Falls, a common and serious problem for the elderly, are associated with significant mortality, morbidity, decreased independent functioning, and premature admission to nursing homes.¹ The incidence and severity of complications related to falls increase steadily after age 60.¹ In 2001, more than 1.6 million seniors were treated in EDs for fall-related injuries.² Unintentional injury is the eighth leading cause of death in the elderly with two-thirds of these unintentional injuries resulting from falls.¹

About one-third of those older than 65 years of age fall each year, and almost half of those older than age 72 who live in the community experience falls.³ Hospitals and nursing homes have a fall incident rate almost three times higher than those living in the community one study reported an incidence of 1.5 falls per bed annually for persons age 65 years and older.² While 20% of falls require medical attention, less than 10% result in fractures.⁴ Of this subset, individuals who sustain hip fractures are at greatest risk for such complications as immobility, disability, and death. Almost 50% of older persons who sustain a serious fall-induced injury never fully recover, and many lose independence for life.⁵

Physical therapists encounter the elderly across all practice settings. This broad exposure to the aging population allows therapists the opportunity to play a significant role in fall prevention by performing thorough fall risk assessments and developing individualized intervention plans. In-depth knowledge of fall risk factors, fall prevention measures, and post-fall assessment tools are essential for all clinicians.

 

Where falls occur

Falls occur everywhere — in one’s home, in the community, and in healthcare institutions.

Falls in the Community: For example, falls in the home usually take place in the bedroom, bathroom, living room, and on the stairs, most frequently while descending. These mishaps most commonly occur during routine activities of daily living. In a study that compared falls in the elderly at home and in the community, one group of investigators found that older persons who fell in and around their own homes were more likely to have their falls caused by factors such as frailty or unsteady gait.⁶

Decreased proprioception and quadricep muscle strength diminish the lateral stability necessary for transfers and activities of daily living.⁶ They also discovered that falls that occurred away from home were primarily due to environmental causes, such as uneven ground or poor lighting. The researchers concluded that both frail and vigorous elderly persons are at risk, and that the risk for falls increases even for the vigorous elderly when they are away from familiar surroundings.⁷

Falls in Healthcare Settings: Falls in the acute care hospital setting have been reported at a rate of 2.6 falls for every 1,000 bed days, but they may vary with patient populations.⁸ They can also be linked to medications, illness severity, and the use of physical and chemical restraints. Research has shown that restraints do not decrease the number of falls or protect a person from injury. In fact, the risk for serious injury may actually increase when restraints are used.^9,10,11 Restraints further promote immobility and lead to muscle wasting, diminished bone density, and pulmonary atelectasis. They are also demoralizing and can interfere with sensory stimulation, leading to disorientation and confusion.

In long-term care settings like nursing homes, falls account for 40% of all admissions.¹² Residents with the greatest risk of falling include those with gait or balance instability, polypharmacy, orthostatic hypotension, dementia/delirium, and other comorbidities.¹³ The rate of fall-related injury is 10% to 25% in this setting, most commonly from fractures and lacerations.¹