Environmental Causes of Falls - #81
Take QuizIdentifying and decreasing environmental risk factors for falls.
Assessment
When an older adult falls, the cause is frequently an interaction between the individual and their environment. The initial evaluation of a patient who falls is directed to assess their injuries. In addition, the clinicians must evaluate the multiple factors which may have contributed to the fall. This is difficult in that the evaluation is out of the context in which the fall occurred. This figure below shows the multiple environmental risk factors which may contribute to falls in older adults.
Intrinsic (physiological attributes of the individual) and extrinsic (environmental factors) are often related to older adult falls. Some of these factors are based on epidemiological studies (*), while others are recognized by the clinician authors of this review. These risk factors include:
A. Disequilibrium*
B. Visual deficits
C. Dysrhythmia; orthostatic hypotension
D. Degenerative joint disease*
E. Loose fitting clothes
F. Poorly fitting footwear or foot sores
G. Pets
H. Rugs or loose mats
I. Dementia; Parkinson’s disease
J. Malnutrition
K. Decondition, muscle wasting, frailty
L. Per-existing stroke or other motor deficit*
M. Slippery surface
N. Stairs with piles of papers and clutter
O. Walker (not being used) and other assist devices
P. Alcohol, medications (sedatives*), a falls alert device (not worn), and eyeglasses
Q. Inadequate lighting
R. Transfers from sitting to standing (with a chair which is not stable)
NOTE: Additional intrinsic and extrinsic fall risk factors such as urinary incontinence have been described but are not depicted in this image.
Image is property of Aurora Health Care
Elderly patients who have fallen or are at elevated risk for falls.
Use the diagram above to identify environmental risk factors for falls and to consider environmental interventions that may decrease falls.
A “fall” is defined as an unexpected change in position from one level to another lower level. According to the CDC, 1/3 of adults aged 65 years and older fall annually. Falls are the leading cause of injury in older adults and result in 18,000 deaths due to fall related injuries annually. 10-15% of all visits to the emergency department yearly are for falls.
Science Principles
- List 5 environmental risk factors that may predispose an older adult to fall.
- List 3 practical ways, which could be communicated to patients and caregivers, for reducing environmental fall risks in the home.
Review of Systems (ROS)
Geriatric Topics
ACGME Compentencies
Science Principles
- Carpenter CR, Cameron A, Ganz DA, Liu S. Older adult falls in emergency medicine- A sentinel event. Clinics of Geriatric Medicine- Geriatric Emergency Department, Malone ML, Biese K, eds. Elsevier publishing. 2018 in press.
- Malone ML, Risk for Falls in Older Adults, Aurora Health Care Geriatric Emergency Department Monthly Newsletter, Feb 2018.
- Michael YL, Whitlock EP, Lin JS, Fu R, O’Connor EA, Gold R; US Preventive Services Task Force. Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med.2010 Dec 21;153(12):815-25.