What are the risk factors for falls in the hospital?

October 2, 2025 •

4 min read

According to the Agency for Healthcare Research and Quality, between 700,000 and 1,000,000 patient falls occur in U.S. hospitals annually. Understanding what are the risk factors for falls in the hospital? is a critical first step toward effective prevention and enhanced patient safety.

Quick Summary

Falls in a hospital are driven by a complex interplay of a patient's health status, known as intrinsic factors, and the hospital environment, or extrinsic factors. Acknowledging these potential threats is paramount for healthcare providers and patients alike to mitigate the risk and avoid injury.

Key Points

Intrinsic vs. Extrinsic Factors: Risk factors for hospital falls fall into two categories: intrinsic (patient-related, such as age and illness) and extrinsic (environmental, like clutter and poor lighting).
Medication Awareness: Many medications, especially psychoactive drugs and blood pressure medication, can increase fall risk due to side effects like dizziness and confusion.
Comprehensive Assessment: Effective fall prevention relies on a multifactorial approach, beginning with a thorough risk assessment upon admission to identify a patient's specific vulnerabilities.
Environmental Control: Modifying the hospital environment by addressing trip hazards, improving lighting, and ensuring equipment is properly used is a highly effective prevention strategy.
Proactive Communication: Both healthcare staff and patients/families must be proactive in communicating needs and concerns regarding mobility and safety to minimize fall risk.
Advanced Age is a Major Risk: Advanced age is a primary intrinsic risk factor, with age-related changes in muscle strength, balance, and vision all contributing to an increased likelihood of falls.

The Serious Impact of Hospital Falls

Falls are the most frequently reported safety incident in acute healthcare settings and can have devastating consequences. Beyond the immediate physical injuries, such as fractures and head trauma, falls can lead to psychological distress, increased fear of falling, delayed recovery, and longer hospital stays. Preventing these events requires a comprehensive approach that addresses the multiple underlying causes.

Intrinsic Risk Factors: The Patient's Condition

Intrinsic risk factors are those inherent to the patient and their current health status. They represent the patient's physical and cognitive vulnerability, which can be amplified in the unfamiliar and often stressful hospital setting.

Age and Physiological Changes

Advanced age is one of the most consistently identified risk factors for inpatient falls, particularly for those over 85. Age-related physiological changes contribute significantly:

Muscle weakness and deconditioning, which can occur rapidly during a hospital stay.
Gait and balance problems, making it harder to move safely.
Changes in vision, including cataracts or glaucoma, which can lead to misjudging distances or obstacles.

History of Falls

A previous fall is a strong predictor of a future fall, indicating a potential underlying issue with balance or mobility. Repeat falls can signal an ongoing problem that requires careful assessment.

Medical Conditions and Acute Illness

Many chronic and acute medical conditions increase fall risk. These include:

Neurological conditions: Stroke, dementia, delirium, and Parkinson's disease can affect coordination, judgment, and awareness.
Cardiovascular issues: Orthostatic hypotension (a drop in blood pressure when standing) can cause dizziness and fainting.
Incontinence or urinary urgency: A patient rushing to the toilet is at a higher risk, especially in an unfamiliar bathroom setup.
Pain: Can impair mobility and concentration.

Extrinsic Risk Factors: The Hospital Environment

Extrinsic risk factors are external to the patient and related to the environment. While intrinsic factors can't always be eliminated, many extrinsic risks are modifiable and can be controlled by hospital staff and design.

Environmental Hazards

The hospital room and surrounding areas can present numerous tripping hazards:

Clutter: Loose equipment, cables, and personal items in walkways.
Lighting: Inadequate or poor lighting, especially at night or in restrooms.
Flooring: Wet or slippery floors from spills, uneven surfaces, or transitions between different flooring types.
Equipment: The unfamiliarity of hospital beds, wheelchairs, and IV poles can increase the risk of entanglement and falls.

Medications and Polypharmacy

Medications are a significant extrinsic risk factor, as they can have side effects that impact a patient's balance, alertness, and cognitive function. The risk is compounded by polypharmacy, or the use of multiple medications simultaneously.

Some high-risk medications include:

Psychoactive drugs: Such as sedatives, hypnotics, and antipsychotics, which can cause drowsiness and confusion.
Cardiovascular medications: Blood pressure drugs that can cause a drop in blood pressure when standing.
Diuretics: These increase the urge to urinate, causing patients to rush to the bathroom.
Opioid analgesics: Can cause sedation and dizziness.

