Falling is a major public health concern, particularly for older adults, often leading to injury, reduced mobility, and a decreased quality of life. Most falls are preventable by addressing the circumstances that cause them. Falls rarely happen due to a single cause but result from a combination of underlying issues known as risk factors. These factors can be identified and managed to significantly lower the chance of an incident. This analysis focuses on the external elements that contribute to fall risk.
Defining the Two Categories of Fall Risk Factors
Fall risk factors are classified into two categories: intrinsic and extrinsic factors. Intrinsic factors originate within the individual, relating to their health, physiology, and physical condition. Examples include muscle weakness, balance or gait problems, vision impairment, and medication side effects. These factors affect a person’s ability to safely navigate their environment.
Extrinsic, or external, factors are environmental hazards or circumstances found outside the individual that increase the risk of a fall. They relate to the immediate surroundings, such as the design of a space or the presence of obstacles. Addressing the surrounding environment is an effective strategy for fall prevention since many external factors are easily modifiable.
Fixed Environmental Hazards
A primary example of an external fall risk factor is inadequate or poor lighting within a living space. Dimly lit hallways, stairwells, and bathrooms make it difficult to perceive changes in floor level or spot potential tripping hazards, especially for individuals with vision changes. Lighting that produces excessive glare can also be hazardous, masking obstacles or causing temporary vision impairment.
Structural deficiencies in the walking surface present another common fixed hazard. Uneven surfaces, such as cracked pavement or loose tiles, create unexpected transitions that can easily trip a person. Worn or frayed carpeting, particularly on stairs, can catch a foot, leading to a loss of balance.
The absence of proper safety aids, such as handrails on both sides of a staircase or grab bars, also removes necessary support mechanisms. Wet or slippery surfaces resulting from structural issues fall into this category. Persistent leaks or areas where water tends to pool create a slick surface with reduced traction. These fixed hazards require structural modification or repair to eliminate the risk.
Temporary and Behavioral External Factors
Many external fall factors are temporary, resulting from poor maintenance or the introduction of objects into the environment. A common example is household clutter, including items like stacks of books or clothing left on the floor near pathways. Electrical cords or telephone wires stretched across a walking area are significant tripping hazards. These obstacles turn a safe route into a dangerous obstacle course.
Another frequent external risk is the presence of loose area rugs and mats that lack non-slip backing. When stepped on, the edges of these rugs can easily slide or curl up, causing the foot to catch and the person to fall.
Choosing inappropriate footwear is a behavioral factor that introduces an external risk. Wearing loose slippers, shoes with slick soles, or high heels significantly increases the chance of a slip or trip. Shoes not firmly attached to the foot may also catch on the ground, disrupting a safe gait.
The improper use or placement of assistive devices creates a temporary external hazard. Using a walker that is incorrectly sized or a cane with a worn tip can make navigation more difficult. Leaving a mobility aid out of reach or placing it in a way that obstructs a path turns a safety tool into a potential tripping hazard.