Falls are the second leading cause of accidental death in the United States each year. According to the home safety council they cause about 5.1 million injuries and nearly 6,000 deaths yearly. (Falls Prevention - Home Safety Council) Many seniors who fall never go home again, and are placed in care facilities or end up in a wheelchair for the remainder of their life. The average cost of health care resulting from a fall is $19,440, not including doctor’s fees. Falls also result in five times more hospitalizations for seniors than the next leading cause. Roughly 25% of such falls are listed as the main cause of death through complications in those over 65 years of age. (Cost of Falls Among Older Adults – CDC) (Hip Fractures Among Older Adults - CDC)
Here are some ways to prevent them:
The stairs are where many serious falls occur, and a large number of them occur when someone is carrying something. So, don’t try to carry too many things at once, and give yourself at least one free hand to grab the handrail. You should have secure handrails on both sides of your steps and stairs, and make sure they run from the top to the bottom extending 12 inches beyond both. They should be rounded and no more than 1 & 1/2 inches in circumference. Their ends should also be shaped to indicate when you have reached the top or bottom. Obviously, keep all litter off stairs. The entire stair length should be well lit, and you should be able to turn on the lights from both ends. Preferably stairs should have no carpet, but instead anti-slip strips or anti-slip paint on them. If there is carpet on the stairs it must be firmly attached and be tightly woven with a low pile. Your stairs should not have noses or open risers. If there are children in the home the stairs should have safety gates. Stair treads should be deep enough for a whole foot, 11 inches or more. Stair rises should be no higher than 7 inches. If you have eye problems you should paint a line at the edge of stairs so you can see it better. The ultimate stairs solutions would be either to live in a house with only one level, or to install an elevator. If you have only a short rise to deal with consider having a ramp instead of steps.
The bathroom is another common place where falls occur. You should have non-slip strips or a mat in the tub or shower. You should also have a non-slip bath mat outside of them. Have grab bars in them, and handle bars on the toilet that makes it easier to stand up. (1) All grab bars must be mounted properly, so they can not only carry a person’s full weight, but also the greater momentary force generated when a person is falling. Replace a sliding glass door with a shower curtain. A shower seat will allow people to wash without having to bend over. A liquid soap dispenser will prevent having to fish around for a dropped bar. And a storage unit attached to the shower or tub will reduce a person’s need to turn around to reach things. You can convert your regular shower head to a hand held shower spray, which will allow you to reach farther. If you buy a tub transfer bench you can remain seated at all times when getting in and out. You also might consider converting over to a walk-in shower. Fix any leaks which might make the floor unnecessarily wet and slippery. Remove soap build-up in tub or shower on a regular basis. Use hard water, since soft-water can make things very slippery. If you need to go to the bathroom often at night, consider using a bedside commode.
In the kitchen you should install cabinets, sliding shelve, and lazy Susans so that you don’t have to reach up to get things. Commonly used items should be stored between waist and shoulder level. To reach higher items have a solid step stool with nonskid steps and feet and a bracing bar to hold on to. Wipe up spills as soon as they happen. The oven and refrigerator should open easily. You should have an area where you can sit down to prepare food. Use non-skid wax on the kitchen floor, and put a non-skid mat by the kitchen sink.
Around the home make sure that cords are not underfoot, and don’t run them under rugs directly where you walk. You should have a straight path through every room. Floors should be smooth and level, but not slippery. Preferably doorways should be wide, 36 inches is a good size. All doors and windows should open and close easily. Living room chairs should be sturdy, not swivel chairs, chairs on casters, or lightweight chairs. All the other furniture should also be sturdy enough for you to lean on. Carry things in your pockets so your hands are free to grab and stop a fall. Don’t walk in the dark, but have night lights in the bedroom, hall, and bathroom. Glowing light switches can help. Make sure your lighting doesn’t produce hazardous shadows or glare, and light cords should be long enough so you don’t have to reach up. Provide good lighting for the closet. Carry a small flashlight on your keychain. Ideally get rid of small rugs, or, if not, at least securely tape them to the floor with double sided carpet tape all around. Repair or replace frayed corners or rolled up edges on carpets and floor coverings. In general you want to minimize bending or climbing. A long-handled grasper can be used to reach objects that are on high shelves or on the floor. Lower the closet shelves. You should get up from chairs or your bed slowly, and take advantage of the fact that higher chairs and couches are easier to ease into and out of. Keep track of where your pets are, and put them in another room before carrying heavy things into the house. Close cabinets and drawers when done. Have a phone close to the floor so you won’t have to get up in case you fall, and keep emergency numbers near each phone. Furniture should have rounded or padded corners in case you fall. (Safety › Edge & Corner Guards)
In the bedroom your bed should be low enough such that you do not have to climb into it, and high enough so that you can sit with your feet on the ground. Have the light switch and your eyeglasses within arm’s reach of where you sleep, and a phone close to the bed so you can answer it from there.
