Little fixes — like good lighting — can prevent falls.
The number of senior householders is on its way up — from more than 26 million today to 45 million in 2030, according to projections by the Harvard Joint Center for Housing Studies. Most older adults want to stay in their homes, and small changes can make a huge difference. Just don’t wait until someone falls, warns gerontologist Jon Pynoos, co-director of the Fall Prevention Center of Excellence in Los Angeles, which offers this excellent brochure on home modification. “People take their environment for granted,” he says. They may resist change. “Good information and examples of changes that are affordable, relatively easy to install, and fit in with the décor of the house,” he says, can smooth the way.
Here’s our rough guide, assembled with Pynoos’ guidance.
The Entrance. First, be sure the lighting is bright. Steps should be wide enough for the whole foot. Mark the leading edge of the first and last steps with bright paint or light-reflecting tape that contrasts with the background color of the flooring. Install sturdy, easy-to-turn door locks. If necessary, install ramps, and make sure all door openings are wide enough to accommodate a walker or wheelchair.
The Living Room. A good reading chair can save Mom’s back, and the right lamp will save her eyes. Soft seating is especially unhealthy for the elderly, who may injure their hips when they struggle to pull themselves up. Ideally, every chair Mom uses should allow her to sit with her feet touching the ground and her knees at a 90-degree angle. But many of us don’t fit standard furniture. For a small woman, consider antique chairs designed when people were smaller. Foot stools are an option, too. “But be careful — people can trip on these,” says Pynoos. Stores sell plus-size seating, as well, under names like “chairs and a half” or “cuddle chairs.” They may be as much as 15-inches wider than a standard recliner, and have thicker foam and extra springs to handle the weight.
Make sure the floors are in good condition. Replace shaggy or wrinkling carpets, which can cause falls. Put anti-slip pads under throw rugs, tape them down, or remove them. Remove any items on the floor, such as stacks of magazines or plants. Any electrical cords from lamps or in-home medical devices should be out of the way. That goes for the bedroom, and halls, too.
The Bedroom. The bed should be just high enough that Mom can get onto it easily and step off without falling. To light the way from bedroom to bathroom, install night lights – at least one every 20 to 30 feet – with built-in sensors, so that they’ll turn on automatically.
The Bathroom. Inside the bathroom, a switch with a built-in light or a motion-activated light that goes on automatically will keep Dad from stumbling in the dark. Install grab bars around the tub or shower and toilet. Buy a “comfort height” toilet, or elevate the seat. Some toilet seats are designed for taller and heavier people. Consider installing a walk-in shower — or a bathtub with built-in seating, if it’s easier for Dad to sit. Wet tile can be slippery. Put in low-pile carpeting or non-skid mats in front of the sink and toilet and outside the tub. Replace faucet knobs with lever handles to make it easy to turn water on and off. Make sure the temperature controls are easy to understand. Temperature-control devices will protect your parent from getting scalded.
The Kitchen. Just about everyone should adjust standard kitchens, says Nick McElhiney, a certified ergonomics-assessment specialist who sells a variety of products for home offices through ErgonomicEvolution.com. A tall person, for example, might do best with a sink 10 inches deep and a short person with one as shallow as 5 inches. Think carefully about customizing if you’re remodeling a kitchen for an elder.
Ideally, when Mom places her palms on the countertop, her arms should be at a 45-degree angle. Installing wood of the correct thickness can raise a countertop, but to make them lower you’ll need to remodel. You can also have counters at different heights.
Consider drawers rather than cabinets with doors, and pick drawers with self-closing gliders. McElhiney recommends cabinets with doors that swing up, which are much more common in Europe and Asia. They can be left open for easy access, without getting in the way. But make sure everything your parent actually uses is within reach, without step stools. In base cabinets, use pullout shelves to minimize bending to search for items in the back. Add grab bars where needed for support.
Evaluate the ideal spots for appliances and food. Store heavy items at between hip and shoulder height (to avoid overstretching) and medium-weight items just above or below the heaviest ones. Do not store heavy items higher than eye level or below the knees. Since most people use food in their freezers least often, choose a refrigerator with a freezer at the bottom so Dad won’t have to bend down for vegetables in the fridge’s crisper drawers.
Install cooktops, wall ovens, and microwaves at the heights that work for the person who uses them most often. Pull-out microwave drawers can be installed at the ideal height and opened by pushing a button. Be sure the controls are easy to use and the numbers are large enough for Mom to read them.
On the refrigerator, post all important phone numbers, including emergency contacts and doctors, along with lists of medications and any essential health information.
Throughout the house. Replace doorknobs with easy, lever-style handles. In key areas, the light switches should have a back light. Windows should be well-sealed, easy to open and close, and shaded so your parent isn’t blinded by glaring sunlight. Put guard rails at the correct height on both sides of the stairs. You might also consider installing video monitoring devices, and remodeling so that your parent can stay on one floor. Any caregivers should sleep in bedrooms on the same floor as well.
If all this sounds complicated or pricy, consider consulting an occupational therapist or a certified “aging in place” home remodeler. Look for local names in the National Association of Homebuilders directory. You can borrow up to $25,000 for remodeling through a government-sponsored loan. Nonprofits like Rebuilding Together bring volunteers in the home for projects.
February 24, 2020
Janet O’Dell, RN