Making the World Safer for Aging Adults

As your parents get older, you start worrying more. Maybe your mother fell last week, and your father couldn't help her up. She seems okay and so does he, but what about the next time she falls?

What if you found out these falls don't have to happen? That might seem impossible, but virtually all falls are avoidable. Fall prevention requires some thought and effort, but it pays off. Of course, there are other ways for your parents to get hurt, perhaps while driving or cooking. These activities, too, can be made much safer.

This guide covers the common ways in which seniors get injured and how these injuries can be prevented. There is an emphasis on falls because they are the leading cause of injuries and death from injuries among people 65 and older.

View from the Experts: Injury Prevention for Seniors

How to Prevent Injuries Resulting from Falls

Falls are all too common among aging adults. The Centers for Disease Control and Prevention reports that among people 65 years old and older, at least one in every four falls yearly. That first fall multiplies the risk of another fall by two times. The majority of the time, seniors don't even let their doctor know about what happened.

Seniors can fall at practically any time: Walking in their house, taking the elevator, navigating bad weather, or playing with their pets. These falls may result in fractures, brain injuries, and a host of other injuries. A ripple effect may also occur. For example, a hip fracture might lead to medical complications. Seniors who are in a wheelchair for the first time could feel depressed and anxious. That in turn can affect their self-esteem and desire to socialize. The recovery time from the hip fracture and the medical complications can also seem to take too long.

Fall prevention starts at home, whether “home” means a home the senior owns or rents, a caregiver's home, or a place such as an assisted living community or a nursing home. Notable things to consider include fall hazards, subpar footwear, medication effects, nutritional issues, and physical weakness. Many of these factors combine to present serious fall risks.

Resolve Fall Hazards at Home

Falling and tripping hazards at home encompass the usual suspects, such as clutter, cords, uneven steps, and rugs. Some things that tend to slip under the radar include pets, loose clothing, inadequate lighting, and bad shoes. There are so many potential fall hazards that you may start seeing them everywhere when you do a risk assessment. To avoid getting overwhelmed, focus first on the rooms and areas you use most.

In general, do the following:

• Clean up clutter from floors, hallways, and staircases.
• Assess each room and area of the house for hazards that might cause you to fall. Check for loose carpets, cords, throw rugs, and the like. Replace, remove, and repair what you need to.
• Live on just one floor of the house. Your risk of falling goes down the fewer times you have to deal with staircases.
• Wear clothing that fits properly so you don't trip.
• Wear shoes instead of just socks, which can be slippery. Alternatively, try nonslip socks. Shoes are still safer overall, but nonslip socks can do the trick if it's painful or difficult for you to wear shoes.
• Install handrails and grab bars for safer navigation in areas such as bathrooms and staircases (both indoor and outdoor staircases).
• Use nightlights in bathrooms and bedrooms.
• Install bright lighting in areas such as hallways and stairways.
• Remember bathrooms, kitchens, and outdoor areas. For example, nonslip mats in the shower and on the porch can prevent falls. So can getting a walk-in tub. Similarly, raised toilet seats and keeping all items within reach may be helpful.
• Train pets to not jump. A dog obedience class can help your pets learn to follow you at a safe distance. Avoid getting kittens and puppies.
• Make your movements purposeful. For example, pause briefly before starting to use a staircase railing or before starting to get up from bed. This helps prevent falls caused by rushing.
• Report any safety hazards you see in an assisted living facility or nursing home as soon as possible.

Of course, you probably don't spend your entire life in your house. You visit loved ones, you socialize with friends, and you go to medical appointments. Some of the tips, such as wearing properly fitted clothing and moving with caution, apply no matter where you are. However, there's a lot more that goes into fall prevention when you're out and about.

