Risk Factors for Falls

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

• Intrinsic vs. Extrinsic
• Interaction/Combination
• of the two

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Populations Differ

• Young-Old
• 60-75 yrs.
• Community- dwelling
• Extrinsic factors

• Old-Old
• gt75 yrs.
• Homebound or institutional dwelling
• Intrinsic factors

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Intrinsic Risk Factors

• Medical
• Number of diagnosis
• Medications their interactions
• Substance abuse

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Intrinsic Risk Factors

• Cognitive
• Allocation of attention
• Awareness of abilities limitations
• Judgment

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Intrinsic Risk Factors

• Emotional
• Depression

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Intrinsic Risk Factors

• Sensory loss
• Somatosensory
• Vision
• Vestibular

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Intrinsic Risk Factors

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

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Intrinsic Risk Factors

• Central Processing
• Responses
• Selection of strategies
• Sequencing
• Scaling

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Intrinsic Risk Factors

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

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Intrinsic Risk Factors

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

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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

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Extrinsic Risk Factors

• Environmental
• Surface
• Visual
• Timing demands

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Extrinsic Risk Factors

• Social
• Living alone
• Socially isolated

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Extrinsic Risk Factors

• Activity Level
• Active vs. sedentary
• Prior experience

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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!

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Home Safety Evaluations
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EXTERIOR

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

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EXTERIOR

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

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INTERIOR

• LIGHTING
• Bright enough
• Glare-free
• Light switches available before entering room

• RUGS/CARPETS
• Non-slip backing
• Edges taped or tacked down
• Minimal padding

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INTERIOR

• TRIP HAZARDS
• Clutter
• Low-lying objects
• Cords

• SEATING
• Chair heights
• Chairs strong enough
• Armrests
• No wheels

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KITCHEN

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

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BATHROOM

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

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BEDROOM

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

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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

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Remember

• Most falls result from an interaction
• of intrinsic extrinsic risk factors

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