rigorously developed, accurate, and quickly completed with the patient present at the bedside. This scale is important as research has found that fall prevention practices are more successful when the patient is involved in the process (Dykes and Hurley, 2021).
Patients will be categorized at the end of the assessment as having a low, moderate, or high risk of falls. The results may also indicate areas that require attention as part of the fall prevention intervention. The recommendations may include exercising, adjusting or reducing the dose of certain medications, taking vitamin D to improve bone strength, undergoing a vision assessment, modifying footwear, consulting a podiatrist, and inspecting the home for potential hazards. These hazards can include insufficient lighting, rugs not adequately secured, or cords on the floor. It may be recommended that an occupational therapist or other health care provider assist with a thorough home assessment (MedlinePlus, 2020).
As patients get older, factors such as chronic or complex illnesses, deconditioning, weakness, and impaired balance lead to an increased risk of falls. For many patients, mobility assistive devices such as canes, crutches, walkers, and wheelchairs can help improve their safety and decrease their risk of falls.
One study found that 29.4% of adults aged 65 and older reported using an assistive device within the prior month when they were outside their homes, and 26.2% used an assistive device inside their homes. Assistive devices can enhance a patient's overall safety and independence, and decrease the risk of falls when used properly (Sehgal et al., 2021).
Canes can help improve standing tolerance and gait by off-loading a weak, injured, or painful limb. They are considered the least stable of assistive devices for mobility, and therefore, patients who use them safely must have adequate balance, upper body strength, and dexterity (Sehgal et al., 2021).
There are three types of canes:
Straight canes: These are a good option for people who need a little assistance with balance or support because of pain on one side of the body.
Quad canes: Quad canes have a larger base of support than straight canes and four-pronged feet, therefore providing more stability.
Straight Canes and Quad Cane
Tripod canes: Tripod canes have a smaller base than quad canes. However, they have a tip design that provides a larger support base and more stability than the straight cane (Bateni et al., 2018).
Crutches are typically used to aid in ambulation for individuals with a temporary or permanent compromise of their weight-bearing ability, most often due to a lower extremity injury or neurological impairment. To utilize crutches safely, a person must have sufficient upper body strength and coordination to transfer their body weight from their legs to their torso and arms. The person must also have enough coordination to support and move their own body weight (Warees et al., 2023).
Older adults rarely use crutches because they require a tremendous amount of upper-body strength. There are two primary types of crutches:
Axillary crutches: These are the most common type of crutches, and are best for short-term use. They are not a good choice for individuals with wrist problems, weak upper body strength, or impaired coordination.
Forearm (Loftstrand) crutches: These are better for long-term use and for individuals with long-term disabilities looking to be more active or participate in sports.
Walkers help provide a larger base of support for patients with impaired balance or lower-body weakness. They are also helpful for patients who cannot weight-bear through one lower extremity, for example, following a hip or knee surgery. Walkers are also used in the pediatric population for children with a medical diagnosis that impairs gross motor development or ability across the lifespan, such as cerebral palsy (Case, 2023). Walkers can improve mobility, independence, participation, and social function. The three most common types of walkers are:
Standard walkers: These walkers are sometimes referred to as pickup walkers. They have four rubber-tipped legs and do not have wheels. This type of walker offers the most stability, but it requires you to lift it to move. They may be most suitable for a person who may lose control of a walker with wheels.
Two-wheeled walkers (Front-Wheeled Walkers/FWW): As the name suggests, two-wheeled walkers have wheels on the front legs, but rubber feet on the back two legs. Two-wheeled rolling walkers are typically more functional and easier to maneuver than standard walkers without wheels.
Front-Wheeled Walker
Four-wheeled walkers (Rollator): A four-wheeled rolling walker, commonly referred to as a rollator, is helpful for patients with higher functional abilities and good balance. They are useful because they provide a seat for patients with impaired cardiopulmonary endurance to rest (Sehgal et al., 2021).