Don’t wear trailing clothes, and if your clothes have long cords shorten them. Avoid bare socks, smooth soled shoes, shoes with shoelaces, and slippers. Instead wear low heeled shoes with good grip, or go barefoot. If you are barefoot you will feel the ground better, and this feedback should help you walk better. (See also: Barefoot Walking and Running – Lost Wanderer) Matt Metzgar reports on a high tech approach that works along these lines. Researchers are doing vibration research that involves providing sensory feedback to people’s feet. Scientists at Harvard are working on vibrating insoles, and one group has shown that such subsensory vibrations do improve the elderly’s gait. (Vibration Roundup – Matt Metzgar, Statipro (a French company), US Patent 6024093 – Proprioceptive sole or pedal device containing crystals for treatment of statural disorders, Vibrating Insoles – Wyss Institute, and Subsensory vibrations to the feet reduce gait variability in elderly fallers)
Outside you need a roof or awning to keep snow off of your home’s entrance-way. Have a place near your door where you can put packages while you close it and get ready to put things away. Sidewalks and walkways should be well lit and clear of debris, clutter, and weeds. You should keep your steps and sidewalks in good condition by fixing broken or uneven steps. Holes and cracks are trip hazards, as are bumps and ridges. Put abrasive strips on outdoor steps, and have a non-stick surface area inside all of your outside entrances. Install motion sensitive lights on your outdoor paths. Have someone shovel immediately after a snow storm, and then apply salt or sand. All entrance areas should have an outside space large enough such that you are not crowded by your swinging door.
To prevent child falls consider installing window guards on windows ground floor and up, unless designated as emergency fire exits. Make sure they have easy release mechanisms. When a child can pull to a standing position, the crib mattress should be adjusted to its lowest position; there should be at least 26 inches between the top rails of the crib drop side and the mattress. Toys, bumper pads, and other objects that can be used as steps to climb out should be removed from the crib. Never leave babies alone on beds, changing tables, or sofas. Strap children into high chairs and strollers. Keep furniture away from windows. Keep windows and doors locked. For bunk beds you should never allow a child younger than age 6 to sleep on the top bunk. For older children, if the upper bunk is not up against a wall, use guardrails on both sides. No matter how old a child is, keep the guardrails in place on the top bunk since children might roll out during sleep. Don’t allow any horseplay on bunks. You should keep dresser drawers pushed all the way in to lessen the risk of a child climbing up the dresser. Make it a habit to push kitchen and dining room chairs in under the table to take away an attractive climbing gym for children. Don’t store desserts or other treats in high locations, particularly over stoves, to decrease climbing temptations. Outside, ladders should be put away and hung on their sides when not in use. Playgrounds should have 12 inches of padding.
Certain situations increase the risk of falling. You should be careful when you are on a stool or ladder in reaching your arms out or overextending your reach. Are there situations where you have to rush, such as getting to the front door, or answering the telephone? Think of ways to eliminate these situations. Slow down, take your time. Also, be careful about consuming alcohol.
One major risk factor to keep in mind is that vitamin D deficiency is very common and can lead to abnormal gait, muscle weakness, osteomalacia, and osteoporosis. (Vitamin D Deficiency in Modern Society – Lost Wanderer)
Other things that increase your risk of include having a history of falls, age, living alone, and being Caucasian.
Medications that can increase the risk include benzodazepine digoxin, diuretics, sedative psychotropics, taking four or more medications, and class 1a anti-arrhythmic medications.
Medical conditions that increase your risk of falling include circulatory disease, poor nutrition or malnutrition, poor postural performance, impaired cognition such as with dementia or memory problems, visual impairments, muscle weakness (indicated in particular by having a slower walk and poor hand strength), a history of stroke, a low body mass index, poor self-rated health and decreased quality of life, chronic obstructive pulmonary disease, depression, arthritis, thyroid problems, incontinence (which leads to frequent bathroom trips at night), impaired mobility, drowsiness, dizziness, poor balance, low blood pressure, Parkinson’s disease, Meniere’s disease (affects the middle ear and causes vertigo), poorly controlled epilepsy, joint stiffness, limited neck movement, any lower extremity disability (loss of strength, orthopaedic abnormality, foot problems, or poor sensation), and difficulty in rising from a chair. Fear of falling can also lead to falling because people who are afraid of falling will restrict their physical activities and become sedentary.
