Fall Prevention for those Aging in Place
Most seniors over 65 prefer to remain in their own homes and Age in Place. There are several benefits to Aging in Place, but understanding the risk of falling is important, as is is the importance of implementing Fall Prevention measures through use of Universal Design tools.
Facts on Falls for Seniors
- Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults. 1
- One-third of Americans over 65 fall each year.2
- More than 95% of hip fractures are caused by falling.3
- Falling once doubles seniors’ chances of falling again.1
- 25% will be dead within one year of a fall4,
- 70% will be released to a nursing home and only 25% of these people will ever regain their former independence.5
While there may be a number of contributing factors to why seniors fall, that influence these data, it is startling nonetheless and raises the need for Fall Prevention.
Fall Prevention Summary
- Falls have serious consequences and dramatically reduce seniors’ quality of life and life expectancy.
- Falls can be prevented by addressing the home environment.
- Plan as early as possible, ideally at the time of retirement.
- Get a third party assessment done of the home to identify risks and mitigation options.
- Ensure that Universal Design Concepts are incorporated in the design.
Falling, Changing Behavior
It’s human nature to wait for an event before implementing mitigation actions. As children, we fell countless times as it was an expected element of the learning process. Eventually we learned that it was better to stay upright, but the learned pattern was that falls were typically minor events, almost always without serious collateral consequences. After 65 years, this well entrenched behavior leaves us set up for serious unanticipated risk. Too often, neither us, or our children, are adequately prepared to identify and address the issue. Waiting for the fall before taking preventive measures is an unnecessary risk with potential for fatal consequences.
To avoid the consequences of a fall, avoid the event in the first place. Sounds simple, but with decades of learned behavior, even simple things require a committed effort.
Let’s break down the inputs to a fall as a way to quantify the Fall Risk. There are three key elements to quantify the risk of an accidental fall– a Physiological Impairment, an Environmental Risk and an Exposure. We can express this as a simple formula:
FR = PI x ER x E
Where: FR = Fall Risk
PI = Physiological impairment
ER = Environmental risk
E = Exposure
At all stages of life, the goal is to keep FR as low as possible. If we experience an increase in PI, ER or E, then we either need to reduce one of the other variables or accept consequences of a higher Fall Risk.
Most days we navigate through our environment just fine as long as the Physiological and Environmental factors don’t present themselves at the same instant.
Physiological Impairments include reduced vision, balance, muscle strength, range of motion, and mobility, as well as fatigue, side effects of medication, and other human related factors. Since these are dynamic factors, they are inherently subject to variability, and typically accumulate as a more challenging set of issues to manage over 65.
Environmental factors include things like trip and slip hazards, low lighting and a long list of things that we can classify as unfit for use such as toilets that are too low, steps that are too high, inadequate railings, etc. In the big picture, most of these remain relatively constant over time. Changes, such as normal weather patterns, that are well understood are generally easy to manage. However, shoveling a snowy walk becomes more challenging due to physiological impairments as we age.
Exposure will vary from person to person, but it is common to see a gradual reduction in activity at some point in later years. A fall event in later years is likely to result in a sharp increase in physiological impairment and a sudden drop in activity (exposure), due to the physical impairment and potential post-fall anxiety. A broken hip is a classic example. While reducing Exposure (activity) may reduce Fall Risk, it comes with significant consequences due to inactivity and generally not a long term healthy alternative for someone with independent living expectations.
Fall Prevention
With all that disturbing news out of the way, what can we do about preventing falls? Medical evidence is clear, life expectancy over 65 correlates strongly with lifestyle activity. Activity is critical to preserving health and life expectancy, and we should do everything possible to sustain activity (Exposure) levels throughout our retirement years.
Physicians work with us to keep on top of our dynamic physiological issues over the years. These health issues can grow in complexity, sometimes with unexpected side effects, particularly when multiple health issues are being treated. Physicians’, however, have much less data regarding our home environment and daily activity levels. That is left largely up to us to understand and manage. Thankfully it is an area that can be actioned in several ways.
Given the importance of maintaining an active lifestyle (Exposure) in the face of slow, inevitable Physiological Impairment, the variable to focus on in retirement years is Environmental Risk.