While the goal of an assistive device is to improve safety and decrease the risk of falls, research has shown that in certain situations, assistive devices can actually increase the risk of falls. It is estimated that almost 50,000 adults 65 and over are treated in US hospitals every year due to falls associated with assistive devices. Some studies suggest that assistive devices may interfere with the legs' lateral movement, which impacts the user's ability to utilize compensatory stepping reactions in the case of a lateral loss of balance. Research suggests that walkers can limit the success of compensatory reactions more than canes. As a result, walkers can increase the risk of falls more than canes. One study found that 12% of falls associated with mobility assistive devices used canes, while 87% used walkers. This study demonstrates the importance of proper training on the safe use of assistive devices (Bateni et al., 2018).
When selecting the appropriate mobility assistive device, several factors must be considered. The first factor is the main reason the patient needs the assistive device. A cane is a good option for patients with arthritis, pain, or injury in one lower extremity or those with only mildly impaired balance. Patients with arthritis or pain in both lower extremities, or those with moderately to severely impaired balance and gait, would likely benefit more from a walker. Another factor to consider is the amount of weight the patient needs the device to support. A cane can only support up to 25% of the patient's body weight, while a walker can support up to 50% (Health in Aging Foundation, 2024). This will be an important factor if the person is on some form of weight-bearing restriction. Weight-bearing restrictions include:
Non-weight bearing (NWB): The person cannot put any weight through a part of the body (typically the lower extremity)
Toe touch weight bearing (TTWB): The person may only put their toe on the ground to lightly stabilize or regain balance with no weight or pressure through the affected limb.
Partial weight bearing (PWB): a certain percentage of body weight may be placed through the limb.
Weight bearing as tolerated (WBAT):
One of the most important aspects of using a cane or walker is to ensure a proper fit. This fit should be done in conjunction with a health care provider. The patient should wear their normal shoes and let their arm hang loosely by their side. The distance should be measured from their wrist to the floor. The walker or cane should be adjusted so that the top of the assistive device is the same distance as the measurement from the patient's wrist to the floor. When the length of the assistive device is correct, there should be a 20 to 30-degree bend in the patient's elbow (Health in Aging Foundation, 2024).
Safe Use of Crutches (Cleveland Clinic, 2025)
Make sure you’re balanced safely before starting to move.
Move both your crutches and your recovering leg forward at the same time.
Push down with equal, even pressure on both handgrips and step through with your other leg.
Regain your balance before stepping again
If walking with one crutch, hold the crutch on the side opposite to the limb that needs support or is painful, just like with a cane. The crutch moves with the affected limb.
The Health in Aging Foundation (2024) offers five steps for safe cane use.
Use the cane on the side opposite the injury, pain, or weakness (unless instructed otherwise by a health care provider).
Put all weight on the good leg.
Move the cane with the bad leg a comfortable distance forward.
Use the cane to help your bad leg support your weight, and then step through with your good leg.
Place the cane firmly on the ground before taking a step, and ensure it is not too far ahead.
The Health in Aging Foundation (2024) provides the following six steps for safe walker use
Stand with toes halfway between the front and back wheels/tips. Roll or lift the walker a step length ahead.
Place the walker firmly on the ground and make sure it is not too far ahead.
Lean forward slightly, using the walker for upper body support.
Take one step.
Repeat
When getting up from a chair, use the chair to push up from and use the walker to stabilize. Do not push up from the walker
Patients must be cautious not only when walking with an assistive device but also when sitting down. They should back up until they feel the chair, bed, or another surface behind their legs. When using a walker or quad cane, it can be left in a standing position, and then the patient can place both hands on the arm of the chair, on the bed, etc., and ease down slowly to a sitting position. When using a standard cane, hold the cane in one hand and the armrest or sitting surface with the other hand, and ease down slowly (Cleveland Clinic, 2024a). When standing, patients should push up from the surface they are sitting on using their arms to transition to a standing position, rather than pulling on the assistive device, to ensure their safety.
The stairs present another challenging area for patients using assistive devices. When going up the stairs with a cane/crutches, the patient should push down and step up with the stronger or uninjured leg. Then they step up with the weaker or injured leg and bring the cane/crutches up. When going down the stairs, the patient should put the cane/crutches down one step, step down with their weaker or injured leg, and then step down with the stronger or uninjured leg. The phrase "up with the good, down with the bad" is often used to remind patients. If a railing is present and within reach, it can be used for additional support with the hand, rather than relying on the cane.
