What are some examples of extrinsic factors to address to prevent falls?

According to the Centers for Disease Control and Prevention (CDC), falls are the leading cause of injury-related deaths for adults over 65. Understanding what are some examples of extrinsic factors to address to prevent falls is crucial for improving safety, as many hazards are outside of an individual's control and can be modified to reduce risk. These external factors range from environmental hazards in the home to medication side effects and improper footwear.

Quick Summary

This guide outlines and explains extrinsic fall risk factors, focusing on environmental hazards, footwear, medication effects, and visual aids. It provides actionable strategies for home modifications, discusses how to review medications and footwear for safety, and highlights the role of physical therapy and regular vision checks in minimizing fall risk.

Key Points

• Clear Environmental Hazards: Remove clutter, secure or remove loose rugs, and keep floors clear to eliminate common tripping hazards.

• Enhance Lighting: Use bright, even lighting and install nightlights in high-traffic areas like hallways and bathrooms to improve visibility and prevent stumbles in the dark.

• Review Medications: Discuss all medications with a doctor or pharmacist, especially those that cause dizziness or drowsiness, to identify and address potential fall risks.

• Choose Safe Footwear: Wear sturdy, well-fitting shoes with non-slip soles and avoid walking in socks on slick floors to maintain better traction and stability.

• Install Assistive Devices: Add grab bars in bathrooms and handrails on stairs, and ensure any mobility aids like canes are properly fitted and used.

• Optimize Vision Aids: For active people, single vision distance glasses might be safer for outdoor walking than multifocals, which can affect depth perception.

• Utilize Physical Therapy: A physical therapist can conduct a home safety assessment and provide expert guidance on environmental modifications.

Extrinsic factors are external hazards and conditions that can increase an individual's risk of falling, and addressing them is a proactive strategy for fall prevention. While intrinsic factors relate to an individual's health, extrinsic factors can often be modified to create a safer living space and reduce the likelihood of accidents. A comprehensive fall prevention plan should address both types of factors for maximum effectiveness.

Home and Environmental Hazards

One of the most common categories of extrinsic fall risks involves environmental hazards, especially within the home where most falls occur. Regular assessment and modification of the living space can drastically reduce fall incidents.

Clearing Clutter and Obstacles

Keeping pathways clear is fundamental to preventing trips and slips. This includes removing or reorganizing common household items that present a hazard.

• Clear Walkways: Move furniture, boxes, stacks of newspapers, and electrical cords out of high-traffic areas. Electrical cords can be coiled or taped against walls to keep them out of the way.
• Secure or Remove Rugs: Loose throw rugs, mats with curled edges, and unsecured carpeting are significant tripping hazards. They should be removed or secured with double-sided tape or a non-slip backing.

Improving Lighting

Poor or inadequate lighting can obscure obstacles, making it difficult for individuals to see and navigate safely, especially in dim conditions or at night.

• Install Night Lights: Place motion-activated or plug-in night lights in bedrooms, bathrooms, and hallways to illuminate the path during nighttime trips.
• Enhance General Lighting: Increase the wattage of bulbs or use brighter LED bulbs to reduce shadows and improve overall visibility. Ensure light switches are easily accessible near room entrances.

Modifying Bathrooms and Stairs

Bathrooms and stairs are high-risk areas for falls and often require specific modifications.

• Install Grab Bars: Securely mount grab bars inside and outside the shower or bathtub, as well as next to the toilet, to provide stable support when transferring.
• Use Non-Slip Surfaces: Place a rubber mat or install non-slip treads on the floor of bathtubs and showers. Non-slip treads on bare-wood steps can also improve traction on stairs.
• Handrails: Install sturdy handrails on both sides of all stairways to provide reliable support.

Medications and Their Effects

Certain medications, or a combination of them (polypharmacy), can increase fall risk due to side effects such as drowsiness, dizziness, impaired balance, or changes in blood pressure. A thorough medication review is a critical extrinsic intervention.

Medication Review and Management

Pharmacists and healthcare providers play an important role in managing medication-related fall risk.

• Identify High-Risk Drugs: Common culprits include sedatives, antidepressants, anti-anxiety drugs (benzodiazepines), blood pressure medications, and opioids.
• Deprescribing: With a doctor's supervision, medication dosages may be reduced or potentially discontinued if risks outweigh benefits. Switching to safer alternatives may also be considered.
• Address Side Effects: Work with a healthcare team to manage side effects that contribute to unsteadiness, such as orthostatic hypotension (dizziness when standing up).

Footwear and Assistive Devices

What a person wears on their feet and how they use mobility aids are key extrinsic factors that influence stability and safety.

Sensible Footwear

Improper footwear is a major contributor to falls.

