When it comes to fall prevention for seniors, some advice is shared so often that it has become the veritable handbook of home safety. Tape down loose wires. Remove fluffy area rugs. Yet the rate of falls among seniors in the U.S. continues to climb, with 3.85 million people over 65 visiting the emergency room for fall-related injuries in 2023, an increase of 38% in the last decade, according to the National Safety Council.
Part of the problem, say experts, is that older adults have a hard time reconciling their changing physical needs with a home they've lived in often for decades. "As capacity changes, people underestimate the sameness of their environment," says physician Gerda Maissel, M.D., president of My MD Advisor, a company that provides medical guidance for seniors and their families in the mid-Hudson Valley, NY. "Everything is in the same place in the house that it's been for years—but you're not the same person you were 10 years ago. There is a false sense of confidence because your surroundings are the same, even though you are not."
For example, walking often turns into more of a shuffle as we age, leaving less ground clearance with every step. "The body changes over time but our perception is that our abilities, like our environment, stay the same," says Dr. Maissel. "And that disconnect is a big reason falls happen."
The traditional approach to fall prevention points a finger at the wrong culprit, adds occupational therapist Carolyn Sithong, the Charlotte, NC-based founder of Home for Life Design, the first web-based assessment tool that helps clinicians measure home safety for seniors. "When we talk about falls, the focus is on 'you aren't strong enough' or 'you lost your balance,'" says Sithong. "We need to change the conversation. Aging is not about 'fixing' the person. It's your environment that needs to adapt."
So what should you really be paying attention to when it comes to fall prevention? Forget what you think you know and take a look at these major fall hazards hiding in plain sight.
In This Article:
Too Bright to See
Catch-22: As you get older, your vision weakens, so you need more light to see well. But eyes also become more sensitive to light with age, says Sithong, so many seniors keep their homes relatively dark. "That means when outside light, which is much brighter than indoor light, comes into the home, it causes a glare," she adds. "This creates areas of the home where seniors literally cannot see. It's really important to get the balance of light correct."
In addition to adding brighter, warm lights that follow common paths of travel inside the home, think about lighting choices for spaces where you spend a lot of time and engage in activities that require balance and precision, like meal prep or showering. "Many people don't have lights in their shower," says Sithong. "But wherever a person spends a lot of time, improving visibility is important."
Transitions Are Tricky
The bathroom and bedroom are often cited as the rooms where most falls occur, but in reality, it's the transition between rooms people don't pay enough attention to, says Sithong. "Floors settle over time, tiles come up, wood warps," she points out. "Those kinds of things aren't often taken into consideration when people are trying to improve their home safety. Looking at flooring is really important, especially in older homes."
Other transition zones include the stairs. While carpeting might seem like a good idea to soften the blow if someone falls going up or down them, it can also make it hard to distinguish the edge of each step. "Carpeting can make it look like one step instead of multiple," notes Sithong, who adds that "for safety, always make sure there are handles on both sides of the staircase."
The Real Reason for Bathroom Falls
The fall risk potential is higher in the bathroom than any other area of the home, research shows. Why? Experts point to several factors: Wet floors, multidirectional twisting and turning in the shower, and transitioning from sitting to standing and vice-versa.
But perhaps the biggest danger is that bathroom trips at night are often led by a sense of urgency: You wake up and have to go now. "Falls usually occur when people are hurrying to do things," says Sithong. The rush to get to the toilet, combined with grogginess of sleep and darkness of the room, raises the odds of tripping or losing your balance. Keeping the path between the bedroom and bathroom clear is important, as are strategically placed grab bars. "Any place where you regularly place a hand on the wall to steady yourself, add a grab bar," she says.
Another useful adaptation: Handheld showers and longer hoses. "A lot of people like the control of handheld showers but they can't reach that high," says Sithong. "An easy fix is placing suction cups lower on the wall to hold the handheld head." Adding a lower wall mount for the shower head also makes it easier to sit in a shower chair while washing.
Many older people prefer to soak in the tub—surrounding tired, aching muscles with warm water is undeniably therapeutic. But stepping over the tub edge, lowering yourself down, then standing up and stepping out provides multiple opportunities for losing your balance, slipping, and falling. Bath lift chairs can solve that, says Sithong. "These are chairs with buttons that you mount in the bath to lower you into the tub to soak and out again." They are surprisingly affordable, she adds, and safe for seniors to use.