Additional factors that can prevent falls when using assistive devices include:
Ensure the assistive device is in good condition, with rubber tips on the bottom.
When possible, avoid throwing rugs or waxed floors. Rugs should be secured if they are deemed necessary.
Use extra caution when walking on wet or slippery surfaces - this includes both outside in the rain, snow, or ice, and inside, especially when there are spills on the floor or when getting in or out of the shower or tub.
For patients who lack sufficient lower-body strength, balance, or endurance for ambulating, wheelchairs are a good mobility option. The wheelchair must be the appropriate size, especially in terms of width, to minimize the risk of skin breakdown. Manual wheelchairs typically require sufficient upper body strength and coordination. Many patients can also use their lower body to assist with wheelchair propulsion. Power chairs are typically a good option for patients who require a wheelchair but lack sufficient strength, coordination, or endurance to propel the wheelchair for functional distances.
In 2008, the World Health Organization (WHO) developed guidelines to standardize wheelchair service delivery. The eight steps include referral and appointment, patient assessment, prescription for the wheelchair, funding and purchasing, device installation/preparation, device fitting, patient instruction/training, and follow-up maintenance and repairs. The main features of a wheelchair include a seat, wheels, tires, casters, leg rests, wheel locks, hand rims, armrests, and cushions. Additional items may include anti-tippers, lap trays, or seatbelts if needed (Owens & Davis, 2023).
A comprehensive wheelchair evaluation includes a complete history and physical examination, as well as assessments of cognitive and communication skills, and consideration of premorbid functioning and comorbidities. The patient's motor and sensory function, muscle strength and tone, vision, hearing, postural control, and range of motion will be assessed for significant deficits in any of those areas that could make the operation of the assistive device unsafe. Consideration of functional impairments, ADLs, IADLs, occupational roles, social engagement, transportation needs, insurance funding, and the home or living environment must also be considered during the wheelchair assessment (Owens & Davis, 2023).
A standard wheelchair is 24 inches in diameter with rear wheels and 8-inch front casters, weighs 40 to 65 pounds, and is designed to be operated using the hand rims on the wheels. There are many other types of wheelchairs available, including lightweight, ultra-lightweight, one-arm drive, standard heavy-duty, and motorized wheelchairs (Owens & Davis, 2023).
The following measurements must be taken to ensure an appropriate fit for a wheelchair:
Seat width, depth, and height
Patient's hip, trunk, and shoulder-width
Patient's shoulder and axillary height
Wheelchair leg, arm, and back height
Wheelchair width, height, and size
Knee-to-seat and knee-to-heel length
Seat to the back, seat to the lower leg, and lower leg support to the foot angle
Fingertip to axle length to allow for self-propulsion (Owens & Davis, 2023)
The wheelchair seating system should provide sufficient support when the patient is seated in the wheelchair. It should allow for normal anatomical alignment while accommodating fixed postural asymmetries. There should be adequate stability when sitting in a neutral position with evenly distributed pressure. The wheelchair should promote function and the successful completion of ADLs and IADLs. The seating system will include a seat and a back. It may also include lateral trunk supports, head supports, and pelvic belt supports. The seating system will either be placed on a manual or power wheelchair base. An efficient seating system should support the trunk and provide stability.
For this reason, the seat and back should be firm. The primary and secondary supports will minimize pressure at the bony prominences of the pelvis and sacrum. Various cushions are available, including foam, gel, contoured, saddle, wedge, antithrust, and pommel (Owens & Davis, 2023).
Additional considerations for wheelchair fitting include:
There should be at least 1 inch of space between the patient's thighs and the armrests.
The pelvis should be positioned with a slight anterior tilt to distribute body weight evenly.
The armrests should allow 30 degrees of shoulder flexion with 60 degrees of elbow flexion.
The foot should be about 2 inches from the ground and mounted far enough from the casters to avoid falls or lower extremity injury, but not too far, as that could place extra tension on the hamstrings (Owens & Davis, 2023).
