How can families support safer ageing at home?

I mentioned earlier that my neighbor’s mum fell in the bathroom on a Tuesday morning. She spent three weeks in hospital followed by months of recovery. Many families do not consider home safety until an accident occurs. The accident usually happens on an ordinary day for no apparent reason.

Most people underestimate the risk of falling in their own home until it actually happens. The way that people hope that other things will happen to other people, such as a car accident, also happens with serious falls in other people’s homes that contain aging parents.

Helping an aging parent live safely in their own home doesn’t have to mean hospitalizing them in a clinical type of environment. The way a home is set up to be safe to live in can be attended to by paying attention to the various details in a home and learning to note areas of risk throughout each room.

Falls in Bedrooms: The Most Unexpected of Accidents

I thought the suggestion that falls in bedrooms were less common than falls on stairs or in bathrooms was quite insightful. People getting up in the middle of the night to go to the bathroom and falling are common. Reaching up for things on high shelves while half asleep can also cause falls.

There are situations where people with decreased strength in their legs have problems getting up from low beds. Using an adjustable bed base can help to make standing up easier. In addition, using bed rails can provide a safe point for people to grab hold of as they are getting in and out of bed. Bed rails are perceived to be a means of allowing people to live independently and do not have to have the perception of weakness that grab bars have.

As stated earlier, night lights (even of very low intensity) as well as floor level bedside lights can provide a cost effective solution.

• Keep frequently used items (glasses, phone, medication) within arm’s reach of the bed
• Remove rugs or mats that can bunch or slip underfoot
• Make sure there’s a clear, unobstructed path to the door
• Check that the bed itself is stable — no wobble, no wheels that shift unexpectedly

The bathroom: where good intentions tend to stall out

Grab rails are agreed to be important in bathrooms to assist people in reaching and in supporting self to standing. However, in practice few are actually installed. Of those that are installed, many are positioned in the wrong place. Additionally, there are many novelty grab rails that are installed in bathrooms, ostensibly as part of the decorative fixtures and fittings. These grab rails are notorious for pulling out of the wall when the most pressure is required- i.e. a moment of crisis- and have the effect of doing nothing to assist the person who requires support and instead create the false sense that there is support there in the first place.

I want to emphasis how worth while an occupational therapist assessment is and I have seen firsthand the devastation to families that have not had an assessment prior to a fall and then wish they had. The OT assessment will identify things that families have not even thought of ie. the height of the toilet, how a bathroom door opens, the lip into the shower recess creates a trip hazard (although not yet been experienced by family). A long list of recommendations most cost very little to implement some requiring a plumber however the knowledge gained prior to a fall is worth its weight in gold.

There is no reason that non-slip flooring, a shower chair and a handheld showerhead mean your ageing parent has to move out of their home. These simple measures can enable them to live safely in their own home for as long as possible.

Living areas: also so very ordinary

Living areas hide the greatest amounts of risk as they are believed to be safe and the risk has accumulated quietly in the most familiar of places in a home. All the furniture is out and it enables people to move around comfortably, unaware of the greatest risk of falls in the home.

The home, the place of safety and security of the aging person and their family members, is a place that presents its own set of challenges for support of the aging person. The majority of falls that occur with the aging population occur in the home and in particular the bedroom. The risks for falls in the home present in a variety of ways. Many falls occur as a result of slips and trips and can be attributed to a variety of factors, some of which are obvious and others which are not so obvious. When we consider the bedroom, people assume that the stairs are the biggest risk for falls, but in fact, the majority of falls that occur with the aging population occur in the bedroom. Reaching for things in the dark of night, and in particular things that are on high shelves can be challenging for some people and present a risk for falls. Getting out of bed in the middle of the night can also be challenging for some people, in particular people who have mobility issues and who experience pain when they move. Adjusting the height of the bed can be an option for some people to support safe movement out of bed. Another option for people who experience difficulty getting out of bed is the use of bed rails. These can provide much needed support for people who require it.

When planning for your aging parent’s safety, it is best to plan when they are calm and are able to make the best decisions for their safety and independence. Making decisions for a parent in the night in a hospital waiting room for extended periods of time is not ideal for making any decisions, especially for decisions that will affect how your parent lives their life.

See also: The Future of Technology in Digital Healthcare

Comparing Home Safety Modifications for the Aging in Place Home

Area	Common risk	Practical fix	Approximate cost
Bedroom	Falls getting in/out of bed	Bed rail, adjusted bed height	Low to moderate
Bathroom	Slipping on wet surfaces	Grab rails, non-slip mat, shower chair	Low to moderate
Living areas	Tripping on cords or rugs	Cable management, furniture rearrangement	Very low
Hallways/stairs	Poor visibility, no support	Handrails, motion-sensor lighting	Low to high depending on scope

What do families need to do?

But with all the safety measures to help and protect an older person in their home that there are today, all it would take is for that older person to be opposed to the safety measure in question and they could have it removed and no one be any the wiser that they were in need of help in the first place. Often people do not want to be a burden to their family and be forced into care, as they feel that they will be losing their independence. It is said that many older people are in denial of their need for help until it is too late.

The way you frame the conversation can make a huge difference. Instead of “we are worried that you will fall,” we say “we want to make sure that you can live here comfortably for as long as possible.” The first opens up a lot of possibilities for discussion. The second sounds like a diagnosis has been read out.

And now, I am reminded of my neighbor whose family had set up his home with grab rails and had modified the house to support his aging. However, he told me that what he wished the family had done sooner was to have a conversation and worked out how to support him in his home before it became urgent and they were forced into making decisions at the last minute in a hospital. Some of those decisions, I am sure, were influenced by guilt. The work that the family did in setting up his home with modifications was important but the most important work was the conversation that needed to happen prior to the home modifications.

This is not a perfectly safe house but every step has been taken to lower the number of falls and to remove as many obstacles as possible to allow your ageing parent or relative to live as independently as possible in their own home.