How can I modify a patient's home to improve shower safety and prevent falls?

Home Modifications for Shower Safety to Prevent Falls

Installing grab bars in the shower is the most effective intervention to prevent falls and should be implemented immediately for patients who keep falling in their shower.1

Assessment of Fall Risk Factors

Before implementing home modifications, assess for specific risk factors:

• Age over 65 increases fall risk, with falls occurring in up to 1/3 of population over 65 and 51% in those over 85 2
• Medical conditions that contribute to falls: cardiovascular disease (40%), neuromuscular disorders (23%), diabetes (16%) 3
• Medications that increase fall risk: antihypertensives (32%), antipsychotics (16%), and anticoagulants (14%) 3
• Environmental hazards in the bathroom, particularly slippery surfaces 2, 1
• Visual or neurological impairments that affect balance 2

Essential Bathroom Safety Modifications

Primary Interventions (Highest Priority)

• Install grab bars inside and outside the shower/tub - Research shows patients with grab bars are 75.8% more likely to recover their balance during slips than those without 1
• Add non-skid floor surfaces or mats in the shower and bathroom floor to increase friction and prevent slips 2, 4
• Ensure even floor surfaces without transitions that could cause tripping 2

Secondary Interventions

• Install adequate lighting in the bathroom, including night lights for evening use 2
• Add a shower chair or bath bench for patients with significant balance issues 2
• Consider a handheld shower head to allow bathing while seated 2
• Replace glass shower doors with shatterproof materials or curtains to prevent injury if falls occur 5

Resources for Implementation

Medicare/Insurance Coverage Options

• Request a home safety assessment from a Medicare-funded occupational therapist who can evaluate the home environment and recommend specific modifications 2
• For patients admitted to the hospital after falls, request physical therapy and occupational therapy evaluations to assess home safety needs 2

Community Resources

• Contact local Area Agency on Aging for information about home modification programs
• Explore state services for visually impaired patients that may provide additional home safety resources 2
• Consider expedited outpatient follow-up that includes home safety assessments 2

Patient and Caregiver Education

Provide education on:

• Proper use of grab bars and other safety equipment 1
• Importance of wearing proper footwear with non-skid soles in the bathroom 2
• Slowing down movements during transfers to avoid dizziness 2
• Removing bathroom clutter and loose rugs that could cause tripping 2
• Scheduling bathroom visits to prevent urgent situations that might lead to falls 2

Common Pitfalls to Avoid

• Overlooking medication review: Many falls are related to medication side effects, particularly from antihypertensives, sedatives, and psychotropics 2, 3
• Focusing only on the bathroom: Fall prevention requires a comprehensive approach including medication management and addressing underlying medical conditions 2
• Delaying implementation: Bathroom falls can lead to serious injuries including traumatic brain injuries and fractures requiring surgical intervention 3
• Ignoring cognitive factors: For patients with dementia, additional supervision and environmental modifications may be needed 6

By implementing these evidence-based modifications, particularly grab bars which have been shown to significantly reduce fall risk, you can help prevent shower falls and maintain your patient's safety and independence.