• Wear Properly Fitting Shoes: Sturdy, flat shoes with non-skid soles provide better support and traction than floppy slippers, high heels, or shoes with slick soles.
• Avoid Walking in Socks: While comfortable, walking in socks on hard floors can lead to slips and falls.
• Maintain Footwear: Replace worn-out shoes, as reduced grip can compromise stability.

Proper Use of Assistive Devices

Canes and walkers are designed to increase stability but can become a hazard if used incorrectly.

• Get Proper Training: A physical therapist can ensure a person is using their cane or walker correctly and that it is properly fitted for their height and posture.
• Regular Inspections: Check that devices are in good working order, with all parts secure and rubber tips intact.

Vision Care and Adaptations

Visual impairment is an intrinsic factor, but the use of corrective eyewear is an extrinsic one. Changes in vision and improper glasses can significantly affect balance and the ability to detect hazards.

Corrective Lenses

While bifocals and multifocal glasses are useful, they can increase fall risk by impairing contrast sensitivity, depth perception, and a person's ability to negotiate obstacles, especially when worn outside.

• Single Vision Lenses: Consider using single vision distance glasses for outdoor walking, as suggested by some studies, to maintain consistent visual perception.
• Regular Eye Exams: Get regular eye exams to ensure prescriptions are up-to-date and address vision issues like cataracts or glaucoma, which are linked to a higher risk of falling.

Home Safety Evaluations and Physical Therapy

These professional services can provide tailored recommendations to further address extrinsic factors. Physical therapists, for example, can perform home safety evaluations and make specific recommendations for modifications. They also address intrinsic factors like strength and balance.

Comparison of Extrinsic Fall Prevention Strategies

Extrinsic Factor	Examples of Problems	Actionable Prevention Strategy
Environmental Hazards	Cluttered pathways, loose rugs, poorly arranged furniture.	Declutter rooms, secure rugs, rearrange furniture for clear walkways.
Inadequate Lighting	Dim rooms, dark hallways, inaccessible light switches.	Install brighter bulbs, use motion-activated nightlights, ensure switches are easily reached.
Medication Side Effects	Dizziness from blood pressure medication, drowsiness from sleep aids.	Regularly review medications with a pharmacist or doctor to adjust doses or find safer alternatives.
Unsafe Footwear	Slippers with slick soles, high heels, ill-fitting or worn-out shoes.	Wear sturdy, flat shoes with non-slip soles. Avoid walking in socks on smooth floors.
Improper Assistive Devices	Incorrectly sized cane or walker, failure to use device when recommended.	Get professional fitting and training from a physical therapist. Regularly check for wear and tear.
Visual Aids	Multifocal glasses worn outdoors, outdated prescription.	Use single-vision distance glasses for outdoor activity. Schedule regular eye exams.

Conclusion

Addressing extrinsic factors is a highly effective way to reduce the risk of falls by creating a safer, more predictable environment. From making simple home modifications like improving lighting and securing rugs to more complex interventions like medication reviews and professional physical therapy, there are numerous actionable steps. By taking a proactive approach to mitigating these external hazards, individuals can significantly increase their safety, maintain independence, and improve their overall quality of life. Collaboration between individuals, family members, and healthcare professionals is key to implementing a comprehensive and personalized fall prevention strategy.

Frequently Asked Questions

What is an extrinsic fall factor?

An extrinsic fall factor is an external hazard or condition that contributes to a person's risk of falling, such as environmental obstacles, medication side effects, or improper footwear.

What environmental hazards are common extrinsic factors for falls?

Common environmental hazards include loose throw rugs, clutter in walkways, poor lighting, slippery floors, and a lack of grab bars or handrails in high-risk areas like bathrooms and stairways.

How can medication lead to falls?

Certain medications, such as sedatives, antidepressants, blood pressure drugs, and opioids, can cause side effects like drowsiness, dizziness, and impaired balance, which increases the risk of falling.

How does footwear affect fall risk?

Improper footwear, including high heels, floppy slippers, and shoes with slick or worn soles, can cause slips and trips. Properly fitting shoes with non-skid soles offer better stability and traction.

Can glasses increase fall risk?

Yes, for active individuals, wearing multifocal or bifocal glasses outdoors can increase fall risk by affecting depth perception. Sometimes, single vision distance lenses are recommended instead for walking outside.

What is the role of a physical therapist in addressing extrinsic factors?

Physical therapists can perform home safety evaluations to identify environmental hazards and provide recommendations for modifications. They also assist with gait and balance training to improve mobility.

Is home modification a single-time effort?

No, home modification is an ongoing process. Regular safety audits are recommended to ensure the environment remains safe, especially as mobility needs change over time.