Why is the post-hospital discharge period particularly high risk for falls?

The period immediately following hospital discharge is one of the highest-risk periods for falls in older adults for several reasons. During a hospital stay, physical deconditioning occurs rapidly: even a few days in bed causes muscle weakness, reduced cardiovascular fitness, and balance deterioration. The person returns home physically weaker than when they left. Medications are often changed in hospital: new medications, changed doses, or different timing of existing medications can cause dizziness, orthostatic hypotension (blood pressure drop on standing), or sedation that were not present before admission. The home environment has not changed but the person's function has: a bathroom that was previously manageable may now require grab rails or a shower chair that were not there before. Fatigue from the illness, surgery, or hospitalisation itself reduces the person's capacity to manage unexpected challenges to balance. The first two weeks at home are the highest-risk window.

What is an occupational therapy home safety assessment for falls prevention?

An occupational therapy home safety assessment evaluates the person's home environment and their ability to perform daily tasks safely given their current functional level. The OT visits the person at home and assesses: entry and exit safety (steps, handrails, paths); bathroom safety (shower, bath, toilet transfers, grab rails, non-slip surfaces); bedroom safety (bed height, transfer space, lighting); kitchen safety; flooring (rugs, thresholds, cords); lighting adequacy; and the person's actual performance of key tasks (getting up from a chair, walking to the bathroom, showering). The OT prescribes modifications and equipment based on the assessment findings. Minor modifications such as grab rail installation and removal of rugs are typically actioned quickly; major modifications such as ramp installation take longer. The assessment is funded through My Aged Care (for people 65 and over) and NDIS (for eligible participants).

What medications commonly increase falls risk?

Several medication classes significantly increase falls risk through effects on blood pressure, balance, sedation, and cognition. High-risk medication classes include: sedatives and sleep medications (benzodiazepines, Z-drugs such as zopiclone); antipsychotics; antidepressants (particularly tricyclics and some SSRIs); strong pain medications (opioids, tramadol); blood pressure medications, particularly if causing orthostatic hypotension (dizziness when standing); diuretics (water tablets, which cause dehydration and electrolyte changes); some heart medications (digoxin, some antiarrhythmics); anti-seizure medications; and medications with anticholinergic effects. People taking four or more medications have a substantially elevated falls risk compared to those taking fewer (polypharmacy). After hospital discharge, a medication review by the GP, pharmacist, or a geriatrician is an important falls prevention measure. In Australia, a Home Medicines Review (HMR) by a pharmacist is a government-funded service available to eligible patients.

What strength and balance exercises reduce falls risk?

Strength and balance training is the most evidence-based falls prevention intervention for older adults. The evidence from systematic reviews and randomised controlled trials is clear: structured programs that include specific balance challenges and lower limb strengthening reduce both the rate of falls and the proportion of people who fall. Effective programs include: the Otago Exercise Programme, a home-based program of leg strengthening and balance exercises shown to reduce falls by approximately 35%; Tai Chi, which has strong evidence for falls reduction in community-dwelling older adults; group-based balance and strength training programs (e.g., Stepping On, Stay on Your Feet); and individually prescribed physiotherapy exercise programs. The key features of effective programs are: they include specific balance challenge (not just general exercise); they include lower limb strength training; they are regular (at least 2 to 3 times per week); and they progress in difficulty over time. A physiotherapist prescribes and teaches the exercises, then the person continues independently or in a group program.

How does My Aged Care fund falls prevention services?

My Aged Care is the government portal for accessing aged care services for people 65 and over in Australia. For falls prevention, My Aged Care funds: occupational therapy home safety assessments and home modifications through the Support at Home program; physiotherapy for strength and balance programs; community nursing for medication management and review; and home support workers for daily assistance reducing falls risk (help with showering, dressing, and activities where falls risk is elevated). Access requires an ACAT (Aged Care Assessment Team) or RAS (Regional Assessment Service) assessment. The ACAT assessment can often be initiated from hospital before discharge; the hospital social worker or discharge coordinator assists with this. If no assessment was done before discharge, calling My Aged Care on 1800 200 422 initiates the process. Wait times for My Aged Care funding can be significant; interim private funding may be needed while waiting.

