Why over one-third of elderly nonfatal falls first occur in the bathroom—and what can be done.
by Jessica Hegg

When it comes to understanding and preventing falls among the elderly, first falls are becoming a more and more important metric.

According to a 1995 study by the American Journal of Public Health, 46.8 percent of first falls have an environmental component—some feature an obstacle that causes the fall like an upturned carpet, slippery area or unsecured item. This metric continues to shrink as time goes on—all the way down to 18.2 percent for fifth falls and onward.

This number would suggest that after an elderly person falls once, their risk of falling—regardless of safety precautions or preventable hazards—increases drastically. If an elderly person has fallen more than two or three times in the past several years, they are likely to fall again, even with the aid of specialized safety equipment and other precautions.

Another interesting metric gathered by this study is the fact that a lack of grab bars and anti-slip mats in bathrooms corresponds with a decrease in falls. Initially, this metric seems counterintuitive, but the explanation is simple—most elderly people and caregivers do not install safety features in the bathroom until a first fall has already occurred.

This knowledge, combined with the fact that first falls are associated with deleterious future falling outcomes, gives us a clear call-to-action when it comes bathroom safety—especially when we consider that elderly people are twice as likely as younger people to experience a nonfatal bathroom injury, and that the bathroom is the single most likely place for an elderly person to experience a fall, clocking in at 35.7 percent.

Understanding The Bathroom Dilemma
There are many reasons that this is the case. First, the elderly visit the bathroom more often than younger people—increased urination is quite common among older people. Over-exertion is another problem—a motion such as rising to get off the toilet, which is a no-brainer to a younger person, can have serious risks to an elderly person, and actions such as reaching for objects that are just out-of-reach can be enough to throw elderly people off-balance.

Other factors include obstacles that can be tripped over—including poorly secured anti-slip mats or rugs, slippery surfaces in the shower or on a tile floor and a lack of necessary precautions such as grab bars in showers and near toilets.

The shower is often the first fixture in the bathroom to be modified—grab bars and anti-slip mats, or shower stools are common—despite the fact that toilet use causes more falls. This could be due to the fact that the toilet is not seen as a fixture that’s in need of safety precautions, or because most elderly people are quite aware that showering is a risky activity, while not seeing simple toilet use as such.

Why are do so many elderly folks (and their caregivers) avoid installing necessary and simple safety precautions in the bathroom? Items such as raised toilet seats, shower stools, walk-in-tubs, anti-slip mats and grab bars all are associated with better outcomes when installed, so why aren’t they installed before an incident occurs?

Talking It Over—and Taking The Necessary Next Steps
One possible explanation is that, just like the rest of us, elderly people do not spend that much time in the bathroom—despite increases in urination and other functions as they age.

Another explanation is that, while securing other areas like kitchens, living rooms, storage closets and bedrooms is common and normal, some elderly people (and the ones caring for them) see bathroom safety as a bit more taboo and embarrassing. It can be awkward for an elderly person to discuss their need for help when performing bathroom activities that, for years, they performed without incident. It can be just as uncomfortable for their caretakers, especially if they are family members or loved ones.

But the statistics don’t lie—the bathroom is the number one cause of falls in the elderly, despite the relatively short amount of time spent in the room. Because of this, securing the bathroom of an elderly person should be your priority when discussing any kind of aging-in-place solution.

Remember: falling once due to an environmental hazard—or for any other reason—drastically increases the chance that an elderly person will fall again. Because of this, it is important to take preventative measures to prevent first falls for as long as possible.

This includes not only necessary bathroom fixtures, but full-home preventative solutions: the bedroom, dining room and kitchen are the next most common places in which elderly people suffer falls, and should all be outfitted with appropriate safety measures, and organized or remodeled so that risks such as excessive reaching, loose carpeting, mats and rugs, and structural hazards such as difficult stairs be addressed and secured.

Don’t Take No For An Answer
So when you’re talking with a patient or client about necessary safety precautions, emphasize how important prevention is to maintaining the autonomy, safety and health of elderly people. It’s not embarrassing to need help—even in the bathroom.

Just like other important things in life, it’s better to have and not need these features than to need and not have them. So bring up these statistics with your clients. Talk to them about the importance of fall prevention, and particularly about preventing the first fall. And make sure they know everything you do about the necessity of bathroom safety and full-home security solutions, so that they can make the best decisions—for themselves, or for loved ones.