At any age, an injury from falling can limit a persons ability to lead an active, independent life. This is especially true for older people. Each year thousands of older men and women are disabled, sometimes permanently, by falls that result in broken bones. Yet many of these injuries could be prevented by making simple changes in the home.

As people age, changes in their vision, hearing, muscle strength, coordination, and reflexes may make them more likely to fall. Older persons are also more likely to have treatable disorders that may affect their balance - including diabetes or conditions of the heart, nervous system, and thyroid. In addition, compared with younger people, older persons take more drugs that may cause dizziness or light-headedness.

Preventing falls is especially important for people who have osteoporosis, a condition in which bone mass decreases so that bones are more fragile and break easily. Osteoporosis is a major cause of bone fractures in women after menopause and older persons in general. Although all bones are affected, fractures of the spine, wrist, and hip are most common. For persons with severe osteoporosis, even a minor fall may cause one or more bones to break.

Falls and accidents seldom just happen, and may be prevented. There are simple steps you can take to make your home safer and reduce the likelihood of falling. The following are some guidelines for preventing falls and fractures.

• Have your vision and hearing tested regularly and properly corrected. Do not wear glasses meant only for reading while walking around.
• Talk to your doctor or pharmacist about the side effects of the medicines you are taking and how they may affect your coordination or balance. Ask them to suggest ways to reduce the possibilities for falling.
• Limit your intake of alcohol. Even a little alcohol can disturb already impaired balance and reflexes.
• Use caution in getting up too quickly after eating, lying down, or resting. Low blood pressure may cause dizziness at these times.
• Make sure that the night time temperature in your home is no lower than 65o F. Prolonged exposure to cold temperatures may cause body temperatures to drop, leading to dizziness and falling. Many older people cannot tolerate cold as well as younger people can.
• Use a cane, walking stick, or walker to help maintain balance on uneven or unfamiliar ground or if you sometimes feel dizzy. Use special caution in walking outdoors on wet and icy pavement.
• Wear supportive rubber-soled or low-heeled shoes. Avoid wearing only socks or smooth-soled slippers on stairs and waxed floors. They make it very easy to slip.
• Maintain a regular program of exercise. Regular physical activity improves strength and muscle tone, which will help you move more easily and keep joints, tendons, and ligaments more flexible. Many older people enjoy walking and swimming. Mild weight-bearing activities may even reduce the loss of bone to osteoporosis. It is important, however, to check with your doctor or physical therapist to plan a suitable exercise program.
• Avoid dangerous behavior such as climbing on a stool if you have times when you feel dizzy.
• Cut out or limit to the minimum sleeping pills and tranquilizers. Experience shows that in many cases these drugs are a habit rather than a necessity, and that people can easily manage without them.
• Learn how to pick yourself up after a fall. You might lie for hours after a fall if you cannot get up (because of a fracture or simply through some temporary incapacity).
• Plan how to alert somebody if you live on your own. Make sure that you can easily call a neighbor and, if there is a telephone, that it is accessible from floor level.

Home assessment checklist for fall hazards

Exterior

• Are step surfaces non-slip?
  
• Are step edges visually marked to avoid tripping?
  
• Are steps in good repair?
  
• Are stairways handrails present? Are handrails securely fastened to fittings?
  
• Is there sufficient outdoor lighting to provide safe ambulation at night?

Interior

• Are lights bright enough to compensate for limited vision?
  
• Are light switches accessible to the person entering the room?
  
• Are lights glare free?
  
• Are stairways adequately lighted?
  
• Are electrical cords and telephone wires out of walking paths?
  
• Are handrails present on both sides of the staircases?
  
• Are step edges outlined with colored adhesive tape and are they slip resistent?
  
• Are throw rugs secured with non-slip backing?
  
• Are carpet edges taped or tacked down?
  
• Are rooms uncluttered to permit unobstructed mobility?
  
• Are chairs throughout the home strong enough to provide support during transfers? Are arm rests present on chairs to provide assistance while transferring?
  
• Are tables (dining room, kitchen, etc.) secure enough to provide support if leaned on?
  
• Do low-lying objects (coffee tables, step stools, etc.) present a tripping hazard?
  
• Are telephones accessible?

Kitchen

• Are storage areas easily reached without having to stand on tiptoe or a chair?
  
• Are linoleum floors slippery?
  
• Is there a non-slip mat in the sink area to soak up spilled water?
  
• Are chairs wheel free, armrests equipped and of the proper heights to allow safe transfer?
  
• If the pilot light goes out on the gas stove, is the gas odor strong enough to alert the person?
  
• Are step stools strong enough to provide support? Are stool treads in good repair and slip resistant?

Bathroom

• Are doors wide enough to provide unobstructed entering with or without an ambulatory assistive device? (Such as a walker)
  
• Do door thresholds present a tripping hazard?
  
• Are floors slippery, especially when wet?
  
• Are skid-proof strips or mats in place in the tub or shower?
  
• Are tub and toilet grab bars available? Are grab bars securely fastened to the walls?
  
• Are toilets too low in height? Is an elevated toilet seat available to assist in toilet transfers?
  
• Is there sufficient, accessible, and glare-free light available?

Bedroom

• Is there adequate and accessible lighting available?
• Are night lights and/or bedside lamps available for night time bathroom trips?
  
• Is the pathway from the bed to the bathroom clear to provide unobstructed mobility (especially at night)?
  
• Are beds of appropriate height to allow for safe on and off transfers?
  
• Are floors covered with a non-slip surface and free of objects that could be tripped over?
  
• Can the person reach objects from closet shelves without standing on tip toe or on a chair?

Prepare in advance for your old age

All right, so you are still young or relatively young, and you dont feel directly concerned by this sort of advice. All the same, it is only sensible to prepare for old age by thinking in terms of prevention.

For more complete information on simple, relatively inexpensive repairs and safety recommendation for your home, write to the U.S. Consumer Product Safety Commission, Washington, D.C. 20207; or call (800) 638-2772. The Commission can also send you a single free copy of the booklet Home Safety Checklist for Older Consumers.

The National Institute on Aging offers information on health and aging. For a complete list of publications, write to the NIA Information Center, P.O. Box 8057, Gaithersburg, MD 20898-8057.

The information for this pamphlet was prepared by Cindy Nigolian, RN, MS, a certified clinical nurse specialist with expertise in gerontology.

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