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Understanding Risk Factors for Falls in Older Adults: Intrinsic and Extrinsic Influences

This presentation by Courtney Hall, PT, PhD at Atlanta VAMC and Emory University delves into the multifaceted risk factors for falls among older adults, categorizing them into intrinsic and extrinsic factors. It explores how different populations, such as "young-old" (60-75 years) and "old-old" (over 75 years), face unique risks based on their living situations and health status. Key intrinsic factors include medical conditions, cognitive abilities, emotional health, and musculoskeletal strength, while extrinsic factors cover environmental hazards and social isolation. The discussion emphasizes the importance of assessing both types of factors to prevent falls effectively.

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Understanding Risk Factors for Falls in Older Adults: Intrinsic and Extrinsic Influences

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  1. Risk Factors for Falls Courtney Hall, PT, PhD Atlanta VAMC Emory University

  2. Risk Factors for Falls • Intrinsic vs. Extrinsic • Interaction/Combination of the two

  3. “Young-Old” 60-75 yrs. Community- dwelling Extrinsic factors “Old-Old” >75 yrs. Homebound or institutional dwelling Intrinsic factors Populations Differ:

  4. Intrinsic Risk Factors • Medical • Number of diagnosis • Medications & their interactions • Substance abuse

  5. Intrinsic Risk Factors • Cognitive • Allocation of attention • Awareness of abilities & limitations • Judgment

  6. Intrinsic Risk Factors • Emotional • Depression

  7. Intrinsic Risk Factors • Sensory loss • Somatosensory • Vision • Vestibular

  8. Intrinsic Risk Factors • Central Processing • Perception of position in space • Anticipatory postural adjustments • Reaction time

  9. Intrinsic Risk Factors • Central Processing • Responses • Selection of strategies • Sequencing • Scaling

  10. Intrinsic Risk Factors • Musculo-Skeletal • Strength • Range of motion • Endurance • Posture (alignment)

  11. Intrinsic Risk Factors • Condition of the feet • Corns, calluses, etc. • Hallux valgus • Bunions • Toenail problems

  12. Intrinsic Risk Factors • Gait • Slow velocity • (.45 m/sec fallers vs. .55 m/sec non-fallers) • Increased double support time • Weaving, wobbling, etc • Difficulty with starts, stops, turns

  13. Extrinsic Risk Factors • Environmental • Surface • Visual • Timing demands

  14. Extrinsic Risk Factors • Social • Living alone • Socially isolated

  15. Extrinsic Risk Factors • Activity Level • Active vs. sedentary • Prior experience

  16. Extrinsic Risk Factors • Recent history of falls • Two or more falls within the last six months • “Unintentionally coming to rest on the floor” • Caution - need to know activity level, too!

  17. Home Safety Evaluations

  18. STEPS: In good repair Nonslip surfaces Edges marked Handrails on both sides Handrails securely fastened EXTERIOR

  19. WALKWAYS: Level Non-slip surfaces Free of objects to be tripped over Sufficient lighting EXTERIOR

  20. LIGHTING: Bright enough Glare-free Light switches available before entering room RUGS/CARPETS: Non-slip backing Edges taped or tacked down Minimal padding INTERIOR

  21. SEATING: Chair heights Chairs strong enough Armrests No wheels TRIP HAZARDS: Clutter Low-lying objects Cords INTERIOR

  22. KITCHEN • Store commonly used items within reach • Step stool-not chair • Non-slip floors • Non-slip mat near sink area to absorb spilled water

  23. BATHROOM • Doors wide enough • Thresholds • Floors slippery when wet? • Skid-proof strips/mats in tub • Grab bars available/securely fastened • Appropriate toilet height

  24. BEDROOM • Night lights/bedside lamps • Clear pathway to bathroom • Bed height • Closet storage easily reached without standing on tiptoe or chair? • Telephone accessible

  25. CONSIDERATIONS • Be cautious when making home modifications • If a hazardous situation is rarely/never encountered, is change necessary? • Predictability lowers risk; unfamiliar surroundings heighten it

  26. Remember: Most falls result from an interaction of intrinsic & extrinsic risk factors

  27. The greater the number of risk factors present, the greater the likelihood of falls.

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