Steady on Your Feet: How Occupational Therapy Addresses Fall Prevention and Vertigo in Older Adults

A Fall Is Never “Just” a Fall — And What the Research Tells Us About Preventing the

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For many older adults, a single fall marks a turning point. It can fracture a hip, shake

confidence, shrink a daily routine, and set off a cascade of fear, inactivity, and declining health

that is difficult to reverse. Yet falls are not an inevitable part of aging. They are preventable —

and occupational therapy is one of the most evidence-supported disciplines for making that

prevention real.

At Adaptive Life Therapy, we work with older adults on two closely connected challenges: fall

prevention and vestibular dysfunction, including dizziness and vertigo. These issues often

travel together, and addressing both — through comprehensive, individualized OT intervention

— can meaningfully change the trajectory of a person’s safety, independence, and quality of life.

The Scope of the Problem: Why Falls Demand Serious Attention

The statistics surrounding falls in older adults are sobering. According to the Centers for Disease Control and Prevention (CDC), one in three adults aged 65 and older falls every year — a number that climbs to one in two for adults over age 80. Falls account for more than 495,000 deaths worldwide annually and represent the leading cause of both fatal and nonfatal injuries among older Americans (Phelan et al., 2024).

In the United States alone, falls among older adults generate an estimated 922,000 hospitalizations and 2.3 million emergency department visits each year, at a combined annual cost of $19.8 billion (Haddad et al., 2023). More than half of all inpatient fall visits involve fracture. The CDC reports that nearly 319,000 older adults are hospitalized for hip fractures each year — and that 83% of all hip fracture deaths are caused by falls. Falls are also the most common cause of traumatic brain injury in this population (CDC, 2024).

Perhaps most troubling is what happens after a fall, even when no serious injury occurs. Research shows that around one-third of older adults develop a fear of falling following a fall event. This fear leads to activity restriction, which leads to deconditioning and muscle weakness, which increases the risk of falling again. It is a vicious cycle — and breaking it requires more than telling someone to “be careful.”

Falls are not an inevitable consequence of aging. They are a signal — one that

occupational therapists are specifically trained to read, address, and help prevent.

Vertigo and Dizziness: An Under recognized Driver of Fall Risk

Many older adults who are at risk of falling are living with an underlying vestibular disorder that has gone unidentified or untreated. Dizziness, unsteadiness, and vertigo are among the most common complaints in adults over 65 — and they dramatically increase fall risk by disrupting the balance systems the body depends on to navigate the world safely.

The most common vestibular condition in older adults is Benign Paroxysmal Positional Vertigo (BPPV) — a condition in which calcium crystals in the inner ear become dislodged and migrate into the semicircular canals, causing sudden, intense episodes of vertigo triggered by head movement. BPPV is most prevalent in adults in their 60s and 70s and is strongly associated with increased risk of falls, postural instability, and decreased quality of life (Bhattacharyya et al., 2017; Sheikhzadeh et al., 2020).

In addition to BPPV, older adults may experience vestibular hypofunction, cervicogenic dizziness, age-related changes to inner ear structure (sometimes called presbyvestibulopathy), and balance disorders associated with neurological conditions such as Parkinson’s disease or stroke. Each of these has a different profile, a different treatment approach, and a different relationship to fall risk — which is exactly why accurate clinical assessment matters so much.

What the Research Tells Us About Vestibular Rehabilitation

A landmark systematic review published in BMC Geriatrics (Herdman & Clendaniel, 2020) analyzed 22 studies encompassing more than 1,280 participants and found that vestibular rehabilitation (VR) is, with moderate quality of evidence, superior to usual care in improving balance, mobility, and vestibular symptoms in older adults. Vestibular rehabilitation — including individualized exercise programs addressing gaze stabilization, habituation, balance retraining, and postural control — was the most widely studied and consistently supported intervention across multiple diagnoses.

For BPPV specifically, evidence strongly supports the use of canalith repositioning maneuvers — such as the Epley maneuver — to physically guide dislodged crystals back to their correct position in the inner ear. A systematic review of clinical trials in elderly patients (Sheikhzadeh et al., 2020) found a consistent trend of improvement in BPPV symptoms, positional nystagmus, and postural balance following repositioning maneuvers, often with significant reductions in dizziness handicap as measured by the Dizziness Handicap Inventory (DHI). Combining repositioning maneuvers with vestibular rehabilitation exercises produced the strongest overall outcomes.

