Preventing Falls for Older People at Home

A fall is often the moment an older person's life changes. Before it, they walked to the shop, fetched water, sat outside with the neighbours. After it, they are in a bed in the back room, and the family is wondering how it happened so fast.

Many falls happen at home, on ground the person has walked for years. That is the hopeful part. A household can change a great deal about its own floors, lights and habits, and much of it costs very little.

None of this is medical advice. If an older person has fallen, take them to a health facility, even if they say they are fine.

Why it matters more after sixty

The World Health Organization's fact sheet on falls states that adults older than 60 suffer the greatest number of fatal falls, and that older people have the highest risk of death or serious injury from a fall. It also notes that people who fall and are disabled by it, especially older people, are at major risk of needing long term care afterwards.

The same fact sheet lists what makes falls more likely: medical conditions, side effects of medicines, physical inactivity and loss of balance, poor mobility, poor memory and poor eyesight, and an unsafe home. Among its recommended measures for older people are a home assessment with changes to the home, and training in walking and balance. The rest of this article is about the first of those, in a Kenyan home.

Light the path, especially at night

Walk the route after dark. Go from the older person's bed to the door, to the latrine or toilet, and back, at night, with no torch. Every place you hesitate is a place they could fall.

Leave a small light on through the night, or put a torch or a rechargeable lamp within reach of the bed, always in the same place. A solar lamp by the bed is better than a phone torch that needs two hands. Never leave a paraffin lamp or candle burning where it can be knocked over.

Light switches and lamps should be reachable before the person steps into the dark, not on the far side of the room.

Floors, steps and clutter

• Clear the walkways. Basins, jerricans, shoes, firewood, children's toys, a sleeping dog. Agree on a place for each one that is not the path to the bed or the door.
• Watch wet floors. Mop when the older person is sitting down, and dry the floor before they get up. A cement floor that has just been washed is as slippery as anything in the house.
• Fix or remove loose mats. A curled edge on a mat or a sack at the door catches feet. Either fix it flat or take it away.
• Trailing wires. Charging cables and extension leads across a doorway are a common trip. Run them along the wall.
• Steps and thresholds. A raised doorstep, a broken step, a muddy slope outside. Paint the edge of a step in a bright colour so it stands out, and repair what is broken. For a ramp, see a ramp costs less than you think.

Do not rearrange the furniture without telling them. Someone who knows where the chair is will reach for it in the dark.

Latrines and bathrooms

The latrine is one of the most dangerous places for an older person. It is often outside, often unlit, the floor is wet, and squatting and rising again takes strength and balance that may no longer be there.

Give them something to hold. A firmly fixed rail, a strong pole, or a rope tied securely at the right height beside the latrine and in the bathing area. Test it with your own full weight before they rely on it.

Consider a seat. A commode chair, or a simple raised seat over the latrine, removes the deep squat. A low, steady stool in the bathing area means they can wash sitting down.

Keep the path to the latrine clear, dry and lit. At night, a covered bucket or commode next to the bed can be safer than a walk across the compound in the dark. Agree this with the person openly, so it is not a source of shame.

Footwear and clothing

Bare feet on a wet floor, or loose slippers with worn soles, make a fall far more likely. A shoe or sandal that holds the heel and has a sole with some grip is better, indoors and out. If shoes do not fit because feet have swollen, find ones that do.

Long wrappers and trousers that drag on the ground catch under the foot. Hem them, or tuck them up before walking.

Night routines and getting up

Get up slowly. The moment of rising from a bed or chair is a risky one for anyone whose balance is going. Encourage the person to sit on the edge of the bed for a short while before standing, and to hold onto something firm as they stand.

Keep what they need close. Water, the lamp, spectacles, a walking stick and a phone, within reach of the bed, every night in the same place.

The bed itself. A bed that is too high or too low makes getting in and out harder. Feet should rest flat on the floor when sitting on the edge.

Eyes, medicines and strength

Following the WHO's list of risk factors, three things are worth raising at a health facility. Eyesight: when were the person's eyes last checked, and are their spectacles still right? Medicines: some cause dizziness or drowsiness, so ask whether any of theirs might, and whether they are being taken as prescribed. Strength and balance: ask a health worker what movement is safe for this person, and keep them walking rather than sitting all day.

If memory is going too, the risks multiply. Our article on caring for a parent who is forgetting covers that household.

After a fall

Do not hurry them up. If they cannot get up easily, are in pain, especially in the hip, or have hit their head, call for help and get them to a health facility. Even a fall that seems to have done no harm should be mentioned to a health worker. A fall can be a sign that something else has changed.

Ask the person afterwards what happened, and walk the place with them. Then fix it.

Where we fit

Lift A Life Foundation is a community based organisation registered with the County Government of Kiambu, certificate RSC/3811/CBO/2024, working in Ruiru. Caring for the elderly is part of what we are registered to do. If you are caring for an older person in Ruiru and want a second pair of eyes on the home, tell us. If you can fit a rail or mend a step for a neighbour, we would like to hear from you.