Risk Factors for Falls

Risk Factors for Falls Courtney Hall, PT, PhD Atlanta VAMC Emory University

Risk Factors for Falls • Intrinsic vs. Extrinsic • Interaction/Combination of the two

“Young-Old” 60-75 yrs. Community- dwelling Extrinsic factors “Old-Old” >75 yrs. Homebound or institutional dwelling Intrinsic factors Populations Differ:

Intrinsic Risk Factors • Medical • Number of diagnosis • Medications & their interactions • Substance abuse

Intrinsic Risk Factors • Cognitive • Allocation of attention • Awareness of abilities & limitations • Judgment

Intrinsic Risk Factors • Emotional • Depression

Intrinsic Risk Factors • Sensory loss • Somatosensory • Vision • Vestibular

Intrinsic Risk Factors • Central Processing • Perception of position in space • Anticipatory postural adjustments • Reaction time

Intrinsic Risk Factors • Central Processing • Responses • Selection of strategies • Sequencing • Scaling

Intrinsic Risk Factors • Musculo-Skeletal • Strength • Range of motion • Endurance • Posture (alignment)

Intrinsic Risk Factors • Condition of the feet • Corns, calluses, etc. • Hallux valgus • Bunions • Toenail problems

Intrinsic Risk Factors • Gait • Slow velocity • (.45 m/sec fallers vs. .55 m/sec non-fallers) • Increased double support time • Weaving, wobbling, etc • Difficulty with starts, stops, turns

Extrinsic Risk Factors • Environmental • Surface • Visual • Timing demands

Extrinsic Risk Factors • Social • Living alone • Socially isolated

Extrinsic Risk Factors • Activity Level • Active vs. sedentary • Prior experience

Extrinsic Risk Factors • Recent history of falls • Two or more falls within the last six months • “Unintentionally coming to rest on the floor” • Caution - need to know activity level, too!

Home Safety Evaluations

STEPS: In good repair Nonslip surfaces Edges marked Handrails on both sides Handrails securely fastened EXTERIOR

WALKWAYS: Level Non-slip surfaces Free of objects to be tripped over Sufficient lighting EXTERIOR

LIGHTING: Bright enough Glare-free Light switches available before entering room RUGS/CARPETS: Non-slip backing Edges taped or tacked down Minimal padding INTERIOR

SEATING: Chair heights Chairs strong enough Armrests No wheels TRIP HAZARDS: Clutter Low-lying objects Cords INTERIOR

KITCHEN • Store commonly used items within reach • Step stool-not chair • Non-slip floors • Non-slip mat near sink area to absorb spilled water

BATHROOM • Doors wide enough • Thresholds • Floors slippery when wet? • Skid-proof strips/mats in tub • Grab bars available/securely fastened • Appropriate toilet height

BEDROOM • Night lights/bedside lamps • Clear pathway to bathroom • Bed height • Closet storage easily reached without standing on tiptoe or chair? • Telephone accessible

CONSIDERATIONS • Be cautious when making home modifications • If a hazardous situation is rarely/never encountered, is change necessary? • Predictability lowers risk; unfamiliar surroundings heighten it

Remember: Most falls result from an interaction of intrinsic & extrinsic risk factors

The greater the number of risk factors present, the greater the likelihood of falls.

Risk Factors for Falls