During one of her first visits to a client’s home, Mana Manoukian, RN, noticed a bit of decor that was a little too close to a fire sprinkler and suggested moving it.

“How did you even see that?” asked the client. 

“That’s what we’re trained to do,” replied Manoukian, MS, RN, CNS, AGCNS-BC, a clinical nurse specialist with Cedars-Sinai Nursing. “We walk in, and we notice the hidden hazards.”

That visit was part of an 18-month pilot study that sent advanced practice nurses like Manoukian into the homes of older adults living in low-income housing. The aim was simple and powerful: By seeing people in their own environments, these highly trained nurses could help patients stay healthier longer by spotting risks that don’t show up in a doctor’s appointment.  

The nurses uncovered common but overlooked issues at home—such as fall hazards and medication mix-ups—and tailored solutions to each person’s needs. The team recently shared what was learned from 122 in-home visits with 26 older adults in Nurse Leader, a peer-reviewed journal.

Manoukian, who is a board-certified adult aging clinical nurse specialist, highlighted some of the advice on how to make our homes and health habits, and those of older loved ones, safer.

Read: Care Coordination for the Sandwich Generation

Checking bedrooms, kitchens, living rooms and hallways is only the beginning. Once throw rugs have been removed and cords tucked away, consider the sidewalks, stairwells and neighborhood you and your loved ones navigate every day. Take a walk around the house or apartment building. Keep an eye out for broken sidewalks, poor lighting or uneven steps. Report needed repairs to building management or the city. 

At the same time, keep in mind fall precautions taken at home must be applied when you go elsewhere, too.

If you rely on a mobility aid, such as a cane or a walker, that’s a must-have, even for “quick trips” to the store or bus stop.

Read: Meeting Older Adults Where They Are

Manoukian said they saw a lot of people who were dehydrated, but pushing the old conventional wisdom to guzzle eight glasses a day doesn’t always work.

Instead, start with small goals. If someone drinks two cups a day, aim to increase intake by half a cup. Remember herbal teas and soups count toward hydration, too.

Also, be practical. For example, someone who is concerned about falls might be wise to cut down on liquids before bedtime to minimize the need for a bleary-eyed and perilous middle-of-the-night walk to the bathroom.

“We’re looking for steady progress while always keeping the whole picture of a person’s health in mind,” Manoukian said. “When changing a habit, you have to consider everything—every goal, every risk, all at once.”

Many older adults juggle more than a dozen medications. That doesn’t always even include vitamins, herbal supplements or over-the-counter medicines. Any of these products, even those billed as “natural,” can interact with prescription medications in ways that can increase dizziness, drowsiness and side effects.

“Always bring everything you take—the prescriptions and the supplements, teas and vitamins, too—when you see your doctor,” Manoukian said. 

Ask if all these remedies are needed, and if they could be causing issues such as fatigue or balance problems. 

“Check if anything can be safely eliminated or reduced, if necessary,” she said.

Read: How to Manage Multiple Prescriptions

Medical appointments can feel overwhelming and can end before you know it. A little preparation can help. Manoukian recommends coming into appointments with a plan and some issues to address. For example:

• Are there any new symptoms?
• Are any medications making you feel dizzy or tired?
• Are you sleeping well?
• Do you have any worries about falling?

Bring the top three concerns—and that complete list of medications and supplements—to the appointment.

“Every person is different,” Manoukian said. “How they grew up, how they live and what they need. We need to help them think about what matters most, so they can make the right health decisions, have more meaningful conversations with their care providers and loved ones, and live their best lives as long as possible.”