ELDERLY FALL PREVENTION
Epidemiology of Elderly Falls (continued)
Falls and the physical environment: a review and a new multifactorial falls-risk conceptual framework.
This paper reviews the literature evaluating linkages between environmental hazards and falls and the efficacy of home-modification interventions. Fifty to seventy percent of falls occur in the home and 40-60% of these are attributed to home environmental hazards. In a study of homes of people over 70, 80% had at least one hazard and 39% had at least five. The bathroom was identified as most commonly containing a hazard, particularly the bath rug. “Major potential home environmental hazards were dim lighting (31.8%), floors that were slippery or had obstacles (18.2%), storage areas out of reach (14.6%), carpeting or rugs that weren't anchored or did not have nonskid backing (14.6%), and loose or non-existent grab bars or handrails (13.0%)” The studies that focused on reducing environmental hazards did not show a strong reduction in the number of falls, however a couple of studies noted reductions when occupational therapists assisted with the reductions. This may have been a reflection of changes in behavior on the part of the clients. There was also an improvement when associated with an exercise program.
Environmental hazard studies have been inconsistent in terms of how significant a role they play in causing falls. For the “vigorous elderly” environmental hazards associated with falls were more likely away from home, on stairs, while walking or climbing. Frail elderly tend to fall at home and often with just standing or turning rather than tripping or slipping on objects. People with limited mobility fall more frequently than very mobile or very immobile people and for these people increased hazards led to an increased the number of falls. One study found an increase in risk taking activities and concluded that many falls had more to do with poor judgment than environmental hazards. Another study in which people without prior history of a fall had a 4-fold increased risk due to increased environmental hazards but prior fallers had no increased risk related to environmental hazards though they have an overall increased risk of another fall. This was attributed to more cautious behavior.