A retrospective outcomes study (Horak et al., 2018) examining patients who completed a formal vestibular rehabilitation program found that both patient-reported outcomes and performance-based measures improved significantly — including gait speed and Timed Up and Go (TUG) scores — even for older adults who had completed BPPV repositioning but continued to experience residual dizziness and elevated fall risk. This underscores that clearing a specific vestibular diagnosis is often not enough: comprehensive rehabilitation addressing postural control and daily function is what restores safety and confidence.

Occupational Therapy’s Unique Role in Fall Prevention

While many disciplines contribute to fall prevention, occupational therapists bring a perspective that no other profession fully replicates: they assess the person in the context of their daily life — their home environment, their routines, their roles, their habits, and their goals. Falls do not happen in a vacuum; they happen in kitchens, on staircases, getting out of the shower, reaching for a shelf, or rising too quickly from a chair. Preventing them requires understanding all of those contexts.

A major scoping review of OT’s role in fall prevention (Elliott & Leland, 2018) identified strong evidence for OT practitioner involvement across three key domains: environmental modification, exercise and balance programming, and multifactorial and multicomponent interventions — the type of comprehensive, individualized approach that consistently produces the best outcomes in the research literature.

A 2025 PRISMA-compliant systematic review of OT-based fall prevention interventions (Acharya et al., 2025) confirmed that multimodal OT strategies — combining strength and balance training, environmental assessment, education, and occupational task-based approaches — significantly improve balance, mobility, functional performance, and psychological outcomes related to fall risk. The review highlighted that resistance training integrated within occupational tasks is a particularly effective component, building real-world strength in the contexts where fall risk is highest.

Home Hazard Assessment and Environmental Modification

One of OT’s most powerful fall prevention tools is the home hazard assessment: a systematic evaluation of the home environment to identify fall hazards and barriers to safe mobility. Loose rugs, poor lighting, absent grab bars, cluttered pathways, low toilet seats, and slippery bathroom surfaces are among the most common and most correctable contributors to fall risk.

Research consistently supports the effectiveness of OT-led environmental modification, particularly for high-risk individuals. A 2023 Cochrane review (Clemson et al., 2023) on environmental interventions for fall prevention found strong evidence that home hazard reduction, especially when delivered by trained therapists to high-risk populations, significantly reduces fall incidence. The personalized nature of these assessments — tailored to each person’s specific home, routines, and physical capabilities — is precisely what makes them effective.

Balance and Strength Training Within Meaningful Activity

Balance and functional strength are not built in a clinic — they are built through repeated, purposeful movement. OT integrates balance and strengthening exercises into the activities that matter to each person: cooking, gardening, getting dressed, navigating stairs, or walking to a car. This activity-based approach creates dual benefits: it builds the physical capacity needed to prevent falls and it restores engagement in the meaningful daily routines that make life worth living.

Education, Self-Efficacy, and Fear of Falling

Fear of falling is itself a risk factor for future falls — one that OT is uniquely positioned to address. By helping clients understand their personal risk profile, practice safe movement strategies, and rebuild confidence through graded activity, OT interventions reduce the anxiety-driven activity restriction that accelerates functional decline. Research cited in a scoping review by Rodríguez-Martínez et al. (2021) documented that fear of falling, loneliness, depression, and social restriction are all interrelated consequences of falls that can be meaningfully addressed through comprehensive OT-based programming

Medication and Multifactorial Risk Review

Many falls in older adults are medication-related. Certain classes of drugs — including sedatives, tranquilizers, antidepressants, blood pressure medications, and some over-the-counter antihistamines — can impair balance, slow reaction time, or cause orthostatic hypotension (a drop in blood pressure when standing). OT practitioners contribute to multifactorial fall prevention by identifying these risks, coordinating with prescribing providers, and educating clients and caregivers on medication safety as part of a comprehensive plan.

What This Looks Like at Adaptive Life Therapy

Our approach to fall prevention and vestibular rehabilitation is thorough, individualized, and grounded in what our clients actually want to be able to do safely. We do not use a one-size-fits-all checklist — we start with a conversation about your life, your home, your history, and your goals.

Our services in this area include:

•       Comprehensive fall risk assessment using validated clinical tools including the Timed Up and Go (TUG), Berg Balance Scale, and functional mobility screening

•       Vestibular assessment and identification of BPPV, vestibular hypofunction, and related dizziness conditions

•       Canalith repositioning maneuvers (including the Epley maneuver) for BPPV treatment

•       Individualized vestibular rehabilitation programs addressing gaze stabilization, habituation, and postural control

•       Home safety evaluation and personalized environmental modification recommendations

•       Strength and balance training embedded in the daily activities most relevant to each client

•       Adaptive equipment recommendations and training — from grab bars and shower chairs to mobility aids and non-slip flooring

•       Education for clients and caregivers on fall risk, safe movement, and home safety strategies

•       Coordination with physicians, physical therapists, and other members of the care team

Whether you or a loved one has experienced a fall, is living with dizziness or vertigo, or simply wants to be proactive about staying safe at home, we are here to help.

