Easier Discussions About Home Safety Changes
Change is hard. We all know that. If change is hard for everyone, imagine that it can be especially hard for aging adults who have decades of habits and preferences. So, when we want to talk to our parents or loved ones about safety changes to reduce fall risks in the home, we all may need a little bit of help to have successful conversations.
Research has shown that falls cause 95% of all hip fractures. 50% of all falls that result in hospitalization happen at home. Given that falls can result in chronic pain, reduced mobility, loss of independence, and even death, we can understand the importance of fall prevention.
We all have different belief systems about living with risk. One of our freedoms and pleasures of adulthood is to experience life and with that, adopt a tolerance for some risks. For example, some of us may ride a motorcycle, go rock climbing, swim across open lakes, drive at high speeds, take investment risks, hang Christmas lights high up on a ladder, or texting while driving. If we understand that everyone has their own internal personal guide to accepting risks of different kinds, then we can have respectful conversations with those who have different tolerances than we do.
Motivation for Change
When we look at the research done to determine how often people implement change when their physicians make them aware of their fall risks, the rate of following through on fall prevention interventions is only about 50%. That means that 50% of people continue to live at risk even after they learn of their fall risk from their doctor. We also have learned that people are often more willing to make minor adjustments (such as taking vitamins) than make big adjustments (such as engaging in exercise or make home modifications).
So, how do we change those numbers? How do we help our loved ones engage in behavioral changes on their own terms? How do we help them find the motivation for change that works for them?
Avoid Fear-Based Reasoning
Providing the statistics on falls in the home or the disastrous consequences of those falls does not necessarily help someone to initiate changes in their own lives. Fear-based conversations rarely motivate someone to reduce their risks or change their behaviors. Even if you are told that “falls cause 95% of hip fractures”, it does not necessarily mean that you would be willing to put a grab bar at the exit of your tub.
Use Respectful Language
If you point out that your loved one has “reached a certain age” or is now “elderly” or “frail”, you will not likely have a constructive conversation. Avoid using derogatory terminology. Using inclusive and respectful language can positively influence your fall prevention efforts. Do not perpetuate agism which harms the self-esteem and dignity of your loved one. Recognize that older adults are not all the same. They have individual preferences, values, and needs. Respectful language promotes collaboration which can ultimately effect safety changes and improve the quality of life for individuals.
In the field of Motivational Interviewing, a collaborative conversation style is used to strengthen a person’s own motivation and commitment to change. It is a communication tool that helps you listen to what a person wants help with, using compassion, acceptance, and partnership to elicit change. Use open-ended questions to learn what is important to the other person. Make statements that acknowledge a person’s strengths or values that increase their confidence for change. Show that you are really listening to them by reflecting back what you are hearing and this will increase your clarity and understanding of what motivates them or would influence them to change. At the end of the conversation, provide a summary confirming your understanding of what motivates them and commits them to making changes.
If your loved one is experiencing cognitive changes or dementia, their judgement and reasoning skills may be somewhat impaired. They may not be able to engage in meaningful conversations or successful collaboration. If so, engage family and caregivers in the collaborative process so that together you may understand what would encourage or motivate the loved one to accept changes. If they feel overwhelmed by the process of setting appointments or looking for home safety products, offer to assist but keep them in the loop so they don’t feel excluded.
There are certain barriers that hinder good communication. Injured pride quickly shuts down conversations. Stigma and false beliefs exist about aging and should not be perpetuated. Change feels difficult, so most people don’t like it. If you want a conversation to be positive and generate change, start with the following: invite honesty, create shared goals, and agree on the next steps.
In many conversations, we are so concerned about sharing our own perspectives that it is hard to hear what the other person is saying. You’ll notice a huge shift by simply beginning a conversation with genuine curiosity about your loved one’s feelings, ideas, and motivations. The solutions for what you want to accomplish are often found in their responses. Try meeting your loved one in the space of how they are feeling (emotions and perceptions) rather than what they need to fix.
Focus on Shared Goals
Consider the huge identity shift that’s required to go from the role of caretaker or head of the family to care receiver. It can feel intrusive or embarrassing for someone to point out your shortcomings. It makes a difference to rally around a shared goal. For instance, maybe you figure out that your loved one’s primary goal is to stay in their home. That can be the motivation for establishing and discussing fall prevention solutions and changes to the home.
Agree on a Plan
Bring any hesitations out into the open and then direct the conversation to the benefits of making safety changes. Start with “Help me to understand what you are thinking of to make your home safer.” Try to offer help in a way that doesn’t feel threatening or inconvenient. After hearing their thoughts, try to agree on 2 or 3 concrete steps. Plan what project to start with and what you can do to help. Create a list of all the changes that would help them reach their goal of safely staying in their home for longer.
Be Gentle With Each Other
Change is hard. Especially for older loved ones. So, when we want to talk to our parents or loved ones about reducing fall risks in the home, invite honesty, focus on shared goals, and agree on a plan. Allow for time in between conversations for reflection, questions, and to develop a readiness for change. Be respectful and most of all be gentle with each other.