There are inherent risks associated with the daily use of a wheelchair. These may include acute injuries, estimated to occur at a rate of 5-21% per year, and chronic injuries. Pressure ulcers result from prolonged pressure on bony prominences, especially the ischial tuberosities. Pressure-relief seating systems and techniques, such as wheelchair push-ups and weight-shifting exercises, are crucial for preventing pressure ulcers. Patients may require assistance from staff with repositioning if they are unable to do so independently. If they are at home, family or caregivers should be trained in pressure-relieving techniques. Patients using manual wheelchairs are at risk of upper extremity injury related to self-propulsion. These injuries are common in the rotator cuff, medial epicondyles, and carpal tunnel. Patients must learn how to safely operate a wheelchair from a physical or occupational therapist. The four common methods of self-propulsion include bilateral upper extremity propulsion, bilateral lower extremity propulsion, hemi-propulsion, and propulsion using all extremities. The most commonly recommended technique is using long forward strokes with both upper extremities. Even when appropriately trained in wheelchair propulsion and optimal seating systems, patients may still suffer from repetitive strain injuries due to the stress placed on the joints. Finally, tips and falls from a wheelchair are common issues. One data set showed that of the approximately 100,000 wheelchair-related injuries evaluated and treated in emergency departments in the US, 65-80% were related to tips or falls from wheelchairs. Patients must be monitored to ensure their safety in wheelchairs and reduce the risk of trips or falls whenever possible (Owens & Davis, 2023).
Wheelchair Safety Tips
It is important to follow basic safety precautions to decrease the risk of tipping over or falling out of the wheelchair, as tipping sideways, forward, or backward is the most common cause of wheelchair accidents.
Avoid reaching for items behind the wheelchair as this can cause the chair to tip. Instead, position the chair as close to the item as possible and use the casters to maintain balance.
Avoid leaning forward beyond the armrest
Ensure the wheelchair brakes are locked when transferring in/out of the wheelchair
Move footrest out of the way before transfers
Keep items out of the way of the wheels and spokes
Do not hang heavy or bulky items from the sides of the chair
Do not use the brakes to slow down or stop the wheelchair when it is in motion.
(Virginia Department of Behavioral Health and Development Services, 2023).
Low vision refers to the loss of sight that prescription eyeglasses, contact lenses, or surgery cannot correct. It involves various degrees of vision loss. The American Optometric Association divides low vision into two categories. Partially sighted refers to a person with visual acuity between 20/70 and 20/200 with conventional prescription lenses. Legally blind refers to a person with visual acuity no better than 20/200 with conventional corrective lenses or a restricted field of vision less than 20 degrees wide. Low vision can impact anyone, as it can result from various conditions or injuries. However, age-related disorders such as glaucoma and macular degeneration are more common in older adults. One in six adults aged 45 and older has low vision, while one in four adults aged 75 and older has low vision. The most common types of low vision include loss of central vision, loss of peripheral vision, night blindness, hazy vision, and blurred vision. Low vision may result from age-related macular degeneration, glaucoma, eye cancer, brain injury, or diabetic retinopathy (Cleveland Clinic, 2024b). The CDC estimates that approximately 7 million people in the US have a vision impairment, and by 2050, more than 8.2 million Americans aged 40 and older are expected to have uncorrectable vision (Centers for Disease Control and Prevention [CDC], 2024).
Many types of support are available to assist people with vision loss to move around safely and independently. Some supports have the purpose of assisting with mobility, while others notify others of the user's vision impairment. Guide dogs are a vital mobility aid for individuals who are blind or have low vision. They also provide support and social benefits. Smartphones can assist with navigation for people with vision loss.
Different types of white canes have different functions.
Symbol cane - indicates to others that the user has low vision. It is not used for detecting obstacles or for support.
Guide cane - a mobility aid that can be used to detect steps or curbs. It can be held diagonally in front of the user for protection or swept from side to side.
Long cane - mobility aid used to detect obstacles in front of the user or ground-level changes. It is used by tapping or brushing side to side.
A red section on a white cane - indicates that the user has hearing and vision impairment.
White walking stick - offers physical support and indicates to others that the user has a vision impairment (Fighting Blindness, n.d.).
