Falls are not a normal or unavoidable part of aging, but rather a complex issue caused by a combination of contributing factors. These predictors can be categorized to better understand and manage the risk in older adults.
Intrinsic predictors: Health and physical factors
Intrinsic factors are health-related conditions and changes within an individual that increase their likelihood of falling. These are often related to age but can be managed with proper care.
- History of previous falls: A history of falling is one of the single strongest predictors of a future fall. Someone who has fallen once is at a significantly higher risk of falling again.
- Balance and gait impairments: Normal aging can cause a decrease in gait speed, balance, and overall stability, making an individual more susceptible to losing their footing. Conditions like Parkinson's disease or stroke can severely impact balance and gait.
- Lower body weakness: As people age, muscle mass and strength naturally decline, a condition known as sarcopenia. Weakness in the legs can make it difficult to recover from a stumble and is a common risk factor. Grip strength has also been identified as a key indicator of overall strength and fall risk.
- Vision problems: Poor vision due to conditions like cataracts, glaucoma, or age-related macular degeneration can make it hard to see hazards and navigate one's surroundings safely. Wearing multifocal glasses can also affect depth perception and increase risk.
- Chronic medical conditions: A variety of chronic health issues can increase fall risk. These include arthritis, diabetes, heart disease, thyroid problems, and urinary incontinence, which can cause urgency and lead to falls, especially at night.
- Cognitive impairment: Conditions like dementia or mild cognitive impairment can increase fall risk due to poor judgment, memory issues, and disorientation. A recent study also linked impaired cognitive performance to falls in Parkinson's patients.
- Psychological factors: The fear of falling is a significant predictor in itself. Individuals who develop this fear may restrict their physical activity, which leads to deconditioning and further increases their risk. Depression has also been consistently linked with a higher incidence of falls.
- Orthostatic hypotension: A sudden drop in blood pressure when standing can cause dizziness or lightheadedness, leading to a fall. This is particularly common in older adults.
Extrinsic predictors: Environmental and medication factors
Extrinsic factors are external hazards and influences that contribute to falls. These are often the easiest to modify.
- Polypharmacy and medications: Taking multiple medications (polypharmacy) significantly increases the risk of falls, especially if an individual is on four or more. Certain drug classes, including sedatives, antidepressants, tranquilizers, and some blood pressure medications, can cause dizziness, drowsiness, or impaired balance. Opioid use has also been identified as a significant predictor.
- Home hazards: The home environment is a common location for falls. Common hazards include:
- Clutter and trip hazards (cords, papers, books)
- Slippery floors or loose rugs
- Broken or uneven steps
- Inadequate lighting
- Lack of grab bars in bathrooms and handrails on stairs
- Poor footwear: Wearing backless shoes, high heels, floppy slippers, or just socks on slippery floors can increase the risk of a slip or trip. Shoes with thin, hard soles may also be less stable.
Comparison of intrinsic and extrinsic risk factors
While intrinsic and extrinsic factors both contribute to fall risk, their nature and modifiability differ significantly.
| Feature | Intrinsic (Individual) Factors | Extrinsic (Environmental/Situational) Factors |
|---|---|---|
| Nature | Internal, biological, and physiological attributes. | External, environmental, and pharmacological elements. |
| Examples | Muscle weakness, chronic diseases, vision impairment, cognitive decline, fear of falling. | Loose rugs, poor lighting, side effects from medications, unsuitable footwear. |
| Modifiability | Can be managed and improved through exercise, medication management, and medical intervention. | Often easier and faster to modify or remove (e.g., tidying clutter, installing grab bars). |
| Intervention | Requires clinical and personal health strategies like physical therapy, medication review, and exercise programs. | Focuses on safety measures, home modifications, and behavior changes. |
| Role | Represents the individual's inherent susceptibility to falling due to their health status. | Creates the hazardous conditions or external influences that can trigger a fall. |
| Significance | Multiple intrinsic factors often accumulate with age, dramatically increasing risk. | Can be the immediate cause of a fall, even in otherwise healthy individuals when combined with specific actions like rushing. |
Fall prediction models and assessment tools
To help predict and prevent falls, healthcare providers use various screening and assessment tools.
- STEADI Initiative: The CDC's STEADI (Stopping Elderly Accidents, Deaths & Injuries) program recommends screening all older adults annually with three key questions: asking if they have fallen in the past year, if they feel unsteady, and if they worry about falling.
- Timed Up and Go (TUG) Test: This is a simple performance-based test where a person is timed while they rise from a chair, walk a short distance, and sit back down. A longer time suggests a higher fall risk.
- Berg Balance Scale: This assessment uses a series of functional tasks to evaluate a person's static and dynamic balance.
- Comprehensive Assessment: This includes a multifactorial evaluation of gait, balance, vision, blood pressure, medications, and home hazards.
Conclusion
Recognizing the predictors of falls—from intrinsic health-related issues to extrinsic environmental factors—is the crucial first step toward prevention. By understanding that a combination of factors, not just one, often contributes to a fall, individuals and caregivers can take a more comprehensive approach to safety. Implementing strategies like regular exercise to improve balance and strength, reviewing medications with a healthcare provider, and modifying the home environment to eliminate hazards can significantly reduce the risk and enhance overall quality of life. A proactive, multifactorial approach is the most effective way to address and manage fall risk.
