Fall risk factors in community-dwelling elderly people

Bergland, Astrid · 2012 · Crossref

DOI: 10.5324/nje.v22i2.1561

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Summary

This review paper addresses the critical public health challenge of falls among community-dwelling elderly people, a problem exacerbated by population aging. Approximately one-third of older adults fall annually, with incidence rates rising significantly with age, leading to disability, loss of independence, and mortality. The study aims to synthesize current evidence on risk factors for falls in home-dwelling individuals aged 65 and older to inform prevention strategies. The author conducted a traditional literature review using databases including Cinahl, Eric, ISI Web of Science, Cochrane Medline, Psycinfo, and dissertation repositories, focusing on English-language articles regarding evidenced-based risk factors. The paper categorizes risk factors into sociodemographic, sensory, neuromuscular, psychological, medical, medication-related, and environmental domains, emphasizing that falls result from complex interactions between intrinsic and extrinsic factors rather than a single cause. Key intrinsic risk factors identified include advanced age, a history of previous falls, and impairments in balance, gait, and mobility. Specific physiological deficits strongly associated with falls include visual impairment (particularly contrast sensitivity and depth perception), reduced peripheral sensation, muscular weakness in the lower extremities, and poor reaction time. Cognitive impairments, especially executive dysfunction, and emotional factors such as depression and fear of falling, are also significant predictors. Medical conditions, including stroke, Parkinson’s disease, and cardiovascular issues like orthostatic hypotension, increase fall risk. Furthermore, polypharmacy and the use of specific medications, notably psychoactive drugs like benzodiazepines, antidepressants, and antipsychotics, are strongly linked to increased fall incidence. Environmental factors and activity levels further modulate risk. While many falls occur indoors during activities of daily living, outdoor falls are more common among healthier, more active individuals. Behavioral choices, such as footwear selection and lighting usage, interact with environmental hazards like stairs and uneven surfaces. The review highlights that balance and gait assessments, such as the Berg Balance Scale and Timed Up and Go Test, are effective screening tools, though their predictive validity varies. The findings underscore that fall risk is multifactorial and that the distinction between intrinsic and extrinsic factors is often an oversimplification. The significance of this research lies in its recommendation for multifactorial fall risk assessments that incorporate physiological, mental, and environmental evaluations. The paper concludes that effective fall prevention requires multidimensional interventions targeting modifiable risk factors. By identifying individuals at high risk through comprehensive assessment, healthcare providers can implement targeted strategies to reduce the substantial personal and societal burden of falls in the aging population.

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• medical conditions