Step Ladders and Stools: You have to be So Careful!

Ladies and Gentlemen, We all appreciate the added safety precautions that must be incorporated into our lifestyle to reduce our risk of falls. Even with this knowledge, we sometimes place ourselves at risk because we are so determined to stay independent – as independent as possible. I imagine that you are agreeing with me. So, I must ask you: Are you still climbing up on step ladders and step stools? I know you answered “yes”. So, let’s think through your “yes”.

Falls Risks – Step Ladders and Stools

I next imagine that you are aware of the fall safety risks associated with using step ladders and stools. Yes? Well, how much do you know? As I start to share with you, please know that Age is not the factor. Your individual fall risk factors, the type of ladder or stool, and your environment are all risk factors for falling from a ladder or step stool. While I am not going ask you to stop using a ladder or stool based on your age, I am going to ask you to think through if you should be using these devices, and if you do, to be careful. At any age, it is easy to fall off a ladder or a stool. I’ve fallen off a ladder in my yard and fortunately fell onto grass, so I was not injured. I expect some of you have fallen from a step ladder and / or stool too.

Ms. C. – My Neighbor

Ms. C., my neighbor, is a repeat faller, with gait and balance problems and trouble feeling her feet, all of which have gotten worse with aging because of her diabetes and she is so sedentary. Ms. C. continues to use a two-step ladder to give her boost in kitchen to reach items in higher kitchen cabinets.

She has no interest in moving these items to a lower cabinet so that she would not have to use this ladder. Ms. C. has lost her balance stepping up onto and down from the ladder in her kitchen, but previously caught herself. The last time she was alone in her home, she lost her balance and fell off the ladder. Ms. C. struck and fractured her right shoulder (dominant side) on the counter on her way down to the floor. The trauma of falling in a seated position onto the floor resulted in a pelvic fracture. You know the rest of the story.

The Evidence of Risk

For years, the Centers for Disease Control and Prevention (CDC) has been collecting data on causes of morbidity and mortality, unintentional injuries and death, with priority interest in falls as the cause, and in this case, falls from ladders.

From results of a 2014 CDC Morbidity and Mortality Report, it was concluded that falling off a ladder was easy and often deadly (Smith, 2014). This report informed the public that falls continued to be a leading cause of unintentional injury death, and then large percent, 43% of falls that were fatal involved a ladder. Among the working population, ladders were contributing factor in approximately 20% of falls with injury. The height of the fall from the ladder mattered. Ladders 6-10 feet tall resulted in the highest number of non-fatal and fatal falls. Of falls from all heights, 49% of fatal falls involved a head injury, compared to upper and lower extremities injuries in non-fatal falls (Smith)

Also, during this time, researchers analyzed falls from ladders over a five and half year period from a trauma registry. Of 27,155 trauma patients, 340 (1.3%) suffered falls from ladders. From their analysis, fallers 66 yoa and older were more likely that other age groups to sustain traumatic brain injuries, more likely to suffer injuries to the trunk of their body, and less likely to sustain hand and/or forearm fractures (Con, et al., 2014). As they analyzed falls by age group and height of the fall, they concluded that older adults sustained different and more severe injury patterns although they fell from lower heights. So, even though the falls from ladders seem rare, the injuries were serious. Their finding prompted ladder safety education for older adults. The most commonly-reported injuries from ladders and step stools are fractured ribs, skulls, hips, legs and arms. The evidence continues to confirm that older adults are at greater injury risk that can result in loss of function or loss of life.

Factors that make older adults at risk for falls on the ground are those that make at risk for falls from ladders or stools. These include but not limited to changes in vision, depth perception, balance, lower extremity sensation, impaired judgement. Yes, these are age-related changes that make older adults at greater risk for falling, and that includes those involving a ladder or stool when stepping onto, standing on, turning and reaching, and stepping down off the ladder to the ground. But remember, it’s easier to fall from a ladder by missing a step and / or loosing balance – falling up, over, and/or down.

Exercise Extra Caution

Ladies and Gentlemen, being careful requires extra caution. Ladder use is dependent on one’s strength, balance, good judgement and proper safety precautions at any age. However, the Senior Fall Prevention Initiative asserts absolute reasons to avoid step ladder use based on your fall history and etiology and medical history that you can read here (Curtis,2021).

To be clear though, home safety guidance does advise that older adults never to climb onto a chair or table to reach for something, change a light bulb, reach to put something away in a high cabinet.

There are ways to minimize one’s risk of a fall and allow some safe ladder use which include, but are not limited to: use a 4-legged ladder; don’t go any higher than 2 steps or ask for help; if you feel unsafe on the first step, stop – don’t go any further (Curtis, 2021). Please read more here for general advice on using a step ladder.

Indeed, sometimes you do need to use a ladder; and, if you are not able to wait for someone else to help you, please be careful. I found a great resource for you: Safe Ladder Tips for Seniors: Expert Tips to Choose the Best One (Mora, 2020), that also have safety tips for you available here. One recommendation that I would like to highlight is the importance of making sure you can call for help if you fall and you are alone. This tip is: Don’t climb a ladder without having someone nearby, someone who can hold onto the ladder for you.

If you can’t wait, make sure you have a medical alert device with you in case you need to call for assistance. Always make sure you can call for help.

To add to my story, my neighbor was alone when she fell off a step ladder in her kitchen. Neighbors checking on her found her and called 911. Thank goodness for neighbors!

Remember that climbing a ladder is always a risk. If you have mobility or balance issues, ask someone else to help you. If you feel tired or dizzy, stay off a ladder. Don’t risk hurting yourself. When you fall, the ladder could also fall with and on you. Exercise Extra Caution.

I hope this information is helpful to you. Remember that your Harmony Team recommends that you exercise extra caution if you choose to use a step ladder or stool. Always talk to your Harmony Team, your Primary Care Provider, about your concerns about falls. Have a conversation that includes your use of step ladders as well as step stools. These conversations are value-added, to keep you safe from falls and that you are rescued should you experience a fall.

Your Harmony Team is committed to reducing your fall risks, to help you prevent falls, and promote your function and independence.

Your Harmony Team is here to help you!

Thank you for reading this message.

Dr. Pat Quigley

References :

Con, J., Friese, R.S., Long, D.M., et al. (2014). Falls from ladders: Age matters more than height. Journal of Surgery Research, 191(2): 262-267. Available : here.

Curtis, M. (2021). Do you know your senior safety score? Ladders and Seniors. Senior Fall Prevention Initiative. Accessed July 7, 2021. Available here

Mora, J. (2020, Jan. 18). Safety ladders for seniors: Expert tips to choose the best one. Daily Home Safety. Accessed July 7, 2021. Available here

Smith, S. (2014). CDC: There’s nothing ‘easy’ about falling off a ladder. Accessed July 7, 2021. Accessed July 7, 2021. Available here

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