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Preventing Falls in the Home

A Consumer Checklist

Falls are an everyday commonplace event which each of us experience quite often. While minor slips and falls may be inconvenient or cause temporary discomfort, some falls can lead to seriously disabling injuries or even death. We tend to downplay most of our falls, blaming them on our own clumsiness or error. However, there are many simple strategies that can be implemented to reduce falls in the home. By recognizing how and where we fall and the array of measures available to decrease the likelihood of a fall, we can make measurable progress toward reducing this enormous injury toll.

Why is fall prevention so important?

Falls have been the second leading cause of unintentional death in America since the early nineteenth century. In 1995, 7,300 Americans died as a result of falls in the home. One in three emergency room visits is for falls, and falls represent the most common cause of injuries and hospital admissions for trauma. The lifetime cost to society for falls in 1985 was $37.3 billion, with $14.7 billion of that composed of direct costs. Falls are the leading cause of injury and death for people over 65 and over half of fatal falls involve people over 75 -- an age group which constitutes only 4% of the population. Falls are also the number one reason children end up in hospital emergency rooms.

Stairs

Stairs in the home present one of the greatest challenges in fall prevention. More than three quarters on all stair falls take place in the home. We tend to fall more often on short flights of steps; in one study 80% of the falls on steps were on stairs with five or fewer steps. Most falls occur on the top or bottom three steps.

  • Use non-skid contrasting tape, rubber stair treads, or coated skid resistant surface treatment on non-carpeted stairs. Apply strips of tape to dry, clean surfaces at one-inch intervals. Three strips of tape provide good traction on a typical step.
  • Check carpeting to make sure it is firmly attached along stairs. Make repairs to worn or loose carpet promptly. Select carpet pattern that doesn't visually hide the edge of steps, leading one to believe the steps have ended when they haven't.
  • Avoid placing throw rugs or scatter rugs at the top or bottom of stairways, or properly secure with carpet tape to prevent slippage.
  • Install stair handrails on both sides.
  • Be sure stairway has high-wattage lighting. Install on/off switches at both the top and bottom of stairs.
  • Never leave books, purse, packages or other objects on stairs.
  • Watch out for a single step since these trip persons frequently.
  • Avoid or exercise caution when the following physical conditions are present on stairs:
    • absence of reachable handrails or handrails placed too low
    • ungraspable railings
    • obstacles on steps, non-uniform step dimensions, or inadequately sized treads
    • dangerous surface materials such as wax, poor surface maintenance, camouflaged tread surfaces, thick or poorly secured tread coverings mats and nosing caps
    • visual distractions in surroundings
  • Avoid the following practices that can contribute to stair falls: hurrying, inattention, obscured vision, carrying large loads, and shoes that are easy to slip in.

Children

  • Use safety gates. At the top of stairs use screw-mounted gates; use pressure-mounted gates for the bottom of the stairs and doorways between rooms.
  • Toddlers should be taught to descend stairs on their stomachs, feet first, and later the importance of using the handrail.

All Rooms

  • Use carpet with short dense pile and/or apply double-sided carpet tape to prevent carpet slippage.
  • Arrange furniture so it is not an obstacle in walking paths.
  • Make sure you can turn on lights without having to walk through dark areas.

Children

  • Never use baby walkers.

  • Keep drawers fully closed to prevent them from being climbed on or pulled out entirely.
  • Windows: Move chairs, cribs, beds and other furniture away from windows.
  • Consider installing window guards on windows ground floor and up, unless designated as emergency fire exits. Make sure they have easy release mechanisms.
  • Consider installing special locks that only allow the window to be opened to a certain height.
  • Never rely on window screens to prevent falls.

Kitchen

  • Use sturdy step stools -- preferably with handrails.
  • Clean spills immediately

Children

  • When using a high chair, (baby swing, stroller, or infant seat), always secure the child in a restraint system which includes a waist and crotch restraint the high chair tray is not intended as a restraint and will not prevent falls.
  • Keep infant seats off tables, counters, and other elevated surfaces -- the best place for them is on the floor.
  • Make it a habit to push kitchen and dining room chairs in under the table to take away an attractive climbing gym.
  • Don't store desserts or other treats in high locations, particularly over stoves, to decrease climbing temptations.

Bathroom

  • Use rubber bath mats or strips in bathtubs and showers.
  • Consider installing grab bars in the bath to reduce further the risk of injury from falls.
  • Clean up water from floor

Children's Rooms

  • Never leave babies alone on changing tables, beds or sofas. Use a changing table that has a restraining strap.
  • When a child can pull to a standing position, the crib mattress should be adjusted to its lowest position; there should be at least 26 inches between the top rails of the crib drop side and the mattress. Toys, bumper pads, and other objects that can be used as steps to climb out should be removed from the crib.
  • On Bunk Beds: never allow a child under age 6 to sleep on the top bunk. For older children, if the upper bunk is not against a wall, use guardrails on both sides. No matter how old a child is, keep the guardrails in place on the top bunk since children roll during sleep. Prohibit horseplay on bunks.
  • Keep dresser drawers pushed all the way in to avoid children climbing up dresser.

Garage

  • Clean spills or slippery surfaces immediately, before walking on them -- especially oil or grease on cement floors.

Outside

  • Install handrails along any flight of outdoor steps.
  • Spread ice melt, rock salt or sand on icy walkways.
  • Observe special precautions when using a ladder.
  • When using a ladder, make sure its base is firm, that all ladder feet are on level ground, and that the ladder is angled against the wall properly.
  • When climbing, face the ladder and hold on to ladder rungs firmly. If reaching, make sure always to keep your hips and body weight centered between the rails.
  • When using a stepladder, make sure it is fully opened and both spreaders are firmly locked.
  • Do not climb a closed stepladder; it may slip out from under you.
  • Avoid standing or sitting on a stepladder's top or pail shelf.
  • Never climb on the back side of a singled-sided stepladder. It is not designed to carry a person's weight.
  • Use a ladder that is the right length for the task you are doing.
  • Avoid climbing beyond the second step from the top of a stepladder and the 4th rung from the top of an extension ladder.

Children

  • Grass and soil surfaces beneath backyard playground equipment should be replaced with hardwood chips, shredded wood mulch, sand, pea gravel, rubber, crushed stone, or another safer material at depths of at least 9 to 12 inches.
  • When riding bikes or using skates or skateboards, require children to wear helmets; look for those that have stickers stating that they meet or exceed safety standards.
  • Vertical posts or pickets in deck, balcony, and stairway railings should be no more than 3 1/2 inches apart if a young baby will have access to the area. The space between horizontal rails or bars, and between the floor and the first horizontal rail or bar, should be no more than 3 1/2 inches.

Posted: Wednesday, February 28, 2001 12:00:00 AM. Modified: Friday, August 05, 2005 2:36:44 PM.

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