When Dan Bawden teaches contractors and builders about aging-in-place, he has them get into a wheelchair. See what it’s like to try to do things from this perspective, he tells them.
That’s when previously unappreciated obstacles snap into focus.
About 2 million older adults in the U.S. use wheelchairs, according to the U.S. Census Bureau; another 7 million use canes, crutches or walkers. Twenty years from now, 17 million U.S. households will include at least one mobility-challenged older adult, according to a December report from Harvard University’s Joint Center for Housing Studies.
Researchers at the Harvard center found that fewer than 10 percent of seniors live in homes or apartments outfitted with basic features that enhance accessibility — notably,
- entrances without steps,
- extra-wide hallways or doors needed for people with wheelchairs or walkers.
We asked several experts to describe some common issues mobility-challenged seniors encounter at home, and how they can be addressed.
The list below is what they suggested may need attention and has suggested alterations, but is not comprehensive.
A ramp will be needed for homes with steps leading up to the front or back door when someone uses a wheelchair, either permanently or temporarily. The estimated price for a five-to-six foot portable nonslip version: $500 to $600.
You want the threshold to be as flat as the floor is,” Bawden said. Consider installing an electronic lock that prevents the need to lean in and insert a key.
Getting through doorways easily is a problem for people who use walkers or wheelchairs.
Widening a doorway structurally is expensive, with an estimated cost of about $2,500. A reasonable alternative: swing-free hinges, which wrap around the door trim and add about 2 inches of clearance to a door.
Ideally, people using wheelchairs need a five-foot-wide path in which to move and turn around, Bawden said. Often that requires getting rid of furniture in the living room, dining room and bedroom.
Another rule of thumb: People in wheelchairs have a reach of 24 to 48 inches. That means they won’t be able to reach items in cabinets above kitchen counters or bathroom sinks.
Older eyes need more light and distinct contrasts to see well. A single light fixture hanging from the center of the dining room or kitchen probably won’t offer enough illumination.
“If someone can afford it, I put in recessed LED lights in all four corners of the bedroom and the living room and install closet rods with LED lights on them,” Bawden said. LED lights don’t need to be changed as often as regular bulbs
Typically, cabinets need to be taken out from under the sink, to allow someone with a wheelchair to get up close, Lichter said. The same is true for the stovetop: The area underneath needs to be opened and control panels need to be in front.
Even for those of us still standing, leaning forward over a sink usually strains the low back, so it’s important to put your feet more underneath you.
This can be essential for anyone with back pain, which is exacerbated by the slight tilt forward required to work at a countertop without clearance to step “under” to balance.
Refrigerators with side-by-side doors are preferable to those with freezer areas on the bottom or on top. Slide out full-extension drawers maximize storage space, as can lazy Susans in the corner of bottom cabinets.
put in a curbless shower with grab bars and a shower seat and a handheld shower head that slid up and down on a pole.
Even a relatively small lip at the edge of the shower can be a fall risk for someone whose balance or movement is compromised.
Cabinets under the sink will need to be removed, and storage space for toiletries moved lower. A moveable toilet paper holder will be better than a wall-based unit for someone with arthritis who has trouble extending an arm sideways.
When a fall is inevitable:
The number one thing to remember, she said, is to protect your head. So if you find yourself falling, pivot to your side and tuck in your head.
The other thing to avoid, she said, is “foosh,” an acronym for “falling onto outstretched hands.” If you do that, all the force of impact will be concentrated there, raising the risk of breaking your wrist.
Instead, if you feel yourself falling, experts said you should bend your elbows and knees and try to take the hit on the fleshiest parts of your body, like the side of your thigh, buttocks and shoulder. “Aim for the meat, not bone,”
The key is to not fight the fall, but just to roll with it, as paratroopers do.
Paratroopers’ goal is to fall sideways in the direction the wind is carrying them — in no way resisting the momentum of the fall.
When the balls of their feet barely reach the ground, they immediately distribute the impact in rapid sequence up through the calf to the thigh and buttocks.
Then they roll over on the latissimus dorsi muscle, the large, flat muscle running laterally down the side of your back, and kick their feet over, shifting their weight so they end up supine with legs bent in front of them.
Difficult as it may sound as you’re hurtling toward the ground — medical bills and disability flashing through your mind — experts said it’s important to relax as you fall.
You’re less likely to hurt yourself if you soften up all your muscles and exhale.
Rigidity is your enemy, while pliability is your friend.
“As unfair as it is, that’s why people who are drunk” tend to be the ones who “don’t get hurt in car crashes,” said Mr. Inouye. “They are loose and just flop around.”