Almost half of patients of nursing home residents experience one fall per year. Falls have associated significant morbidity and mortality, and a proportion of falls can be deemed avoidable. There are a variety of risk factors associated with falls, many of which are not modifiable. There has been increasing focus upon the relationship between psychotropic medications and falls as this is seen a potentially modifiable risk factor. This article reviews some of the clinical challenges about balancing falls risk mitigation strategies with the management of behavioral and psychological symptoms of dementia.