Risk Assessment: Identifying Factors Associated with Falls and Conducting Fall Risk Assessments
By Stephen O'Hare, President, Pedors Shoes
Falls are a significant public health concern, particularly among older adults, and can lead to severe injuries and reduced quality of life. Identifying risk factors associated with falls is crucial for implementing effective preventive strategies.
Here we explore various risk factors, including age, medical conditions, medication side effects, environmental hazards, and lifestyle factors, that contribute to falls. Additionally, we provide insight into conducting fall risk assessments for individuals within different settings, such as homes, workplaces, and healthcare facilities. By understanding these risk factors and utilizing appropriate assessment techniques, healthcare professionals and caregivers can proactively address fall-related risks and implement preventive measures.
Risk Factors Associated with Falls
1. Age-related Factors
Biological risk factors include those pertaining to the human body and are related to the natural aging process, as well as the effects of chronic, acute or palliative health conditions.
Biological risk factors include advanced age, decreased mobility and balance and muscle weakness. Loss of muscle mass (known as sarcopenia) can lead to postural sway creating problems with balance and gait, and proprioception. Blood pressure that drops too much when you get up from lying down or sitting down can also affect balance along with visual impairment, acute or chronic illness and disability (i.e. cognitive impairment, stroke, arthritis).
Some conditions cannot be changed, such as gender or age, while others may be prevented or compensated for, such as muscle weakness or poor vision.
2. Medical Conditions
There are multiple medical conditions that can increase fall risk including diabetes, heart disease, or problems with your thyroid, nerves, feet, or blood vessels can all affect balance and lead to a fall. Cataracts, glaucoma and vision-related problems linked to stroke or dementiaare also known risks for fall.
3. Medication Side Effects
Drugs that can affect balance, as well as antipsychotic medications used for behavioral issues, can increase the risk of dizziness and confusion. Other adverse drug effects that increase fall risk include those for sedation, orthostatic hypotension, syncope, dizziness, drowsiness, changes in blood pressure or impaired balance.
4. Environmental Hazards
Studies have shown that on average, 50 to 60 percent of falls occur within the home. Environmental factors include home hazards, such as clutter, lack of stair railings, loose rugs or other tripping hazards, lack of grab bars in the bathroom, and poor lighting, especially on stairs.
5. Lifestyle Factors
Behavioural risk factors for falling include actions, emotions or choices of the individual. Behavioural risk factors include history of falls, fear of falling, poor nutrition and/or hydration, lack of physical activity, inappropriate footwear and clothing, and taking multiple medications, particularly psychoactive medications like tranquilizers or antidepressants. Other lifestyle factors include alcohol and recreational drug use which are also known to increase fall risk.
6. Cognitive Decline
Cognitive impairment (CI) increases an individual's risk of falls due to the role cognition plays in gait control. Older adults with dementia fall 2–3 times more than cognitively healthy older adults and 60–80% of people with dementia fall annually.
7. Medical Conditions
Chronic Diseases
Among falls prevention program participants, the top three chronic conditions are arthritis, heart disease, and diabetes.Exploring the relationship between chronic conditions and fall risk can identify solutions and program options to promote healthy aging.Engaging participants and providers in evidence-based programs across the continuum of care encourages community partnerships and collaboration.
Cardiovascular Disorders
Cardiovascular pathology involves a large number of diseases that can increase the risk of falls and are highly prevalent in the elderly, such as arrhythmias (atrial fibrillation, AF), postural hypotensive syncope (PHS), thyroid disorders, dyslipidemia, previous acute myocardial infarction (AMI), history of stroke, systemic arterial hypertension (SAH), heart failure (HF), Diabetes Mellitus 2 (DM2)
Neurological Disorders
Falls are an unfortunate, yet frequent complication for people with neurological disorders. From Parkinson's disease and Diabetes Mellitus to neuromuscular disorders, and from brain tumors to multiple sclerosis, neurological disorders affect the brain and central nervous system.
Musculoskeletal Disorders
Musculoskeletal disorders (MSDs) are soft-tissue injuries caused by sudden or sustained exposure to repetitive motion, force, vibration, and awkward positions. These disorders can affect the muscles, nerves, tendons, joints and cartilage in your upper and lower limbs, neck and lower back and by extension affect core strength and balance.
8. Medication Side Effects
Sedatives and Hypnotics
Sedatives and hypnotics are two classes of prescription drugs that are commonly called “tranquilizers,” “sleeping pills,” or “sedatives.” They affect your central nervous system – your brain and spinal cord – and have a relaxing, calming effect. They are often prescribed to older adults for problems including anxiety and difficulty sleeping.
These side effects lead to conditions that increase fall risk including sleepiness, dizziness, difficulty focusing or thinking, blurred vision impaired depth perception, slowed reaction times and reflexes.
Antihypertensive Medications
Antihypertensives are a class of drugs that are used to treat hypertension. Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke, heart failure, kidney failure and myocardial infarction with the most common side effects being dizziness or lightheadedness and feeling tired, weak, drowsy, or a lack of energy.
Psychotropic Medications
Psychotropic medication refers to a group of drugs that doctors may prescribe to treat a variety of conditions.These medication types include antidepressants, antianxiety medications, antipsychotics, and stimulants. They work by affecting neurotransmitters in the brain.There are side effects and potential risks relating to psychotropic medications,including dizziness, drowsiness and fatigue
9. Polypharmacy
Polypharmacy is an umbrella term to describe the simultaneous use of multiple medicines by a patient for their conditions. Most commonly it is defined as regularly taking five or more medicines but definitions vary in where they draw the line for the minimum number of drugs
10. Environmental Hazards
Environmental factors include home hazards, such as clutter, lack of stair railings, loose rugs or other tripping hazards, lack of grab bars in the bathroom, and poor lighting, especially on stairs.
11. Conducting Fall Risk Assessments
When determining the protocols to adopt for a fall risk assessment the following considerations need to be evaluated for each individual.
- A Medical History and Physical Examination
- Functional Assessments
- Balance and Gait Assessment
- Vision and Hearing Evaluation
- Setting-specific Assessments
- Home Fall Risk Assessment
- Workplace Fall Risk Assessment
- Healthcare Facility Fall Risk Assessment
- Preventive Strategies
- Interventions Based on Risk Factors
- Environmental Modifications
- Assistive Devices and Safety Equipment
- Exercise and Physical Therapy
Conclusion
By comprehensively evaluating risk factors associated with falls and conducting tailored fall risk assessments, healthcare professionals, caregivers, and policymakers can work collaboratively to mitigate fall-related risks and enhance the overall safety and well-being of individuals in various settings.