Sarah noticed it on a Tuesday evening. Her 78-year-old mother was walking from the kitchen to the living room, and her hand never left the countertop, then the wall, then the back of the dining chair. She was “furniture-surfing,” gripping every stable surface along her path. Sarah had seen it before but told herself it was nothing. This time, something clicked. She wondered: is Mom actually at risk for a fall, or am I overreacting?

If you have asked yourself a similar question about your aging parent, you are not alone. More than one in four Americans aged 65 and older experience at least one fall every year, totaling roughly 14 million reported falls annually.¹ Every 11 seconds, an older adult is treated in the emergency room for a fall-related injury.² Yet most families have no systematic way to evaluate whether their parent is actually at risk. They rely on gut instinct, waiting until that first serious fall forces their hand.A fall risk assessment changes that. It gives you a clear, evidence-based framework to evaluate your parent’s risk level before a fall happens. The tools in this guide are the same ones used by physical therapists and geriatricians, adapted so you can use them at home, today, without any special equipment. By the end of this article, you will know exactly how to screen for risk, test balance and mobility, assess every room for hazards, and build a prevention plan that actually works.

For families concerned about nighttime falls and bed safety, the SonderCare Aura Premium Hospital Bed features FallSafe ultra-low height technology that lowers the bed platform to just 10 inches from the floor, significantly reducing fall injury risk during the most dangerous hours.

Why Every Family Should Assess Fall Risk Before the First Fall

In caregiver communities online, one pattern repeats itself again and again: the first serious fall is the event that forces families to take action. Before that fall, the warning signs were there. The unsteadiness. The near-misses. The way Dad started avoiding the stairs. But those signs were rationalized away. After the fall, panic sets in.

The stakes of waiting are real. The age-adjusted fall death rate in the United States increased by 41% between 2012 and 2021, reaching 38,742 deaths in a single year.³ Falls now result in approximately 2.4 million emergency department visits among adults 65 and older each year.⁴ In 2019 alone, more than 290,000 older adults were hospitalized for hip fractures, the vast majority caused by falls.⁵ One in four seniors who fracture a hip will die within six months.⁶

The financial burden is equally staggering. Total annual healthcare spending on non-fatal falls among community-dwelling older adults reached $80 billion in 2020.⁷ The average inpatient hospital stay for a fall injury costs $18,658, while a single emergency department visit averages $1,112.⁸

Consider Tom, a 52-year-old project manager in Denver. His father had been “a little wobbly” for months. Tom kept meaning to look into it but assumed the doctor would catch any real problem. Then his father tripped over a throw rug at 2 a. m. on the way to the bathroom. The hip fracture that followed meant surgery, a rehab facility stay, and six months of recovery that fundamentally changed his father’s independence. Looking back, Tom says the hardest part was knowing the signs were there all along.

A proactive fall risk assessment is one of the most impactful things you can do for your parent’s safety. It takes less than an hour, requires no medical training, and the evidence shows that identifying risk factors early allows families and healthcare providers to intervene before that first fall ever happens.

7 Warning Signs Your Parent May Be at Risk for Falls

Before you conduct a formal assessment, pay attention to these behavioral changes. Many of them are subtle, and your parent may not mention them out of pride or fear of losing independence.

Furniture-surfing: Reaching for walls, countertops, or furniture while walking through the house. This is one of the earliest and most reliable visual indicators of balance decline.
Slower gait or shuffling: Walking noticeably slower than they did six months ago, or dragging their feet rather than lifting them clearly off the ground.
Avoiding stairs: Making excuses to stay on one floor, or gripping the railing with both hands while ascending or descending.
Unexplained bruises: Marks on arms, legs, or hips that they brush off or cannot explain. These often indicate near-falls or minor falls they have not reported.
Declining invitations to go out: Turning down social engagements, errands, or outings they previously enjoyed. Fear of falling in public is a common but unspoken concern.
Difficulty rising from chairs: Needing to push off armrests, rocking forward for momentum, or avoiding low seating entirely.
Medication changes: New prescriptions for blood pressure medications, sedatives, antidepressants, or sleep aids. These are classified as Fall-Risk-Increasing Drugs (FRIDs) and can significantly affect balance and alertness.

If you recognize two or more of these signs, a structured fall risk assessment is warranted. The following sections walk you through exactly how to do one.

How to Screen for Fall Risk at Home Using the CDC STEADI Method

The CDC’s STEADI (Stopping Elderly Accidents, Deaths & Injuries) initiative provides the most widely used fall risk screening framework in the United States. It was developed for healthcare providers, but the initial screening steps are simple enough for any family caregiver.

Start with three questions. The CDC recommends asking your parent:

“Have you fallen in the past year?”
“Do you feel unsteady when you are standing or walking?”
“Do you worry about falling?”