There are many health related preventive steps you can take to help prevent falling. Get your vitamin D level checked. You should regularly get your eyes and hearing tested. If you have foot problems get them treated. You should exercise, for example take Tai Chi Lessons, and perhaps even learn better how to fall. Work on increasing your balance, strength, cardiovascular capacity, and flexibility. Review your medications (including supplements and other products you take over-the-counter) with your doctor.
Assistive devices can be very helpful in preventing and coping with falls. If your doctor recommends a walker or cane for stability, learn how to use it properly from a health care professional, and then do use it. Some people use hip protectors, or get an alarm device they wear in case they fall. There are a number of other assistive devices, mobility aids, and other helpful gadgets available. (Arthritis Aids – Gadgets – Products – Tools – Adaptive Equipment) Keep all such devices in good repair. (replace worn rubber tips, etc.) During winter cleats for your shoes and boots can be helpful for dealing with ice. (Polar Cleats) (Get-A-Grip Advanced – Snow & Ice Traction Cleats)
If you do fall you should try to fall on your side or buttocks, rolling over naturally turning your head in the direction of the fall, and keep your arms bent. Don’t necessarily try to get up right away, but assess the situation, and then, if the situation suggests it, crawl to find something to raise yourself up with.
(1) A raised toilet seat will also make it easier to get up. But, on this issue there is a trade-off, since using a squat toilet is the natural and healthier way for you to do your business. (The Squat Toilet – Lost Wanderer) For someone who has a condition such as arthritis, I have read that in Asia they make a squat toilet that starts out in sitting position and then mechanically lowers you into position.
(Practical Guide to Universal Home Design: Convenience, Ease, and Livability – Remodeling, Building, and Buying a Home) (Preventing Slips and Falls) (Prevention of Slips, Trips and Falls) (The Fall Prevention Project) (Preventing Falls in the Home – NAMIC Online) (A Home Fall Prevention Checklist for Older Adults – MetLife) (Minnesota SeniorSafe – Minnesota Safety Council) (Fall Prevention Home Safety Checklist What YOU Can Do To Prevent Falls – Minnesota Safety Council) (Preventing Falls at Home)(Home Fall Prevention Guidelines) (Preventing Injuries from Slips, Trips and Falls) (Preventing Falls: How to Develop Community-based Fall Prevention Programs for Older Adults - CDC) (What Causes Falls in the Elderly? How Can I Prevent a Fall?) (Preventing Falls in the Elderly by K.R. Tremblay Jr., and C.E. Barber1 (12/05) (What are the main risk factors for falls amongst older people and what are the most effective interventions to prevent these falls? - World Health Organization – Europe) (Aging well: Making your home fall-proof – CIGNA) (Handicap Shower Safety – 10 Money Saving Keys to Fall Proof Your Shower Area – No Tools Required! – Ezine Articles) (How to Fall-Proof a Bathroom for Seniors – Denise Wang) (Fall-proof your home – Humana) (Tumble-Proof Your Home to Prevent Falls – Common sense precautions for all ages By Sandra Wendel) (Fall Prevention Center of Excellence) (Preventing Slip-and-Fall Accidents) (Fall Prevention Center) (CDC – Falls – Older Adults) (What you can do) (Preventing Falls) (Preventing Injuries from Slips Trips and Falls – NASD) (Public Enemy Number One: Slips, Trips and Falls) (Falls – Older Adults – Home & Recreational Safety - CDC) (Falls Among Older Adults: An Overview – Home & Recreational Safety – CDC) (Falls in Nursing Homes – CDC)(Fall Prevention Activities – CDC) (Preventing Falls: What Works – CDC) (Help Older Adults Live Better, Longer: Prevent Falls and Traumatic Brain Injuries - Public Health Grand Rounds) (Podcasts — Unintentional Injury Prevention – CDC) (Causes of Falls – Wrong Diagnosis) (Causes of Falls – Osteoporosis-INFO.com) (Preventing Falls Among Older Adults – Patricia M. Burbank) (Pets cause falling injuries – Wellsphere) (Creating a Fall Proof Environment in Your Home - National Safety Council) (Safety First: Fall Risks and Fall Prevention Tips – parentgiving) (Be Safe at Home – Minnesota Falls Prevention) (Falls – Older Adults - CDC)