“I don’t know if it makes a difference to safety?” perception vs actuality: A mixed-methods study on older adults’ experiences of home stair falls revealed during COVID-19 lockdown

In the United Kingdom (UK), stair falls in older adults’ homes cause up to 575 deaths and 350,000 injuries annually, costing the NHS £435 million. The stair falls may be related to hazards such as poorly designed/absent handrails, too steep/narrow stairs, poor step surface (e.g., loose carpets), and poor lighting. Our study aimed to understand older adults’ experiences of independent living and home stair falls during the first COVID-19 lockdown, and shed light on older adults’ physical staircase dimensions that influence stair fall risks in relation to UK government guidelines. A mixed-methods approach was employed, conducting semi-structured interviews alongside quantitative home stair assessments with 22 participants aged ≥ 60 years. The stair assessments captured the physical dimensions (i.e., measurements of pitch, rise and goings) of their home stairs, and if they perceived their stairs safe to negotiate. We identified four overarching themes common across older people living independently: effects of lockdown on daily living during the COVID-19 pandemic; stair-related accidents and perceived causes; fall preventative measures and safety awareness; and attitudes towards ageing and care services. Although all of the participants perceived their stairs to be safe, nearly half of participants’ staircases (40%) did not meeting the UK government guidelines for pitch, rise and going. While the COVID-19 lockdown provided a unique context for exploring fall risk and stair safety, our findings highlight broader, ongoing issues. Despite emotional attachment to their homes, many lacked staircases that meet current UK government guidelines, highlighting a need for targeted interventions to mitigate environmental hazards. Additionally, financial constraints and education further complicate efforts to enhance home safety. Discrepancies between perceived and objective safety assessments highlight the need for comprehensive care approaches and evidence-based home design guidelines, allowing for collaborative support for ageing in place. Bridging this gap is essential for reducing home stair falls.