Take Care in Wintry Conditions and Other Inclement Weather Situations

Virtually every area of the country deals with bad weather at some time. Seniors in areas that get rain, fog, snow, ice, and darkness for longer periods are at heightened risk for falls. For this reason, you should:

• Wear footwear that has an irregular texture on the soles for the best grip possible. You can also deploy add-ons such as Yaktrax, which fit over your footwear and boost your traction.
• Check last year's footwear at least a couple of months before wintry weather is supposed to arrive to ensure it can handle another season.
• Clean your boots and shoes after you are safely inside. It's easy for snow or ice to freeze on shoes even if you are inside.
• Give yourself plenty of time to get places so you don't have to rush.
• Stay home if there isn't an urgent need to go out.
• Use a grip wherever possible. For example, handrails help you descend steps, and holding onto a door handle gets you out of a car more safely. Similarly, gloves should help you better grip canes, walkers, and railings.
• Keep your hands free of objects so you're as stable as possible.
• Look over your walking options for the safest paths.
• Check that your walkers or canes are in good shape from top to bottom. The handle should still offer a good grip, and the tip at the bottom could have a retractable ice pick.
• Use an ice carpet to protect against skids in both good and bad weather. In snow and ice, this carpet should help you maintain good balance when you walk.

Ease into Vision Corrections or Skip Them Altogether

Vision changes are a risk factor for falls. In fact, getting new eyeglasses can increase your risk if they mean a huge change in what you perceived before. For example, new eyeglasses might make something that used to seem far away much closer now—closer than it really is. Progressive lenses and bifocals can also mess with people's vestibular balance and distort peripheral vision. Here's what you can do:

• Stick with the same type of lens you're used to unless there's a compelling reason to do otherwise. For instance, if you wear single-vision glasses, it's risky to switch to bifocals. This is particularly true if you have fallen before or are at risk of falling.
• Opt for more conservative vision corrections if a jump in vision would otherwise be huge. Give your brain and sense of balance time to adjust gradually.
• Work with optometrists well-versed in how vision influences fall risks for senior citizens.

Balance the Use of Medications against Fall Risk

Medications can affect your blood pressure, blood sugar, and brain. They may make you less steady on your feet, affect your visual perception, lead to drowsiness, and much more.

The good news: This fall risk factor is usually the easiest to change.

• Visit your doctor regularly to assess the need for medications associated with fall risk and to evaluate the lowest effective dosage for your drugs.
• Investigate if there are non-medication treatment options available.
• Switch or stop medications as needed/as feasible.
• Balance the risks of falling against the condition the medication is supposed to help with.

Even over-the-counter medications can prove problematic. Many come with side effects such as drowsiness and blurred judgment, so do be careful.

Strengthen Your Body, Especially Your Lower Body

Being in decent shape is a great way to prevent falls and fall injuries, as is having adequate muscle mass. Even if you think you have a long way to go physically, a little bit does a lot. Now is always a good time to start moving.

Virtually any type of physical activity helps in at least one of these areas: strength training/resistance, gait and coordination, balance, flexibility, and stamina.

• Stretching exercises: Help with balance and muscle flexibility
• Weight machines, bands, and hand weights: Promote muscle strength
• Yoga, tai chi and exercises such as heel raises: Enhance flexibility and strengthen muscles
• Aerobic exercises such as biking and walking: Strengthen your lower body and your leg muscles

It helps to get moving, no matter what you do. Studies show that the average senior may watch as much as seven hours of TV a day. All of that sitting to watch TV in addition to sitting for other activities such as reading increases your risk for walking issues. The less time you spend on your feet, the harder it becomes to walk when you do attempt to.

Always talk with your doctor before beginning a new exercise regimen. There may be fall risks you weren't aware of, and your doctor may be able to suggest alternative exercises.

Eat Certain Foods, and Take Vitamin D

Nutrition is another way to maintain muscle mass. Unfortunately, many seniors have diets filled with cake, cookies, white bread, and other processed foods. They should focus on consuming more foods such as:

• Beans
• Eggs
• Meat
• Chicken
• Fish
• Milk
• Cheese
• Cottage cheese

These foods are high in protein, which helps you keep up that muscle mass. In addition, vitamin D promotes muscle strength, and a lack of adequate vitamin D is common among seniors. Supplements can do the trick, but request to have your vitamin D levels checked first. If you need a supplement, it'll generally be in the 800 mg to 2,000 mg range per day.