What is orthostatic hypotension and why does it cause falls?

Orthostatic hypotension (also called postural hypotension) is a drop in blood pressure that occurs when a person stands up from sitting or lying down. In healthy adults, the cardiovascular system compensates for position changes within seconds; in people with orthostatic hypotension, this compensation is inadequate, causing a transient drop in blood pressure to the brain. This produces dizziness, lightheadedness, blurring of vision, and a feeling of unsteadiness that lasts several seconds to minutes after standing. Falls caused by orthostatic hypotension typically occur within 30 seconds to 3 minutes of standing. Risk factors for orthostatic hypotension include: blood pressure medications; dehydration; prolonged bed rest (which occurs during hospitalisation); cardiac conditions; Parkinson's disease; and diabetes. Management includes: reviewing and adjusting blood pressure medications with the GP; adequate hydration; rising slowly from sitting (pause at the edge of the bed before standing); compression stockings; and timing of blood pressure medication.

What equipment reduces falls risk in the bathroom?

The bathroom is the highest-risk room for falls in the home. Equipment that reduces bathroom falls risk includes: grab rails beside the toilet (to assist with sit-to-stand) and in the shower (to provide a fixed handhold during showering); a non-slip mat in the shower or bath; a shower chair or shower stool (allows showering while seated, eliminating the standing balance demand); a raised toilet seat (reduces the knee and hip extension required to stand from the toilet); a bath board (spans the bath for a seated entry and exit); a hand-held shower rose (allows showering while seated without needing to move under the fixed shower head); and a long-handled shower brush and sponge (reduces the need to bend). An OT prescribes specific equipment based on the assessment of the person's transfers and shower ability. Installation of grab rails requires appropriate wall studs or toggle bolts; some funding programs cover installation separately from equipment.

What should family members do to support falls prevention at home?

Family members play an important role in falls prevention, particularly in the weeks immediately following hospital discharge. Key actions for family: ensure the OT home assessment happens quickly after discharge and that recommended modifications are made promptly; remove identified hazards (loose rugs, extension cords, items on the floor) before the person comes home; ensure the home is well-lit, including nightlights for nocturnal trips to the bathroom; check that the person's medications are organised and that they understand any changes made during the hospitalisation; attend the physiotherapy appointment if possible, so family members also know the prescribed exercises and can encourage completion; ensure the person has an emergency call device or personal alarm that they actually wear; and report any new falls or near-falls to the GP promptly. Families should resist the urge to reduce the person's activity excessively after a fall or near-fall: physical activity is protective against future falls; excessive restriction leads to deconditioning that increases risk.

Falls Prevention After Hospital Discharge: Home Assessment and Rapid Provider Referral Checklist

Key Points

The two weeks immediately following hospital discharge are the highest-risk period for falls: the person returns home physically weaker, on potentially changed medications, into an unchanged environment that may no longer be safe for their current function
An OT home safety assessment is the highest-priority falls prevention intervention after discharge; it should occur in the first week at home where possible; fund this privately if My Aged Care is not yet in place
Medication review by a GP, pharmacist, or geriatrician after discharge identifies falls-risk medications; a government-funded Home Medicines Review (HMR) is available to eligible patients
Structured strength and balance programs (Otago Exercise Programme, Tai Chi) reduce falls rates by approximately 35%; physiotherapy prescription is the starting point
Orthostatic hypotension causes falls in the first minutes after standing; rising slowly, adequate hydration, and medication review address this
My Aged Care (1800 200 422) funds OT, physiotherapy, and home support for falls prevention; initiate the ACAT assessment from hospital if possible; private interim funding may be needed while waiting

Falls After Hospital Discharge: Acting Quickly

Falls after hospital discharge are not inevitable, but the risk is real and the window for prevention is short. The first two weeks at home are the highest-risk period, and the most effective interventions need to be in place before the first fall happens, not in response to it.

