Understanding Which are extrinsic factors responsible for falls in older adults?

The Centers for Disease Control and Prevention reports that over 36 million falls are reported among older adults each year. Understanding which are extrinsic factors responsible for falls in older adults is a critical first step in proactively preventing these potentially life-threatening incidents and maintaining independence.

Quick Summary

External, modifiable factors like environmental hazards, unsafe footwear, medication side effects, and improper use of assistive devices are primary causes of falls in older adults. Mitigating these risks is key to prevention.

Key Points

• Environmental Hazards: Clutter, poor lighting, and uneven surfaces are major external contributors to falls in and around the home.

• Inappropriate Footwear: Ill-fitting or slick-soled shoes, as well as walking in socks, significantly increase the risk of slipping and tripping.

• Medication Side Effects: The external introduction of certain drugs can cause internal side effects like dizziness and sedation that impair balance and increase fall risk.

• Improper Assistive Device Use: Mis-sized, damaged, or misused mobility aids like walkers and canes can compromise, rather than improve, stability.

• Situational Factors: Rushing, distraction, and navigating unfamiliar environments are behavioral extrinsic factors that increase the likelihood of a fall.

• Multifactorial Nature: Falls are often the result of an interaction between multiple intrinsic and extrinsic factors, emphasizing the need for a comprehensive prevention strategy.

The Hidden Dangers: Uncovering External Causes of Falls

While intrinsic factors, or an individual's own health conditions, play a role in fall risk, a surprising number of incidents are triggered by extrinsic factors. These are external influences that interact with an older person's physical and cognitive state to cause a fall. Recognizing and addressing these factors is essential for creating safer living environments and protecting senior health.

Environmental Hazards in the Home

For many older adults, the home is where most falls occur. Simple, everyday objects can become significant hazards when combined with age-related changes in vision, balance, and mobility. A thorough home safety assessment can identify and resolve these dangers.

Poor Lighting and Glare

Inadequate lighting can hide obstacles, while intense, direct glare can temporarily blind someone with decreased vision or heightened sensitivity. Key lighting concerns include:

• Insufficient illumination in hallways, stairwells, and bathrooms.
• Shadows created by poorly placed lamps.
• Reflective glare on shiny floors or from uncovered windows.
• Light switches that are hard to reach, forcing a person to navigate in the dark.

Unsafe Flooring and Surfaces

The surface an older adult walks on can be the difference between a smooth stride and a sudden fall. Common floor-related risks include:

• Loose rugs or carpets with curled edges.
• Slippery floors, especially in kitchens and bathrooms.
• Uneven surfaces, such as cracked sidewalks or flooring transitions.
• Clutter in walking paths, like electrical cords, magazines, and other obstacles.

Inadequate Support and Unstable Furniture

Older adults often rely on furniture for support, especially when moving from a sitting to a standing position. When furniture is unstable, it poses a major risk. Examples include:

• Using lightweight tables or chairs that can tip over.
• Lack of secure handrails on stairs and in hallways.
• Missing or insecure grab bars in bathrooms, particularly near the toilet and in the shower.

The Impact of Inappropriate Footwear and Clothing

What older adults wear on their feet and bodies can directly contribute to their risk of falling. The wrong choice in footwear is a highly preventable risk factor.

Unsafe Footwear

• Slippery or Worn Soles: Shoes and slippers with slick, worn-out bottoms offer no traction and can cause a person to slip on smooth floors.
• Lack of Support: Backless shoes, floppy slippers, and high heels provide little stability and alter a person's gait.
• Poor Fit: Ill-fitting shoes that are too loose or too tight can cause trips or foot pain that affects balance.
• Walking in Stockings: Walking on hard floors in socks or stockings is extremely hazardous due to lack of grip.

Hard-to-Manage Clothing

Clothing that is too long or restrictive can create a tripping hazard. For instance, pants with long cuffs can get caught on feet or furniture, leading to a fall.

Medication as an Extrinsic Trigger for Falls

Many commonly prescribed and over-the-counter medications can cause side effects that dramatically increase the risk of a fall. The medication itself is an external substance that triggers an internal, physiological response. This is especially true for older adults, whose bodies process drugs differently with age.

Common Medication-Related Side Effects

• Dizziness and Lightheadedness: Medications for high blood pressure, heart rhythm, and depression can cause a sudden drop in blood pressure upon standing, a condition called orthostatic hypotension.
• Sedation and Confusion: Psychoactive drugs like sedatives, muscle relaxants, and antidepressants can cause drowsiness and mental fogginess, impairing coordination and judgment.
• Polypharmacy: Taking multiple medications can increase the risk of harmful interactions. The more medications an older adult takes, the higher their risk of falling.