There are many other low-vision devices available to assist patients with low vision in completing daily activities, thereby improving their overall quality of life. Optical aids utilize magnifying lenses to enlarge objects, making them easier to see. These include correctly refracted glasses, magnifying spectacles, stand magnifiers, handheld magnifiers, and telescopes. There are also non-optical assistive devices that can be helpful with daily tasks. These include watches, timers, and devices with audible features for tasks such as measuring blood pressure or blood glucose levels, as well as large-print books, newspapers, magazines, checks, and large-sized numbers. Additionally, high-contrast colors on devices such as telephones, thermostats, watches, and remote controls can also be helpful. Several electronic devices can be helpful for patients with low vision. These include video magnifiers, audio and electronic books, smartphones and tablets with adjustable features, and computers with features such as reading aloud or magnifying the screen (Turbert & Gudgel, 2024).
The number of visually impaired adults 70-79 years of age is predicted to increase by 211%, and those 80 and older are predicted to increase by 280% by 2050. Visual impairment can have a profoundly negative impact on older adults in many ways. However, the increased risk of falls can be one of the biggest threats. Some common causes of falls due to tripping include lack of attention to surroundings, encountering unexpected obstacles, and misjudging distances or angles. Visual impairment can contribute to those common causes of tripping falls. Research has found that older adults with visual impairment experience significant mobility deficits. One study found that 46% of people who experienced a fall-related hip fracture reported that poor vision was the cause of the fall (Nguyen et al., 2021).
Environmental modifications can be completed in the home in collaboration with home health therapists to decrease the risk of falls in patients with low vision. Modifications such as installing secure railings on both sides of stairs and hallways, ensuring adequate lighting and clear walkways in all rooms, removing or securing throw rugs, and installing grab bars near the toilets and inside bathtubs and showers are helpful for all patients, especially patients with low vision. Research has found that virtual home assistants, such as Amazon Echo and Google Home, can be connected to smart light bulbs for voice-activated lighting, which can decrease the risk of falls. Voice-activated lighting allows users to turn on the light before getting out of bed and turn it off once they return, without ever needing to touch a light switch. This technology can be helpful for all patients, especially those with low vision. Home health providers must ensure that patients use the recommended assistive devices safely and consistently to decrease the risk of falls (Nguyen et al., 2021).
People with hearing loss have difficulty both hearing and understanding speech (Hearing Loss Association of America [HLAA], n.d.). Disabling hearing loss affects nearly 25% of adults aged 65 to 74 and 50% of adults aged 75 years and older. Only 30% of adults 70 years and older who could benefit from hearing aids have ever used them. As of December 2019, a total of 736,900 cochlear implants had been implanted worldwide. This count includes around 118,000 adults in the US (National Institute on Deafness and Other Communication Disorders, 2024). Despite advances in hearing aids and cochlear implants, these devices often fail to fully enable users to hear and understand communication in various settings. Hearing aids have a limited range, making it difficult to separate background noises from the sounds the person is actually trying to hear. Hearing Assistive Technology (HAT) can improve the lives of people living with hearing loss. Assistive listening systems and devices can bridge the gap between the user and the source of sound by eliminating the effects of distance, background noise, and reverberation. Telecoils, also known as T-coils, enhance the functionality of hearing aids and cochlear implants, particularly in noisy environments. T-coils are built into many hearing aids, all cochlear implants, and some streamers. They are an essential component for users who want to access an assistive listening system easily and directly. People who use hearing aids or do not have a T-coil in their hearing aids can use a hearing loop, FM system, or infrared system with a receiver and headphones, a telecoil-equipped personal amplifier, or special telecoil-equipped earbuds with a smartphone (HLAA, n.d.).
Hearing loops consist of a copper wire in a room, theater, or counter connected to a special loop "driver" to a public address or sound system. An electromagnetic field is created, which connects to a telecoil in hearing aids, cochlear implants, or receivers. Loops are the most user-friendly assistive listening devices as they are simple, effective, and discreet. Infrared systems (IR) work like a television remote control. A transmitter sends sound from a public address or sound system to an IR receiver using infrared light waves. This technology cannot be used outside during the daytime as the light will affect the system. The signals are sent and received in a straight line, so the user should sit in a central location. FM systems transmit wireless, low-power FM frequency radio transmission from a sound system to FM receivers. The advantage over IR systems is that the FM is not affected by direct sunlight, making it suitable for use outside. The user needs a receiver and either a headphone or neck loop for both IR and FM systems. Neck loops eliminate the need for headphones in users with telecoil-equipped hearing aids or cochlear implants (HLAA, n.d.).