This guide provides a practical, actionable framework for families, support workers, and the people themselves who are returning home after a hospitalisation and want to reduce falls risk. It covers the home assessment, medication review, exercise, bathroom safety, equipment, and the providers involved in rapid falls prevention support.

Understanding Why Falls Risk Is Elevated After Discharge

Physical Deconditioning

Hospitalisation causes rapid physical deconditioning. Research shows that older adults lose muscle strength measurably after even 2 to 5 days of bed rest. Balance, which depends on muscle strength, proprioception, and cardiovascular response, deteriorates in parallel. The person who could safely transfer from the shower at home before they went to hospital may now find the same task more difficult.

Medication Changes

Hospital admissions typically involve medication changes: new medications added, existing medications adjusted, some stopped. Many medications with falls-risk potential are started or changed in hospital:

Sedatives and sleep aids for pain or anxiety during the admission
Increased doses of blood pressure medications
New opioid pain medications
Altered heart medications

These changes may not have been assessed for their falls risk implications by the time the person is discharged.

Environmental Mismatch

The home environment has not changed while the person was in hospital. But the person has. The bathroom that was safe for them at their pre-hospital function level may now require grab rails or a shower chair. The step at the front door that was manageable before may now be a significant hazard. This mismatch between changed function and unchanged environment is one of the most predictable and preventable causes of post-discharge falls.

Fatigue

Illness, surgery, and the disruption of hospitalisation cause significant fatigue. Fatigue reduces attention, slows reaction time, and decreases the physical reserves needed to recover from a stumble. The first weeks at home are often exhausting.

Rapid Provider Checklist: Week by Week

Before Discharge (in Hospital)

Ask the discharge team:

Has an OT home safety assessment been arranged? If not, request one.
Have all medication changes been documented in a single updated medication list?
Has a physiotherapy referral been made for strength and balance after discharge?
Has an ACAT or RAS assessment been initiated for My Aged Care (if 65 and over)?
Are home support workers arranged for the first week at home?
Has a follow-up GP appointment been booked within 1 to 2 weeks of discharge?

Before the person arrives home:

Remove rugs from main walking areas
Ensure adequate lighting, including nightlights for the bathroom and hallway
Clear pathways of clutter, cords, and obstacles
Install a temporary non-slip mat in the shower if permanent equipment is not yet in place
Ensure medications are organised and the new list is accurate

Week 1 at Home

Priority 1: OT Home Safety Assessment

Book or arrange an OT home safety assessment within the first week. If My Aged Care funding is not yet in place, fund privately. The cost of a single OT home visit is substantially less than the cost of a fall.

The OT will assess:

Entry and exit safety (steps, paths, ramps)
Bathroom safety (shower, toilet, bath transfers)
Bedroom and living area safety
Flooring and lighting
The person’s actual performance of key transfers

The OT will recommend:

Equipment to be hired or purchased (shower chair, raised toilet seat, grab rails)
Modifications to be made (rail installation, ramp, lighting)
Strategies for specific high-risk tasks

Priority 2: GP Medication Review

Book a GP appointment within the first two weeks to:

Review all medications for falls risk
Request a Home Medicines Review (HMR) referral to a pharmacist
Assess for orthostatic hypotension (measure blood pressure sitting and standing)
Ensure chronic conditions are being managed appropriately

Priority 3: Support Worker Rostered

A support worker for showering, dressing, and high-risk daily tasks provides an additional safety layer in the first weeks while function is still recovering. Support workers must be briefed on the person’s specific falls risk and the falls prevention strategies in place.

Weeks 2 to 4

Physiotherapy: Strength and Balance Program

Arrange a physiotherapy appointment to prescribe a strength and balance exercise program. The physiotherapist:

Assesses current strength, balance, and functional mobility
Prescribes a home exercise program (commonly the Otago Exercise Programme or a tailored variant)
Reviews the program after 2 to 4 weeks and progresses appropriately
Identifies whether a group-based program (Tai Chi, gym-based strength program) is appropriate

The program should be prescribed within the first 2 to 3 weeks of discharge; every week of delay is a week where deconditioning continues and risk remains elevated.

