When talking about Senior & Elderly Safety, the first question to ask and answer is: “What is the difference between a senior person and an elderly person?” …and the answer is ‘nothing or everything’ depending on the perspective of the situation and one’s viewpoint.
In the context of accidents and injuries, one becoming elderly can be viewed as one being experienced and therefore wise – which is most certainly a very respectful way to look at a potential benefit and attribute of getting older. However, along with getting older and becoming elderly, concerns about both physical and mental abilities declining become a concern. One can definitely get older and not show any signs of either physical or mental decline, and that’s great, and that’s when I view a person as becoming qualified as a ‘Senior by age qualification’, rather than being defined by their physical condition. That said, Seniors, aka elders, who are showing signs of being elderly are the ones who get focused on when considering their needs when it comes to keeping them safe in the home. The needs of an elderly person are ‘ability-dependent’ considerations. What we really mean by that, of course, what is there in the home that might represent a risk of an accident and injury because they are no longer the fully capable person they used to be?
We take many things for granted when we are younger and fully capable. When it comes to those who are becoming elderly, things that we haven’t perhaps paid much attention to now require consideration. Things to consider include:
- Due to declining eyesight, how well are they able to judge – especially in poor lighting conditions – where to walk? Is the likelihood of a trip, a slip, or a fall becoming a concern?
- Due to balance issues, is falling over when doing normal things like getting dressed, getting in and out of the shower or bathtub, or negotiating steps, stairs, and ramps becoming a concern?
- Due to loss of hand-strength and grip, are spills and worse – especially in the kitchen – becoming a concern?
- Due to dizzy spells caused by low blood pressure or vertigo, are unexpected falls a concern?
Declining Cognitive Ability
Once either physical or mental decline is noticed, the level of concern steadily increases year-by-year. For many, the reality is that a trip, a slip, or a fall is what brings the decline in cognitive ability to the individual’s and the family’s attention. Cognitive decline most often is gradual, so gradual that it doesn’t get noticed by those living with the elderly person but rather gets noticed by others before it gets noticed by either the individual themselves or the family members they live with. Following Holidays – especially Thanksgiving, Christmas, and New Year – an increase in families searching for information about Long Term Care and retirement living is experienced each year by Senior care communities – which include Long Term Care Nursing Homes, Assisted Living Communities, Residential Care Homes, and even Independent Living Retirement communities. Other Holidays like Easter, Memorial Day, and July 4th also cause an increase in the number of inquiries searching for available rooms and apartments for the elderly. This is because it is these dates that families either visit their Seniors, or the Seniors come to visit their grandchildren. It may have been six months or even a whole year or more since a family get-together took place; and such a period of time is often enough for a physical or mental decline to become noticed.
Those who work at Senior Care communities frequently hear the family members who are assisting their parents with finding a ‘retirement home’ comment, “It seems that other people had noticed (our parents’) decline months or even years ago before we did.”
Of course, when there is a major event such as a stroke or heart attack, cognitive ability decline can be sudden and often rapid. Once a single event has occurred – whether a fall or a stroke – the individual, regardless of whether they consider themself to be elderly, needs to live with more awareness of their health and developing limitations than they did previously. If they are indeed elderly and showing signs of becoming frail, concerns for future incidents are even greater.
Getting older is by its very nature progressive and, in most cases, the decline is non-reversible. Many of the conditions that cause cognitive decline and dementia, of which, Alzheimer’s disease, vascular dementia, and Parkinson’s disease are among the most common are recognized as being ‘causes without cures’.
Also, we need to remember that we don’t all live in the same home environment, outside and around the home, or inside.
One of the concerns regarding seniors with dementia (Alzheimer’s disease or another type of dementia) is wandering. When an elderly person with the dementia symptom of failing short-term memory leaves the home unattended there is a risk that they will not know how to get back home. Places that were once familiar are no longer familiar; streets that were once familiar are no longer recognized. For more help visit our post on ‘Wander Prevention‘.
Paths and Walkways
Starting outside the home, with return trips to home and also visitors in mind, how even are the paths and walkways from where the car is parked to the front door, side door, and any other entrances to the home?
An elderly person might be using a walking cane for assistance or even a walker.
If the pathways are rough or uneven in any way and there are dips, cracks, or potholes, might they cause an elderly person to stumble? Many attractive pathways present problems. Many years ago when the paving slabs, bricks, or tile were laid they not only looked good but they were level, but over time the surface has become uneven. A one-centimeter ‘step’ (that’s a difference in height of two adjacent slabs of less than one half an inch) will make using some walkers difficult. There are walkers with small wheels and there are walkers with larger wheels. Walkers with larger wheels must always have brakes otherwise they can all too easily shoot out from under the person who is pushing the walker, which would be the person who is relying on the walker for walking stability, especially on a downhill slope. An issue regarding the type of brakes is hand strength. Brake levers that are similar to those used on bicycles are of no use unless the person using the walker has a strong grip. If the elderly person does not have a strong grip, then walkers which only require one to press down on the handles in order to control the walker are the safest option.
Are there steps that have to be negotiated; indoors or outdoors?
Due to hip, knee, ankle, or foot problems elderly people often develop walking difficulties that make negotiating even a low step a challenge. For example, knee osteoarthritis, common in older people, can cause pain and limited motion, and many elderly people have hip replacement surgery which almost always results in steps and stairs becoming a challenge. Others have foot problems that mean they easily trip over their own feet and steps represent a big challenge and an elevated risk for tripping for them.
When one thinks of ramps, generally wheelchairs or mobility devices like scooters come to mind. If a person is unable to manage steps without difficulty, a ramp is often the obvious solution. There are strict guidelines for the amount of slope of a ramp. Ramps can be permanent structures or they can be moveable and transportable.