A “yes” to any one of these questions indicates increased fall risk and signals the need for a more thorough evaluation.

For a deeper self-assessment, the CDC’s “Stay Independent” questionnaire uses 12 yes-or-no questions covering fall history, medication use, assistive device needs, and emotional concerns about falling. A score of four or higher identifies the person as being at elevated risk. You can complete this questionnaire together during a visit, or even over the phone if you are caring for a parent from a distance.

Online option: The Falls Free CheckUp tool, developed by the National Council on Aging, offers a digital version of this screening. It takes about five minutes and categorizes risk as normal or elevated. This is particularly useful for remote caregivers who want to walk a parent through an initial assessment by phone.

3 Simple Fall Risk Tests You Can Do at Home Today

Beyond the screening questionnaire, three validated physical tests give you measurable data about your parent’s balance, mobility, and lower body strength. You do not need any special equipment. A chair, a stopwatch (your phone works), and a clear 10-foot walking path are all you need.

Important safety note: Stand close enough to steady your parent if they lose their balance during any of these tests. Have them wear their usual shoes. Do not attempt these tests if your parent is feeling unwell or dizzy.

Timed Up and Go (TUG) Test

Ask your parent to sit in a standard armless chair. On your signal, they should stand up (without using their hands if possible), walk 10 feet at their normal pace, turn around, walk back to the chair, and sit down. Time the entire sequence with a stopwatch.

How to interpret results: A time of 13.5 seconds or more suggests higher fall risk and mobility issues that should be discussed with a doctor or physical therapist. A 2014 systematic review and meta-analysis found that this cutpoint had a pooled specificity of approximately 0.74, meaning it is moderately effective at identifying individuals who are not at risk, though its sensitivity is lower.⁹ The TUG test works best as one piece of a larger assessment, not as a standalone predictor.

30-Second Chair Stand Test

Using a chair without arms, have your parent sit in the middle of the seat with feet flat on the floor and arms crossed over their chest. Time them for 30 seconds and count how many times they come to a full standing position and sit back down.

This test measures lower body strength, one of the strongest predictors of fall risk. Compare their score to the age- and gender-based norms available in the CDC STEADI materials. Generally, fewer than 8 stands for someone aged 75-79 indicates below-average leg strength.

4-Stage Balance Test

Ask your parent to hold four progressively challenging positions for 10 seconds each:

Feet side by side (easiest)
Instep of one foot touching the big toe of the other
Tandem stance: one foot directly in front of the other, heel to toe
Single-leg stand: standing on one foot

Inability to hold the tandem stance (position 3) for a full 10 seconds is a clinically significant indicator of poor balance. Stand beside your parent with your hands ready to provide support during these tests.

Room-by-Room Home Safety Assessment Checklist

Environmental hazards account for an estimated 30 to 50 percent of all falls among older adults.¹⁰ A systematic walk-through of your parent’s home can identify and eliminate many of these hazards in a single afternoon. Here is what to look for in each area.

Living Areas and Hallways

Remove loose rugs, runners, and floor mats, or secure them with double-sided tape
Clear walking paths of electrical cords, newspapers, shoes, and pet toys
Ensure all rooms have adequate lighting, including bright overhead lights and easily accessible switches
Verify that furniture is stable enough to lean on (wobbly end tables are a common hazard)
Install night lights along frequently traveled hallways

Bathroom

The bathroom is the highest-risk room in the home. Wet surfaces, hard edges, and the physical demands of sitting and standing make it a fall zone.

Install grab bars inside and outside the tub or shower, and next to the toilet
Place non-slip mats in the tub or shower and on the bathroom floor
Consider a shower chair or transfer bench for seated bathing
Add a raised toilet seat if your parent struggles to rise from a standard height
Keep a clear, well-lit path from the bedroom to the bathroom

Bedroom and Nighttime Safety

Nighttime bathroom trips are the single most common fall scenario reported by caregivers. Seniors wake up disoriented, rush to the bathroom in the dark, and trip over obstacles they cannot see. Bed height plays a critical role here. A bed that is too high forces a longer, more precarious step down; a bed that is too low makes standing up difficult.

The SonderCare Aura Premium Hospital Bed addresses this directly with its Hi-Lo adjustment system, which allows the bed platform to move from a FallSafe ultra-low position of just 10 inches (17 inches to mattress top) up to 39 inches for caregiver ergonomics during the day. The pre-programmed 21-inch transfer position provides the ideal height for safe bed-to-wheelchair or bed-to-standing transfers. For nighttime safety, the Underbed Auto-Nightlight ($219) provides motion-activated floor illumination that lights the path the moment your parent’s feet touch the floor, without requiring them to fumble for a light switch.

