Memory care and dementia
A memory-care unit fails differently from the rest of a building. The risks are elopement, disorientation, agitation that gets medicated instead of understood, and a physical environment that is working against the resident all day.
40 items in 10 categories. This is the source list, in full, in the order it is walked. Nothing is summarized away.
Wandering Prevention & Security
Category 14 of 54 · 6 items
- Secured entrances/exits to prevent wandering (e.g., locked doors with keypads)
- Alarm systems or monitoring devices at all exits
- Staff awareness of residents with high risk for wandering
- Enclosed outdoor areas safe for resident use
- Emergency exit doors equipped with alarms or security systems
- Clear signage and visual cues to help residents navigate the facility
Resident Safety for Cognitive Impairments
Category 15 of 54 · 6 items
- Elopement prevention plans in place for at-risk residents
- Rooms free of sharp objects or items that could cause harm
- Monitoring systems (e.g., cameras or staff checks) in place for high-risk residents
- Non-toxic, safe cleaning supplies used in resident areas
- Secure storage of medications, cleaning supplies, and hazardous materials
- Easily accessible emergency call systems in resident rooms
Environmental Comfort & Design
Category 16 of 54 · 6 items
- Bright, natural lighting to reduce confusion and anxiety
- Clearly marked rooms and common areas with large, easy-to-read signs
- Clocks, calendars, and daily schedules visible to residents
- Simple, calm decor (no excessive patterns or bright colors that may cause disorientation)
- Temperature control systems in place to maintain a comfortable environment
- Noise control measures in place to reduce agitation or confusion
Routine & Engagement
Category 17 of 54 · 4 items
- Safe, enclosed outdoor spaces for physical activity
- Daily activity schedule for cognitive stimulation and social interaction
- Adequate staff-to-resident ratio to ensure individualized attention
- Activities tailored to the cognitive abilities of residents
Fall Prevention
Category 18 of 54 · 4 items
- Non-slip flooring or carpets in resident rooms and common areas
- Low-rise beds with bed rails, if necessary
- Removal of clutter and potential tripping hazards from rooms and hallways
- Proper lighting in hallways and bathrooms, especially at night
Behavioral Support & De-escalation
Category 19 of 54 · 4 items
- Staff trained in dementia care and behavioral management techniques
- Quiet, designated spaces for residents to calm down if agitated
- Consistent daily routine to reduce confusion and behavioral issues
- Monitoring for sudden changes in behavior that may indicate distress or illness
Nutrition & Hydration
Category 20 of 54 · 4 items
- Adaptive eating utensils available for residents with motor challenges
- Regular hydration reminders and accessible water stations
- Nutritious, easy-to-eat meals designed for cognitive and physical abilities
- Assistance with feeding for residents who need it
Medication Management
Category 21 of 54 · 3 items
- Strict protocols for administering medications to avoid overmedication
- Medication logs updated daily for residents with cognitive impairments
- Staff trained to identify adverse reactions to medications in memory care patients
Dignity & Privacy
Category 22 of 54 · 3 items
- Respectful language and interactions with residents at all times
- Private areas for personal care (dressing, toileting) maintained
- Personal belongings and room decor that reflect the resident’s preferences and history
Where this sits
This is one of seven groups in the review. The safety review · all 54 categories.
What the evidence says reduces falls in a care facility
This is one of the few areas of long-term care with a large, current randomized evidence base, and it is worth reading it accurately rather than generically. The 2025 Cochrane review of falls prevention in care facilities pooled 104 randomized trials and 68,964 residents.
- Exercise. Active exercise probably reduces the rate of falls, rate ratio 0.68 (95% CI 0.51 to 0.91; 14 trials, 2,215 participants, moderate-certainty evidence). The same review reports high-certainty evidence that if the exercise is not sustained there is no effect (RaR 1.02, 95% CI 0.78 to 1.32). It is a program, not a course.
- Multifactorial programs, done properly. Multifactorial interventions overall showed little or no effect on fall rate (RaR 0.87, 95% CI 0.68 to 1.12). But those that were tailored to the individual resident and engaged staff probably produce a large reduction: RaR 0.61 (95% CI 0.54 to 0.69; 7 trials, 3,553 participants, moderate certainty). The difference between those two numbers is the difference between having a falls policy and running one.
- Vitamin D probably reduces the rate of falls, RaR 0.63 (95% CI 0.46 to 0.86; 5 trials, 4,603 participants) — but the review notes the population in those trials had low vitamin D levels.
- Hip protectors in nursing and residential care produce a small reduction in hip fracture risk, RR 0.82 (95% CI 0.67 to 1.00), an absolute effect of about 11 fewer hip fractures per 1,000 people (14 studies, 11,808 participants, moderate quality).