Med Stacking Is a Worry
Most older adults have no idea that the drugs they take to prevent illness, aches, or to sleep better can also contribute to a higher fall risk.
Often, the issue is not one specific medication but the arsenal of drugs many seniors take and the way they interact with each other. "It's called med stacking," says Dr. Maissel. "Someone already on one medication for bladder problems is now given a Parkinson's disease medication or a drug for high blood pressure. Not all doctors are trained in drug interactions. Or they know what they're prescribing, but not the full list of what a patient is taking. Pretty soon, there is a polypharmacy effect."
The cumulative effect of one drug with a high fall-risk profile with another medication that also affects balance or alertness can spell big trouble. Additionally, many people assume medications or supplements sold over the counter are relatively benign in terms of side effects, but that's not always the case. "My favorite culprit is Benadryl," says Dr. Maissel. Benadryl, an anticholinergic, blocks the histamine receptors that contributes to allergy symptoms. "But it also makes you dizzy and may contribute to falls," she adds.
Hip Weakness Destabilizes You
While environmental modifications hold the key to lowering fall risk, how you care for your body also plays a role. All things being equal, physical strength and stability naturally diminish with age, says Dr. Maissel. In particular, loss of strength in the gluteal muscles raises the odds of falls.
"The gluteus medius that stabilizes the hips when you move side-to-side and contracts to keep the unsupported hip elevated when you stand on one leg," says Dr. Maissel. "If you don't have strength in this muscle, the unsupported hip drops and you quickly become destabilized."
Simple glute-strengthening exercises, like side steps using a resistance band for 10 minutes a day, can help you maintain strength in these important muscles.
Less Flexibility Means Higher Fall Risk
"Imagine a tulip stem that can bend in the wind versus an oak tree," says Dr. Maissel. "Stems flex, tree trunks break. As you lose flexibility with age, you become like the tree trunk: Once you lose your balance, you can't recover it. You don't bend, you break."
Less flexibility in the joints of your foot and ankle means that the walking motion you've taken for granted your whole life (heel down, sole down, knee over toes, hips over knee) becomes restricted. "The ability of the knee to track over your toes when you walk is due to ankle mobility," says Dr. Maissel. "If you don't have full range of motion, you lose that natural walking stride and start to shuffle—and that increases your risk of falls."
The Fear Factor Is Real
Apprehension over falling is ironically one of the greatest risk factors for doing so, both Dr. Maissel and Sithong say. Once the body tenses up in anticipation of a fall, movement becomes less automatic and you begin to carry yourself differently, which destabilizes your balance, explains Dr. Maissel.
Still, the belief that extra caution may prevent falls persists. A survey from researchers at the Centers for Disease Control and Prevention (CDC) found that 81.6% of older adults endorse "being more careful" as a top strategy for avoiding falls. That approach, which researchers note has little evidence to support it, puts the responsibility of fall prevention solely on seniors, rather than the spaces they live in.
Sleep Is a Sneaky Fall Factor
Insufficient or low-quality sleep may play a part in increasing your risk of falls. One analysis over more than 200,000 adults found a 30% higher likelihood of falls in those who experienced minimal sleep, poor sleep quality, or multiple sleep disturbances. "People who sleep less than six hours are at increased fall risk," says Dr. Maissel. "That's true whether you are a senior or a caregiver as well."
You don't have to literally be skimping on sleep to raise your fall risk: Fatigue has a similar association with falls. "With either poor sleep or fatigue, the bottom line is that you are functioning at a lower level," says Dr. Maissel. "Then on top of that, maybe you're taking a medication that affects your balance, or finding standing up or sitting down is becoming difficult. It's a layering effect—one risk factor on top of another and another. Eventually, those layers tip you over—literally."
A Little Prevention Goes a Long Way
If there's one thing experts want to stress about fall prevention, it's that acting early is always the right move. "Fractures from falls can set people back months in progress and what they want to do," says Dr. Maissel. "And some fractures are preventable."
Ensuring your safety starts with seeing an expert for an honest assessment of your current mobility, then taking stock of the environment around you. "People get medical assessments for how strong they are, what kind of balance they have, how good their vision is—but assessing the home is an afterthought," says Sithong. "It's hard to think of your home as unsafe when you've lived there for 40 years, but you need to change your mindset. The environment needs to be modified to avoid falls now and in the future."
Have Questions?
Not sure which home safety products could help reduce fall risk in your space? Contact our customer service at 888-404-1724.
Sources
