Stairs, Steps and Thresholds: Making Them Safe

Why stairs and steps are so risky

• Height of a fall. A fall down a flight carries far more energy than a trip on level ground.
• Balance and strength. Climbing needs strong legs; descending needs control, and older muscles tire.
• Vision and depth perception. Poor light, glare and low contrast hide step edges; bifocals and varifocals distort the view downwards; see reading glasses, bifocals and varifocals: falls and choices.
• Footwear and clothing. Loose slippers, socks, long garments and carrying items increase risk.
• Medicines and health. Dizziness, low blood pressure, drowsiness, breathlessness, arthritis and neuropathy all increase risk.
• Hurrying and distraction. Phone calls, doorbells and carrying items cause missteps.
• Poor stair design. Steep, narrow, uneven or worn steps, no rail, loose carpet and clutter.

For the wider picture, see preventing falls in older adults.

Handrails

A good handrail is the single most important feature.

• Both sides of the stairs, if possible, so that a person can use whichever hand is stronger and can hold on in both directions.
• The full length, from the top to the bottom step, extending slightly beyond the first and last steps so the user can hold on while stepping on or off.
• Continuous, with no breaks at corners or landings.
• At the right height, about 85 to 100 cm above the front edge of the steps, roughly waist height.
• A good grip: a round or oval rail of about 3.5 to 5 cm diameter that the hand can wrap around, not a flat or wide bar, with a clear space of at least 5 cm between the rail and the wall.
• Strong and firmly fixed into solid structure, with fixings into studs or masonry, tested to carry full body weight.
• Smooth, non-slip surface, warm to touch (wood or coated metal).
• Contrast with the wall so it is easy to see.
• No loose fittings or wobble. Check regularly.

On outdoor steps, add rails too, particularly where steps are exposed to rain; see garden, balcony and terrace safety.

Lighting

• Bright, even light over the whole staircase, with no dark patches or glare. Avoid single bulbs that cast shadows.
• Switches at the top and the bottom, so that you never climb or descend in the dark.
• Motion-sensor or night lights on stairs and landings; see motion-sensor night lights.
• Light-coloured walls to reflect light.
• Avoid glare from shiny floors and bare bulbs.
• Light at the foot of outdoor steps and at the door; see lighting and colour contrast at home.

Visible edges

Older eyes struggle to see where one step ends and the next begins, particularly on plain, uniform stairs.

• Contrasting strips on the front edge of every step (a bright colour or a light stripe against a dark tread, or the reverse).
• Different colour for the treads and risers.
• Non-slip strips with a contrasting colour; see anti-slip tape and coatings.
• Avoid patterned carpets that hide the edges.
• Paint or mark the first and last steps, which are the most often missed.

Surfaces

• Non-slip treads: rubber or textured strips, tight carpet or grippy paint. Avoid polished marble and smooth tiles without non-slip treatment, which are very slippery when wet or when worn in socks.
• Secure carpets. Loose or worn carpet is a major hazard; fix or replace it.
• No loose rugs at the top or bottom.
• Clean and dry. Wipe spills and keep outdoor steps free from algae, leaves and water.
• Repair damaged steps and uneven treads; see a builder for cracked or sloping steps.

Step dimensions

You cannot always change the structure, but know the problem. Steps with a riser (height) of about 15 to 18 cm and a tread (depth) of at least 25 to 28 cm are easier. Steep steps with narrow treads are hard. If steps are very steep, a builder can advise on modifying them, or you might consider a ramp, a stair lift or relocating living space.

Entrance steps and thresholds

A single step at the front door, a raised door sill or a bathroom threshold can trip a shuffling walker.

• Handrail on the entrance steps.
• A small ramp over a low threshold or step; see portable ramps for thresholds. Check the gradient (about 1 in 12 or gentler), width, edges and a non-slip surface.
• A strip or contrasting colour on the threshold.
• Remove unnecessary thresholds, or ask a builder to bevel them.
• A bench or stool at the entrance for sitting to put on shoes.
• Good lighting and a clear approach.
• Keep mats flat or remove them.
• Consider a wider, level path and a ramp for wheelchair users.

Habits for safer stair use

• Use the handrail every time, even for a few steps.
• Go slowly, one step at a time if needed.
• Never rush, or use stairs while distracted.
• Do not carry items that block the view or the hand; use a bag across the body or a basket at the top and bottom.
• Wear proper shoes with grips; not socks, loose slippers or sandals; see walking aids and footwear.
• Use "up with the good, down with the bad" if you use a stick or have a weak leg; see using a walking stick on stairs and slopes.
• Stop and rest if breathless or tired.
• Keep stairs clear of objects.
• Turn on lights before using.
• Get help if dizzy or unwell.
• Avoid stairs at night if drowsy or if your medicines make you dizzy; use a downstairs bedroom or commode.

Reducing the need for stairs

Think about how often your parent really needs to use stairs, and whether life can be rearranged.

• Move the bedroom, toilet and living area to one floor, ideally the ground floor; see ground-floor or upper-floor living.
• Keep daily needs on one level, including a toilet.
• Use a bedside commode at night.
• Install a stair lift or a platform lift if stairs must be used; see handrails and stair lifts.
• Duplicate equipment on each floor, such as a second stick, glasses and reading light.
• Plan trips: collect everything before climbing.
• Use a lift in apartment buildings; see lifts and apartment living for seniors.

Special situations

Dementia. Stairs can be confusing, and people may forget to use the rail or miss steps. Use contrast and gates, and consider supervision.

Poor vision. Strong contrast, good lighting and consistent rails; see low vision home safety.

Walkers and wheelchairs. Stairs are not safe with a walker or wheelchair; use a ramp, a lift or a second device on each level.

After surgery or stroke. Follow therapist's advice; see walking frame after hip or knee surgery.

Breathlessness or heart conditions. Rest on landings; consider limiting use.

Children and visitors. A gate at the top of stairs may protect a confused parent.

When to ask a professional

An occupational therapist or physiotherapist can assess stair safety, teach technique and recommend rails, lifts or changes. A builder or carpenter should fit rails and repair steps. A doctor should check dizziness or falls. Our care advisors can arrange a home safety visit and source fittings; see occupational therapy home assessment.