For more detailed information on which medications pose a risk, the National Institutes of Health (NIH) is a great resource. This resource provides information on a wide range of factors influencing fall risk National Institutes of Health (NIH) - Falls in Older Adults.

The Danger of Improperly Used Assistive Devices

Assistive devices like walkers, canes, and wheelchairs are meant to provide stability, but when used incorrectly, they can become a fall hazard.

Common Device-Related Issues

• Incorrect Fit: A walker or cane that is the wrong height can negatively affect posture and balance.
• Worn-Out Parts: Worn-out rubber tips on canes or brakes on wheelchairs can fail when needed most.
• Failure to Use: Not using a prescribed device consistently or correctly undermines its purpose.

Situational and Behavioral Triggers

Certain actions and circumstances can increase fall risk, even in a safe environment. These situational factors often involve rushing or being distracted.

The Role of Rushing and Distraction

• Multitasking: Trying to carry items while walking, or talking on the phone while navigating steps, can be dangerous.
• Rushing to the Bathroom: Especially at night, rushing to use the toilet can lead to a fall when not fully awake or in dim lighting.
• Unfamiliar Surroundings: A new environment, whether a relocated home or a hospital, can present unforeseen hazards.

Comparison of Extrinsic Fall Risks and Solutions

Hazard Category	Specific Risk	Solution
Environment	Clutter in walkways	Keep paths clear of electrical cords, rugs, and furniture.
Environment	Inadequate or glaring lighting	Install brighter, diffused lighting. Use motion-sensor lights and accessible switches.
Environment	Slippery floors	Use non-slip mats in bathrooms and kitchens. Use non-skid wax.
Footwear/Clothing	Worn or ill-fitting shoes	Wear properly-fitting shoes with non-skid soles. Avoid walking in socks.
Footwear/Clothing	Long or dragging pants	Hem pants to an appropriate length.
Medication	Dizziness, sedation, confusion	Regularly review all medications with a doctor or pharmacist.
Assistive Devices	Worn tips or incorrect fit	Ensure proper fit and maintenance of walkers and canes. Replace worn parts.
Situational	Rushing or distraction	Prioritize safety. Take time when moving and avoid multitasking.

Conclusion: A Proactive Approach to Fall Prevention

Fall prevention in older adults is a multifaceted effort that goes beyond addressing internal health issues. By focusing on the external, or extrinsic, factors, caregivers and older adults themselves can make significant, controllable changes to their living space and daily routines. Conducting a thorough home assessment, choosing appropriate footwear, managing medication with a professional, and using assistive devices correctly are all actionable steps toward a safer, more independent life. A proactive, preventative mindset is the most powerful tool against falls.

Frequently Asked Questions

What is the difference between intrinsic and extrinsic factors for falls?

Intrinsic factors are an individual's internal conditions, such as muscle weakness, poor vision, or a medical illness. Extrinsic factors are external influences, like environmental hazards, footwear, or medications, that increase fall risk.

How can I assess my home for extrinsic fall risks?

Perform a walk-through of your home, paying close attention to flooring, lighting, and clutter. Ensure all walkways are clear, install brighter lights and nightlights, secure loose rugs, and add grab bars in the bathroom.

Which medications are most commonly associated with fall risk?

Medications that can affect balance and increase fall risk include certain antidepressants, sedatives, muscle relaxants, and blood pressure medications. Always discuss your medications with a doctor or pharmacist.

What type of footwear is best for preventing falls in older adults?

Look for sturdy, supportive shoes with non-skid soles that fit well and enclose the foot. Avoid walking barefoot, in socks, or in backless slippers, as these provide minimal traction and support.

Can pets contribute to falls in the home?

Yes, pets can be an extrinsic factor. Small pets that dart around can create a tripping hazard, while larger pets may cause someone to lose their balance if they unexpectedly get in the way.

How do assistive devices become an extrinsic fall factor?

Assistive devices become a fall factor when they are not properly maintained, correctly fitted, or used as intended. Examples include a walker with faulty wheels or a cane with a worn-out rubber tip.

Are there any specific home modifications that are most effective for preventing falls?

Key modifications include installing handrails on both sides of stairways, placing grab bars in showers and near toilets, and ensuring all rooms are well-lit to improve visibility and reduce glare.