Fall prevention: home hazards

Fall prevention averts more than just falls. It also prevents the injuries, chronic pain, disability, loss of mobility, and even deaths that falls cause. Because many falls – especially in older adults – still occur at home, that’s a good place to start.

Bathrooms have some obvious fall hazards because of factors such as slippery tiles and difficulty getting in and out of tubs. The good news is that people are more aware of fall risks in the bathroom, and may have already taken action to reduce those.

“Because a lot of information about home safety is already out there, when I ask people if they have safety features in their bathroom, they say yes, I have a rubber mat, yes I have grab bars,” says Azeena Ratansi, Occupational Therapist with the Centre for Osteoporosis and Bone Health at Women’s College Hospital. “So those behaviours have already seen improvement and change.”

In contrast, there are other areas of the home and other home activities that need greater recognition as fall hazards.

Steps to safety

Stairs are an area where most injurious falls commonly take place. For stair safety, have handrails on both sides, and ideally, always use them when going up and down. At the very minimum, hold at least one handrail.

Carrying a laundry basket down the stairs has one of the highest incidences of injurious falls. Laundry is unavoidable for most people, so it’s important to find a safer way to get it from the hamper to the machine, which is often on a different floor.

“My favourite is to toss it into a garbage bag and just throw it down the steps,” Ratansi says. “Alternatively, if you are carrying a laundry basket, carry it on your hip. Not only does that free up your other hand to hold the handrail, but it also clears your visual field so you can see where you are stepping.”

If the stairs are smooth hardwood, consider getting a runner to help avoid slipping. However, Ratansi recommends getting a solid – not patterned – stair runner.

“It should be solid because studies in older individuals have found that patterned runners provide a visual distraction, leading to a higher likelihood of falls,” she explains.

Vision changes can also affect fall risk. Be aware that glasses with multifocal lenses can make depth perception more difficult, and can be dangerous on stairs.

Visual changes due to aging also affect lighting needs. Ratansi notes that as people age, they need more light.

“Studies have shown that by the time you reach your 60s, you need three times the amount of light to discern objects as clearly as you did when you were  in your 20s,” she says.

“This is really important for people who have to get up in the night to go to the bathroom. Make sure the path is illuminated. We often suggest getting lights that adapt to motion so that as soon as you approach the bathroom, it goes on.”

Height hazards

Standing on a chair to reach a high shelf or change a light bulb is another common risk.

“Standing on a chair is sometimes unavoidable; but many people don’t do it safely,” Ratansi says. “The safest way to position a chair is to have the back positioned in front of you – against a wall or cupboard. However, 70 per cent of people position the back of the chair to their side, often using it as a support to hold onto as they climb on and off. That means that if they need to lean a bit to the side to retrieve something from a shelf, they’re going to tip the back of the chair and potentially cause it to flip over.”

If possible, use a proper footstool to reach things. The ideal footstool should be deep enough to accommodate your whole foot.

“Your stability is affected by the amount of contact your foot has with the surface,” Ratansi says. “Very often when you step up on something, your foot is overhanging. With many of those multi-level step stools, you’re partly on and partly off.”

Regardless of what you are standing on, be careful not to overextend by leaning or reaching too far.

“We have a lot of patients who have fallen doing things like putting up curtains, leaning way past their base of support,” Ratansi says.

If you find you’re using a stool or standing on a chair regularly, consider reorganizing to make the things you use often more accessible.

“Keep frequently used items between waist and shoulder height. That’s the ideal zone – what we call the work zone or the reach zone. If you know you’re going to use a plate, a mug, a bowl, keep them in that zone,” Ratansi says.

“You’re not going to prevent every fall, but you can take significant steps to minimize the risk.”