RISK FACTORS FOR FALLS

Falls are the leading cause of injury deaths and disabilities among persons aged >65 years. In the United States, one of every three older adults falls each year. In 1997, nearly 9,000 persons aged >65 years died from falls. Of those who fall, 20%-30% sustain moderate to severe injuries that reduce mobility and independence and increase the risk for premature death. Older adults are hospitalized for fall-related injuries five times more often than they are for injuries from other causes and women are nearly three times more likely than men to be hospitalized for a fall-related injury.⁶

An assessment of the factors that lead to falls is difficult, as studies use different methods of calculating and defining the underlying factors leading to a fall. Rubenstein ² reviewed and analyzed falls in nursing home patients and after evaluating the fallers specified a "most likely cause" of the fall. The results from this combination of studies are shown in the table.

Falls in Nursing Homes:
Etiology

Elderly nursing home residents are most likely to fall because of gait disorders, weakness, dizziness, and confusion. ² In contrast, elderly individuals living in the community are most likely to have falls related to accidents or environmental factors, most likely related to their tendency to be exposed to more dangerous situations than the nursing home population.⁷

Interacting Factors

Falls may be viewed as the result of the interaction between intrinsic factors, environmental factors, and situational factors.⁷ Intrinsic factors describe patient-specific factors, such as muscle weakness or acute illnesses, that may contribute to a fall.⁸ Extrinsic factors describe those related to the environment, such as loose throw rugs, wet floors, etc. Finally, situational circumstances are determined by the nature of activities that an older person may engage in.

Because of the interdependence of these different factors, it is often difficult to individually isolate them, and therefore not appropriate to assign a single factor as "causing" a fall.⁹

The evaluation of an individual who has fallen includes a thorough history of the circumstances and symptoms that surrounded the falling episode.² Specific symptoms may help elucidate the potential intrinsic cause. Physical examination should include evaluation of orthostatic changes in blood pressure, the presence of arrhythmias, focal neurologic signs, confusion or other sensory impairments, and gait disturbances.²

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