Health & Wellness

Home Safety

Fall Prevention & Home Safety

By Kathleen Stross, DPT, MS, CHC

For those with vestibular disorders, falls are a real problem. No longer just for the elderly, losing balance can occur without warning when dizziness or imbalance strikes, resulting in injury, disability or isolation. Even if a person has never had an actual fall, the fear itself can lead to social withdrawal, anxiety, depression, and decreased activity.

Medications, vestibular rehab exercises, and safety strategies are among the important preventative measures for those with vertigo and imbalance. In addition to that, fall-proofing your home could add confidence and security, and reduce the risk of falling or injury if a fall occurs.

Vestibular patients benefit from environments that allow them to use their vision and somatosensation/proprioception to compensate for their vestibular weakness. So, keeping your environment safe means creating an environment where you can stay grounded, and see what’s going on, using all your senses for better equilibrium.

3-Zone Home Safety Assessment

Do a home survey, walking around the outside and inside of your home looking in three different zones.

Zone 1: eye level

Head and eyes: optimal vision depends on good lighting and minimizing head movements.

Zone 2: hands and seat level

Arms and hips: need to be able to grab ahold, or sit down on a moment’s notice.

Zone 3: ground level

Legs and feet: need firm, level surfaces, free of obstacles or unexpected changes.

Walk around the house three times, making notes as you go. Each time you will be focusing on a particular zone, as shown above. Be sure to include not only the inside of your home but the outside area as well, including all doors, gates, and steps to enter or exit the home.

The first time, walk around looking at everything in Zone 1, eye level and above. Can you see enough to walk around during the daytime and at night? Could you see if the power went out? Is everything overhead within reach without needing to climb?

Walking around for Zone 2 requires that you walk and stop every 5-7 feet. Each time you stop, think about what would happen if you a) got dizzy and started to fall, or b) needed to sit down. Is there something close by to grab onto or a chair (without wheels) if you needed to quickly sit down?

During the third walk around your home, focus on Zone 3. Do you have a clear path in every room? Are there newspapers, throw rugs, or other items on the floor? Although rugs may be decorative, they can be a trip hazard. Firm, stable surfaces are best for balance. If you prefer carpet, then wall-to-wall carpeting is best, with a low pile and minimal to no padding. A thick padding underneath your carpet can have you feeling particularly unsteady when your body is not able to feel connected to the floor. Outside, make sure you have a level walking path (wide enough for walking with a cane or walker) through the grass or garden area. Minimize the grade of sloping surfaces or add a handrail.

Things I can do to reduce my risk of falling

  • Wear nonskid shoes that are secure on my feet
  • Make sure my clothes fit well so they won’t catch on something or trip me
  • Get regular exercise to maintain strength and flexibility
  • Have my vision checked every two years and maintain a current glasses prescription
  • Maintain healthy blood pressure
  • Pay attention to new medications and possible side effects or drug-drug interactions that can cause dizziness
  • Limit alcohol to two drinks or less per day

Making changes in your home may be difficult. There are many reasons why people don’t take the recommended preventative measures, and later have regret when they feel their fall could have been prevented.

Don’t make excuses. If you are off balance, nothing is more important than keeping your home safe to prevent falls.

  • Install grab bars
  • Add a ramp or handrails
  • Get a cane or walker
  • Consider a bedside commode or shower chair
  • Visit the doctor or therapist to discuss your balance concerns

Ask others for help

Invite a friend to help you complete your safety walk-through, and take notes or make a To-Do list.

Have someone else come and complete jobs that require climbing or reaching high overhead.

Safety Considerations by Area

There are specific challenges that come with each area in your home. Here are some examples and recommendations that can be applied to specific areas of your home.

Entrances to the home

Look at all the doors for clearance and safety. Every home should have multiple ways to exit. Make sure you look at every door for safe passage. Are locks easy enough to open with one hand? Fire or storm damage can make your favorite exit impassable; make sure you are able to leave out of any door, in a hurry. Watch for anything that can cause you to trip, like a high step, edge, or mat. If you have steps up to the door, consider installing a railing. If you have gates, make sure they are able to be unlocked quickly in the event of an emergency exit.

Kitchen

Keep paths clear. Low profile rubber mats are ok in front of the sink and refrigerator if you dispense water from the fridge door. Consider a rolling cart to help you move items around during meal prep.

Bathroom

Pay special attention here. An elevated toilet seat and grab bars make toileting safer and more energy efficient. If you step into the shower, place a grab bar where you can hold on while stepping over the edge. Install grab bar(s) for assistance getting up and down from the toilet.

Bedroom

Waking up in the morning can especially difficult, and dangerous. Sit on the side of the bed for a few moments before you stand up. Say good morning to your vestibular system by turning your head up/down, and side-to-side a couple of times. Make sure you can see clearly. Once you stand up, stretch to stand up really straight, look to make sure you have enough light and a clear path before you start walking. Keep your cane or walker at the bedside.

Lights are essential

Whether in the daytime or during the nighttime, adequate overhead and floor lighting can make things easier for you to get around the house.

Upgrade your bulbs to save on energy costs. But be careful when you shop. Some LED bulbs take a few minutes to produce full light when turned on. You want an energy efficient bulb that produces full light immediately upon turning on.

Yard/Garden

if you love to garden, it’s worth it to clear and level out a path around the yard. Stepping stones or pavers, while lovely, are not the best option here. Consider a concrete path, or a tightly laid brick path. The goal is to have a path that has plenty of room for your feet to land (without requiring precise foot placement) and is stable and level. Crushed gravel/limestone is better than rounded pebbles because they can be tamped down to provide a more secure surface.

Car/Garage

Garages tend to be dark. Consider installing additional fluorescent lighting. This is usually a simple task for a handyman because a fluorescent lighting kit can easily plug into the power from the garage door opener. Maintain a clear path for safe and easy access to the trashcan or car. If you store things in the garage, keep the items you use them most at chest or waist level, so you have easy access to them without having to climb, bend, or reach.

Assistive Devices

If you use a cane or walker it may be helpful to have more than one. If you live in a two-story house, you may want to keep one upstairs and downstairs. That way you can walk to the stairs, leave your walker, ascend using the handrails, and pick up your second walker that you left near the top of the stairs. When it’s time to go downstairs, park your walker at the top of the stairs, descend carefully using the handrails, and rejoin the walker you left at the foot of the stairs. If you use a cane, consider adding a strap so that you can keep it on your wrist in case you need to hold something in that hand.

For further tips, use VeDA’s provider directory to find a physical or occupational therapist near you.