The finding most often reported the wrong way round
Medication review on its own does not reduce falls. The 2025 Cochrane review found medication optimization as a single intervention may make little or no difference to the rate of falls (RaR 0.92, 95% CI 0.75 to 1.13; 13 trials, 4,314 participants, low certainty). A dedicated 2022 systematic review of 49 randomized trials reached the same conclusion and said so directly: these interventions “should not be implemented as a stand-alone strategy in falls prevention but included in multimodal strategies.” A 2021 meta-analysis of five trials of withdrawing fall-risk-increasing drugs found no change in fall rate (RaR 0.98, 95% CI 0.63 to 1.51).
CareGuard is a deprescribing-minded organization and this cuts against the easy version of that argument, so it is stated plainly. Reducing medication burden is worth doing on its own terms — for cognition, for sedation, for anticholinergic load, for the resident’s day. It is not a falls program by itself, and any facility told otherwise is being sold something.
Which drug classes the association actually implicates
The association between medications and falls is nonetheless large and well characterized. Three companion meta-analyses covering 131, 248 and 281 studies report adjusted odds ratios for a fall of 2.02 for SSRIs (95% CI 1.85 to 2.20), 1.81 for long-acting benzodiazepines (1.05 to 3.16), 1.60 for opioids (1.35 to 1.91), 1.57 for antidepressants overall (1.43 to 1.74), 1.55 for antiepileptics (1.25 to 1.92), 1.54 for antipsychotics (1.28 to 1.85), 1.42 for benzodiazepines overall (1.22 to 1.65), 1.36 for loop diuretics (1.17 to 1.57), and 1.75 for polypharmacy itself (1.27 to 2.41).
In one Japanese cohort of 459 residents (mean age 87) with 645 falls over a year, medication was judged to have influenced around three-quarters of all falls, and more than 80% of those involved psychotropic drugs.
References
- Dyer SM, et al. 2025. Interventions for preventing falls in older people in care facilities. Cochrane Database of Systematic Reviews. [Cochrane review, 104 RCTs, 68,964 residents] · PMID 40832852 · doi:10.1002/14651858.CD016064
- Cameron ID, et al. 2018. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database of Systematic Reviews (9):CD005465. [Cochrane review, 95 trials, 138,164 participants] · PMID 30191554 · doi:10.1002/14651858.CD005465.pub4
- Seppala LJ, et al. 2022. Medication reviews and deprescribing as a single intervention in falls prevention: a systematic review and meta-analysis. Age and Ageing 51(9):afac191. [systematic review and meta-analysis, 49 RCTs] · PMID 36153749 · doi:10.1093/ageing/afac191
- Lee J, et al. 2021. Deprescribing fall-risk increasing drugs (FRIDs) for the prevention of falls and fall-related complications: a systematic review and meta-analysis. BMJ Open 11(2):e035978. [systematic review and meta-analysis, 5 RCTs] · PMID 33568364 · doi:10.1136/bmjopen-2019-035978
- de Vries M, et al. 2018. Fall-risk-increasing drugs: a systematic review and meta-analysis. I. Cardiovascular drugs. Journal of the American Medical Directors Association 19(4):371.e1-371.e9. [meta-analysis, 131 studies] · PMID 29396189 · doi:10.1016/j.jamda.2017.12.013
- Seppala LJ, et al. 2018. Fall-risk-increasing drugs: a systematic review and meta-analysis. II. Psychotropics. Journal of the American Medical Directors Association 19(4):371.e11-371.e17. [meta-analysis, 248 studies] · PMID 29402652 · doi:10.1016/j.jamda.2017.12.098
- Seppala LJ, et al. 2018. Fall-risk-increasing drugs: a systematic review and meta-analysis. III. Others. Journal of the American Medical Directors Association 19(4):372.e1-372.e8. [meta-analysis, 281 studies] · PMID 29402646 · doi:10.1016/j.jamda.2017.12.099
- Oya N, et al. 2022. Over half of falls were associated with psychotropic medication use in four nursing homes in Japan. International Journal of Environmental Research and Public Health 19(5):3123. [retrospective cohort, 459 residents] · PMID 35270813 · doi:10.3390/ijerph19053123
- Santesso N, et al. 2014. Hip protectors for preventing hip fractures in older people. Cochrane Database of Systematic Reviews (3):CD001255. [Cochrane review, 19 studies] · PMID 24687239 · doi:10.1002/14651858.CD001255.pub5
- Montero-Odasso M, et al. 2022. World guidelines for falls prevention and management for older adults: a global initiative. Age and Ageing 51(9). [consensus guideline] · PMID 36178003 · doi:10.1093/ageing/afac205
Ask for a safety review of your facility
A CareGuard safety review walks the building against 189 items in 54 categories and reports what it finds to you, not to your site manager. The registration form takes the facility and a contact for the ownership group; scope is settled in the conversation that follows.