Intrinsic Risk Factors: Internal Indicators of Fall Risk
Intrinsic risk factors stem from a person's individual health, physiology, and psychological state. Recognizing these internal indicators is the first step toward effective fall prevention. For older adults, many of these factors are directly related to age-related changes, but they can affect people of any age depending on their health status.
History of Previous Falls
A prior history of falls is one of the strongest predictors of future falls. Individuals who have fallen once are at double the risk of falling again. Understanding the circumstances of a past fall—such as the location, time of day, and activity—provides vital clues for prevention. A healthcare provider will often ask about the number and frequency of falls, as well as whether any injuries occurred.
Impaired Balance and Gait
Difficulty with balance and walking patterns, or gait, are significant red flags for fall risk. Symptoms include shuffling steps, needing to hold onto furniture while walking, or a fear of falling that restricts movement. Clinical tests can assess these issues, including the Timed Up and Go (TUG) test, the 30-Second Chair Stand Test, and the Four Stage Balance Test. The TUG test, for instance, assesses the time it takes for a person to rise from a chair, walk 10 feet, turn around, and sit back down; a result of 12 seconds or more may indicate a high fall risk.
Medications and Polypharmacy
Taking multiple medications, a condition known as polypharmacy, is a major risk factor. Certain medications, or the interactions between them, can cause side effects like dizziness, drowsiness, confusion, or low blood pressure (orthostatic hypotension). Some of the riskiest drug classes include sedatives, tranquilizers, antidepressants, antipsychotics, and certain blood pressure medications. A thorough medication review by a healthcare provider or pharmacist is an essential part of a fall risk assessment.
Chronic Health Conditions
Various chronic illnesses can directly contribute to an increased risk of falls. These include arthritis, which can cause joint pain and mobility issues, and Parkinson's disease, which affects gait and balance. Neuropathy from diabetes can cause numbness or tingling in the feet, impairing a person's sense of foot position. Cardiovascular issues like irregular heartbeats or orthostatic hypotension can cause lightheadedness or fainting.
Sensory Impairment
Clear vision is vital for navigation and detecting obstacles. Impaired vision, due to conditions like cataracts, glaucoma, or reduced contrast sensitivity, significantly raises fall risk. Similarly, hearing loss can affect spatial awareness and balance. Regular vision and hearing check-ups are important preventative measures.
Cognitive and Psychological Factors
Cognitive decline, including dementia and mild cognitive impairment, can lead to poor judgment and a reduced awareness of environmental hazards. Emotional factors like depression and a fear of falling can also lead to reduced activity levels and muscle deconditioning, paradoxically increasing fall risk. Fear of falling is a cyclical issue where a person becomes less active to avoid falls, which in turn leads to muscle weakness and an even higher risk of falling.
Extrinsic Risk Factors: Hazards in the Environment
External factors within a person’s environment are a major contributor to falls, and identifying these is crucial for prevention. In fact, environmental hazards are responsible for a significant percentage of falls, especially within the home.
Home and Workplace Hazards
- Poor Lighting: Insufficient lighting in hallways, stairs, and bathrooms can make it difficult to see and navigate safely, especially for those with vision impairments. Glare from overly bright lights can also be a problem.
- Obstacles and Clutter: Cluttered walkways, loose electrical cords, and misplaced objects create tripping hazards. Keeping pathways clear is a simple but effective strategy for reducing risk.
- Uneven and Slippery Surfaces: Loose throw rugs, wet floors, and uneven steps or flooring transitions are common culprits for slips and trips. Installing non-slip mats and securing rugs can help.
- Lack of Support Features: The absence of grab bars in bathrooms, handrails on stairs, or chairs with stable armrests can increase the risk of a fall during transfers. Home modifications to install these features are often recommended for those at risk.
Footwear and Assistive Devices
Wearing inappropriate footwear is a modifiable risk factor. Examples include walking in socks on slippery floors, wearing shoes with slick soles, or wearing ill-fitting or unstable footwear. The improper use or fit of assistive devices, such as walkers or canes, can also increase fall risk. A physical therapist can provide guidance on proper device use and fitting.
Assessment Methods for Identifying Fall Risk
Healthcare providers use various tools and clinical observations to evaluate a person’s fall risk comprehensively. The assessment typically combines a patient history, physical examination, and functional performance tests.
| Assessment Method | Description | What It Indicates |
|---|---|---|
| Patient Interview | Asks questions about a history of falls, fear of falling, and medication use. | A "yes" to falling in the past year or worrying about falls indicates a higher risk. |
| Timed Up and Go (TUG) Test | Measures the time it takes to stand from a chair, walk 10 feet, turn, and sit again. | Taking 12 seconds or longer suggests increased fall risk. |
| 30-Second Chair Stand Test | Measures lower body strength and endurance by counting the number of times a person can rise from a chair without using their arms. | A lower number of repetitions for a given age group suggests weaker leg muscles and higher fall risk. |
| 4-Stage Balance Test | Assesses static balance by having a person hold increasingly difficult standing positions. | Inability to hold a challenging position (e.g., tandem stance) for 10 seconds indicates poor balance. |
| Orthostatic Blood Pressure Test | Compares a person's blood pressure when lying down versus standing. | A significant drop in blood pressure upon standing can cause dizziness and increase fall risk. |
| Medication Review | Evaluates all prescription and over-the-counter drugs for side effects and interactions. | Identifies specific medications that cause drowsiness, dizziness, or confusion. |
Conclusion: Taking a Multifactorial Approach to Fall Prevention
No single finding is solely responsible for indicating a person is at risk for falls; rather, it is often a combination of multiple intrinsic and extrinsic factors that increases a person's vulnerability. The strongest indicators include a history of recent falls, problems with gait and balance, and the use of certain medications. Cognitive and sensory impairments, chronic diseases, and environmental hazards also play a significant role. By adopting a comprehensive, multifactorial approach that includes regular screenings, thorough assessments, and targeted interventions, healthcare providers and individuals can work together to effectively reduce fall risk and promote a safer, more independent life.
It is essential to address both the individual's health status and their living environment. For example, a person with gait instability who also lives in a home with poor lighting and loose rugs is at significantly higher risk than someone with only one of these factors. Taking proactive steps to identify and mitigate these risks is the key to preventing falls.
