Caregiving: Preventing Falls

Q. My mother-in-law has fallen several times in her home, and we’d like to make her home safer. What are some ways we can make her home more "fall-proof?"

A. If your mother-in-law is living alone, then you and she may wish to speak your local office of the aging, or a social worker, to determine if she needs more assistance to live more safely at home for as long as possible. A home evaluation can also be conducted to determine what special needs your mother-in-law may have. Some communities offer this service for free; other communities may refer you to a home healthcare agency on a fee-for-service basis. A geriatric clinic may be better equipped to help you and your mother evaluate the need for social services, a need that may increase with time.

General safety guidelines

First, consider some or all of these general safety guidelines:

• Have emergency numbers (police, fire, poison control and a neighbor’s phone number) readily available in case of emergency. Suggestion: write these numbers on a sticker and put on the receiver. Consider purchasing a programmable phone. Phones developed for those with low vision may be most appropriate for an older person no matter what their vision status, since they are easy to use and have large high-contrast features.
• Have at least one phone located where it is always accessible. Suggestion: keep a cordless phone in your pocket. This is especially important if you fall and can’t get up to use the phone. Consider leasing a lifeline button through your local hospital or via a national company. These are low-cost but work anywhere in the home, as long as the person is wearing the button.
• Make sure smoke detectors work properly.
• Avoid the use of space heaters and electric blankets; these are fire hazards.
• Make sure halls, stairways, and entrances are well lit. Install a night-light in your bathroom and hallway. Make sure there is a light switch at the top and bottom of the staircase. Turn lights on if you get up in the middle of the night. Make sure lamps or light switches are within reach of the bed if you have to get up during the night.
• Make sure treads, rails and rugs are secure on all stairways. Install a rail on both sides of the stairs. If stairs are steep, it may be helpful to arrange most of your activities on the lower level to reduce the number of times stairs must be climbed.
• Install metal handles on the walls next to doorknobs of all doors and entrances to make it more secure as you travel through the doorway.

Living room/bedrooms

• Place furniture with wide spaces in between, giving you enough room to move around. Establish a route through the living room that gives you something to hold on to as you walk -- this will help you from falling in case you lose your balance. <
• If possible, arrange furniture so outlets are available for lamps and appliances without the need for extension cords. If extension cords are used, make sure they are secured with tape and out of the way so you don’t trip on them.
• Use chairs with straight backs, armrests, and firm seats—this will make it much easier for you to get up and sit down. Add firm cushions to existing pieces to add height and make it easier to move.
• Install handrails along walls, hallways, and stairwells where there is nothing to hold on to.

Bathroom

• Use an elevated toilet seat and/or safety rails to assist standing from a low surface. <
• Do not use towel racks or bathroom tissue holders to help you stand.
• Install grab bars inside and outside the bathtub or shower.
• Use a bathtub transfer bench or a shower chair with a back support.
• Put extended lever handles on faucets to make them easier to turn.
• Install grab bars and put a non-skid mat or decals in the bath tub or shower.
• Get rid of small bathroom rugs that may cause you to trip, instead purchase a large rug that covers most of the floor and apply non-stick backing, or install wall-to-wall carpeting.

Kitchen

• Install non-skid rubber mats near the sink and stove. Clean spills immediately.
• Place utensils, pots, pans, and measuring cups on a peg board or in an accessible cupboard instead of in lower cupboards which require bending. Sit when getting things out of lower cupboards.

What are some ways my mother-in-law can maintain her balance to prevent falls?

1. Keep at least one hand free at all times; try using a backpack or fanny pack to hold things rather than carrying them in your hands. Never carry objects in both hands when walking, as this interferes with maintaining balance.
2. Attempt to swing both arms from front to back while walking. This may require a conscious effort; however, it will help maintain balance, posture, and reduce fatigue.
3. If you become "frozen," visualize stepping over an imaginary object, or have someone place his or her foot in front of yours to step over. Try not to have a caregiver or companion "pull" you, this may throw you off balance and even prolong the episode.
4. If balance is a continuous problem, you may want to consider a walking aid such as a cane, walking stick or walker.
5. Keep in mind that insurance usually covers physical therapy targeting balance if there is a gait or vestibular disorder. When therapy is completed, the home exercise program must be maintained. Other activities that improve balance include tai chi and yoga. It is not difficult to find low-cost community programs for seniors to help improve balance.
6. Consciously lift feet off of the ground when walking. Shuffling and dragging of the feet is a common culprit in losing your balance.
7. When trying to navigate turns, use a "U" technique of facing forward and making a wide turn, rather than pivoting sharply.
8. Try to stand with feet shoulder length apart. When feet are close together for any length of time, you increase your risk of losing your balance and falling.
9. Do one thing at a time! Don’t try to walk and accomplish another task, such as reading or looking around. The decrease in your automatic reflexes complicates motor function, so the less distraction, the better!
10. Do not wear rubber- or gripping-soled shoes as they may "catch" on the floor and cause tripping.
11. Move slowly when changing positions. Use deliberate, concentrated movements and, if needed, use a grab bar or walking aid. Count 15 seconds between each movement; for example, when rising from a seated position, wait 15 seconds after standing to begin walking.