poorer physical fitness, and less socialization. This can lead to a cycle of falling, fear of falling, limited activity, and thus an increased risk for falling (Hornyak et al., 2013; Mane et al., 2014; Young & Williams, 2015). Finally, this sobering statistic should
draw attention to this health emergency: “Every 13 seconds an older adult is seen in an emergency department for a fall” (Cameron et al., 2015).
RISK FACTORS FOR FALLING
This section will describe the myriad of influences on fall risk in older adults. Some influences are a result of typical aging, some are due to pathologic changes that occur with aging, and Population subsets at risk for falls Falls in older adults are the negative result of multiple risk factors; the greater the number of risk factors, the higher the chances of falling. Although many of the average community- dwelling older adults are at risk for falls, there are subsets of older adults who have higher than average risk. Research shows that a history of an injurious fall in community-dwelling older adults older than 75 years of age can be one of the best predictors of future falls (Pohl, Nordin, Lundquist, Bergstrom, & Lundin-Olsson, 2014). The risk for falls increases if the older Intrinsic and extrinsic fall risk factors If therapists can identify the existing risk factors for falls then interventions can be designed to modify or eliminate those risk factors that are susceptible to change. However, some factors are not modifiable, like age. There are several ways in which to categorize risk factors for falls, including, but not limited to, ability to predict future falls, factors that are modifiable versus
some are environmental. Emphasis will be placed on factors that should be assessed in a fall risk evaluation.
adult lives with multiple chronic conditions and diseases (Renfro et al., 2016), such as Alzheimer’s disease and related dementias, intellectual or developmental disabilities, multiple sclerosis, or Parkinson’s disease. Additional conditions include arthritis, cancer, chronic obstructive pulmonary disease, diabetes, depression, heart disease, myocardial infarction, hypertension, and stroke (Sibley, Voth, Munce, Straus, & Jaglal, 2014). Women fall more frequently than men (Pohl et al., 2014).
unmodifiable, and factors that are intrinsic or inherent to the person versus extrinsic factors such as environmental hazards. The type and number of fall risk factors help to determine what components of a fall risk assessment require a more detailed evaluation (Table 1 lists intrinsic and extrinsic fall risk factors).
Table 1: Risk Factors for Falls Intrinsic
• Muscle weakness, especially in lower extremities. • Physical inactivity. • History of falls.
• Low vitamin D. • Orthostatic hypotension. • Dizziness. • Medication issues/errors. • Cognitive decline. • Ethnicity. • Impaired sensation in feet. • Gender/age. • Chronic disease.
• Gait abnormalities. • Improper AD use. • Poor balance. • Poor vision care. • Fear of falling. • Depression. • Poor self-efficacy.
Extrinsic
• Improper footwear. • Poor lighting. • Low chairs/toilets/sofas. • Trip hazards. • Stairs. • Uneven surfaces. • Wet surfaces.
• Loose carpet/rugs. • Lack of bathroom safety equipment. • Improper handholds. • Furniture/clutter. • Cabinets or storage inaccessible to user. • Narrow doorways/paths limited AD. • Polypharmacy.
AD = Assistive device. Note . From Western Schools, 2019.
Modifiable and unmodifiable fall risk factors Modifiable risk factors can be altered through changes in lifestyle, improved health, or therapeutic interventions. First, addressing modifiable risk factors can have a more immediate effect on the overall chance of future falls. Environmental risk factors for falls are extrinsic factors that are typically modifiable and should be among the first areas addressed in fall prevention. Environmental fall risk factors can be categorized as hazards inside the home or outside of the home in the community. Although frailer, less active older adults are more likely to fall inside their home where they spend the majority of their time, more active older adults tend to fall outside the home where fall hazards are less predictable and many times outside of the control of the older adult. Therefore, examples of community fall risk hazards, such as uneven flooring or steps, slippery sidewalks or faulty handrails, as well as fall risk factors in the home environment, should be assessed, modified, and eliminated if possible as part of a multifactorial fall prevention program. Unmodifiable or irreversible fall risk factors are characteristics of an older adult that cannot be changed or influenced.
These can include factors such as the following: ● Age : Especially over 80; one in three adults over 65 years of age fall once per year, whereas adults over 85 years of age fall four to five times more often than their peers 65 to 69 years of age (Bird et al., 2013). ● Sex : Women fall more than men in every age category; they sustain more injuries, especially fractures, seek more medical attention, and stay in the hospital longer than men (Stevens & Sogolow, 2005). ● Illness : Some chronic illnesses are irreversible, such as diabetes mellitus, Parkinson’s disease, alcoholism (Renfro et al., 2016). ● Ethnicity : African Americans are 24% less likely to have initial or recurrent falls than non-Hispanic whites, but when they do fall they are more likely to fall indoors (Nicklett & Taylor, 2014). ● History of falls : The best predictor of future falls is if a fall resulted in an injury or if the older adult has sustained two or more falls (Carpenter et al., 2014).
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