Fall Prevention in Architectural Design
When it comes to fall prevention, the way we design a space can help minimize the chances of falls and accidents that may occur. Here are five design elements I have learned through my years of practice designing healthcare facilities.
SPACE
Richard Lasam
11/25/20253 min read
When moving within a built environment, one generally walks from point A to point B. This activity of moving in a physical space should be among the considerations an architect needs to remember in the design process. A specific aspect of design for movement in a physical space, which is usually part of healthcare facility design (but can be applied to other building types), is “Fall Prevention.”
A “fall” in this context is about the spontaneous loss of balance of a person, be it by an external force or the person losing stability, which results in the person falling to the ground, potentially causing harm. There are four types of falls that an architect needs to consider, as presented in the book Planning, Design and Construction of Healthcare Facilities (p.89):
1. Accidental falls. These occur when low-risk patients trip over an IV pole, fall out of bed when they reach to get something, or encounter another environmental hazard.
2. Anticipated physiological falls. These are the most common type of patient falls. These occur in patients who have risk factors that can be identified in advance, including abnormal gait, high-risk medication, urinary frequency, or dementia.
3. Unanticipated physiological falls. These occur in patients who have a low risk of falls in general but suffer an event—a seizure, stroke or fainting episode—that results in a fall that could not have been predicted.
4. Behavioral or intentional falls. These occur when a patient acts out.
Design to minimize falls
Through their design, architects can create spaces that minimize falls, which are also known as “sentinel events.” Design, however, cannot fully prevent falls as there are too many variables to account for—anything from random chance, human nature, or operational lapses. To quote the same source: “Design should be able to assist with accidental and anticipated physiological falls. Little can be done in the built environment or processes for unanticipated physiological and behavioral or intentional falls.”
Regardless of this challenge, there are design interventions that can be applied to healthcare facilities that will mitigate potential falls in the physical space. These are the elements that I have integrated into my design works over the years:
1. Specifying non-slip surfaces. Falls often occur due to a loss of stability from stepping on a slippery floor caused by certain types of floor materials. Avoid using smooth floors in areas that are likely to have fall events, such as patient rooms, corridors, and toilet and baths. Common non-slip surfaces specified in healthcare facilities are vinyl sheet flooring, vinyl floor tiles, or rough floor tiles.
2. Creating visual clarity of design in circulation spaces. The healthcare facility space should allow patients, staff, and visitors to easily see where they are going, especially if there are vertical floor elevation changes in the space. Clear sight lines also allow staff to identify and prevent potential fall accidents within an optimal period. Design interventions of this nature are wide corridors, bright lighting, and nurse stations that have a proper line of sight to potential accident-prone spaces.
3. Choosing clean and clear color dynamics in the space. Part of the visual clarity of a space involves the colors that will be specified in the interior design of a healthcare facility. Floors and walls should be distinct in the visual field of the visitors, patients, and staff of the healthcare facility. To reinforce the “clarity” of the walls and floors, avoid specifying distracting colors in the design, and focus on creating clean edges to materials (especially floor elevations) so as to reduce the risk of falls caused by a sensory disturbance in the environment.
4. Adding handrails to high accident spaces. Since falls are bound to happen eventually, handrails are a good design element to add to any space. Corridors should have handrails (often with different levels to accommodate patients with differing heights), as well as most toilets and baths.
5. Applying proper toilet and bath design. As mentioned in the book, 30% to 50% of falls in the United States of America occur in toilets, so designing these spaces particularly well in healthcare facilities is critical. Focus on accessibility, none-slip flooring, good lighting, proper spacing of toilet fixtures, and handrails. These elements can reduce accidents that can happen within the space.
Design can only help prevent falls in a passive manner; effective fall prevention is a combination of design and operational policies of the healthcare facility. Do note that the design interventions mentioned here are also applicable in other building types, such as residential or commercial settings.
For further reading, you can also check out my post on hallway design fundamentals in healthcare settings, infection control, or avoiding design flaws that may cause “hospital fear.”