Fall-Proofing Ideas for the Bathroom

Dr. Rein Tideiksaar - October 22, 2012 10:56 AM

What’s the most dangerous room in the house for elders? If you answered the bathroom, you guessed correctly. More than one in three elders fall each year and as many as 80 percent of these falls are in the bathroom. The bathroom presents many hazards, from hard, porcelain fixtures to wet, slippery floors that place elders at risk. Knowing who’s at fall risk and taking safety precautions can greatly reduce the risk falling and keep you or a loved one away from the emergency room. 

Risk Factors
The most hazardous activities for elders, which result in bathroom falls, include:

Getting on and off  the toilet

Stepping in and out of the bathtub or shower

Injuries in or near the bathtub or shower account for more than two-thirds of emergency room visits. 

Elders are susceptible to bathroom falls and injuries for many reasons:

Poor eyesight 

Decreased reflexes  

Balance problems
 
Loss of muscle strength in the arm and legs

Impaired transfers (inability to get up/down from the toilet and in/out of bathtubs/ showers safely). 

Health conditions associated with impaired balance (diabetes, arthritis, Parkinson’s disease, Alzheimer’s, stroke, taking several medications, etc.).

Osteoporosis (the risk of injuries is greatest in those elders with loss of bone strength).

Bathroom Safety Measures

Providing safety in the bathroom, especially for elders who are uunable to complete everyday tasks with the same mobility they once had, is crucial in avoiding falls. Here are 5 areas to focus on: Fall-Proofing Ideas for the Bathroom

Entrance 

The bathroom door should open with door swinging outward (in case of a fall in the bathroom requiring assistance). Sliding-pocket or accordion folding doors are an alternative. Also, remove door locks.
Lighting needs to be easily accessible. There should be an easily reachable light switch near the entrance. Consider installing a nightlight or replace the current light switch with a “glow switch.”
Night or motion lighting along the path from the elder’s bedroom to the bathroom can help with safe navigation at night.

Slippery Surfaces 

Remove any dangerous rugs that could cause slips and trips; replace them with anti-slip mats (especially around the shower or bathtub). As an alternative, attach double-sided carpet tape or put rubber anti-skid mats under small rugs.
Place non-skid mats, strips and decals to the floor in front of the shower or bathtub, in the shower or bathtub and in front of the toilet.
A rubber mat or non-slip adhesive strips applied to the bathtub or shower floor surface provides stable footing and visual cuing. Sometimes individuals with decreased depth perception view tub/shower surfaces as "bottomless pits" and become fearful when entering. 
Place non-skid adhesive strips on the top of sink edges to guard against hand slippage if these surfaces are used for balance support.

Grab Bars

Holding onto towel bars for balance support may seem like a good idea, but often have disastrous consequences if they break under the pressure. Towel bars do not provide enough support; they are made for supporting towels and not a person’s full weight.
Consider installing grab bars in and around the shower, bathtub and toilet. Well-secured grab bars help with getting in and out of the tub or shower and up and down from the toilet. 
All grab bars should be mounted at the appropriate height. If they are too low, it can be hard to get proper leverage; if they are too high, it can be easy for the person to lose their grip. It’s important to screw (not just nail) the grab bars into the drywall; test the bars for stability by grabbing onto them as if you were actually falling (they should not budge). Lastly, all grab bars need to be slip-resistant and color contrasted from the wall for visibility. 

Bathtubs and Showers

If the person has trouble standing and balance is a challenge, consider a shower chair. The addition of a hand-held shower nozzle, which is easier to use than the standard shower head, especially while seated. 
If the person is unable to step in or out the tub, the use a bath bench is preferable to a shower chair. 
If the person requires help with getting in and out of the bathtub, a walk-in bath, which is easier to access, may be an option. .
Other injury precautions include:
Replace glass shower doors with unbreakable plastic or shower curtains. 
Set the water heater thermostat at 120 F or lower to prevent scalding. Have the person get into the habit of checking the temperature by hand before entering the shower or bath.
Make sure the towels, soap and shampoo are within easy reach.
Use soap on a rope (secured to something reachable) to avoid reaching and stooping. 

Toilets

If an elder’s buttock is lower than their knees when seated on the toilet and/or they require several attempts to rise from the toilet or lose balance in doing so, the toilet is too low. If the elder has trouble getting off the toilet, many options exist:
Toilet grab bars (either wall or toilet- attached) can often compensate for low toilet seats. 
Install a toilet safety frame. This fits around the toilet and has armrests, so the user has support when standing up and sitting down. 
Add a raised toilet seat, which can be be installed on existing toilets. 
Lastly, a bedside commode is beneficial if toilets are inaccessible or difficult for an individual to use.
Selecting the appropriate equipment and/or safety modification can be difficult, especially with so many choices available and too many web sites telling you what you may not need.  A visit by a physical or occupational therapist (ask your doctor for a referral) can help make sure that you get the ‘right’ equipment (grab bars, shower chairs, bath benches, toilet modifications, etc.) for you or your loved ones safety concerns.

Rein Tideiksaar Ph.D., PA-C (or Dr Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting. To learn more, check out the Doctor’s professional profile on LinkedIn: http://www.linkedin.com/pub/dr-rein/6/759/592. If you have any questions about preventing falls, please feel free to email Dr. Tideiksaar at drrein@verizon.net

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