The images shown here are a very small sample of temporary and permanent ramp installations. If you have a family member, old or young or, anywhere in between, having a permanent ramp installation obviously provides the highest level of safety, but a transportable ramp can provide easy and safe access to places one is visiting when wheelchairs and scooters are not so well accommodated.
The difference between steps and stairs – or more correctly, staircases – is that stairs are generally indoors and steps are generally outdoors, but that’s only one way of choosing whether to call a progressive and continuous series of steps a flight of steps or call them a staircase – which we frequently simply refer to as ‘the stairs’. Inside your home, you might have both steps and stairs which is not at all uncommon in split-level homes. Whether it’s called a staircase or a flight of stairs is of no importance to a person who has difficulty climbing more than three or four vertical steps, and from a safety perspective, even just a single step can cause a trip and a fall which can result in serious injury to an elderly person.
Stairways are one of the most frequent places for falls to occur and yet it seems little is published about stairway falls, or more importantly, how to prevent them. The most frequent causes of accidents involving steps and on stairs include (1) Inadequate or unstable handrails, (2) poor lighting, (3) torn or poorly secured carpeting, (4) slippery surfaces, and (5) improper stair design.
Handrails need to be secure and solid and also easy to grip firmly. Lighting might be poor for a number of reasons; it might be at certain times of day when sunlight is reduced but lights have not yet been turned on – and, as mentioned earlier – an older person with diminished vision would be vulnerable to such a situation; light bulbs may have blown and not been replaced, a person is unfamiliar with the building and didn’t know where the light switch was located or simply that installed lighting is inadequate or even non-existent. Carpeting or mats covering steps or stairs need to be secure so that they cannot slide, and there should be no tears or rips that might cause a person to catch the heel of their footwear when coming down the stairs or the toe when going up the stairs as either can cause a person to trip and fall or slide down. Steps and stairs that are not covered by a non-slip covering and that might present a slippery surface, especially when wet, include tiled steps, either indoor or outdoors. The final item listed – improper stair design – might be because the property is older, but it could be a cause in a newer home to if building code guidelines were ignored.
Generally, more women are involved in falls than men, except male children through age 16 have more falls than their female counterparts. More adult women than adult men suffer stairway falls because most falls occur in the home, and women spend more time at home than men. Additionally, few men wear high heels which are thought to contribute to stairway falls.
In addition to slips and falls on stairs while walking up or down stairs – down being the more dangerous – there are also accidents that occur for other reasons. One such situation is when an elderly person chooses to ‘perch’ themselves on the top step to make it easier to pull on their socks or stockings, or to put their shoes on. “Why?” I hear you asking, “would an elderly person sit on the top step of the stairs; why not the bottom step?” “You can’t lean back far enough when you sit on the bottom step,” is the answer. That’s right. Many elderly people lose their ability to bend sufficiently to pull their socks, stockings or shoes on so they find somewhere to sit – which might be a chair or their bed, or, if the bed or chair are not low enough, it might be the top step of the stairs. As already mentioned, the bottom step doesn’t work because you can’t lean back far enough when you sit on the bottom step. So, where’s the danger? In order to find your foot to put a sock or stocking on most people have to look down and that means leaning forward. Lean forward just a little too much and you over balance and tumble headfirst down the stairs, and as an elderly person, reaching out to grab the upright spindles that support the bannister if you have them, is probably the best you can do to prevent falling all the way down; so you might end up with just a dislocated shoulder or a broken collar bone instead of breaking a vertebrae or two, otherwise known as breaking your back.
While mentioning shoes and stairs, there are certain types of carpet slippers that can, over time, become shiny and quite slippery. Yes, we’re talking about the soles of the slippers becoming shiny and slippery. Regardless of the age of the wearer, shiny, slippery soles on footwear have little or no grip on either carpet, polished wood or steel surfaces. This means the potential for serious falls, especially on steps and stairs. Elderly people are well advised to take off their carpet slippers when going upstairs or downstairs and walking up or down the stairs in stocking feet or bare feet. This simply means having two pairs of slippers; one pair for upstairs and another pair for downstairs.
Bathtubs and Showers
When Seniors begin to feel their age because they aren’t as agile as they used to be, the bathtub becomes one of the first of many things that represent an increased likelihood of an injury at home. First, it’s stepping into the bathtub, in many cases – especially with older, deeper tubs – having to climb into the bathtub. Next, it’s the likelihood of slipping and, third, it’s the challenge of getting out of the bathtub. The first image shows a bathtub-shower combination where slipping becomes a high possibility, increasing as the individual gets older. The solution is a non-slip bath mat, the kind with rows of suction cups on the underside to make sure that the bath mat cannot slip. This helps getting-in the tub, standing, and getting-out if one is simply showering. If one chooses to sit in the bathtub, then, unless there are good, solidly secure grab bars, the likelihood of a slip actually increases.
In the second image, the one beside the bathtub-shower combination is a Bathtub Cut-Out where the existing bath has been modified to provide an easy-to-step-in, easy-to-step-out bathtub – a modification that is done in a day and involves both low cost and no plumbing. Affordable and effective. Local agents that are qualified to do this can be found via www.lifewaymobility.com/showers-bath/tub-cut-outs/.
The three most important safety items in the bathroom are non-slip bath mats, grab bars, and eliminating the need to climb into a bathtub.
Most Seniors become addicted to their medication dispensers. These simple to use, low technology devices keep medications organized on a week-by-week basis, and in addition to helping an individual be sure to take their medications,, whether it’s just once a day or multiple times a day, they also help one aware of what day of the week it is! A critical thing to bear in mind when it comes to family safety is that these need to be kept out of reach of small children.
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