How to Assess Fall Risks in an Elderly Relative's Home

Assessing fall risk in an elderly relative's home means looking at two things together: the person and the environment. Start with how they're moving and feeling — balance, medication, dizziness, past falls — then walk the home room by room checking for the hazards that turn a wobble into a fall: loose rugs, poor lighting, unsupported stairs, and slippery bathroom floors. Falls are the leading cause of injury-related death in people over 75 in the UK, and around 1 in 4 falls in older people results in a serious injury such as a hip fracture — but most home hazards are genuinely easy to fix once they're spotted.

Here's how to work through both parts properly, and what to do if the assessment turns up something that needs more than a quick fix.

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Start With the Person, Not the House

Before looking at the home itself, a few honest questions about how your relative is actually managing day to day tell you more about their real fall risk than any hazard checklist:

• Have they fallen in the past year? Even a fall they've brushed off as "just a trip" is one of the strongest predictors of another one.
• Can they get up from a chair without using their arms? Struggling to rise unaided, or needing to push hard on armrests, points to leg weakness that affects balance throughout the day.
• Do they grab furniture or walls to steady themselves while walking? This is often something families notice without registering it as significant — but it's a clear sign balance isn't reliable.
• Do they feel dizzy or unsteady, especially turning their head or standing up quickly? This can point to postural hypotension (a drop in blood pressure on standing) or an inner ear/balance issue, both of which are common and both of which are treatable.
• What medications are they on? Certain medications — sedatives, some blood pressure medications, and combinations of multiple drugs — are well-established fall risk factors, particularly in older adults.
• Is there any change in vision, hearing, or memory? All three affect how safely someone reads and reacts to their environment, from spotting a step edge to hearing a warning called from another room.

None of these need a clinical assessment to notice — they just need an honest, unhurried conversation and some time watching how your relative actually moves around, rather than asking "are you managing okay?" and taking a reassuring answer at face value.

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Room-by-Room Home Hazard Checklist

Once you've got a sense of the personal risk factors, walk the home itself with fresh eyes — hazards that are invisible to someone who's lived with them for years are often obvious to a visitor.

Hallways, stairs and entrances

• Handrails on both sides of the stairs, secure and full-length
• Clear, well-lit stair edges — consider contrasting tape on the top and bottom steps
• No loose rugs, trailing cables, or clutter in walkways
• A stable, well-lit route from bedroom to bathroom for night-time trips

Living room

• Chairs and sofas at a height that allows standing up without excessive effort
• No low coffee tables or loose footstools in the main walking path
• Phone and TV remote within easy reach, so there's no need to get up quickly

Kitchen

• Frequently used items stored at waist-to-shoulder height, not requiring a step stool
• Floor kept dry and clear, spills wiped immediately
• Non-slip mat by the sink if the floor gets wet

Bathroom — statistically one of the highest-risk rooms

• Grab rails by the toilet and in the shower/bath
• Non-slip mat or strips in the shower or bath
• Raised toilet seat if standing up is difficult
• Bath mat outside the shower removed or secured, not left loose on a hard floor

Bedroom

• A lamp or light switch reachable from bed, no fumbling in the dark
• Nightlight for the route to the bathroom
• Bed at a height that allows sitting on the edge with feet flat on the floor

Lighting throughout

• Well-lit stairs, hallways and entrances — dim lighting is one of the most common and most fixable hazards in older adults' homes
• Light switches at both ends of stairs and hallways where possible

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Watch for Behavioural Clues, Not Just Physical Ones

Some of the most telling signs don't show up on a checklist — they show up in how your relative has quietly changed their routine to avoid a risk they may not have named out loud. A relative who's stopped using the stairs more than once a day, avoids a particular chair because getting up from it is hard, or has started keeping a walking stick "just by the bed" but not admitting to needing it, is often managing a fall risk they haven't told anyone about.

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What to Do If You Spot a Fall Risk

Finding hazards or warning signs doesn't mean drastic changes are needed overnight — but it's worth acting on rather than monitoring indefinitely. A few practical next steps:

• Fix the obvious environmental hazards first — loose rugs, poor lighting and trailing cables are usually quick, low-cost changes.
• Speak to their GP if there's a history of falls, dizziness, or a recent change in mobility — some causes (medication side effects, blood pressure, vision) are medically treatable.
• Arrange a professional falls risk and balance assessment. A physiotherapist can assess strength, balance and gait properly — not just guess from watching someone walk across a room — and build a targeted plan to reduce risk, alongside practical guidance on home adaptations that go beyond a generic checklist.

Rehalign provides home visit physiotherapy for older adults across the West Midlands, including Birmingham, Solihull, Coventry, Walsall, Wolverhampton and Dudley — including balance and gait assessment and practical home safety guidance, in the home itself. Book a home safety and falls risk assessment or get in touch if you'd like a second opinion on a relative's home.

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