Additionally, there are many smartphone apps that utilize speech-to-text recognition, allowing them to transcribe conversations in real time and provide assistance to individuals with hearing impairments to facilitate conversations.
Hearing Devices
Assistive listening devices (ALDs) are handheld amplifiers with microphones that allow users to communicate more effectively in one-on-one conversations. They capture the sound the user wants to hear while filtering out some background noise. The Pocketalker is an affordable ALD. Bluetooth is a short-range wireless technology frequently used to connect cell phones, televisions, computers, tablets, hearing aids, and cochlear implants. Captioning refers to the text of the audio portion of a video or film, which is displayed directly on the screen. Communication Access Realtime Translation (CART) is the verbatim text of spoken presentations at live events. Sometimes, people with hearing loss may need CART in addition to an assistive listening device (HLAA, n.d.).
A 2025 scoping review examined digital technologies used for fall detection in older adults, categorizing the technologies based on their functions, type, and usability (Konara Mudiyanselage et al., 2025). The research examined studies that included older adults living in care homes, nursing homes, residential homes, respite care homes, and skilled and ambulatory care facilities (Konara Mudiyanselage et al., 2025). The study identified four categories, which included motion and sensor technologies, imaging and visual systems, environmental sensors, and robotic and autonomous systems (Konara Mudiyanselage et al., 2025). Commonly used sensors included accelerometers, gyroscopes, infrared array sensors, and smart carpet pressure sensors. Common data storage methods included wearable devices, cameras, and floor-mounted sensors. Common communication technologies included Bluetooth, Wi-Fi, and GPS, with notification methods that included alarms and cloud-based communications. The healthcare team, comprising healthcare providers, emergency services, and family members, played a vital role in the development of fall detection systems (Konara Mudiyanselage et al., 2025). More fall detection systems, including wearable body sensor devices, floor sensor techniques, robots, and thermal sensors, are becoming available and commercialized in numerous countries. However, other technologies are still emerging and require further development (Konara Mudiyanselage et al., 2025). The study also noted a variety of environmental sensors, including electronic bed/chair sensors, floor-sensing models, foot switch sensors, pressure, temperature, altitude sensors, heartbeat sensors, and skin-wearable sensors.
Wearable Fall Alert System
Smartwatch Fall Detection
Mobile health, or mHealth, is being increasingly used to deliver healthcare services to patients (Dino et al., 2025). mHealth includes telemedicine, remote healthcare processes, medication adherence, fitness, and technology for fall detection and prevention (Dino et al., 2025). Mobile phone or smartphone applications are typically used in mHealth; however, smartwatches and other wearable devices are also popular (Dino et al., 2025). The features of mHealth applications are mostly static, smartphone-based, and asynchronous, with functionalities tailored to the specific needs of older adult users living in a home setting (Dino et al., 2025). Developers need to address long-term approaches that include pre- and post-fall strategies, as well as consider the users’ comorbidities (Dino et al., 2025).
