Helping the Elderly Avoid Falls

Sept. 8, 2010 -- The risk factors for indoor and outdoor falls among the elderly differ, and not all falls indicate poor health, a study shows.

Researchers found that risk factors for indoor falls include being a woman and having an inactive lifestyle. Risk factors for outdoor falls include being a man and being more physically active.

The study is published in the Journal of the American Geriatrics Society.

Falls among the elderly are common, with as many as 40% of people age 65 and older falling each year. Falls can lead to serious injuries, such as a fractured hip or concussion.

While a great deal of attention has been paid to indoor falls, little is known about the risk factors for outdoors falls, which are also common. According to the study researchers, almost 50% of falls among older people occur outdoors.

The study may help health care providers better tailor prevention strategies that help the elderly avoid falling.

Researchers led by Marian T. Hannan, DSc, MPH, a senior scientist at the Institute of Aging Research of Hebrew SeniorLife, an affiliate of Harvard Medical School in Boston, examined older adults who were randomly selected from households in the Boston area. The participants provided information on any falls that occurred over a two-year period and also underwent physical examinations.

Indoor vs. Outdoor Falls

Hannan and her colleagues found that:

• Risk factors for indoor falls included being female, older age, inactive lifestyle, disability, having lower cognitive function, taking more medications, and overall poorer health.
• Risk factors for outdoor falls included being male, being younger and more physically active, having more education, and having average or better-than-average health.
• Among all the falls that were recorded, 9.5% resulted in serious injury, including 10.2% of indoor falls and 9% of outdoor falls.
• The majority of outdoor falls occurred on hard concrete surfaces, including sidewalks, streets, curbs, outdoors stairs, and parking lots. Fourteen percent of outdoor falls occurred in yards or gardens.

The study participants included 765 men and women, ranging in age from 64 to 97; 36% were male and 64% were female.

The findings could have implications in how patients are identified for being at risk for falling. Current fall prevention programs overlook risk factors associated with outdoor falling, the researchers note. They should be updated to consider a person's activity level as well as other characteristics.

"Most fall prevention programs emphasize the prevention of indoor falls, particularly through strength, balance, and gait training; use of assistive devices; treatment of medical conditions; reduction in the use of certain medications; improvement in vision; and the elimination of home hazards," Hannan and her colleagues write. "More attention needs to be paid to the elimination of outdoor environmental hazards involving sidewalks, curbs and streets, such as repairing uneven surfaces, removing debris, installing ramps at intersections, and painting curbs."