Fall Risk Elder Assessment – Hazards and Prevention

Falls are the single biggest cause of fatal injuries in people 65 and older, so keeping elders safe in a home where they may have lived for decades is one of a family’s biggest challenges.  The familiarity of the surroundings and the history of safety can work against both the recognition in adult children of growing dangers and can build resistance on the part of the elder to any change in a familiar and comforting environment.

There is good/bad news here:  fortunately, many factors that contribute to fall risk are under a family’s control; unfortunately, fall risks are sometimes especially difficult to eliminate, because it can require change that generates resistance in the elder to the very actions needed to improve safety.  When we visit families, one of our first activities is a review of the home to inspect for these risks; we typically find that a person who recently moved to a condo or other new arrangement has many fewer accumulated hazards than someone who has lived decades in a home and intends to stay.

Many sources are available to help families take action to reduce fall risks. AARP, Mayo Clinic, and the Center for Disease Control, for example, all contain articles on the topic.  For those tackling the task at home along, here are some tips culled from our experience.

Physical Health

Regular exercise is probably the single biggest factor that helps reduce falls. If the elder will participate in a class like Tai Chi, which focuses on strength and balance, that is best.  But simply walking 20-30 minutes daily at a moderate pace is an enormous help.  Studies consistently show that people who remain active walkers later in life fall less often than more sedentary counterparts.

Review meds, and when possible, reduce them.  Write down every prescription and non-prescription drug or supplement, including anti-depressants and sleep aids, and take them for review by the senior’s physician.   Request a review for side effects and interactions that may increase fall risk.

Limit access to alcohol.  Even in safe doses, alcohol makes everyone a bit less steady, and alcohol abuse among elders, who are often lonely and isolated, is surprisingly common.

Check the elder’s health.   Poor vision, inner ear problems, urinary tract infections, and other health conditions may be the harbingers of increased fall risk.

Environment

Turn your attention to the environment.  Start with the elder himself or herself - be sure the elder wears proper shoes. Flip flops, sandals, and bedroom slippers, even in the home, can cause a stumble or fall.  Properly fitting and sturdy shoes are the keys the stable walking.

Next, examine each of the home’s component parts. Consider these questions:

Floors

Is there a clear path through every room?  If you have to walk around furniture, or if there are low items like coffee tables or foot stools, these will increase fall risk. Even if items have been present for decades, try to move them; they represent a risk now that they did not in years past.  If necessary, consider saying that they need repair or that they are dangerous for a grandchild. Avoid arguments over whether the elder is likely to fall; most likely, the response will be “I’ve lived here 50 years and haven’t fallen, so I want nothing to change.”  Your goal is not to get elders to agree that their skills are declining; it is rather to remove the risks, so always try to do it in a way that leaves the person’s dignity intact.

In particular, remove small throw rugs – these are among the most significant hazards. (“We took it for cleaning” or “It was ripped and is being repaired” are handy excuses if needed.) If the rug is so well-loved that it cannot be removed without undue stress, use double-sided tape on a non-stick backing to keep it securely in place.

If there are small objects on the floor, remove them.  These include pet toys or pet food dishes, laundry baskets, footstools, shoes, magazines and newspapers, etc.  Especially in the bedroom, where people often rise at night in the dark and are disoriented and sleepy, these present significant fall risks.

Get wires and extension cords out of the way.  If necessary, have an electrician install a new outlet.  Tape or staple cords out of the way.

Examine stairs and hallways.  Be sure they are well-lit – often older homes do not have bright lighting for stairways.  Be sure the light can be turned on/off from both the top and bottom of the stairs. If not, call to have a new switch installed.  Is there loose or torn carpet? Remove it or replace it.  Even better: attach non-slip rubber treads to the stairs.  Check for sturdy hand-rails on both sides of each stair.

These changes of course will not prevent all falls, but they can go a long way to eliminating the risk of unnecessary injuries.

Our next column will address fall risks in bathrooms and bedrooms separately, because they are so important.