Bathroom fall prevention in California: what the research says and what to do this week

Falls are one of the most serious health risks of later life, and they are often preventable. According to the Centers for Disease Control and Prevention (CDC), about 14 million older adults in the United States, roughly one in four people aged 65 and over, report a fall each year. The CDC also notes that one fall doubles the chance of another, and that fewer than half of older adults who fall tell their doctor. Those numbers are why families start paying attention to the bathroom.

Why the bathroom is a hard room

Think about what a standard bath asks of the body. You lift one leg high over a tub wall while balancing on the other, on a surface that may be wet. You lower yourself to the bottom of the tub, then push back up with wet hands. You turn in a tight space. Each step is a test of strength, balance and joint flexibility. Add a dim night-time trip, slippery tile, a bath mat that slides, or a dizzy spell from a blood pressure medicine, and the risk climbs.

Start with the low-cost changes

The National Institute on Aging (NIA), part of the National Institutes of Health, recommends a set of home changes room by room. For the bathroom, these are the core ones. None requires a remodel.

• Grab bars inside and outside the tub or shower, and next to the toilet, installed into framing or with proper anchors by someone who knows how.
• Non-slip surfaces: non-skid mats or strips on any surface that may get wet, including the tub floor and the floor outside it.
• Night lighting: a night light in the bathroom and along the path from the bedroom, ideally one that turns on automatically.
• A shower seat or transfer bench so the person can bathe sitting down.
• A hand-held shower so water can be directed while seated.
• Raised toilet seat or toilet safety frame if standing up from the toilet is hard.
• Remove loose rugs or replace them with rubber-backed mats.
• Keep everything within reach: soap, shampoo and towel where the person will not need to lean or twist.

An occupational therapist can assess the home and recommend specific equipment and placement. Ask the person's doctor about a referral; it is often the best money a family spends.

Look beyond the bathroom

The NIA and the CDC both stress that falls usually have several causes at once. Home changes help most when combined with these steps:

• Talk to the doctor about falls. Mention any fall, near-fall or dizziness, even if no one was hurt.
• Review medicines. Some medicines, and combinations of them, cause dizziness or drowsiness. A doctor or pharmacist can review the full list.
• Check vision every year and update glasses. Avoid walking around in reading glasses.
• Exercise for strength and balance. Programs such as tai chi have been studied for fall prevention. Many California Area Agencies on Aging and senior centers offer evidence-based balance classes.
• Wear supportive footwear with non-slip soles, not socks or loose slippers.
• Stand up slowly, especially after a warm bath, which can lower blood pressure.

Where a walk-in tub fits

A walk-in tub is a bigger change than a grab bar, and it is not the right answer for everyone. What it does well is remove the single highest-effort movement in a standard bath: stepping over a tall tub wall and lowering to the floor of the tub. With a walk-in tub the person steps over a low threshold, sits on a seat at about chair height, and stays seated for the whole bath. Grab bars and controls are within reach of the seat.

It also brings its own routine that must be followed every time. The door only opens after the water has drained, so the person waits seated during drain time. Warm water can make some people light-headed, so standing up slowly matters. If the person has memory problems, the steps may need supervision. Our caregiver guide covers how to help safely.

Signs it is time to change the bathtub

• The person has stopped taking baths, or bathes less often, because getting in feels risky.
• They hold onto towel bars, the sink or the shower door to get in and out. Those were not designed to hold body weight.
• There has been a fall or a near-fall in the bathroom.
• A caregiver is lifting or steadying the person over the tub wall.
• A doctor or therapist has suggested bathing changes after a surgery, stroke or joint replacement.

California help with fall prevention

The California Department of Aging lists fall prevention and home modification resources on its website and funds local programs through the state's network of 33 Area Agencies on Aging. Its Dignity at Home Fall Prevention Program has provided grants to local agencies for home safety assessments, equipment and home modifications for eligible adults aged 60 and over or people with disabilities who meet income limits. Funding and availability vary by county and by year, so ask your local agency what is offered now. The statewide information line is 1-800-510-2020, and it connects you to the agency for your county. More detail is in our California aging resources guide.