Aging Well Means Staying Active — Safely

The goal of fall prevention is not to wrap older adults in bubble wrap and keep them from moving. It is to help them move more — with greater confidence, greater safety, and greater freedom. Research is clear that the fear and restriction following a fall are often more damaging to long-term health and independence than the fall itself. Breaking that cycle is exactly what skilled occupational therapy is designed to do.

At Adaptive Life Therapy, we believe that every person deserves to feel safe in their own home, to participate in the activities they love, and to age with confidence. Fall prevention and vestibular therapy are not about limitation — they are about possibility.

Contact Adaptive Life Therapy to schedule a fall risk assessment or vestibular evaluation. Let’s keep you moving.

Works Cited

Acharya, S., et al. (2025). Occupational therapy interventions for fall prevention in older adults: A systematic review of multimodal strategies. Multimodal Technologies and Interaction, 5(3), 33. https://doi.org/10.3390/mti5030033

Bhattacharyya, N., Gubbels, S. P., Schwartz, S. R., Edlow, J. A., El-Kashlan, H., Fife, T., & Holmberg, J. M. (2017). Clinical practice guideline: Benign paroxysmal positional vertigo (Update). Otolaryngology–Head and Neck Surgery, 156(3_suppl), S1–S47. https://doi.org/10.1177/0194599816689667

Centers for Disease Control and Prevention. (2024). Facts about falls. National Center for Injury Prevention and Control. https://www.cdc.gov/falls/data-research/facts-stats/index.html

Clemson, L., Stark, S., Pighills, A. C., Tiedemann, A., Lamb, S. E., Ali, J., & Sherrington, C. (2023). Environmental interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 3, CD013258. https://doi.org/10.1002/14651858.CD013258.pub2

Elliott, S., & Leland, N. E. (2018). Occupational therapy fall prevention interventions for community-dwelling older adults: A systematic review. American Journal of Occupational Therapy, 72(4), 7204190040p1–7204190040p11. https://doi.org/10.5014/ajot.2018.031062

Haddad, Y., Miller, G. F., Kakara, R., Florence, C., Bergen, G., & Burns, E. R. (2023). Cost of U.S. emergency department and inpatient visits for fall injuries in older adults. Injury Prevention, 30, 272–276. https://doi.org/10.1136/ip-2023-045023

Herdman, S. J., & Clendaniel, R. A. (Eds.). (2020). Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: A systematic review. BMC Geriatrics, 20, 513. https://doi.org/10.1186/s12877-020-01899-9

Horak, F., Klatt, B., Jacobs, S., Huertas, A. M., & Woollacott, M. (2018). Patient-reported and performance outcomes significantly improved in elderly patients with vestibular impairment following rehabilitation: A retrospective study. Journal of Vestibular Research, 28(3–4), 233–241. https://doi.org/10.3233/VES-180617

Kakara, R., Bergen, G., Burns, E., & Stevens, M. (2023). Nonfatal and fatal falls among adults aged ≥65 years — United States, 2020–2021. MMWR: Morbidity and Mortality Weekly Report, 72, 938–943. https://doi.org/10.15585/mmwr.mm7235a1

Phelan, E. A., Mahoney, J. E., Voit, J. C., & Stevens, J. A. (2024). Assessment and management of fall risk in primary care settings. Medical Clinics of North America, 99(2), 281–293.

Rodríguez-Martínez, M. C., Fernández-Mateos, M., Del Pino, R., & García-Hernández, D. (2021). Occupational therapy and the use of technology on older adult fall prevention: A scoping review. International Journal of Environmental Research and Public Health, 18(2), 702. https://doi.org/10.3390/ijerph18020702

Sheikhzadeh, M., Lotfi, Y., Mousavi, A., Heidari, B., & Bakhshi, E. (2020). Effectiveness of otolith repositioning maneuvers and vestibular rehabilitation exercises in elderly people with benign paroxysmal positional vertigo: A systematic review. Brazilian Journal of Otorhinolaryngology, 88(S1), 21–33. https://doi.org/10.1016/j.bjorl.2021.06