If you are evaluating your parent’s bedroom for fall risk, also check for making a bedroom safe for an older adult. The bedroom assessment should include verifying that a lamp or light switch is within arm’s reach of the bed, that the path to the bathroom is completely clear of obstacles, and that the bed height allows your parent to sit on the edge with feet flat on the floor and knees at a 90-degree angle.

Medical Causes of Falls Families Often Miss

Many caregivers focus exclusively on environmental hazards, the loose rugs and poor lighting, while overlooking medical factors that may be the primary contributors to their parent’s fall risk. A thorough fall risk assessment must evaluate both.

Medications are a major culprit. Fall-Risk-Increasing Drugs (FRIDs) include sedatives, benzodiazepines, antidepressants (especially SSRIs), blood pressure medications that cause dizziness upon standing (orthostatic hypotension), anti-epileptics, and even over-the-counter sleep aids containing diphenhydramine. A professional medication review can identify drugs that increase fall risk. Many pharmacists will perform this review at no charge if you bring a complete medication list, including supplements and over-the-counter products.

Other medical factors to discuss with your parent’s doctor include:

Vision changes: Cataracts, glaucoma, and macular degeneration all reduce depth perception and hazard detection. First-eye cataract surgery alone has been shown to reduce falls by approximately one-third.¹¹
Muscle wasting (sarcopenia): Age-related loss of muscle mass and strength is one of the strongest predictors of falls. It accelerates with inactivity, creating a vicious cycle.
Orthostatic hypotension: A drop in blood pressure when moving from sitting to standing, causing lightheadedness. Common with blood pressure medications.
Peripheral neuropathy: Reduced sensation in the feet, often associated with diabetes, makes it harder to feel the ground and maintain balance.
Cognitive decline: Even mild cognitive impairment affects the ability to process environmental hazards and react to balance challenges.

When to Request a Professional Fall Risk Assessment

Your at-home assessment provides valuable initial data. But if your parent scored positive on the STEADI screening, took longer than 13.5 seconds on the TUG test, or has fallen in the past year, a professional assessment is the recommended next step.

An Occupational Therapist (OT) can conduct a comprehensive home safety assessment, identifying hazards you may have missed and recommending specific modifications. Research shows that OT-led home modifications can reduce falls by 30 to 40 percent in high-risk individuals.¹² A Physical Therapist (PT) can perform a detailed gait and balance evaluation and prescribe an individualized exercise program targeting your parent’s specific weaknesses.

To request a professional assessment, ask your parent’s primary care doctor for a referral. Medicare and most private insurance plans cover PT and OT visits when ordered by a physician. When you speak with the healthcare team, share the results of your at-home screening: “Mom scored positive on two of the three STEADI questions, and her TUG time was 16 seconds.” This gives the clinical team a concrete starting point.

For broader home safety modifications that go beyond fall risk, including doorway widening, ramp installation, and bathroom renovations, see our guide to aging in place home modifications.

Your Fall Prevention Action Plan: What to Do After the Assessment

Assessment without action does not reduce risk. Once you have identified your parent’s specific risk factors, here is how to address them.

Start an Evidence-Based Exercise Program

Exercise is the single most effective fall prevention intervention supported by research. The Otago Exercise Program, a structured home-based regimen of lower-limb strengthening and balance exercises, has been shown to reduce falls by 23 to 40 percent.¹³ Tai Chi programs, particularly Tai Ji Quan: Moving for Better Balance, reduce falls by 31 to 58 percent, making it one of the most effective interventions available.¹⁴ Both programs are typically delivered with initial instruction from a physical therapist, followed by regular home practice.

Maria, a registered nurse in Philadelphia, started attending Tai Chi classes with her 81-year-old mother after their at-home fall risk assessment revealed significant balance deficits. Within three months, her mother’s TUG test time improved from 17 seconds to 12 seconds. More importantly, her mother’s confidence returned. She stopped gripping furniture while walking and resumed her weekly grocery shopping trips independently.

Make Targeted Home Modifications

Act on the specific hazards you identified during your room-by-room walk-through. Prioritize the bathroom (grab bars, non-slip surfaces) and the bedroom-to-bathroom nighttime pathway (lighting, clear path, appropriate bed height). Research demonstrates that comprehensive home safety interventions can reduce hospital readmissions by up to 39 percent.¹⁵

For families where bed height and nighttime transfers are a concern, the SonderCare Aura Premium Hospital Bed provides a measurable safety advantage. Its FallSafe ultra-low position brings the sleeping surface to just 17 inches from the floor (with mattress), comparable to a low futon. During the day, the Hi-Lo system raises the bed to a comfortable height for sitting, standing, and caregiver assistance. The bed is certified to International Hospital Standard, carries a 500 lb weight capacity, and includes Multi-Height Assist Rails. Combined with the Underbed Auto-Nightlight for motion-activated pathway illumination, the bedroom becomes significantly safer during those vulnerable nighttime hours.

