Intrinsic (Physiological) Factors
Intrinsic factors relate directly to the patient's physical and mental health. These are often the most significant contributors to fall risk, especially among older adults and individuals with pre-existing conditions.
Age-Related Changes
- Decreased muscle strength and balance: As people age, muscle mass (sarcopenia) and strength naturally decline, affecting gait and stability. Reflexes may also slow, reducing the ability to recover from a trip or slip.
- Impaired vision: Conditions like cataracts, glaucoma, and poor depth perception make it harder to see obstacles or uneven surfaces.
- Poor hearing: Hearing impairment can reduce awareness of potential hazards in the environment.
- Cognitive decline: Dementia and mild cognitive impairment can impair judgment, memory, and spatial awareness, leading to missteps and falls.
Medical Conditions
- Neurological disorders: Conditions such as Parkinson's disease, stroke, and peripheral neuropathy can cause gait abnormalities, weakness, and loss of sensation in the feet.
- Cardiovascular issues: Orthostatic hypotension (a sudden drop in blood pressure when standing) and cardiac arrhythmias can cause dizziness and fainting.
- Chronic diseases: Conditions like arthritis, diabetes, and osteoporosis can cause pain, joint stiffness, and weakened bones that increase fall-related injury risk.
- Incontinence: An urgent need to reach a toilet can cause a patient to rush, increasing their risk of a fall.
- Foot problems: Pain, deformities, or improperly fitting footwear can negatively impact balance and stability.
Extrinsic (Environmental) Factors
Extrinsic factors are external hazards in the patient's surroundings that can trigger a fall. These are often modifiable with careful assessment and adjustment.
- Home hazards: Common household risks include cluttered walkways, loose electrical cords, slippery rugs, and uneven flooring transitions.
- Poor lighting: Inadequate or glaring lighting, especially in hallways, stairwells, and bathrooms, can conceal hazards and impair vision.
- Lack of safety features: The absence of grab bars in bathrooms, handrails on stairs, and non-slip mats in wet areas significantly increases risk.
- Unsafe footwear: Wearing backless shoes, high heels, or slippery-soled slippers can reduce stability.
- Unfamiliar environments: Patients in hospitals or new care facilities are at higher risk due to being in unfamiliar surroundings.
Medications and Behavioral Factors
Certain medications and a patient's behavior can also significantly impact fall risk. A comprehensive medication review is a critical component of any fall risk assessment.
Medication Use (Polypharmacy) Taking multiple medications (polypharmacy) is a major risk factor, particularly when five or more medications are used simultaneously. Several classes of drugs are known to increase fall risk due to side effects like drowsiness, dizziness, and confusion.
- Psychoactive drugs: Benzodiazepines, sedatives, and some antidepressants and antipsychotics can cause sedation, slowed reaction times, and impaired balance.
- Blood pressure medications: Antihypertensives, especially when first started or with dosage adjustments, can cause orthostatic hypotension.
- Opioids and pain relievers: These can lead to sedation, dizziness, and impaired cognition.
- Diuretics: These can cause dehydration, electrolyte imbalances, and the need for frequent, urgent trips to the bathroom.
Behavioral Risk Factors
- Previous falls: A history of falling once significantly increases the risk of falling again.
- Fear of falling: Patients who fear falling may reduce their physical activity, which leads to muscle weakness and an even higher risk of falls.
- Inappropriate use of assistive devices: Using a cane or walker incorrectly, or not using one when needed, can cause instability.
- Risk-taking behavior: Attempting to reach for objects on high shelves, climbing on furniture, or hurrying in unfamiliar or hazardous environments.
Fall Risk Factor Comparison
| Category | Key Intrinsic Factors | Key Extrinsic Factors | Key Medication Factors |
|---|---|---|---|
| Physical Health | Decreased muscle strength, poor balance, vision/hearing impairment, age-related changes, arthritis | Cluttered pathways, poor lighting, slippery floors, rugs, lack of handrails | Psychoactive drugs (sedatives, antidepressants), blood pressure meds, opioids, multiple medications |
| Mental Health | Cognitive impairment (dementia), altered mental status, poor judgment | Unfamiliar or over-stimulating hospital environments | Antipsychotics, benzodiazepines causing confusion or sedation |
| Mobility & Gait | Abnormal gait patterns, foot pain, peripheral neuropathy (from diabetes) | Inappropriate footwear, unsuitable or missing assistive devices | Medications causing dizziness, unsteadiness, or impaired coordination |
| Lifestyle & Habits | Vitamin D deficiency, low physical activity, fear of falling | Wet surfaces (e.g., in bathrooms), uneven outdoor pavement, icy conditions | Sudden medication changes, poor medication adherence, alcohol or substance use |
Conclusion
Identifying and mitigating fall risk in patients requires a comprehensive approach that considers a wide range of factors. Fall risk is rarely the result of a single issue but rather a combination of intrinsic, extrinsic, and behavioral factors. Healthcare providers can use tools like the CDC's STEADI initiative to screen and assess patients, tailoring interventions to address each individual's unique risk profile. For patients, understanding personal health conditions, medication effects, and environmental hazards is the first step toward proactive fall prevention. Through a collaborative effort between patients, families, and healthcare teams, many falls can be prevented, leading to improved safety and quality of life. For further resources, visit the Centers for Disease Control and Prevention's STEADI website.