Comparison of Intrinsic and Extrinsic Risk Factors

Understanding the distinction between intrinsic (patient-specific) and extrinsic (environmental) factors is key to developing effective prevention strategies.


Feature	Intrinsic Risk Factors	Extrinsic Risk Factors
Nature	Internal to the patient	External to the patient
Examples	Age, recent fall, cognitive state, comorbidities, certain medications	Environmental hazards, staffing levels, communication failures, bed height
Modifiability	Often less modifiable (e.g., age or dementia), but effects can be managed	Highly modifiable (e.g., controlling clutter, improving lighting)
Assessment	Evaluated during patient history and physical exam	Assessed through environmental safety rounds and staff protocols
Focus of Prevention	Patient monitoring, targeted interventions (e.g., mobility assistance)	Environmental changes, staff training, consistent communication

A Multifactorial Approach to Fall Prevention

Because falls are rarely caused by a single issue, a multifactorial assessment and intervention program is the most effective prevention strategy. This involves:

Thorough Patient Assessment: On admission, healthcare staff should conduct a comprehensive fall risk assessment. This includes a review of the patient's medical history, current medications, mobility status, and cognitive function.
Individualized Care Plans: Based on the assessment, a personalized care plan is developed. This might include regular toileting assistance, specific mobility aids, or medication adjustments.
Environmental Modifications: Creating a safer environment involves ensuring the bed is in a low position with locked wheels, placing personal items and the call light within reach, and maintaining clear pathways.
Staff Training: Educating staff on fall prevention protocols, effective communication strategies, and the importance of responding promptly to patient calls is vital.
Patient and Family Education: Empowering patients and their families with information about fall risks and prevention strategies helps create a vigilant safety culture.

The Role of Technology in Prevention

In addition to traditional methods, technology is increasingly used to mitigate fall risks. Bed or chair alarms, motion sensors, and smart socks can alert staff to a patient attempting to get up unassisted. However, these are tools, not replacements for attentive, patient-centered care.

Your Part in Ensuring Safety

As a patient or family member, you play a crucial role in preventing falls. Don't hesitate to speak up about concerns and communicate your needs clearly. Asking for help, especially for activities like getting out of bed or using the restroom, is a sign of prudence, not weakness.

Conclusion

Understanding what are the risk factors for falls in the hospital? is an essential part of ensuring patient safety. Falls are a complex issue resulting from a combination of individual vulnerabilities and environmental hazards. By implementing a comprehensive, multifactorial approach that includes thorough risk assessment, individualized care plans, environmental modifications, and technology, healthcare providers can significantly reduce the incidence of falls. Patient and family involvement in this process is paramount. Staying informed and proactive is the best way to prevent falls and promote a quicker, safer recovery. For more information on fall prevention, consult resources like the Centers for Disease Control and Prevention.

Frequently Asked Questions

Intrinsic risk factors are patient-specific characteristics that increase fall risk. These include advanced age, a history of previous falls, muscle weakness, gait and balance problems, poor vision, cognitive impairment (such as dementia or delirium), and certain medical conditions like stroke or orthostatic hypotension.

Extrinsic risk factors are related to the hospital environment. They include environmental hazards like slippery floors, inadequate lighting, clutter, incorrect bed height, and improperly functioning or placed equipment like wheelchairs or IV poles. Organizational factors, such as staffing levels and response times, also play a role.

Many medications can increase fall risk. Psychoactive drugs (sedatives, hypnotics, antipsychotics) can cause drowsiness and confusion. Blood pressure medications can cause orthostatic hypotension, or a drop in blood pressure when standing, leading to dizziness. Polypharmacy, the use of multiple medications, also heightens risk.

Cognitive impairments, such as dementia or delirium, significantly increase fall risk. Patients may forget their physical limitations, be disoriented in their surroundings, or have impaired judgment, leading them to attempt to get up without assistance.

Patients and families can help by being proactive. This includes using the call button for assistance, ensuring personal items are within easy reach, wearing non-slip socks, and communicating any concerns about dizziness, weakness, or medication side effects to the healthcare team.

While fall risk assessment tools like the Morse Fall Scale or Hendrich II are used to identify patients at higher risk, studies show they are not always sensitive enough to prevent all falls. The most effective approach is a comprehensive, multifactorial intervention based on the patient's individual needs rather than relying solely on a score.

Following a fall, hospitals conduct an investigation to understand the contributing factors and determine if injuries occurred. This often involves a root cause analysis to identify systemic issues and prevent future incidents. The patient's care plan is re-evaluated to address the identified risks.