Take Care of Your Feet, and Use Proper Footwear

Proper foot care and proper footwear have been touched on in a few places above but deserve a separate section as well. The basics of what you can do are:

• See your doctor as soon as possible if you experience foot pain.
• Use shoes that have soles of less than half an inch and that don't have overly padded insoles. Otherwise, you risk shoes that are too high up and that affect your balance. Think wide and low-profile.
• Do foot exercises every day such as turning your ankles in a circular motion and moving your toes up and down. They promote good blood circulation.
• Replace shoes once tread wear manifests itself.
• Use Velcro straps and hook and loop closures when possible. If you strongly prefer laces, keep them snugly tied for the best fit and to avoid a tripping risk.
• Stay away from open-backed shoes and heels as they can lead to instability.
• Keep your nails trimmed, and treat calluses, corns, blisters, and bunions right away.
• Wear shoes when you are home instead of going barefoot or wearing socks.

Use Walkers and Canes

Walkers or canes can keep you as stable and safe as possible. However, choosing the right type for you is imperative.

• Choose your gear with care. Don't use a walker or cane offered by someone else unless a professional such as a physical therapist has deemed it safe. If you borrow or purchase a second-hand cane from someone else, it can become a fall risk because of an improper fit.
• Consult with an occupational or physical therapist for an assessment of proper walking aids. Some folks are better off with walkers or canes that have wheels versus those that don't. There are also quad canes with four legs and those that are one leg.
• Move your walker about one step in front of you. Ensure all legs touch the floor before you walk forward into the walker.
• Use proper cane technique when dealing with stairs. This link from the Arthritis Foundation gives detailed information.
• Keep an eye on your walker or cane's rubber tips. Replace worn ones.

Do Fall Risk Assessments

A fall risk assessment brings together all of the points touched on above. Such assessments consider the senior's home environment, any previous history of falls, medications the senior takes, the person's level of cognition, level of mobility, any incontinence issues that may lead to rushed movements, any depression issues, and general health and foot health.

You can do a basic self-assessment or have a friend or relative do one for you. Professional caregivers, occupational therapists, and physical therapists can also give assessments. If you're in the hospital for whatever reason, it's possible one will be done there. Assessments are also common practice when you go into assisted living, nursing care, and memory care.

After the assessment(s), a fall prevention plan can be developed for you. It may contain interventions like exercise program recommendations and recommendations for dealing with home hazards. The specific interventions vary with each person, of course.

If you want to set up a professional assessment for yourself or for a loved one, check with an occupational therapist. There may also be community resources such as care managers who specialize in helping older folks.

Keep Injuries from Becoming Worse

It's possible that you might fall despite taking excellent precautions. To keep a potential injury from becoming worse:

• Carry a charged cellphone with you at all times or wear an emergency alert bracelet. Call for help as soon as possible.
• Communicate with your doctor about the fall as soon as possible.
• Keep important phone numbers handy and in large print.

By acting swiftly if you do fall, you might stave off injuries or prevent injuries from becoming more serious. Also, perform a self-assessment for fall risks to prevent future falls.

Address Issues with Caregivers

The caregivers who help seniors get around should be in decent physical shape themselves. Unfortunately, what happens sometimes is that similar-age spouses try to help each other. One might be a little stronger than the other but still not in good enough physical shape to serve as an ambulatory aid. This can lead to both spouses falling, or if one falls, the other one may get injured trying to help the other one up.

Issues with caregivers can result in other fall-related risks. For instance, a family caregiver who lacks professional training might not recognize that a new medication could be causing disorientation in the senior or that the senior's shoes are in poor condition.

If you are a family member caring for an older loved one, minimize the fall risks as much as possible. If you are caring for your spouse who is about your age, it may be safer for both of you if other folks help your spouse get around or if your spouse starts using walkers or canes.

Preventing Injuries that Stem from Driving

In many cases, driving is a great thing for seniors because it helps them stay mobile and active. A good number of seniors are mentally and physically sharp enough to drive safely, but they remain at increased risk of injury due to age. Plus, if they get injured, recovery times tend to take longer and can lead to a host of complications. Of course, some seniors lack the mental or physical abilities to drive safely.

