Falls in Older Persons: Risk Factors and Prevention

Falls are a marker of frailty, immobility, and acute and chronic health impairment in older persons. Falls in turn diminish function by causing injury, activity limitations, fear of falling, and loss of mobility. Most injuries in the elderly are the result of falls; fractures of the hip, forearm, humerus, and pelvis usually result from the combined effect of falls and osteoporosis.^1,2

Prevention of falls must span the spectrum of ages and health states within the older population and address the diversity of causes of falls without unnecessarily compromising quality of life and independence. Most falls, however, do not cause sufficient injury to receive medical attention.

Between 30 and 50 percent of falls result in a variety of minor soft tissue injuries that do not receive medical attention; the remainder cause no injury or only trivial damage. ³ Age-related disturbances in the organization and central neurological integration of sensory and motor functions may impair the speed, effectiveness, and reliability of postural reflexes, leading to falls.⁴

There are a number of ways to help prevent falls in and around the home:

• Repair sidewalks and stairways.
• Make sure there is adequate lighting.
• Check footwear to make sure it is safe.
• Install grab bars or handrails where needed.
• Have nonskid surfaces in the bathroom.

Because falls tend to occur where people spend the most time, a home-oriented prevention strategy is important. An approach that combines medical and physical therapy evaluation with a home environment assessment may be particularly effective owing to the fact that physical disabilities and environmental factors interact to cause many falls.^5,6

References:

1. Alexander BH, Rivara FP, Wolf ME. The cost and frequency of hospitalization for fall–related injuries in older adults. American Journal of Public Health 1992;82(7):1020–3.
2. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query and Reporting System (WISQARS) [online]. Accessed August 5, 2016.
3. Gryfe, C., Amies, A., and Ashley, M. A longitudinal study of falls in an elderly population. I. Incidence and morbidity. Age and Ageing 1977; 6:201-210. 
4. Stelmach, C. E., and Worringham, C. J. Sensorimotor deficits related to postural stability: Implications for falling in the elderly. Clinics in Geriatric Medicine 1985; 1(3):679-694. 
5. Rubenstein, L. Z., Robbins, A. S., Schulman, B. L., Rosado, J., Osterweil, D., and Josephson, K. R. Falls and instability in the elderly. Journal of the American Geriatric Society 1988; 36(3):266-278.
6. Tinetti, M. E., and M. Speechley. Prevention of falls among the elderly. New England Journal of Medicine 1989; 320(16):1055-1059.