Retirement is the time to step back and take a realistic look at the home environment. Is anyone moving around a bit slower and taking extra caution compared to when in their forties? Is anyone avoiding certain areas of the home? That’s a subtle but sure sign of compensating for Physiological Impairment and deserves attention. Going slower helps in the early stages but only buys us a little time. Eventually one reaches a tipping point, at which time falling is imminent.
When should we address environmental risks? What seems clear is that we should ACT BEFORE A FALL. Unfortunately, most of us are unaware of the slowly escalating Fall Risk and by default, take no action to improve our environment until after an event. The earlier the improvement, the more years the homeowners will be able to appreciate and benefit from them.
If cost of home improvements is the basis for inaction, consider the alternative. The medical costs of injury treatment, including rehabilitation can be significant on their own. If the fall victim is in the 75% who never return to independent living, the escalated costs of assisted living can be staggering, as are the emotional consequences brought on by all the changes to lifestyle, community and housing. Getting ahead of a fall can be priceless.
Step 1: Get an assessment done of the home. This should be a detailed review of your entire home that takes into account the needs of all the residents. The assessment will raise up areas of concern and should rate them in terms of urgency and ease of implementation. In addition, there should be a list of recommendations and estimated costs.
It’s a good idea to have assessments done every 3-5 years, as both the homeowners’ needs change, as well as the assistive devices that are continually being introduced to the market.
If you’ve been looking for an excuse to move, this might be the last straw, but keep in mind the same assessment should be conducted on any new residence before finalizing such a decision.
Step 2: Develop your long term plan to make your home friendlier and safer. It is imperative to put a long term plan in place that makes sense. Everything doesn’t have to be done immediately, but the urgent, low cost items should certainly be addressed first. Once a long term plan is developed, it will provide immediate peace of mind for minimal cost. It will also allow for costs to be better predicted and controlled, as well as result in a better overall design.
The best plan will prevent a fall before it occurs, add equity to the home, and make it safer and more inviting for family and friends to come and go. Planning should start as soon as the homeowners have decided upon retirement.
Step 3: Design. Chances are the home was built to “typical” design standards, which is why there are some issues to resolve. The assessment should have raised the need for improvements that incorporate Universal Design Concepts. A Universal Design-based design ensures that sound principles are applied and that the home is addressed from several vantage points, including mobility and visual limitations not considered in typical house designs. A Universal Design will also result in architectural features that add equity to the home. In contrast, a metal or wood ramp parked in the front of the home will detract from the equity as someone will be saddled with the cost to remove it later.
Step 4: Execute the plan. With your plan in hand, start screening contractors to come up the one that can provide the changes that best fit your needs. This can be daunting, but don’t allow it to deter you from your mission. There will be some work and disruption involved, but you will reap the benefits for years to come. The majority of homeowners choose to work with a General Contractor (GC), as GC’s are best equipped to deal with a range of trades and should be able to keep your overall needs in mind. Friends can offer helpful referrals, but don’t start until you have high confidence that the GC is someone you can work with, understands your values and has earned your trust.
Step 5: Relax and enjoy an active home life. This is the best part! Your home should now be more welcoming than at any point before. The Universal Design will have introduced several fall prevention features that will have removed fall hazards and opened up the spaces. Family and friends, young and over 65, will be able to come and go more freely and maintaining community ties will be easy as well. Your home will be simpler to maintain and you should be able to relax and enjoy a sense of having your home under your control.
References:
1. Center for Disease Control and Prevention, Falls 2009 CDCFactSheet, May 2009
2. National Council on Aging, Falls Prevention Facts
3. Hayes WC, Myers ER, Morris JN, Gerhart TN, Yett HS, Lipsitz LA. Impact near the hip dominates fracture risk in elderly nursing home residents who fall,1993
4. Barone A, Giusti A, Pizzonia M, Razzano M, Palummeri E, Pioli G, Predictors of mortality after hip fracture: results from 1-year follow-up., 2006
5. My Mother’s Hip, Luisa Margolies, 2004
6. J Am Geriatric Society, 2006 Jul; 54(7):1145-7.
7. Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in elderly fallers. Age and Aging 1997
Useful links:
https://www.iofbonehealth.org/facts-statistics
http://www.nsc.org/learn/safety-knowledge/Pages/safety-at-home-falls.aspx
http://www.merckmanuals.com/home/older-people’s-health-issues/falls/falls-in-the-elderly
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3135440/
http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
http://www.homemods.org/about_us/index.shtml
https://www.ncsu.edu/ncsu/design/cud/