Practice Common Sense Driving Techniques

The safe driving tips recommended for folks of any age apply to seniors. They include:

• Wearing a seat belt
• Not driving when intoxicated and/or medicated
• Taking the time to understand a new medication's effect before driving
• Staying distraction-free (no texting or talking on the phone, for example)

Seniors are also encouraged to drive during safe times. That is, it's a good idea to limit or cut out your driving when it's dusky, foggy, rainy, snowy, or dark. Likewise, use caution when traffic is heavy or high-speed like it tends to be during rush hour and on interstates.

General tips for senior drivers include:

• Driving vehicles with “smart” features” that mean less physical exertion
• Using public transportation if feasible
• Having vision checked by a doctor regularly
• Undergoing medication reviews regularly to check for interactions and side effects
• Exercising to enhance flexibility and strength
• Planning routes ahead of time and going to destinations with ample and easy parking
• Giving more space than necessary to the traffic around you
• Leaving earlier than you need to
• Checking that the car fits you well
• Taking a refresher course on driving, which might also reduce your insurance rates

Talk Early and Respectfully

It is ideal for seniors to talk early and proactively with their loved ones to plan for the eventuality that they cannot drive. This also lets them ease into alternative transportation arrangements. Of course, it is often the family members who must initiate the conversation. It's usually not an easy talk to have, but it is necessary.

Tips for such a conversation include:

• An early start: Ask your parents while they are still relatively young how they'd like you to approach them if you observe unsafe driving behaviors.
• Alternatives and solutions: You can try getting your parents to drive less by offering to take them places. Likewise, you can buy them transit passes, or teach them how to use rideshare apps. When you have the conversation about driving, ask how they've enjoyed these alternative solutions and what could be done to make these solutions easier.
• A respectful tone: Acknowledge that your parents are likely afraid about having this conversation. Show that you know what's potentially at stake—their independence, for example.
• Even presentation: Say something such as, “I don't want you to get hurt or to see you hurt someone else,” rather than, “You're a bad driver. You're 80 years old and need to stop driving right now.” Use phrases such as, “driving safer,” instead of “quitting driving,” even if you really do aim for your parents to stop driving.
• Third-party: Offer to have your parents' driving evaluated by a third party such as a driving rehabilitation specialist. Your parents may be more willing to listen to what this person has to say than to what you say.
• Great minds: Ask your parents to think of alternatives to driving rather than force-feed them a long and confusing list. Say that you all will work together to maintain their independence.
• Specific examples: Use specific examples that scare you and others instead of generalizing with phrases such as, “speeding too much” or “bad driver.”
• Consult with others: Your parents' doctor, a geriatric care manager, or law enforcement offer may be able to help with modifications such as wider mirrors. In some cases, authority figures can ask your parents to take a driving test.

Preventing Injuries that Stem from Cooking

A lot goes on in the kitchen. For seniors, the kitchen may be where they cook for their families most nights. On weekly or special occasions, they may even spend hours in the kitchen putting together large, delicious meals for family members and friends. Being good in the kitchen is a source of pride for many folks, but it can also lead to injuries and deaths.

The National Fire Protection Association lists these potential kitchen dangers:

• Leaving equipment unattended
• Keeping combustibles and heat sources too close together
• Misusing material and equipment
• Discarding material improperly
• Turning something on or off accidentally
• Forgetting to clean food and surfaces

Here's a look at how kitchen injuries and illnesses can be prevented.

Make the Kitchen Itself Safer

Remember fall prevention from earlier? It comes into play here again if kitchen clutter needs to be cleaned up. Same if the lighting is dim. Other tips include:

• Use unbreakable material instead of glass.
• Keep pot handles turned inward.
• Keep an eye out for any water that might leak from the refrigerator.
• Use Lazy Susans on counters and in cabinets to minimize your reaching and bending.
• Test smoke detectors every month and dust them.
• Replace smoke detector batteries every year.
• Use only the cabinets within reach so you don't have to use footstools or contort yourself unnecessarily.
• Stow heavier objects at waist level to reduce the bending and lifting you have to do.

