Expert Q & A

Assessing a Senior's Function and Fall Risk

Nov 09, 2012 10:17AM
Question: My uncle aged 60 lives alone in a 2-story house and I worry about his safety. What do you suggest?

Fall Prevention Expert,  Dr. Rein Tideiksaar
Every family worries about the safety of an aging relative. And for good reason. Falls are one of the most serious issues facing elders. About one-half of all falls suffered by elders take place within the familiar surroundings of one’s home (i.e., occurring in the bedroom, bathroom, living room, on the stairs, etc.). Most mishaps occur during everyday routine activities (such as, walking; getting up from bed, chairs, or toilet; going up and down stairs; reaching or bending to place or retrieve objects; etc.)

As we grow older, the onset of age –related physical changes and chronic health conditions (diabetes, Parkinson’s disease, arthritis, etc.) can result in difficulties with everyday activities, thereby placing elders at risk of falling. For example, a decline in vision might cause one to misjudge distances, such as steps. Muscle weakness can affect one's balance, thus increasing the chances of falling when getting up from a chair or stepping into the shower. A stiffening of the knees may result in walking with a ‘shuffle’, which can lead to trips and slips. Likewise, unsafe environments by themselves can lead to problems with everyday activities and fall risk. For example, poor lighting can lead to trouble seeing slip and trip hazards. Getting up from low-seated chairs or toilets can easily cause balance loss in elders with limited muscle strength.

Will your uncle be safe living alone? If your uncle is reasonably healthy and is able to get up from chairs, walk, climb steps and maintain good balance, the likelihood of falling in his home is low. Even so, I’d recommend some simple safety steps that are sensible for ALL ages, such as maintaining good lighting (especially by the stairway), keeping pathways free of clutter/obstacles, and removing slippery throw rugs. I’d also suggest watching for warning signs of failing health and fall risk, such as unexplained bruising, skin scrapes, trouble getting up from chairs (a sign of muscle weakness) or difficulty with walking, balance and mobility.

On the other hand, if your uncle’s health is starting to deteriorate and he’s already experiencing problems with his everyday activities, he may be at risk of falling. I’d suggest a visit to his doctor to check out his health and risk status. At the same time, I’d recommend a home visit by an occupational therapist who can assess your uncle’s function and fall risk, and suggest specific safety measures.

You mentioned that your uncle lives in a 2-story house; obviously the stairway is a safety concern for you. Maybe you’re even considering re-locating your uncle’s bedroom/bathroom to the first floor to avoid the risk of a stairway fall. But before you act, consider this: routinely walking up/down the stairway may actually protect against falling. People living in multi-story houses with stairways generally have better balance than people living in single story houses without stairways (walking stairs on a daily basis increases leg strength and balance). For safety, I’d make sure that the stairs are equipped with handrails on both sides and well lit, especially by the top/bottom steps (most stairway falls occur while missing the first/last step).

Lastly, attempting to eliminate the risk of falling entirely in your uncle is impracticable; at any age, we are all slaves to gravity and can accidentally slip or trip. The trick is to find the right balance between risk and safety. No doubt, your uncle is probably typical of most aging persons; they cherish their autonomy and independence. Have the courage to allow your uncle to live as independently and freely as possible, even if it means accepting some risk and putting up with occasional bruises/skin scrapes. But also let your uncle know that you are concerned about his safety and will work with him to prevent falls. Elders want to feel that they have some control over their lives. This can be achieved by making elders a part of the safety discussion and decision planning regarding their risk and the need for safety.

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Rein Tideiksaar Ph.D., PA-C is the founder and president of FallPrevent, LLC, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has designed numerous educational and clinical fall prevention programs.  For more information, go to
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