1. Risk Factors for Falls Courtney Hall, PT, PhD Atlanta VAMC Emory University

2. Risk Factors for Falls  Intrinsic vs. Extrinsic  Interaction/Combination of the two

3. Populations Differ:  “Young-Old” 60-75 yrs. Community- dwelling Extrinsic factors  “Old-Old” >75 yrs. Homebound or institutional dwelling Intrinsic factors

4. Intrinsic Risk Factors  Medical Number of diagnosis Medications & their interactions Substance abuse

5. Intrinsic Risk Factors  Cognitive Allocation of attention Awareness of abilities & limitations Judgment

6. Intrinsic Risk Factors  Emotional Depression

7. Intrinsic Risk Factors  Sensory loss Somatosensory Vision Vestibular

8. Intrinsic Risk Factors  Central Processing Perception of position in space Anticipatory postural adjustments Reaction time

9. Intrinsic Risk Factors  Central Processing Responses Selection of strategies Sequencing Scaling

10. Intrinsic Risk Factors  Musculo-Skeletal Strength Range of motion Endurance Posture (alignment)

11. Intrinsic Risk Factors  Condition of the feet Corns, calluses, etc. Hallux valgus Bunions Toenail problems

12. Intrinsic Risk Factors  Gait Slow velocity  (.45 m/sec fallers vs..55 m/sec non- fallers) Increased double support time Weaving, wobbling, etc Difficulty with starts, stops, turns

13. Extrinsic Risk Factors  Environmental Surface Visual Timing demands

14. Extrinsic Risk Factors  Social Living alone Socially isolated

15. Extrinsic Risk Factors  Activity Level Active vs. sedentary Prior experience

16. Extrinsic Risk Factors  Recent history of falls Two or more falls within the last six months “Unintentionally coming to rest on the floor” Caution - need to know activity level, too!

17. Home Safety Evaluations

18. EXTERIOR  STEPS: In good repair Nonslip surfaces Edges marked Handrails on both sides Handrails securely fastened

19. EXTERIOR  WALKWAYS: Level Non-slip surfaces Free of objects to be tripped over Sufficient lighting

20. INTERIOR  LIGHTING: Bright enough Glare-free Light switches available before entering room  RUGS/CARPETS: Non-slip backing Edges taped or tacked down Minimal padding

21. INTERIOR  SEATING: Chair heights Chairs strong enough Armrests No wheels  TRIP HAZARDS: Clutter Low-lying objects Cords

22. KITCHEN  Store commonly used items within reach  Step stool-not chair  Non-slip floors  Non-slip mat near sink area to absorb spilled water

23. BATHROOM  Doors wide enough  Thresholds  Floors slippery when wet?  Skid-proof strips/mats in tub  Grab bars available/securely fastened  Appropriate toilet height

24. BEDROOM  Night lights/bedside lamps  Clear pathway to bathroom  Bed height  Closet storage easily reached without standing on tiptoe or chair?  Telephone accessible

25. CONSIDERATIONS  Be cautious when making home modifications If a hazardous situation is rarely/never encountered, is change necessary? Predictability lowers risk; unfamiliar surroundings heighten it

26. Remember: Most falls result from an interaction of intrinsic & extrinsic risk factors

27. The greater the number of risk factors present, the greater the likelihood of falls.