Fall-proof strategies for seniors’ homes and lifestyles
The fear of falling is a real concern for seniors. More than 1 in 3 people age 65 and older fall each year, according to the AARP. Each year, 3 million older people are treated in emergency rooms for fall injuries, and over 800,000 patients are hospitalized, according to the U.S. Centers for Disease Control.
Many of these accidents are preventable, and there are steps seniors and caretakers can take to avoid these accidents.
The National Council on Aging has worked to raise awareness about how to prevent fall-related injuries in older adults and is a vocal advocate for fall prevention programs.
“It’s about more than just awareness. It’s understanding what actions you can take to prevent falls and injuries,” says Kathy Cameron, senior director for National Council on Aging’s Center for Healthy Aging.
According to the CDC, falls are the leading cause of hip fractures and brain injuries among older adults. “We’re all about preventing falls – particularly the first fall,” Cameron says. “When someone has experienced a fall, they’re more likely to have another.”
A safer home environment
Some of the most common risk factors for falls are present in the home. Everyday household items like bath mats and charging cables can present significant — even deadly — hazards for older individuals who suffer from arthritis, dizziness or loss of balance.
“Most people want to age in place. They want to stay in their home as long as possible,” Cameron says. “However, homes don’t change. People change, and we want to make sure our homes do change as we get older.”
One way to address this issue is to have a health care professional, such as an occupational therapist, perform a thorough safety assessment of the home to make sure older adults can function to their fullest capacity in the space where they live. “It could be simple things like rearranging the furniture. Or maybe they need to sit down more when they cook,” Cameron says.
Physical therapist Ryan Usner, the founder of the PT exchange MOREPhysicalTherapy.com, works with seniors in their homes and in rehab settings, often after they experience falls and injuries.
The most basic environmental changes are to remove “slip and trip” hazards such as rugs, clutter, electrical cords, and pet toys, Usner says. Rugs can be secured with double-sided tape, while furniture should be secure and sturdy. “Try to stay away from rolling chairs and chairs that are too low to the ground,” he says.
There are also structural features of homes such as stairs, bathtubs, and toilets that can become more difficult for seniors to use as they age.
“In my experience bathrooms are the most commonplace seniors fall,” Usner says. “You should check to see if they can step into and out of their tub without difficulty.”
Adding features such as a shower bench, rubber mats and grab bars are easy and inexpensive ways to modify bathrooms to prevent falls. Nightlights can make it easier to use the bathroom in the middle of the night. It’s also a good idea to make sure towel bars are easy to reach, he says.
In the kitchen, appliances and other heavy or frequently used items should stay on lower shelves, preferably below eye level. “This simple change will make using the kitchen much easier for them,” Usner says.
A prime opportunity to start thinking about home assessments is at the point of retirement. “If they’re making some decisions about where they want to live, that’s a good time to look at their existing home, if that’s where they want to stay. Or if they want to move, identify a place where they can age in place,” Cameron says.
A home remodel presents another ideal opportunity for assessing home safety. People over age 55 account for more than half of all spending on home renovations in the United States.
“Most people don’t want to think that far out. But if their decision is to stay put, it’s going to be less expensive to do it at the point of remodeling rather than later on, maybe when they’re in a crisis situation,” Cameron says.
Then as people age, Cameron says it’s a good idea to reassess the home every five years, or more frequently if an individual has a cognitive impairment such as dementia.
The best medicine?
Even for able-bodied individuals, medications may present another risk factor for fall injuries. Blood pressure medicines, diuretics, beta-blockers, sedatives, and narcotics are among the medications most associated with increased fall risks.
Adding a new medication or increasing dosage can introduce new and unexpected side effects. Some medications may cause dizziness, vision impairments, confusion, sleepiness and other side effects that can compromise physical stability.
“I’m a pharmacist by training. We recommend patients get their medicines reviewed by a pharmacist or primary care physician at least on a regular basis,” Cameron says.
When assessing medications, check to see if doctors have prescribed the appropriate dosage for an individual’s size and physical condition, and to make sure those medications don’t interact with other prescriptions. Many older adults suffer from more than one chronic condition or disease, and often physicians don’t want to make changes to medications that other doctors have prescribed, Cameron says.
“Most doctors aren’t trained in geriatrics and don’t have the knowledge to prescribe safely,” Cameron says. “There are even medications that older adults need to avoid, but many doctors don’t know about that list.”
Eyewear is another consideration when reviewing prescriptions, as impaired vision is an often-overlooked risk factor, Usner says. “Make sure if they wear glasses, that they are clean and the correct prescription. They may need to see the eye doctor to update their eyeglass prescription,” he says.
Because muscle mass deteriorates with age — especially for people who are physically inactive — maintaining strength and balance can play a significant role in lowering the risk of falls.
Generally speaking, the “use it or lose it” mantra holds true for seniors – but with some caveats, says Usner, who provides senior wellness and fitness services at clients’ homes.
“Our bodies adapt to the stress of exercise by getting stronger, so getting out and walking 45 minutes a day or lifting weights three days a week are all things that will get them stronger,” he says. “But for me to give the same advice to a senior who has balance issues, that would be setting them up for a fall.”
A simple test known as a single-limb stance can be used to assess a person’s balance. “The research shows that if someone can’t stand on one leg for more than five seconds, they are a high risk of falling,” Usner says.
A person who is in a high-risk category can focus first on activities that promote balance, and then progress to more advanced exercises over time. For seniors with minor balance issues, Tai Chi can help improve stability and has been shown to help reduce falls, Usner says.
A growing number of resources are becoming available to help seniors and caretakers prevent falls and injuries.
In terms of physical activity, some insurance programs offer gym membership discounts to seniors or cover fitness programs such as SilverSneakers and Silver&Fit. Insurance plans may also cover outpatient physical therapy services for balance issues.
To make homes safer, organizations such as the Home Modification Occupational Therapist Alliance and the National Association of Home Builders Certified Aging in Place Specialist program provide home assessment and modification resources.
Medicare will cover home safety assessments for qualifying individuals, such as those receiving home health care, after hospitalization. Although Medicare does not pay for modifications such as wheelchair ramps and grab bars, it does cover certain types of durable medical equipment, including raised toilet seats.
There are some resources that will help pay for home modifications and programs through the U.S. Department of Housing and Urban Development and federal Community Development Block Grants. And nonprofits such as Rebuilding Together and Habitat for Humanity offer home repair services for older adults.
“I would recommend that people contact their area agency on aging to find out what is available in their community to support home modifications,” Cameron says.