Every company that sells bathroom work says the work prevents falls. The best available evidence says that is true for some households and not true for others, and the gap between the two is wide enough that you should know which household you are before you spend anything.
This page reports both halves of that finding. Half of it argues for the work. Half of it argues against selling the work to people who do not need it. We publish both because you can go and check them, and because a contractor who only tells you the useful half has told you something about himself.
What the review found
The reference is the 2023 Cochrane review of environmental interventions for preventing falls in older people living at home. A Cochrane review pools the trials on a question, weighs them by quality, and then grades how much confidence the pooled answer deserves. Low certainty means the number could move a lot with better trials. High certainty means it probably will not.
This review produced two results at once. In adults selected for higher risk, meaning people who had already fallen or who had a mobility limitation, changing the home environment reduced the rate of falls by 38 percent. Cochrane graded that high certainty.
In the general older population, not selected for risk, the same kind of work showed no effect. The rate ratio was 1.05, which is a wash. Cochrane graded that high certainty as well.
Why the second half is not a technicality
A high-certainty null is not the absence of evidence. It is evidence, and it is strong. It says that if you take a broad group of older adults who have not had a problem and modify their homes, you should not expect the falls to go anywhere. Further trials are unlikely to overturn it.
Compressing the two findings into the single sentence "home modification prevents falls" throws away the more certain of the two. It is the sentence the whole industry uses. We do not use it, because it is not what the review says, and because a claim you can check is worth more than a claim you cannot.
What the split does give you is a clean way to sort yourself. There are two honest reasons to change a bathroom here, and they are different reasons for different people.
Track one: something has already happened
If someone in the house has fallen, or uses a cane or a walker, or has a limitation that makes the bathroom the hardest room in the house, the 38 percent result is the one that applies to you. That is the strongest evidence available for anything in this trade, and it is worth acting on.
The fixture at the centre of it is usually the tub. A standard 60 inch alcove tub has exactly the footprint of a 60 by 30 inch roll-in shower, so in most houses here the room already has space for a no-step shower without moving a wall.
What goes in it is not decoration. Floor tile specified to a wet dynamic coefficient of friction of 0.50 or higher, which is the barefoot wet category the 2022 revision of ANSI A326.3 created; the 0.42 printed on some tile boxes is a different category. Grab bars rated to 250 pounds of force, anchored into solid blocking or into rated retrofit anchors. A hand-held shower on a slide bar so the water comes to the person. A seat, with a bar within reach of it. Lever handles, rocker switches, a comfort-height toilet.
If an occupational therapist has written recommendations, send them to us and we build to them. She has seen the person move. We have not.
Track two: nothing has happened, and you would like to keep it that way
The Huntsman World Senior Games brought 12,034 registered athletes aged 50 and over to this county in 2024. Nobody in that group needs a safety pitch, and most of them would be insulted by one. The same is true of a large share of the people who call us.
The honest case for that household is not medical. It is that a curbless shower is a better room. It is easier to clean, which matters more every year. It is easier to use with a hose and a seat. It does not have a tub wall to swing a leg over when you are carrying a towel. And it is already right if the situation changes, which means the work happens on your schedule instead of during a bad month.
That is a design argument and an independence argument, and we will make it plainly. We will not dress it up as a medical device.
How to tell which track you are in
The trials sorted people by history and by measured limitation, not by age or by how anyone felt about the stairs. You can do a rough version of the same sort at your kitchen table, and it takes about a minute.
A yes to any of the following puts you in the first track, where the evidence is strong. All no puts you in the second, where the case for the work is a design case and we will make it as one.
- Has anyone in the house fallen in the last year, including a fall that did not cause an injury and that nobody mentioned to a doctor?
- Does anyone use a cane, a walker, a wheelchair or a shower chair, even occasionally?
- Has a doctor, a physical therapist or an occupational therapist raised the subject of the house?
- Is anyone avoiding the tub, washing at the sink, or waiting for someone else to be home before bathing?
- Is anyone holding the towel bar, the sink, the toilet or the shower valve to steady themselves? A towel bar is not rated for that and it is a common way people find out.
