Preventing Falls in the Home

Falls are the leading cause of hospitalizations for the elderly in the US and can lead to life changing events including surgery to repair broken bones, rehabilitation in a nursing home, and loss of mobility.  Fortunately the risk of falls can be significantly reduced with observation and some no and low cost adjustments.  Below are some places to start.

1. Medications - Many medications include side effects like drowsiness or dizziness but the combination of several medications may also produce side effects of their own or increase the side effects of certain medications.  Ask your physician to review current medications and to look for combinations that may be of concern.  You can also check with your pharmacist; many times they are more attuned to looking for interactions between medications.  A gerontologist - a physician specializing in geriatric medicine - however, may be the best choice.  As we age our metabolism changes and medication doses may need to be adjusted to produce the desired effect.  It is not uncommon for an elderly patient to require far less of a medication than a younger adult, even if they have been on that medication for many years.  Periodically check medications to see if they are being taken properly; skipped or additional doses can complicate the issue.
2. Limitations - Be aware of any physical limitations that may exist.  Weakness from a stroke or injury, Parkinson's, or other medical condition.  If these conditions are present, talk with your physician, home health nurse, or Elder Care Consultant about what specific dangers are present.
3. Assistive Equipment - Wheel chair, walker, cane, braces, or special footwear can all limit mobility in the home.  Make sure all areas of the home are easily accessible using assistive equipment.  Does the wheel chair or walker fit into the bathroom and to the commode?  Are floor transitions smooth and manageable?  The other concern here is that the needed equipment is actually used.  All the time.
4. Stairs - Stairs may be one of the most frightening obstacles for care givers.  Develop a plan to make the home suitable without using the stairs.  Even if you don't need that limitation today I can guarantee you will at some time, either during short term recovery or because of a permanent change in condition.  Can a bedroom be set up on the first floor?  Is there a bathroom, or at least a commode?  Where are laundry and kitchen facilities located?  Having a plan in place will definitely be worth your while.  Are there hand rails?  It's probably a good idea to have a hand rail on each side to be prepared for any limitations in the future.  The treads of the stairs should be covered in non-slip material.  If the stairs are carpeted, make sure the carpeting is secure.  For wooden and other hard surfaces you can install stair treads made of carpet or vinyl; again, make sure they are securely attached.
5. Outside Access - How easy is it to get in to and out of the home?  Again, this may not be an issue today but I promise you it will be an issue some day.  The ideal is to have ground level access to the outside from the main floor.  If this is not possible a ramp can be built.  There are even portable ramps you can purchase!
6. Bathrooms - Bathrooms, statistically, are the most dangerous room in your home.  Spend some time here to look for potential trouble spots and correct them.  Grab bars are cheap and easy to install around at least the back and one side of the commode and inside and outside of the tub or shower.  Though there are guideline for installation heights, you may need to consider the short or tall person using them and adapt as necessary.  Make sure that non-skid materials are installed in the tub or shower.
7. Lighting - As we age our eyes require more light to see properly.  Diseases of the eye can also reduce visibility.  Look at every area of the home; kitchen, bathroom, bed room, living area, stairs, hallways and entry ways.  Make sure there is good lighting in every area.  A higher wattage bulb or adding a lamp may be all that is required.
8. Reach - Reorganize storage areas and place the most commonly used items within easy reach to eliminate stretching or climbing.
9. Clutter - Remove clutter from frequently used areas and walkways.  Look at the arrangement of furnishings and other items.  Rearrange so there is a clear path to other areas of the home.  
10. Throw Rugs - This is a personal pet peeve (hence the photo).  Loose rugs in any room, including the kitchen and the bathroom, pose a problem for walkers, canes, and yes, even feet.  This is the area where I find the greatest resistance.  
11. Footwear - This is another area where I get resistance.  Safe footwear is a complete shoe, with toes and a heel, and a firm, non-slip sole.  Soft slippers and sandals, though comfortable, tend to fit loosely and do not provide support.
12. Spills - Spills should be cleaned as soon as possible.  Though I know this should go without saying, it may be difficult for an older person to reach the floor to clean up a spill.  Keeping a light mop handy may help remove the bulk until the spill can be properly cleaned.

It is important to approach this task with an open mind and objective observation.  If this has been the home for a long time it may be a good idea to have an impartial person with you.  A healthcare professional or an Elder Care Consultant can add a different perspective.  Once you've made the necessary changes to the home make sure to monitor from time to time to ensure everything is still as safe as possible.