Risk Factors for FallsRisk Factors for Falls

Courtney Hall, PT, PhDCourtney Hall, PT, PhD

Atlanta VAMCAtlanta VAMC

Emory UniversityEmory University

Risk Factors for FallsRisk Factors for Falls

Intrinsic vs. Extrinsic Interaction/Combination

of the two

Populations Differ:Populations Differ:

“Young-Old”• 60-75 yrs.• Community-

dwelling• Extrinsic

factors

“Old-Old”• >75 yrs.• Homebound or

institutional dwelling

• Intrinsic factors

Intrinsic Risk FactorsIntrinsic Risk Factors

MedicalMedical• Number of diagnosis• Medications & their interactions

• Substance abuse

Intrinsic Risk FactorsIntrinsic Risk Factors

Cognitive• Allocation of attention• Awareness of abilities &

limitations• Judgment

Intrinsic Risk Factors

EmotionalEmotional• Depression

Intrinsic Risk FactorsIntrinsic Risk Factors

Sensory loss• Somatosensory• Vision• Vestibular

Intrinsic Risk FactorsIntrinsic Risk Factors

Central Processing• Perception of position in space• Anticipatory postural

adjustments• Reaction time

Intrinsic Risk FactorsIntrinsic Risk Factors

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

Intrinsic Risk FactorsIntrinsic Risk Factors

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

Intrinsic Risk FactorsIntrinsic Risk Factors

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

Intrinsic Risk FactorsIntrinsic 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 FactorsExtrinsic Risk Factors

Environmental• Surface• Visual• Timing demands

Extrinsic Risk FactorsExtrinsic Risk Factors

Social• Living alone• Socially isolated

Extrinsic Risk FactorsActivity Level

• Active vs. sedentary• Prior experience

Extrinsic Risk FactorsExtrinsic 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 EvaluationsHome Safety Evaluations

EXTERIOR

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

INTERIORLIGHTING:

• 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

KITCHENKITCHEN

Store commonly used items within reach

Step stool-not chair Non-slip floors Non-slip mat near sink

area to absorb spilled water

BATHROOMBATHROOM

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

fastened Appropriate toilet height

BEDROOMBEDROOM Night lights/bedside lamps Clear pathway to bathroom Bed height Closet storage easily reached without standing on

tiptoe or chair? Telephone accessible

CONSIDERATIONSCONSIDERATIONS

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.