When I worked as an occupational therapist in home care, I routinely received referrals to provide home safety assessments for individuals for fall prevention. Often, the referral was made after an individual had experienced a fall and the goal was to prevent further falls from occurring. The importance of fall prevention cannot be stressed enough.
“Falls are the leading cause of injury among older Canadians with 20-30% seniors experiencing one or more falls each year. Falls cause 85% of seniors' injury-related hospitalizations, 95% of all hip fractures, ...and over one third of seniors are admitted to long-term care following hospitalization for a fall.” (Government of Canada, 2015).
This month, Clinical Corner will address some of the risk factors associated with falls at home or in the community. Next month, Clinical Corner will review some strategies to reduce the risk of client falls. (November was Falls Prevention month in Canada, which provided the inspiration for this topic!)
Risk Factors for Falls
There can be numerous risk factors that contribute to the potential for an individual to fall. The risk factors may be categorized as biological, behavioural, social/economic and environmental (Province of British Columbia, 2018). Let’s look at each of these categories to see how they contribute to the risk of falls.
Biological Risk Factors
Biological risk factors are those that relate to the human body, the natural aging process and the effects of acute or chronic health conditions. The following factors are associated with an increased risk of falling:
- Being over 80 years of age. Those who are older have an increased risk of falls. This may be due to musculoskeletal and sensory changes associated with aging.
- Balance and gait deficits. Changes in vision, cognition and postural control may lead to impairments in balance, contributing to the risk for falling for older adults. Variability in stride timing or foot placement has also been shown to contribute to the risk of falls.
- Chronic conditions. Individuals with chronic conditions that impair mobility, gait and/or balance have a higher risk of falls. Examples of such conditions are Parkinson’s disease, diabetes and arthritis. Urinary or bladder incontinence or urgency is also associated with increased risk of falls as individuals may rush to the bathroom.
- Cognitive impairment. Individuals with cognitive impairment are two to three times more likely to have an injury-sustaining fall than individuals without cognitive impairment.
- Low vision. Changes in vision and visual attention can contribute to the risk of falling as older individuals may be unable to see potential tripping hazards in the environment.
- Muscle weakness. Decreased endurance and muscle weakness can lead to falls as individuals are unable to prevent a trip or stumble from turning into a fall.
(Public Health Agency of Canada, 2014).
Behavioural Risk Factors
Risk factors that are behavioural relate to the emotions, choices or actions of an individual. It may come as no surprise, for example, that the consumption of excessive alcohol has been associated with increased risk of falls. Some clothing and footwear may also pose an increased risk of falls. For example, long, loose clothing may form a tripping hazard. Shoes with smooth tread, thick soles, or high/narrow heels are associated with increased risk of falls. A fear of falling or a history of previous falls are other risk factors. In fact, “The most powerful predictor of a fall is a history of falling. … Individuals with a history of multiple falls are considered at high risk, while those with a single previous fall are considered at medium risk.” (Accreditation Canada, Canadian Institute for Health Information & Canadian Patient Safety Institute, 2014, p. 10).
A fear of falling may limit an older adult from participating in physical activities, leading to deconditioning, muscle weakness and poor balance, which were cited above as biological risk factors. Improperly maintained or incorrectly fitted mobility aids can also lead to increased risk of falls. For example, walker handles being at the incorrect height for an individual or loose wheel locks on a walker or wheelchair may lead to increased risk for falls (Public Health Agency of Canada, 2014).
Socio-economic Risk Factors
One’s social and economic environment is considered a determinant of one’s health (World Health Organization, 2018). With respect to falls, social isolation and low socio-economic status are associated with increased risk of falls. Potential explanations are that a poor environment, difficulty accessing the healthcare system and/or low health literacy may be contributing factors affected by the socio-economic environment (Public Health Agency of Canada, 2014).
Environmental Risk Factors
Environmental risk factors relate to the indoor and outdoor physical environment. Factors in one’s home environment, including tripping hazards, poor lighting, and inadequate bathroom set-up for an individual, contribute to the risk of falls in one’s home. In the community, increased risk of falls is associated with poor lighting, uneven sidewalks, poor stair design, lack of handrails, and obstacles, such as bike racks and sidewalk benches. Weather factors also contribute to increased risk of falling. Snow, ice and rain can make surfaces slippery. Accumulations of snow can make walking or using a mobility device more difficult (Public Health Agency of Canada, 2014).
Many factors contribute to the risk of falls. Such factors include biological, behavioural, socio-economic and environmental. Next month, Clinical Corner will address strategies to reduce the risk of falls for older adults.
- Accreditation Canada, Canadian Institute for Health Information & Canadian Patient Safety Institute. (2014). Preventing falls: From evidence to improvement in Canadian health care. Retrieved from: http://www.patientsafetyinstitute.ca/en/toolsResources/Documents/Interventions/Reducing%20Falls%20and%20Injury%20from%20Falls/FallsJointReport_2014_EN.pdf
- Government of Canada. (2015-03-16). Seniors' falls in Canada – Infographic. Retrieved from https://www.canada.ca/en/public-health/services/health-promotion/aging-seniors/publications/publications-general-public/seniors-falls-canada-second-report/seniors-falls-canada-infographic.html.
- Public Health Agency of Canada. (2014). Seniors’ falls in Canada. Second Report. Retrieved from https://www.canada.ca/content/dam/phac-aspc/migration/phac-aspc/seniors-aines/publications/public/injury-blessure/seniors_falls-chutes_aines/assets/pdf/seniors_falls-chutes_aines-eng.pdf
- Province of British Columbia. (2018). What contributes to falls? Retrieved from https://www2.gov.bc.ca/gov/content/family-social-supports/seniors/health-safety/disease-and-injury-care-and-prevention/fall-prevention/what-contributes-to-falls
- World Health Organization. (2018). Health impact assessment (HIA). Retrieved from https://www.who.int/hia/evidence/doh/en/