SUB-PROBLEMS INCLUDING LEADING TO IMPAIRMENT AND BEST PRACTICES FOR THE BUILT ENVIRONMENT (HOME AND COMMUNITY)
(See Chapter 3, “Built Environment—Healthy Homes and Healthy Communities”)
Injuries in homes cause over 18,000 deaths, over 7 million people being disabled for at least 1 full day, and a financial loss of $100 billion dollars per year. The top five causes of home injuries are falls, poisoning, fire and burns, airway obstruction, drowning, and submersion in water.
General Best Practices for the Built Environment (See endnote 4)
• Utilize a home safety checklist such as that developed by the New York State Health Department in every area of the residence especially in the kitchen, bathroom, nursery, bedrooms, basement, garage, on the stairs, and in the out of doors, to determine potential hazards. (See endnote 4 for a comprehensive list for all areas.)
• Rapidly correct all hazards found in the survey listed above.
• Remove all potential impediments from walkways inside and outside of the structure.
• Building inspectors should inspect the bracing and condition of all balconies protruding from buildings to determine if they are safe, properly maintained and secure, and a limited number of people should be allowed on the balcony at any given time. There definitely must be weight restrictions.
• Before remodeling properties built prior to 1978, determine if there is lead paint present in the remodeling areas.
• Use damp mops or damp or treated cloths to remove dust from surfaces to prevent individuals from inhaling potentially contaminated material.
• Avoid use of solvents and other hazardous materials in enclosed areas.
• Provide adequate light in all areas.
• Have a licensed electrician inspect all wiring, receptacles, and appliances on a periodic basis and make sure that all appliances are grounded.
• Properly install, operate, clean, maintain, and ventilate all wood-burning equipment and chimneys.
• Eliminate all smoking from the indoor and immediate outdoor areas of the structure.
• Establish a household emergency and escape plan and practice it for the potential rapid removal of people from the premises.
• Provide, inspect, and maintain smoke alarms and carbon monoxide evaluation units.
• Wash hands thoroughly before preparing food, after using bathroom facilities, after changing diapers, after handling solid and hazardous materials and wastes, and after helping the sick.
• Properly ventilate all areas of the structure and change air filters on a regular basis.
• Only purchase cleaning materials, pesticides, and other hazardous materials that are in childproof containers.
• Store all cleaning materials, pesticides, and other hazardous materials in well-ventilated areas away from children.
• Use safety gates and safety latches in all areas where children or older people can harm themselves by means of falls, especially around swimming pools.
• Use safety rails and grab bars where appropriate to assist people in maintaining their balance.
• In areas where radon gas is a problem in structures, periodically test for this substance and then take necessary action if the results are positive.
• Properly maintain and utilize bicycles and other moving conveyances.
• Properly train individuals utilizing bicycles and other moving conveyances on how to prevent injuries.
• Fence in all swimming areas and lock all doors leading to the pool.
• Set the hot water heater at a maximum of 120°F.
• Put signs out when washing floors and only wash one half at a time, allowing a dry surface for individuals to walk on in the structure.
• Place the Poison Control Center phone number by each telephone in the house and enter it on each cell phone for immediate access: 1-800-222-1222.
There are three principal risk factors involved in falls among older people:
1. Biological risk factors which include problems of mobility caused by muscle weakness or improper balance; chronic health conditions such as arthritis, strokes, post-polio syndrome, etc.; vision changes and loss; loss of feeling in the feet; and inner ear balance problems
2. Behavioral risk factors which include inactivity; use of alcohol; taking of medications and possible interactions; lack of knowledge of causation of falls and means of prevention; and reckless behavior
3. Environmental risk factors which include home and outdoor environmental hazards such as clutter, poor lighting, throw rugs, holes and step downs out of doors, and slick and slippery surfaces; steep inclines; poorly maintained railings and staircases, etc.; incorrect size, type or use of walkers, canes, crutches, wheelchairs, and other mobile devices; and poorly designed interior and exterior areas
In children, the principal risk factors are related to the child’s age, state of development, type of activity, and level and intensity of activity. Also, children fall more frequently in poor neighborhoods with minority groups and older rental housing.
One third of adults aged 65 and older fall each year; 20-30% of these individuals suffer moderate to severe injuries which may affect their ability to live independently and may be a cause of early death. Falls in older adults result in hospitalizations five times more than other types of causation of injuries. Falls are the leading cause of fatal and non-fatal injuries in this age group. People who fall will frequently fall again within a short period of time. In 2010, there were 2.3 million non-fatal fall injuries among older people which were treated in emergency departments and more than 662,000 of these people were hospitalized. The direct medical costs were $30 billion. About 21,700 older adults died from unintentional fall injuries, with men having a considerably higher rate. People age 75 or older fall four to five times more often than those aged 65-74 and are therefore more apt to be placed in a long-term care facility. Falls in older people account for over 95% of hip fractures as well as numerous traumatic brain injuries. An unwanted complication of the falls for the individuals is the fear of falling again, which may limit the persons’ lifestyle and creates a greater dependency on family as well as other people. (See endnotes 6, 7, 8.)