Schedule Key Appointments

Primary care doctor: Share your assessment findings and request medication review
Physical therapist: For gait/balance evaluation and exercise prescription
Eye doctor: Annual eye exam; address cataracts, glaucoma, or vision changes
Pharmacist: Free medication fall-risk review (bring the full medication list)
Podiatrist: Foot problems and improper footwear contribute to falls more than most families realize

Address Footwear and Daily Habits

Discourage your parent from walking in socks, loose slippers, or bare feet. Well-fitting shoes with non-slip soles, worn inside the house, provide significantly better traction and stability. Encourage your parent to take their time when standing up, especially first thing in the morning or after sitting for a long period, to allow blood pressure to stabilize.

For a comprehensive approach to fall prevention that covers equipment, exercise, environment, and emergency planning, visit our fall prevention guide for seniors at home.

Taking the First Step

A fall risk assessment is not a one-time event. Your parent’s risk profile will change as their health, medications, and living situation evolve. Reassess every six months, after any new medication, after any fall or near-fall, and after any significant health change.

The fact that you are reading this article means you have already noticed something. Maybe it is the furniture-surfing, the slower pace, or the way your parent hesitates at the top of the stairs. That instinct matters. The tools in this guide transform that instinct into a structured, actionable assessment.

One in four older adults falls every year.¹ A proactive fall risk assessment is the single most important step you can take to make sure your parent is not one of them. Start with the three STEADI screening questions today. Time the TUG test this weekend. Walk through the house with fresh eyes. These small actions can prevent the fall that changes everything.

Have questions about how bed height and safety features can reduce fall risk at home? Speak with a SonderCare bed expert for personalized guidance on creating a safer bedroom environment.

References

Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System (BRFSS), 2020. 27.6% of U. S. adults aged 65+ reported one or more falls in the preceding 12 months, equating to approximately 14 million individuals.
National Council on Aging. “Falls Prevention Facts.” Based on CDC emergency department visit data for older adults.
Centers for Disease Control and Prevention. “Facts About Falls.” The age-adjusted fall death rate increased 41% from 55.3 per 100,000 in 2012 to 78.0 per 100,000 in 2021, with 38,742 fall deaths recorded.
Healthcare Cost and Utilization Project (HCUP), 2018. An estimated 2.4 million emergency department visits among adults aged 65+ were attributed to fall-related injuries.
Healthcare Cost and Utilization Project (HCUP), 2019. Over 290,000 hospitalizations for hip fractures among adults aged 65+ in the United States.
Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates SL. “The 1-Year Mortality of Patients Treated in a Hip Fracture Program for Elders.” Geriatric Orthopaedic Surgery & Rehabilitation. 2010;1(1):6-14.
Florence CS, Bergen G, Atherly A, et al. “The Medical Costs of Fatal and Non-Fatal Falls in Older Adults.” Total annual healthcare spending on non-fatal falls estimated at $80 billion in 2020.
Healthcare Cost and Utilization Project (HCUP), 2016-2018. Average inpatient visit cost: $18,658; average ED visit cost: $1,112 for fall-related injuries.
Barry E, Galvin R, Keogh C, Horgan F, Fahey T. “Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis.” BMC Geriatrics. 2014;14:14. Pooled specificity of 0.74 at the 13.5-second cutpoint.
Lord SR, Menz HB, Sherrington C. “Home environment risk factors for falls in older people and the efficacy of home modifications.” Age and Ageing. 2006;35(suppl 2): ii55-ii59.
Harwood RH, Foss AJ, Osborn F, Gregson RM, Zaman A, Masud T. “Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial.” British Journal of Ophthalmology. 2005;89(1):53-59.
Clemson L, Mackenzie L, Ballinger C, Close JC, Cumming RG. “Environmental interventions to prevent falls in community-dwelling older people: a meta-analysis of randomized trials.” Journal of Aging and Health. OT-led home modifications shown to reduce falls by 30-40% in high-risk populations.
Thomas S, Mackintosh S, Halbert J. “Does the ‘Otago Exercise Programme’ Reduce Mortality and Falls in Older Adults?” A 2025 meta-analysis confirmed fall reduction of 23-40% with significant improvements in TUG test performance.
Li F, Harmer P, Fitzgerald K, et al. “Tai Ji Quan: Moving for Better Balance.” Reduces falls by approximately 31-58%; recognized as one of the most effective exercise interventions for fall prevention.
Aging in Place Modifications research data. Home safety interventions demonstrated reduction in hospital readmissions by up to 39%.