Stairs are an overlooked national problem, writes Dr Philip Hodgson. Adapted housing should be key to health planning
Every year, thousands of older people have falls in their homes with devastating effects.
Falls are the leading cause of death by injury for older people, rising 11% in a year for the over-75s, according to the Royal Society for the Prevention of Accidents (RoSPA). They add to overstretched hospitals’ workloads, and are the most common reason for fragility fractures, which cost the UK £4.4bn annually.
They take away confidence and independence, often leaving people reliant on relatives for help or having to move into residential homes. So why, as a society, aren’t we doing much more to prevent them?
Frailty and with it, a loss of balance, strength and vision decline does not arrive suddenly or unexpectedly. It will happen to almost all of us, as we reach old age. Those who are not yet experiencing this period of life will probably know a family member or friend who is.
It’s a universal problem and the government, house builders, the NHS and family units must take it seriously and address it, as a matter of urgency.
Changing the housing stock to reduce falls
The design and construction of the majority of UK homes, including new builds, seems to wish away the inevitability of mobility decline.
Only around a tenth of properties occupied by over 75s meet basic accessibility criteria, such as a downstairs toilet and level access to the front door. For millions of older people living in properties with two or more floors, stairs can be an accident waiting to happen, every single day.
Going upstairs to bed or downstairs to make a cup of tea can become a risky endeavour. We can’t expect older people to just be cautious, if they don’t have the strength or flexibility to support themselves if they stumble.
In many cases, their only option is to spend most of their time in one room or live, sleep, wash, eat and use the toilet on a single floor. They can struggle to maintain or clean their properties or themselves. In my work, I’ve come across people who no longer feel clean enough to go out and socialise.
Being wary on the stairs may avoid a broken hip, but inactivity can accelerate mobility decline, damage heart health, mental health, and increase problems around obesity and diabetes.
The over-65 population will rise from 12.7m in 2022 to 22m in 2072.
The increase in fragility and long-term conditions means accessible homes will become increasingly essential assets for reducing hospital admissions and NHS costs.
Studies have shown that appropriate home adaptations, such as homelifts, can reduce falls requiring medical treatment by around 26%. The right adaptations can delay a move into residential care by up to four years, delivering substantial costs and preserving quality of life.
The government’s plan to build 1.5m homes by the next election, may or may not succeed. At present, according to housing secretary Angela Rayner, it’s looking unlikely. But however many properties eventually arrive, if they are not legally required to have facilities to allow aging in place and reduce falls, they may not be fit for purpose.
Planning rules need to change so that stairs are formally recognised as a health risk. Some homes can be one storey – though they tend to take up more space, relative to the amount of people living in them. But others should at least have downstairs bathrooms, wide hallways that allow rollators and people using other walking aids through easily, level doorways and low-level kitchen cupboards. Most importantly, they should have room to install equipment, such as a homelift, which enables safe movement between floors.
Embed early home adaptation into discharge planning
A big move forward in taking falls more seriously would be for central government, the NHS and local authorities to collaborate more closely on making home adaptations key to follow-up care.
Older patients are frequently medically fit to leave hospital, whether they’ve had an accident or operation, but cannot do so safely because their homes are unsuitable for recovery.
The Department of Health should encourage early referral for home adaptations to be a standard part of discharge planning. Proactive housing interventions could be carried out through new, carefully structured referral partnerships between the authorities and home-improvement and accredited home-adaptation providers. This would allow timely assessment and installation where stairs, multi-level access or other accessibility problems present a clear risk.
This could free hospital beds sooner, prevent re-admissions and reduce the need for expensive home care. The current system is heavily weighted towards reactive spend, where NHS and social care budgets are focused on emergency admissions, care packages and residential placements.
Adopting a more proactive strategy will reduce spend in the long term and recurring dependence on health and social care services.
More support for primary care would be a massive positive step, too. GPs are supposed to identify, assess and support people over 65 with moderate or severe frailty. However, according to a recent House of Commons’ Public Accounts Committee report, they are too overworked to do so. In 2024/25 just 17% of such patients were assessed.
Overcoming the problem stairs pose might seem like a nice-to-have idea. Something we can look at if there’s ever more money floating around local authorities or the NHS. But it’s not – we are at a critical stage right now.
With a quarter of Britons expected to be over the age of 65 in less than 50 years, it’s a national emergency that should be front of mind for planners, developers, ministers and medical professionals.
Main image: Dr Philip Hodgson is a lecturer in health research at Northumbria University and an expert in home and health, and older people wellbeing He is a spokesperson for Stiltz Homelifts
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