Addressing Falls Prevention through Home Modifications

Falls are extremely common in older people. Consequences of falling, whether it be in their home environment or out in the community include potential injury, functional decline, decreased independence, and in some unfortunate situations, death. Falls can not only have physical ramifications, but they can also create reduced confidence in carrying out activities of daily living.

Older adults who have had a fall previously are more likely to develop a fear of falling again, resulting in limiting their engagement in essential daily occupations.  

 Occupational therapists play a major role in falls prevention to ensure older people can remain living at home as safe and independent as possible. Understanding both intrinsic (relating to the individual) and extrinsic (influenced by the individual’s environment) factors associated with falls is valuable for an occupational therapist to acknowledge when recommending home modifications.

 Intrinsic factors that may contribute to falls include…

• Balance disorders

• Gait difficulties

• Older age

• Musculoskeletal conditions

• Neurological disorders

• Muscle weakness

• Decreased vision

 Extrinsic factors that may contribute to falls include…

• Slippery floors or surfaces

• Uneven flooring or terrain

• Rugs and other tripping hazards

• Inadequate lighting

• Environmental obstacles

• Chairs and armchairs without armrests

• Insufficient support

 Multiple studies evidently display the effectiveness of home modifications prescribed by occupational therapists in significantly reducing the occurrence of falls in older adults. These modifications may fall under the following three categories:

 Alterations or additions to the existing structure

Widening doorways can assist with increasing accessibility throughout walkways. The addition of ramps can prevent tripping over flights of stairs or steps, smaller threshold steps or door lips. Altering the existing layout of the house may be a beneficial option such as creating a first-floor bathroom or bedroom to avoid walking up stairs. Including appropriate flooring including non-slip tiles may be beneficial to prevent slips. It is important to ensure there is proper lighting such as a night light, motion sensor lighting options, brighter lights to improve visibility.

Installation of specialised equipment

Installing grab rails, particularly in bathroom near the shower, bath or toilet can make transfers safer, especially in the bathroom environment where water is present causing slipping hazards. Installing stair handrails can make going up or down the stairs safer and less physically demanding for older adults. A handheld shower hose can assist with washing an individual’s body to prevent reaching and bending which can cause loss of balance and result in a fall. Using a raised toilet can make it easier to get on or off the toilet. Shower stools or benches can be beneficial for those with reduced balance or standing tolerance and create more stability when showering. A bed side rail can assist with getting in and out of bed safer and easier.

Changing location of objects/items

The key is to eliminate tripping hazards. Rearranging furniture is an option that may need to be considered to ensure there are clear pathways. This correlates with decluttering so that there are no obstructions that can pose as tripping hazards and to open up the clearance space. Removing or securing rugs can assist with preventing slips or trips.

 Falls can display devastating consequences, however with the appropriate recommendations and education, they can be prevented. It is important to tailor home modifications to the specific needs of the individual. Identifying the client’s intrinsic and extrinsic factors associated with falling will facilitate a thorough evaluation of their risk factors that need to be addressed in intervention. These recommendations should be established together with the client and their caregivers to ensure for long-lasting impacts and adherence of the modifications to prevent future falls, improve quality of life and increase participation in activities of daily living for older adults living at home.

  ~ Written by Giuliana D’Aprile, Allied Health Assistant