House Shoes for Seniors: The Fall Risk on Your Feet

The number on your feet

One in four adults 65 and older falls each year, and falls are the leading cause of injury and injury death in that age group.⁵ Most of the advice about falls is about the house: grab bars, lighting, rugs. The one thing that goes with you to every room gets a line at the bottom of the checklist, and it should be near the top.

Two studies make the case. A nested case-control study of 1,371 adults 65 and older in Washington state examined the footwear people had on when they fell. “Athletic and canvas shoes (sneakers) were the styles of footwear associated with lowest risk of a fall,” while “going barefoot or in stocking feet was associated with sharply increased risk, even after controlling for measures of health status (adjusted odds ratio=11.2).“¹ The conclusion: “Fall risk was markedly increased when participants were not wearing shoes.”¹

The MOBILIZE Boston study followed 765 people, mostly 70 and older, for more than two years and asked about footwear at each fall. “At the time of in-home falls, 51.9% of people were barefoot, wearing socks without shoes, or wearing slippers; 10.1% of people reported that their usual footwear was one of these types.”² Those shoeless or slippered fallers had an adjusted odds ratio of 2.27 for a serious injury compared with people in other shoes. The authors’ advice: “It may be advisable for older individuals to wear shoes in their home whenever possible to minimize the risk of falling.”²

Read that first sentence again. People who usually went shoeless were 10 percent of the group, but shoeless feet were under half the falls. The slippers you put on for a minute are the ones you fall in.

What to wear indoors

The National Institute on Aging’s rule fits on a card: “To fully support your feet, wear nonskid, rubber-soled, low-heeled shoes,” and “don’t walk on stairs or floors in socks or in shoes and slippers with smooth soles.”³ It also names the offenders: “unsafe footwear such as backless shoes or high heels” raises fall risk.³

Put together with the research, the indoor shoe looks like this:

• Closed back. A heel counter that holds your heel so the shoe cannot slide off on a stair and your toes do not have to grip to keep it on.
• Rubber, non-skid sole. Tread that grips wood, tile, and the kitchen floor, not fleece, leather, or worn-smooth rubber.
• Low heel, wide base. The flatter and wider the contact with the floor, the steadier you are.
• A closure that actually closes. Laces, elastic no-tie laces, or hook-and-loop straps, so the shoe fits the foot rather than flopping on it.

The style that did best in the research was the plain athletic shoe, and for a lot of people the answer is a lightweight walking sneaker kept for indoor use. For people who want warmth and the feel of a slipper, buy a lined house shoe built the same way: closed back, rubber sole, strap. The difference between that and a scuff slipper is the whole point of this article.

The slipper problem

Nobody buys a slipper to fall in. People buy them because feet get cold, because shoes pinch swollen feet, because laces are hard with arthritic hands, or because they have gone barefoot in their own house for 70 years. Each of those has a fix that is not a backless slipper.

Cold feet. A fleece-lined house shoe with a closed back and rubber sole is as warm as a slipper. Wool socks under a walking shoe are warmer.

Swollen or sensitive feet. A wide, extra-depth shoe with a hook-and-loop strap, sold as a diabetic shoe, opens flat, does not pinch, and adjusts through the day as swelling changes. It is the shoe that ends most “it hurts” refusals.

Hands that cannot tie. Elastic no-tie laces turn any sneaker into a slip-on with a heel that still holds. A long-handled shoehorn finishes the job without bending.

Habit. Keep the house shoes beside the bed and put them on before standing. Keep a second pair by the door. The barefoot trip from bed to bathroom at 2 a.m. is the one that matters most, which is why the bedroom setup and night lighting belong in the same plan.

When the person refuses

A caregiver on a forum described a mother with dementia who “continues to take off her shoes/slippers,” refused them indoors “and now even outside,” and in winter wore “a pair of socks.”⁶ Her workable compromise, after trying everything: Velcro diabetic slippers for outside and non-slip socks indoors.⁶

That compromise is the right order of fallbacks. First offer the lined closed-back house shoe that feels like a slipper. If the answer is still no, grip socks, the hospital-style socks with rubber tread on the sole, beat bare feet and plain socks, because they fix the slippery-sole half of the problem. They do not fix the other half: no heel support, nothing between the foot and whatever is on the floor, no help on a stair. So if grip socks are the floor, the rest of the house has to do more: a clear path from bed to bathroom, night lights that come on by themselves, nothing on the floor, and the dementia-proofing basics if memory loss is behind the refusal.

A refusal is also information. Feet that hurt in shoes may have a bunion, a nail problem, or neuropathy that a podiatrist can treat, and a person who cannot manage closures may need the same grip aids for the rest of the day. If the shoes are one of several things being refused, our guide to signs it is time for more help puts it in context.

Buying them

The APMA’s buying rules are simple and most people skip them: have your feet professionally measured every time you shop, because age and health change foot size; measure both feet late in the day and buy for the larger one; wear the socks you will wear with the shoes; and walk around the store before you pay.⁴ If you have a foot problem, bring your orthotics and ask a podiatrist what to look for, and check whether the shoe carries the APMA Seal of Acceptance, which the association “grants to products found to promote good foot health.”⁴

Two maintenance habits: replace house shoes when the tread is worn smooth or the heel counter has gone soft, because a worn sole is as slippery as a sock, and in wet weather keep outdoor shoes off hard floors or change at the door.

Where this fits

Shoes are the piece of fall prevention you carry to every room. They work alongside the house: a room-by-room safety check, flooring without throw rugs, and lighting on the night route. And if a fall does happen, in shoes or out, how to get up after a fall is worth reading before you need it.

Key takeaways

• Barefoot or in socks carried about 11 times the fall risk of athletic shoes in one study; half of at-home falls in another happened shoeless or in slippers.
• Indoors, wear a closed-back shoe with a rubber non-skid sole and a low heel, from the moment you get up. A walking sneaker is the proven style; a lined house shoe built the same way is the cozy one.
• Run the 1-2-3 test: stiff heel, flexible toe, no twist. Backless slippers fail it.
• Fix the reason for the slipper: lined for cold, extra-depth with straps for swelling, no-tie laces for hands, shoes by the bed for habit.
• If the person refuses, grip socks beat bare feet, and the house has to do more.

What’s next

• Make the 2 a.m. trip safe: bedroom safety for seniors and lighting for aging eyes.
• Walk the whole house: home safety assessment checklist.
• Floors that match the shoes: best flooring for aging in place.
• Know the technique: how to get up after a fall.

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Reviewed by John Smith, CAPS, Certified Aging-in-Place Specialist. This guide is general safety information, not medical advice. Foot pain, swelling, numbness, or a wound on the foot should be seen by a podiatrist, who can also fit shoes to a foot that has changed shape; an occupational therapist can match footwear to the person’s balance and the floors in the home.