Age is the variable that actually moves
Fall death rates do not rise gently across later life. The National Center for Health Statistics put the 2020 rate per 100,000 at roughly 24 for men and 13 for women aged 65 to 74, 82 and 57 at 75 to 84, and 330 and 270 at 85 and over. Those are deaths from falls rather than injuries, and the shape is the point. The rate more than triples at each step.
That curve is why the headline number for everyone over 65 is too coarse to plan from. A 67 year old and an 87 year old are not in the same conversation, and treating them as one group is how the industry ends up selling grab bars to people who do not need them and missing the houses where they matter most.
What the numbers say about this county
The Census Bureau's July 1, 2025 estimate puts St. George city at 108,713 people with 21.8 percent aged 65 or over. Washington County runs 22.4 percent. Those are the figures to use; other numbers circulate locally and do not match the Census file.
The CDC's analysis of Behavioral Risk Factor Surveillance System data reports that 41.7 percent of US adults 65 and over have a disability. Mobility is the most common at 26.9 percent, then hearing at 14.9 percent, independent living at 9.8 percent, cognition at 9.5 percent, vision at 6.6 percent and self-care at 5.5 percent. Across all adults the figure is 25.7 percent.
Multiply the two local numbers and roughly nine percent of the adult population here is an older adult with a disability. That is not an edge case being accommodated. In a bathroom conversion business it is most of the phone calls.
What we are not claiming
The Cochrane review measured falls in the home. It did not measure independence, hospital admissions, how long anyone stayed in the house, or whether the bathroom was pleasant to use. None of those were the outcome, so none of them are ours to claim on the strength of it.
We are also not offering medical advice, and we do not assess anyone. We build rooms. The people qualified to say what a particular person needs are that person's doctor and occupational therapist, and their recommendations outrank our opinion every time.
Everything cited on this page is public. The Cochrane review is indexed and free to read the abstract of, the CDC tables are published, and the Census figures are three clicks from the QuickFacts page. You should not have to take our word for any of it.
What we’d do at your house
We ask first whether anyone in the house has fallen or uses a cane or a walker, because the honest answer changes what we recommend and what we say about it.
If the answer is yes, we walk the whole route, bed to bathroom, in the dark, not just the bathroom in daylight.
If the answer is no, we design for how you want the room to work now and build it so it is already right if that changes.
We measure the tub alcove early, because in most houses here a 60 by 30 shower fits where the tub is without moving a wall.
If you have an occupational therapist, send us her recommendations and we build to them.
We will tell you which lines on a quote are doing real work and which ones are decoration, including ours.
Sources
What this page says comes from the documents below, read in full. It describes them. It is not legal advice. Confirm with your association, your city, or an attorney before you act.
- Cochrane 2023, environmental interventions for preventing falls in older people at home: 38% reduction in higher-risk adults (high certainty); RR 1.05, no effect, unselected population (high certainty) briefs.txt brief 10
- CDC fall-injury rate curve across 65-74, 75-84 and 85+ (roughly 112 / 241 / 515 per 100,000) briefs.txt brief 10
- Huntsman World Senior Games, roughly 11,000 athletes over 50; the design pitch rather than the safety pitch for that audience briefs.txt brief 10
- US Census QuickFacts: St. George city 108,713, 21.8% aged 65+, July 1 2025 estimate; Washington County 22.4% 06-accessibility-older-user-corpus.md §0; briefs.txt §5 'check first' item
- CDC MMWR (2016 BRFSS data): 41.7% of adults 65+ report a disability; mobility 26.9%, hearing 14.9%, independent living 9.8%, cognition 9.5%, vision 6.6%, self-care 5.5%; all adults 25.7% 06-accessibility-older-user-corpus.md §0
- 60 inch alcove tub equals the 60 by 30 roll-in shower footprint briefs.txt §3 finding 2
- ANSI A326.3, 2022 revision: DCOF 0.50 or higher for barefoot wet areas, not 0.42 briefs.txt brief 09
- Grab bars rated at 250 pounds-force; blocking versus rated retrofit anchors briefs.txt brief 09 and brief 13; §5 do-not-publish list
- Hand-held shower on a slide bar, seat, lever handles, rocker switches, comfort-height toilet briefs.txt brief 13
- Voice: staying in the house rather than decline; build to the occupational therapist's recommendations; volunteering the unhelpful fact as the credibility move 02-research/08-trust-language-bank.md §7 accessible living, §5, §12