More than one-third of adults over the age of 65 fall each year. This past month, my family experienced that statistic firsthand through the passing of a family member. It opened my eyes up to how severe and frequent these situations are.

Thinking back through my childhood, I can recall multiple fall incidences involving many members of my family, and I’m sure many of you can relate. With an aging population that is growing by the day, it is important for all designers—from residential to healthcare—to understand the impact that their designs can have on minimizing this risk. After all, the majority of patient falls can lead to premature death.

Patient falls can stem from many factors, including reduced hip and leg strength, flooring surfaces, and vision impairments. And falls can happen anywhere. Today, I’d like to focus on residential and healthcare settings and how we as designers can help to improve these statistics.

With more and more older adults wishing to stay in their home environment as long as possible, it is important to be in an environment that is as safe as possible. Things to consider in residential design include steps such as the following: remove loose mats, provide contrast on steps and curbs, improve lighting, install grab bars, and check for any irregularities in layout (La Grow, It is, however, important to be aware of the client’s use of and circulation in the space. Perhaps a chair is used for temporary support while he or she is walking across the room. Careful observation and discussion should take place before making any drastic changes. Many older adults, especially those with vision impairments, rely on memory of the composition of the room. So, if that chair is gone and he or she gets up in the middle of the night, there could be a fall incident. Along the same lines, unstable furniture is also another risk factor to be mindful of.

Around 10% of all falls occur in a healthcare facility (Barach), and most falls in healthcare facilities occur when patients are trying to get to the bathroom. By allowing for larger patient rooms that accommodate family members who are able to assist the patient, the number of falls reduces.

Other factors to consider are the proximity of the bathroom to the bedside, appropriate lighting and lighting sensors, carpeting, and the nursing floor layout. Some studies, including those by Ulrich and Barach, suggest that clustering patient rooms close together and decentralizing nurse stations can drastically reduce the number of falls since nurse visibility is then increased.

The single-bed room layout is both a blessing and a curse in this issue—good in that with more room to accommodate family and visitors, extra hands are around to assist. However, it is not a beneficial situation when those family members are gone and, in fact, the majority of falls happen when the person is alone and unassisted. Although a design solution may not be a cure-all to the problem, it’s important for designers to take steps to reduce the probability as much as possible.

These solutions only begin to scratch the surface of steps that can be taken to reduce falls, and as outlined in the Gulwadi article, many other environmental features can influence falls. The relationship of the environment and patient falls is an area that still needs to be researched more in-depth, but some studies, such as the La Grow study, show more than 50% of falls occur due to an environmental factor. With our decisions impacting these situations, it is important to provide our clients and end-users with spaces that address the risk factors. After all, our hospitals and homes should be safe havens, not safety hazards.

1. Barach, P. (2008). The Impact of Environmental Design on Patient Falls. Healthcare Design, 8(11): 64-70.
2. Gulwadi, G.B., Keller, A.B. (2009). Falls in Healthcare Settings. Healthcare Design, 9(7): 28-34.
3. La Grow, S.J., Robertson, M.C., Campbell, A.J., Clarke, G.A., Kerse, N.M. (2006). Reducing hazard related falls in people 75 years and older with significant visual impairment: How did a successful program work? Injury Prevention, 12(5): 296-301. Available online at:
4. Ulrich, R., Quan, X., Zimring, C., Joseph, A., Choudhary, R. (2004). The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity. Report to The Center for Health Design for the Designing the 21st Century Hospital Project. Available online at: