How to Set Up a Home for Fall Prevention

Among those age 65 and older, falls are the leading cause of injury, with over 14 million older adults in the U.S. falling each year. Moreover, the Centers for Disease Control and Prevention (CDC) notes that falling once doubles the chances of falling again, and the consequences can range from disruptive to catastrophic. Every 11 seconds, an older adult is treated in an emergency room for a fall.

No wonder, then, that many older adults fear falling. Ironically, that fear brings a new set of challenges. "Fear of falling often causes people to restrict their movement and activity, which leads to muscle weakness, further loss of balance, and even greater risk," says Partha Nandi, M.D., a clinical associate professor of medicine at Michigan State University in East Lansing. "It becomes a cycle. That is why fall prevention is not just a safety issue, it is a quality-of-life issue."

The CDC reports that many factors contribute to falling, including lower body weakness, vitamin D deficiency, vision problems, arthritis, and use of certain medications that affect balance. Not all fall risks can be mitigated. But a big one can be: hazards and dangers in the home.

Start With a Room-by-Room Safety Assessment

"Most home fall hazards are hiding in plain sight," says Dr. Nandi. "You have tripping hazards, poor or inadequate lighting, clutter, and obstacles. That's why it's worth doing a walkthrough of a home with a fresh perspective about what might increase fall risk."

Ideally, this assessment should be done with your loved one, he says. That helps them feel involved and empowered to make changes, and to identify the hazards themselves. Some common fall hazards you're likely to encounter:

• Clutter in walkways or along stairs
• Exposed wires and cords
• Low lighting that creates shadows
• Overgrown outdoor areas
• Slick or slippery surfaces on tile or vinyl flooring
• Throw rugs that slide easily when stepped on
• Uneven flooring

To make sure you're not missing any potential hazards as you walk through the home, consider using a safety checklist, such as this one, which asks key questions about lighting, flooring, stairways, and balance support.

Improve Lighting Throughout the Home

Inadequate lighting is strongly associated with a higher fall risk, research has found. Poor lighting makes it more difficult to see tripping hazards, and it also impairs balance and coordination. "Because vision plays an important role in maintaining balance, hallways and walkways should be well lit," says Rick Douglass, D.P.T., a doctor of physical therapy and chief clinical officer at FYZICAL Therapy and Balance Centers in Sarasota, FL. "Installing nightlights between the bedroom and bathroom can also help reduce the risk of falls, particularly during nighttime trips to the bathroom." Consider these simple upgrades to make the home safer:

• Add brighter bulbs in key areas.
• Consider motion sensory indoor lights for stairs.
• Increase available lighting throughout your house.
• Keep a flashlight handy in each room with a clear pathway.
• Keep a light within easy reach of your bed in case you get up during the night.
• Make sure the paths to light switches are completely clear.

Spot and Remove Tripping Hazards

When certain items of decor have been in a home for a long time, it's easy to overlook their potential for causing someone to trip, says Lindsey Biel, OTR/L, an occupational therapist in private practice in New York City. For that reason, it may be helpful to walk through the space with a friend who is less familiar with your home. These are a few of the items to keep an eye on, says Biel:

• Doorway thresholds. Add a ramp to reduce the risk of tripping when going from one room to another.
• Furniture, plants, and bookcases. Move anything situated near heavily used walking paths.
• Loose floorboards or floor tiles. Repair any that you find.
• Loose electrical cords. Tape them down along baseboards so they don't extend into a room.
• Unsecured throw rugs. Secure them with carpet tacks or double-stick tape, paying special attention to corners that can curl up.

Even if your loved one isn't currently using a power chair or rollator, consider what would be needed if that becomes necessary, Biel suggests. Often, that means creating wider walkway areas and reducing any objects or clutter near doorways.

Make Bathrooms Safer

The bathroom is one of the most common locations for falls in the home. Wet surfaces in the shower or bathtub create slipping hazards and stepping in and out of the tub or shower requires balance and coordination, explains Douglass.

"Activities such as washing your hair or face may temporarily reduce your vision and alter your sense of balance, increasing the risk of a fall," he adds. You can improve bathroom safety and reduce fall risk with a few upgrades:

• Consider a shower chair and handheld shower head.
• Install grab bars near toilets and showers.
• Install raised toilet seats, potentially with armrests if grab bars cannot be placed close to the toilet.
• Use a shower caddy or organizer that's within easy reach with shampoo, conditioner, soap, and washcloth.
• Use non-slip bathmats.

Bathroom safety will likely be an ongoing project when it comes to reducing fall risk, says Dr. Nandi, as your loved one's mobility needs change. "Paying attention to how the bathroom is used and the mobility concerns it brings up should be part of a regular assessment when it comes to aging in place," he says.

Focus on Stairs and Hallways

These types of transitional spaces, where you're going from one part of a home to another, can often be overlooked when it comes to tripping hazards, but they play a big role in maintaining safety, says Douglass. Some tactics here include:

• Add brightly colored tape to the edges of stairs to make them easy to see.
• Declutter steps so they are free of objects.
• Improve visibility with bright lighting, with switches at the top and bottom of stairways and at both ends of a hallway.
• Put handrails on both sides of stairs, not just one side.
• Use non-slip stair treads.

Assessing stairways is particularly important since stair falls in older adults are responsible for a high rate of severe injuries, including hip fractures and traumatic brain injuries, according to the CDC.

Create a Safer Bedroom Environment

Being able to navigate through a bedroom, particularly in the middle of the night if nature calls, is an essential part of preventing falls in seniors. Some safety measures include:

• Add bedside lighting.
• Ensure a clear path to the bathroom.
• Keep essentials within reach.
• Position the bed at an appropriate height, where feet can be flat on the floor while sitting on the edge of the bed.

Keep mobility aids like canes or rollators right next to the bed so they can be used upon waking. Also, consider installing a grab bar next to the bed to make it easier to get in and out of bed rather than relying on a piece of furniture or chair for steadiness, or invest in a motorized lift bed that tilts forward to help your parent move from lying to sitting to standing.

Organize the Kitchen for Easier Access

Spills due to cooking and dishwashing can increase the risk of slipping, but kitchen organization itself is underappreciated as a way to reduce falls, Biel says. For example, placing frequently used equipment and dishes on higher shelves or stashing them in low cupboards that require bending over to access can increase the chance of someone losing their balance and falling, she notes. To improve your home's kitchen safety, consider these strategies:

• Avoid step stools when possible.
• Create accessible work zones.
• Keep floors dry.
• Store regularly used items between waist and shoulder height.

"Most of all, rearrange cabinets, drawers, and cupboards so you have easy access to the pots, pans, bowls, and plates that you use often," says Biel. "Never use a step stool if you can possibly avoid it, and if you do have to use one, get an option that has a bar to hold onto."

Don't Overlook Entryways and Outdoor Areas

Spending time outside can be a boon for aging in place. Research on older adults who had access to nature found they experienced numerous benefits related to physical health, emotional regulation, and cognitive function. But outdoor areas can have tripping hazards as well, so consider strategies such as:

• Add handrails where needed.
• Improve outdoor lighting.
• Repair uneven walkways.
• Use non-slip mats at entrances.

If your parent loves to garden, consider using raised beds or boxes that can be positioned at hip-to-chest level to prevent them from having to get up and down off the ground as they garden. Raised planters also allow someone to sit in a chair while gardening, which can help prevent fatigue.

More Tips to Help Preserve Independence

When it comes to reducing fall risk, it's common for older adults to limit their physical activity, but that's the wrong approach, believes Dr. Nandi. "Fall prevention should never be an excuse to stop moving, because movement is medicine," he says. "The goal is to make the home safer so that people can keep being active, not to restrict activity out of fear."

Instead, he encourages older adults to maintain an exercise routine that includes building strength and improving balance. Research suggests that physical activity, particularly strengthening the legs, can reduce fall risk by up to 50% in older adults.

If you're unsure where to start with building a consistent exercise program that includes balance and strength, Dr. Nandi recommends talking to a personal trainer or physical therapist who has experience with older adults (ask your health provider for a referral).

Another important way to prevent falls and safely age in place is to stay in communication with your health team, he adds. It's vital to make sure there are no health conditions or medications that may be increasing fall risk. For example, cardiovascular disease, osteoporosis, metabolic disorders, and sensory issues like glaucoma are all common during aging—and they can each contribute to potential falls.

In general, staying on top of your health, getting adequate physical activity, and assessing a home for potential fall hazards can all add up to a safer experience while aging in place.