Read Before Discharging: Home Safety Checklist!


  Arete Rehab is redefining successful aging.

Arete Rehab is redefining successful aging.

Safety Begins at Home: An Ounce of Prevention is Worth a Pound of Cure

Falls are the leading cause of injury among older adults. The statistics are staggering and account for increased nursing home and hospital admissions, a decline in function and independence, death, and skyrocketing medical costs. Many falls go unreported, therefore, the statistics reflect only reported falls. The following statistics on reported falls shed light on the serious nature of falls among older adults:

One-fourth of Americans age 65+ falls every year

  • Every 11 seconds, an older adult is treated in the emergency department for a fall, every 19 minutes an older adult dies from a fall

  • Falls are the leading cause of fatal injury and the most common cause of non-fatal trauma related hospital admissions among older adults

  • Falls of the most common cause of Traumatic Brain Injury (TBI)

  • An estimated 72.8 million injuries annually, 800,000 hospital admissions, 27,000 deaths occur from falls

  • More than 95% of hip fractures are caused by falling usually falling sideways

  • The financial toll increases as the population ages and may reach $67.7 billion by 2020

  • 87% of all fractures are due to falls. Two thirds are those who fall will fall again within 6 months

  • One-fourth of seniors who fracture a hip from a fall will die within six months of injury

The Complexities of Falls

Falls rarely result from a single cause, and are often due to complex interactions such as sensory loss(vision, hearing, sensation),  physiologic age related changes(cardio-pulmonary), medication interactions, neurological impairment (Parkinson’s, peripheral neuropathy), musculoskeletal conditions (osteoarthritis, decline in strength), impaired cognition(confusion, altered mental status, judgment, memory), and environmental hazards.

The World Health Organization (WHO) has two major categories for risk factors related to falls: Biological and Behavioral.

Biological Risk Factors include:

  • Age: fall related mortality rates increase exponentially with age, with the greatest increase after age 85.

  • Sex: Women have an injury rate 40-60% higher than men. Women are 2.2 times more likely to sustain a fracture after a fall.

  • Medical Conditions:

    • Diabetic women are 1.6 times more likely to fall and twice as likely to suffer fall-related injuries.

    • Depression is associated with 2.2 fold increased risk of falling but the causality is unknown.

    • Women with mixed incontinence are three times more likely to fall.

    • Persons with Alzheimer’s disease are twice as likely to fall as people of the same as without the disease.

    • Approximately 38-68% of individuals with Parkinson’s disease experience falls due to balance impairments.

  • Physical Conditions:

    • Muscle weakness is associated with almost five times greater risk of falling.

    • Visual impairment is associated with slow reaction time, increased body sway, and a 2.3 times increased risk of multiple falls.

    • Cognitive impairment is associated with increased fall risk ranging from 2.0 to 4.7.

    • Lower BMI and weight loss are associated with low bone density and an increased risk of fall related fractures.

    • Foot problems such as severe bunion, toe deformity, ulcers and deformed nails are associated with a two -fold increased fall risk.

Behavioral Risk Factors include:

  • Sedentary Behaviors: Muscle atrophy and a decline in strength often result from sedentary behaviors. Individuals who are inactive fall more frequently than those who are moderately or very active. Fear of falling causes inactive behaviors. Fear of falling occurs in 30% of people 65 and older, and is significantly associated with changes in balance in mobility, muscle weakness, and an increase in fall risk.

  • Medication Intake: use of four or more medications is associated with fear of falling and a 9-fold increased risk of cognitive impairment.

  • Alcohol Misuse: Alcohol intake of more than 14 drinks per week or 1000g a month increases the risk of injurious falls that can lead to hospitalization or death.

  • Inappropriate Footwear:

    • Athletic shoes may be associated with fall risk because the relatively thick soft midsoles interfere with proprioception or position sense.

    • Going barefoot or wearing only socks is associated with fall risk.

Falls are Preventable!

Falls are not inevitable part of aging, and many can be reduced, if not prevented. Evaluating the home environment for hazards, barriers, accessibility and modifications is essential in addressing fall reduction/prevention. It is often difficult to be objective or aware of the potential hazards in our own environment.  Too often, a cherished throw rug can become the culprit in a fall when our shoe catches on it. Bathrooms are one of the most common places for injuries to occur as wet surfaces increase our risk for falling.

Important First Steps in Fall Prevention

The best place to start in reducing the risk of falls is by making sure that the home is safe.  In order to do this, it is important to look at what can be done both indoors in each room including hallways, and the garage, and outdoors including yards, and entryways. It is also important to assure that communication systems are in place as is appropriate pending the individual to be used in the event of an emergency.  Due to the high risk of falls associated with medication issues, it is also important to assure that a system is in place to allow for appropriate management of medication.  Finally, if oxygen is used in the home, there are important steps to make sure that fall risk is managed as related to tubing.

Follow Our Checklist for Home Safety!

With all of the space both inside and outside of the home, as well as accounting for communication systems, medication management, and oxygen systems, home safety can be a daunting task!

To make an overwhelming process a little bit easier, we have composed a checklist to improve home safety!