Reduce the Chances of a Fire in the Kitchen

Even a small kitchen fire can result in huge changes to a senior's quality of life and ability to function. Try the following tips:

• Stay with your food—always. Unattended food is the main contributor to kitchen fires.
• Avoid using an automatic-brew setting on coffeemakers.
• Wear clothing that fits properly.
• Switch to two-handle pots for easier lifting and carrying.
• Invest in good-quality oven mitts.
• Use automatic shut-off devices such as toasters that turn off if they've been left on for a certain amount of time.
• Keep items such as potholders and kitchen towels away from cooking surfaces.
• Clean diligently after each cooking session to avoid the buildup of grease, fat, and oil.

Take Care with Food Prep and Storage

It's possible to get injured from improper food prep and storage. To make sure that doesn't happen, you can:

• Put leftovers in the refrigerator right away after a meal.
• Keep your refrigerator temperature at or below 40 degrees Fahrenheit and your freezer temperature at 0 degrees Fahrenheit.
• Throw food out if there is any doubt it could be unsafe.
• Purchase pre-sliced food so you don't need to use a knife as often.
• Keep vegetables and meats stored separately.
• Label and date your leftovers.
• Use red cutting boards for meats and green cutting boards for vegetables to avoid cross-contamination.

Preventing Injuries that Stem from Fires

Folks aged 65 and older are two times more likely than other adults to get hurt or killed in fires, according to the National Fire Protection Association. To reduce the chances of this happening to you, try the following.

Keep the Lines of Communication Open

Having a telephone and emergency phone numbers handy facilitates communication between you and responders in case you're trapped in your bedroom.

Set Up Alarms with Vibrations or Flashing Lights

Traditional smoke alarms are not effective with some elderly people because they cannot hear the alarms as well. Installing ones that use vibrations or flashing lights solves the issue. It also helps to have an alarm in each room and hallway.

Check Windows and Doors

For the most part, seniors should be able to open all windows and doors in their homes in case they need to escape from a fire. One exception is in high-rise buildings, where safety precautions don't allow some windows to open. Another exception is if the senior is prone to wandering off. In general, any security bars in your home should have emergency release devices.

Use Sprinkler Systems

If you're looking for a new apartment, especially one in a high-rise, get one that has a sprinkler system. Rent as close to the ground floor as possible to make getting out easier.

Test Everything with Fire Drills

Do fire drills at least twice a year (once monthly is ideal). A drill is your opportunity to test whether a senior needs help getting out, or if that is already clear, to test how well the helper assists. A drill also assesses how well the senior responds to fire alarms (is a sound-only alarm still sufficient, for example?).

Follow general fire prevention tips for seniors:

• Keep fire extinguishers on each floor of the living space and test that seniors can use them.
• Service and clean chimneys, wood stoves, and fireplaces each year.
• Keep a 3-foot-wide radius around space heaters, and turn them off when they are not in use (and use automatic shutoff heaters).
• Blow out candles as soon as possible, and never leave them unattended or burning while you sleep.
• Sleep on the lowest level of the house possible.

Conclusion

As you can see, many aspects of injury prevention in seniors are interconnected. For example, conducting a medication review and making any necessary changes could decrease your fall risk plus make you safer when you drive and cook. A medication review and change can also help you escape more quickly in the eventuality of a fire.

Similarly, starting a regimen of moderate exercise helps with fire escape, safer driving, and fall prevention, among others. Basic injury prevention in seniors can be summed up with a few valuable tips:

• Clearing the home of fall hazards
• Installing mobility aids such as guardrails and nonslip surfaces in the home
• Eating a well-rounded diet and taking vitamin D supplements
• Limiting driving to daylight and low-traffic times
• Exercising regularly and moderately
• Using safe equipment in activities such as cooking
• Communicating openly with doctors, professionals, loved ones, and any caregivers

It often takes a village to keep a senior injury-free. Thankfully, resources for senior injury prevention abound.

Additional Resources

• Falls from Medline Plus – This comprehensive guide offers information to help you evaluate your risk of falling and to learn more about prevention and risk factors.
• Medications and Fall Risk – This page lists many medications and medication types that could increase your chances of falling.
• SeniorDriving – This AAA website aims to help seniors drive safer and longer. It offers information on whether your car fits you properly, medications that may be hindering your ability to drive well, smart features to look for in cars, and much more.
• Fire-Safe Seniors Program – Get help planning and implementing fire safety in your home or your loved one's home. This page includes assessment tools, handouts, and flyers.