The Fall That Hasn’t Happened Yet

What did the study find?

Murphy, Williams, and Gill surveyed 1,064 community-living people aged 72 and over (Journal of the American Geriatrics Society, 2002). They separated fear of falling from what people did about it, which is what makes the study useful.

• 57 percent reported no fear of falling
• 24 percent reported fear of falling, without restricting activity
• 19 percent reported restricting their activity because of that fear

So 43 percent carried a fear of falling, and close to one in five had already given something up over it. None of those people appear in any injury count. Nothing had happened to them.

What does giving something up lead to?

The CDC addresses this directly on its Facts About Falls page, in a single sentence: “When a person is less active, they become weaker and this increases their chances of falling.”

The same page notes that “falling once doubles your chances of falling again.” We are quoting both as published CDC statements. What either means for any particular person is a question for a doctor, and this is not a page that answers it.

What can be said without going beyond the sources is that avoidance is not a neutral response. It is a response with a cost of its own, and the research literature has been describing that cost for over twenty years.

Why the bathroom in particular?

Because of what kind of room it is, rather than anything about the people using it.

A bathroom cannot be avoided in the way a staircase or a garden path can. It contains hard surfaces at close range, it is the one room in a house that gets deliberately wet, and it is used with the door closed. A kitchen is also hard and also slippery, and it accounts for 7.2 percent of at-home falls treated in emergency departments against the bathroom’s 22.7 percent, according to a 2020 analysis by Moreland and colleagues (American Journal of Lifestyle Medicine).

It is also the room where the equipment tends not to be. In a study published in JAMA Internal Medicine in 2021, Lam and colleagues found that 42 percent of older adults who would clearly benefit from bathing or toileting equipment did not have any (JAMA Internal Medicine, 2021). The gap was widest, at 49 percent, among those aged 65 to 74 — the people least likely to have had an event that prompts somebody to install it.

The tub that stopped being used

A bathtub that is dry because the household switched to sponge baths at the sink is not a bathroom without a problem. It is a bathroom where a decision has already been made, quietly, without anybody calling it that.

It will never appear in an injury statistic. Nothing was reported, nothing was treated, and no figure anywhere counts a bath somebody stopped taking. The 19 percent above is the closest the literature gets to counting it.

What actually changes when the room changes?

Only what the room contains. That is a smaller claim than the category usually makes, and it is the only one we can support.

A seat means sitting is available for the length of a shower rather than something to be managed. A handheld on a hose means the water can be brought to where somebody is sitting rather than the other way round; the 2010 ADA Standards require exactly that in accessible showers, on a hose of at least 59 inches. A low threshold means there is no tub wall to clear, wet, on the way out — and the CDC’s data records that particular movement in 9.8 percent of all bathroom injuries against 2.2 percent for getting in (MMWR, June 2011). Three grab bars mean there is something rated to hold within reach of where somebody stands.

None of that is a health outcome and we are not going to present it as one. The strongest evidence on modifying homes, a 2023 Cochrane review by Clemson and colleagues (Cochrane Database of Systematic Reviews), found benefit for professionally delivered home assessments among people already at higher risk, no measurable benefit in the general population, and no measured effect on fractures. None of those trials studied a walk-in shower.

What we will say is that a room somebody has quietly stopped using is a real thing, that it happens well before anybody gets hurt, and that it is not usually discussed because it does not generate a statistic. It seemed worth writing down.

Where the numbers come from

Fear of falling and activity restriction: Murphy SL, Williams CS, Gill TM, Characteristics associated with fear of falling and activity restriction in community-living older persons, J Am Geriatr Soc, 2002. Fall location data: Moreland BL et al., Am J Lifestyle Med, 2020. Unmet equipment need: Lam K et al., JAMA Internal Medicine, 2021. CDC statements: Facts About Falls. Bathroom injury data: MMWR, June 10, 2011.