Community Group Programs

Once initial physiotherapy exercises are established:

Stepping On: an evidence-based community falls prevention program for older adults
Tai Chi classes: community or private; many community centres run sessions specifically for older adults
Gym-based strength programs with exercise physiologist supervision

The Bathroom: The Highest-Risk Room

The bathroom is where most home falls among older adults occur. It combines wet surfaces, limited handholds, awkward postures (getting in and out of the shower or bath), and often poor lighting.

Immediate Actions (Before Professional Assessment)

Place a non-slip mat inside the shower or bath
Remove items that require bending from the shower floor
Ensure there is at least one fixed object (towel rail, wall) to hold while stepping in and out

After OT Assessment

The OT will prescribe specific bathroom equipment based on the assessment. Common prescriptions:

Grab rails: The specific location, angle, and height of grab rails matters; an OT-prescribed installation is more effective than installing rails in approximate locations. Most rails are fitted to wall studs; hire a handyperson experienced with bathroom rail installation.

Shower chair or stool: Allows showering while seated. A shower chair has four legs and a back; a shower stool has no back and requires more balance. The OT determines which is appropriate. The person showers seated, using a hand-held shower rose.

Raised toilet seat: Fits over the existing toilet, raising the seat height by 5 to 10 cm. Reduces the knee extension required to stand, lowering falls risk during this common task.

Bath board: For people who need or choose to use a bath; the board spans the bath and allows a seated entry and exit rather than stepping over the bath wall.

Personal Alarms and Emergency Response

A personal alarm (also called a medical alert device or pendant alarm) is an important safety layer after discharge. If the person falls when alone, they need a way to call for help.

Types of personal alarm:

Pendant alarm: Worn around the neck or wrist; button pressed to connect to a monitoring centre that calls contacts or emergency services
Automatic fall detection: Some modern devices detect a fall automatically and send an alert without the person needing to press a button (useful if the person is unable to reach the button after a fall)
Smartwatch alerts: Some smartwatches include fall detection

Personal alarms are funded through My Aged Care and some NDIS plans. They are also available for private purchase or monthly subscription.

Provider Team for Falls Prevention

Provider	Action	When	Funding
OT	Home safety assessment; equipment; modifications	Week 1	My Aged Care, NDIS, private
GP	Medication review, orthostatic hypotension assessment	Week 1-2	Medicare
Pharmacist (HMR)	Home Medicines Review for falls-risk medications	Week 2-3	Medicare (HMR service)
Physiotherapist	Strength and balance program	Week 2-3	My Aged Care, NDIS, Medicare CDM
Exercise physiologist	Ongoing community exercise program	After initial physio	My Aged Care, NDIS
Community nurse	Monitoring, medication management, wound care if relevant	As needed	My Aged Care, NDIS
Support workers	Personal care, high-risk task assistance	Daily	My Aged Care, NDIS Core

Key Resources

My Aged Care - home support for people 65 and over including OT and physiotherapy (1800 200 422)
NDIS - disability support funding for eligible people under 65
Australian Commission on Safety and Quality in Health Care - clinical guidelines on falls prevention
Stepping On program - evidence-based community falls prevention program for older adults

Connecting with Falls Prevention Providers

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Andre Smith All articles

Co-founder & CEO

Andre is the co-founder and CEO of Carevo. He holds a Bachelor of Commerce, majoring in Marketing, and a Bachelor of Arts from UNSW Sydney, where his majors were International Relations, Politics, Information Systems, and Media and Communications, graduating in 2014, and went through the UNSW 10x Founders accelerator in 2023.

Falls Prevention After Hospital Discharge: Home Assessment and Rapid Provider Referral Checklist

Key Points

Falls After Hospital Discharge: Acting Quickly