Fall is the leading cause of accidental injuries among the 65+. Statistically, six out of ten falls happen at home, some of which are fatal. Hence, elderly fall prevention must start with discussing fall hazards at home.

Places around the house where you are most likely to fall are:

• Stairs
• Living room
• Bedrooms
• Bathroom
• Garden 

Poor lighting, structural obstruction, clutters, and slippery surfaces are common causes of falls. Older people are especially vulnerable to these unfavourable conditions. 

Most of these home hazards could be removed with just a bit of effort, for example, by removing clutters in the living environment. Low-cost products may reduce some hazards: non-skid mats in the shower/bathtub, securing mats with double-sided tape and installing motion sensor lights in the hallway and door entrances. Other home modifications, such as installing a stair lift, are more costly and may require professional advice.

Make home safety your top priority

To ensure the home is safe for an older adult, we should conduct checks systematically to look for and fix potential hazards. For this purpose, there are available various home assessment tools. Some of these tools are simple and easy to use. They are usually in the form of a checklist that guides us around the house to do the checking job. Although not comprehensive, the checklist points out the common hazards and what measures we should take to eliminate them.

CDC has a useful checklist for elderly fall prevention at home. The checklist goes through possible hazards in each area of your home. For each hazard, the checklist tells you how to fix the problem. Armed with this tool, you will soon find out and fix those hazards for yourself or your loved one.

Bedroom

30% of falls occurred in the bedroom. Some elderly fall while getting out of bed or when in a hurry to go to the bathroom. The stumble may be due to hypotension, confusion, effects of medication, joint stiffness or foot problems. In addition, they may trip over rugs or clutters on the floor if they don’t see well in dim light. 

Solution:

• Bedside lamp which is easily reached and switched on. 
• Low bed.
• Non-slip padded mats are placed next to the bed.
• Install bed rails to prevent falling out of bed and provide extra support for sitting up and getting in and out of bed. 
• Remove clutters and secure cables.
• Either remove the rug or tape it down securely

Bathroom

13% of falls occurred in the bathroom. 

Solution:

• Make sure the floor surface is non-slippery, clean, dry and uncluttered.
• Fixed bath mats with double-sided tape or remove them.
• Use a non-skid mat in the bathtub or shower.
• Install grab bars inside the shower or bathtub and near the toilet.

Living room 

31% of falls occurred in the living room, where the elderly spends a lot of his/her time. They often trip over throw rugs, clutters, and trailing electric cables on the floor. They may suffer a tumble if their walking frame or walking stick gets caught on awkwardly placed furniture.

Solution:

• Move furniture out of the way of the usual walking route.
• Tidy away clutters such as books, magazines, phones, remote controls etc.
• Fix throw rugs securely with double-sided tape or get rid of them completely.
• Tidy and secure phone and electrical cables along the wall or under the carpet.
• Adequate lighting is important. Install a motion sensor light or virtual voice assistant device to control light so that the elderly do not have to search for light switches in the dark. 

Stairs

Risk of falling increases in homes with stairs or steps. Falling from a height results in much more severe injuries.

Solution: 

• Install sturdy handrails on both sides of the stairs.
• Ensure adequate lighting at the top and bottom of the stairs.
• Ensure no loose-fitting carpet on the steps, and no clutters, rubbish or other obstructions.
• Make hardwood stairs less slippery by adding traction: securely fitted carpet, anti-slip adhesive stair treads, and applying an anti-slip floor finish to the wood surface. 
• Consider installing a stair lift to avoid the risk of walking up and down the stairs.
• Ideally, a single-story home is more suitable for the elderly, especially frail ones.

Garden

Common accidents include: slipping on steps or paths covered with moss (or ice in the winter), tripping over garden tools, and falling from steps while cutting hedges.

Solution:

• Trim shrubs and hedges to keep the path clear and ensure the path is clean and level.
• Avoid potentially dangerous chores or situations.
• Clear and tidy away tools after use.  

Driveway and front door steps

Solution:

• Make sure the entrance is well-lit. Install motion sensor lights
• Install handrails on both sides of the front door steps.
• Ensure the ground is level, and there are no uneven paving slabs.

Fall hazards assessment and home modification is an ongoing job which is best done periodically. We have to adjust the modified facilities when the condition and functional capability of the older person change.

Check for Safety: A Home Fall Prevention Checklist for Older Adults

Home hazard assessment

A formal and thorough Home Hazard Assessment is a service provided by health professionals experienced in fall prevention. The task is usually undertaken by an occupational therapist who will visit your home to identify potential hazards and advise on how to deal with them.

Besides assessing the home environmental conditions, the occupational therapist also assesses the functional capabilities of the older adult living there. He or she advises on appropriate equipment and home modification according to the present condition and ability of the elderly. The requirement of an elderly who already uses a walking frame is quite different from another one with no mobility problem.

When introducing a new piece of equipment to the home, it is important to ensure the elderly can use it correctly and efficiently. Initial training and follow-up visits may be required to ensure the outcome is as expected.

Usually, the occupational therapist will advise on recommended suppliers and installers of the equipment. If the cost of home modification is high, he/she may be able to advise on the source of finance and how to apply for it.

You can enquire about home hazard assessment through your healthcare provider or local authority.

Environmental Assessment and Modification as Fall-Prevention Strategies for Older Adults