The older adult population is at an increased risk for injury based on physiological and age-related changes (e.g., decreased muscle mass and bone strength), and disease-related changes (e.g., vision and hearing loss, cognitive loss, arthritis). Sustained injuries may lead to profound impacts on an older adult’s physical, cognitive, social, and emotional health, resulting in increased disability, diminished function and quality of life, and even death.  Injury prevention benefits individuals by mitigating these injury risks.

Standard recommendations for injury prevention in older adults include:

1. Seatbelt safety: use lap and shoulder safety restraints in vehicles.

2. Bicycle and motorcycle helmets: ensure proper fit for head size and purpose. Helmets should be specific for their purpose.

3. Detectors and alarms: evaluate hearing acuity.  Use lithium batteries (longer lasting, lower risk for non-functioning device). Multi-modal alarms (sound, flashing lights) are available.       

• Smoke detectors: install on each level of housing and outside each sleeping area.
• Carbon monoxide detectors: install near sleeping areas, near attached garages and near fuel burning fireplaces or appliances.

4. Firearms storage / handling / removal

• Store firearms where only accessible to the owner and designated persons with use only by a competent and experienced individual.  Firearms should be stored locked and unloaded, with a gun lock or in a gun safe.
• Removal of firearms may be done in consultation with law enforcement or in accordance with local laws. Contact your local police or sheriff for details.
• Consider drawing up a “firearm retirement date” alongside advance directives.

5. Medications:

• Encourage medication use only as directed by the clinician or pharmacist.
• Check all medications in the household against clinician lists, checking both brand and generic names for consistency. Discrepancies should be called to the clinician.
• Use pill boxes and reminder alarms to ensure avoid accidentally missing or double dosing medications. Avoid taking medications directly from prescription bottles.
• Keep a list of all medications, including over-the-counter meds and naturopathic medications, either in the wallet or a picture of the list on a phone.
• Remove, separate, or clearly flag any unused medications; otherwise, dispose of them with a provider or at a designated drop off location (e.g., pharmacy, police or fire station).

6. Burn Prevention:

• Water temperature: set water temperature no higher than 120˚ F / 49˚ C.  Use thermometers in full immersion baths (safe bath temperature is 95 to 100˚ F / 35-38˚ C), particularly for sensory, mobility, or cognitively impaired individuals.

• Heating devices: use caution with therapeutic heating devices – place layers of cloth between the skin and device, check skin integrity regularly, do not fall asleep while using. Heating devices are inappropriate for persons with advanced heart disease, peripheral vascular disease, impaired sensation, hepatic or renal insufficiency, and dementia.
• Burners: avoid loose clothing that can ignite. Use electric burners rather than gas flame.
• Cooking: use a large numerical timer when cooking. Have working smoke alarms, use two handed pots and cups to avoid spilling. Electrical equipment should have automatic turn-off features. Use caution with microwave ovens as steam may cause burns.
• Smoking: avoid smoking if using oxygen or while using sedative medications or substances. Smoke only in a non-upholstered chair.
• Lights: avoid halogen bulbs due to high temperature, using LED or florescent bulbs instead.

7. Fall prevention:

• Inquire about recent falls and circumstances surrounding falls.
• Transfers: assess upper body/arm strength, quadriceps strength.
  • Grab bars (horizontal or vertical, not diagonal; mounted to joists or supports, not drywall); are particularly helpful in bathroom shower and toilet areas. Shower chairs extending outside the shower area can help with transitioning into and out of the shower. Raised toilet seats and frames, particularly with arm supports may help in cases of weakness.
  • Chairs should not be too low or too deep to help with safe rising, and cushions should not be too soft. Ideal chair height is 18 inches (46 cm) high and 19 inches (48cm) deep.
• Stair rails – dual rails are ideal and should be set at 1.5in (4cm) below elbow height (33-36in / 84-91cm) and extend beyond the stairs.
• Throw rugs: should be removed or secured with double sided tape to the floor. Pile height should be low to medium to avoid tripping. Avoid carpet protectors (cloth or plastic) as these tend to bunch up.
• Cords: should be either secured or wrapped to prevent snagging or catching.
• Door thresholds: doorsills may be removed if using a walker or if there is low step height.
• Lighting: use lighting with sufficient contrast to permit highlighted foreground from background. Use outdoor lighting and nightlights. 

8. Pressure injury prevention:

• Ensure that appropriate pressure relieving cushions are used for those with mobility or sensory problems.

9. Emergency contacts:

• Keep an emergency contact list easily accessible when traveling.
• Alerts: use an emergency response system / personal emergency response system: this can be at-home or on-the-go (GPS linked) systems.
• Telephone: use adequate amplification if hearing impaired. Many cell phones can pair to hearing aids. Visual ringers are also helpful for hearing impaired individuals.

10. Wandering:

• Door locks or door alarms – use two door locks to increase difficulty in leaving the home.
• Safe return bracelet/watch and use of a wander guard or alarm system (may be GPS linked) may assist if a search is needed.