Smartphone-based systems are preferred in mHealth because they are easily accessible, portable, can monitor numerous health functions, and have user-friendly interfaces (Dino et al, 2025). They are also effective in monitoring and detecting falls due to built-in accelerometers and sensors (Dino et al., 2025). Technological advances have led to an increase in the use of mobile health apps to measure mobility and assess fall risk. A 2023 review examined the evidence that smartphone inertial measurement units, IMUs, the technology included in mobile technology that can measure movement, gait, balance, and fall risk, found that they can provide an objective way to quantify balance and gait function in older adults (Hsieh, Chen, & Sosnoff, 2023). The review, which examined articles published between 2017 and November 2021, included adults aged 50 years and older, articles that utilized mobile technology, and measured at least one fall risk factor. Most of the apps developed focused on measuring fall risk factors related to screenings. While two apps reviewed included specific prevention measures, neither examined the effectiveness of mitigation strategies (Hsieh, Chen, & Sosnoff, 2023). Additionally, while five apps integrated mobile technology into a fall prevention trial, only two of those apps included mobile technology as a fall risk assessment and prevention tool (Hsieh, Chen, & Sosnoff, 2023). The review found that mobile technology, incorporating personalization, prediction, prevention, and participation (P4), offers a tailored approach to fall prevention (Hsieh, Chen, & Sosnoff, 2023). The study found that most of the apps focused on prediction but lacked a robust algorithm to measure risk factors. The authors suggest that the entire P4 model should be included in future apps. However, smartphones can objectively measure static and dynamic balance as a fall risk factor, and mobile health technology can offer solutions for implementing the P4 model of fall prevention in community settings (Hsieh, Chen, & Sosnoff, 2023). Mobile technology has the potential to prevent falls on a large scale; however, additional studies are needed to determine if mobile technology can provide tailored and scalable interventions (Hsieh, Chen, & Sosnoff, 2023).
Cindy is a home health nurse who was called to a home where the patient, Mrs. Graham, had experienced several falls over the last week. Her family was worried that Mrs. Graham would end up in the hospital, as she was 89 years old. They report severe arthritis, difficulty standing up and walking, and often shuffling her feet. During the admission assessment, Cindy noticed that Mrs. Graham became very agitated when she attempted to stand up and kept falling back into the chair. Cindy helped Mrs. Graham to stand up and asked her to walk with her for a short distance. She was very unsteady and needed assistance from Cindy to prevent falling backward. Cindy noticed that the throw rugs throughout the home were unsecured. When she checked the bathroom, she found that there were no grab bars in place. During a medication review, Cindy noted that Mrs. Graham was on an antidepressant and an antihypertensive, both associated with an increased risk of falls. Cindy educated the family on the importance of either removing or securing the throw rugs and recommended installing grab bars near the toilet and in the shower. She informed Mrs. Graham and her family that she referred the patient for physical and occupational therapy services. They will collaborate as a team to work with the patient and her family on safety issues. Finally, Cindy informed Mrs. Graham's primary care physician of the referrals for therapy and the medications that could increase the risk of falls. Cindy was able to take the necessary steps to ensure the patient's safety in the home setting.
Rene is a home health occupational therapist who received a referral for Mrs. Graham. On her initial home health visit, Renee reviewed Mrs. Graham’s medical history, prior level of functioning, medications, and discharge summary to identify concerns. Rene also assessed Mrs. Graham’s ability to perform ADLs and found that she had poor balance when standing to complete her dressing and grooming tasks. Additionally, she noticed that she wears poorly fitting shoes at home, which increases her risk of falling. Rene also conducted a home safety assessment and found poor lighting throughout the hallway, throw rugs in the kitchen and bathroom, a low commode seat in the bathroom, and unsafe transfers on and off the commode. Rene spoke with Mrs. Graham and her family and made recommendations to improve safety, including proper footwear, to support safety with ADLs and functional transfers. She also recommended grab bars and a raised commode seat in the bathroom. She also provided education on safe transfer techniques and strategies to reduce the risk of falls during daily routines. Rene will work with Mrs. Graham and her family to support increased ADL independence, improved functional transfers, and decreased fall risks in the home. Rene will also consult with Mrs. Graham’s physical therapists to discuss what type of assistive mobility device they recommend for Mrs. Graham.
Patient safety is the responsibility of the interdisciplinary team in any healthcare setting. Falls can be debilitating and even fatal. Healthcare providers must take all necessary measures to ensure the safety of their patients and decrease the risk of falls whenever possible. Falls can have a significant financial impact on a person's overall quality of life. A fear of falling can lead to social isolation and overall debility, thereby increasing the risk of future falls. The goal of assistive devices is to enhance patient safety and reduce the risk of falls. The patient must learn to use the devices properly, as they can pose a safety risk when used incorrectly. Assistive devices are also available for patients with low vision and hearing loss to improve their overall quality of life. Mobile Health is also playing an increasingly important role in patient safety and fall detection, as it is easily accessible and user-friendly.
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CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.
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