The physical environment as a fall risk factor in older adults: Systematic review and meta‐analysis of cross‐sectional and cohort studies

Letts, Lori; Moreland, Julie; Richardson, Julie; Coman, Liliana; Edwards, Mary; Ginis, Kathleen A. Martin; Wilkins, Seanne; Wishart, Laurie

doi:10.1111/j.1440-1630.2009.00787.x

Cited by 80 publications

(67 citation statements)

References 79 publications

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“…This result is confirmed by several studies. The presence of hazards in the environmental setting (that has not been designed according to UD principles) increases the risk of falls for the older adults (Letts et al 2010;Stevens et al 2001, Northridge et al 1995Berg et al 1997). Obviously, Fig.…”

Section: Discussion Of the Resultsmentioning

confidence: 99%

“…Scholars suggest that certain aspects of the environment and the settings to which older people are daily exposed increase their risk of falls (Letts et al 2010;Stevens et al 2001). The results of a retrospective study in Australia indicate that older persons who live in houses with more environmental hazards (e.g.…”

Section: The Risk Of Injuries In Older Adults' Housesmentioning

confidence: 99%

“…In addition, physical attributes of older adults' houses (e.g. slippery floors, insufficient illumination) have long been associated with injuries among the older adults (Letts et al 2010;Stevens et al 2001); therefore, it could be expected that some environments are riskier than others for older adults.…”

Section: The Conceptual Frameworkmentioning

confidence: 99%

“…A higher number of falls take place in the areas of an apartment with lower levels of adoption of the principles of UD (e.g. the kitchen; Letts et al 2010;Stevens et al 2001). 3.…”

Section: The Conceptual Frameworkmentioning

confidence: 99%

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Assessing the quality of the indoor environment of senior housing for a better mobility: a Swedish case study

Bamzar

2018

J Hous and the Built Environ

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The aims of this article are to assess the quality of the indoor living environment of a senior housing (rental apartments for older adults aged 65+) in Hässelgården, Stockholm Municipality (Sweden's capital), in 2014, in relation to their mobility, and to suggest improvement strategies. First, the physical indoor environment of older adults is examined via a fieldwork checklist devised in accordance with the principles of universal design (UD). Second, their indoor environment is assessed through a survey that includes subjective questions about seniors' use of space, experience of falls, and safety perception. Third, the study explores whether the applications of UD in the seniors' indoor living environment contribute to the understanding of their use of space, experience of falls, and safety perception. Fieldwork inspections and a detailed survey with residents are used as a basis for the empirical analysis. Overall, 27 out of 56 questionnaires were collected, and ten apartments have been visited in the fieldwork. Findings indicate that the living room has the highest UD score compared with those for the kitchen and the bedroom. The older adults spend most of their time in the living room and the kitchen. A low UD score (e.g. kitchen and bedroom) is associated with a higher number of falls but not with low levels of safety perception and use of space. The article concludes with suggestions to improve housing safety of Hässelgården's senior housing, which may also help prevent falls in the older population elsewhere.

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Section: Discussion Of the Resultsmentioning

confidence: 99%

Section: The Risk Of Injuries In Older Adults' Housesmentioning

confidence: 99%

Section: The Conceptual Frameworkmentioning

confidence: 99%

“…A higher number of falls take place in the areas of an apartment with lower levels of adoption of the principles of UD (e.g. the kitchen; Letts et al 2010;Stevens et al 2001). 3.…”

Section: The Conceptual Frameworkmentioning

confidence: 99%

See 2 more Smart Citations

Assessing the quality of the indoor environment of senior housing for a better mobility: a Swedish case study

Bamzar

2018

J Hous and the Built Environ

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“…[82][83][84] Activity avoidance decreases physical functioning and can result in social isolation 85,86 associated with FRI risk. 87,88 Other studies have used socioeconomic status to proxy for an area's social environment and norms.…”

Section: Fall-related Injuries Among Older Adultsmentioning

confidence: 99%

Examining Contextual Influences on Fall-Related Injuries Among Older Adults for Population Health Management

Hoffman

Rodríguez

2015

Population Health Management

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The objectives were to assess the associations between fall-related injuries (FRIs) treated in the emergency department (ED) among older adults in California and contextual county-level physical, social, and economic characteristics, and to assess how county-level economic conditions are associated with FRIs when controlling for other county-level factors. Data from 2008 California ED discharge, Medicare Impact File, and County Health Rankings were used. Random effects logistic regression models estimated contextual associations between county-level factors representing economic conditions, the built environment, community safety, access to care, and obesity with patient-level FRI treatment among 1,712,409 older adults, controlling for patient-level and hospital-level characteristics. Patient-level predictors of FRI treatment were consistent with previous studies not accounting for contextual associations. Larger and rural hospitals had higher odds of FRI treatment, while teaching and safety net hospitals had lower odds. Better county economic conditions were associated with greater odds (ß = 0.73, P = 0.001) and higher county-level obesity were associated with lower odds (ß = -0.37, P = 0.004), but safer built environments (ß = -0.31, P = 0.38) were not associated with FRI treatment. The magnitude of association between county-level economic conditions and FRI treatment attenuated with the inclusion of countylevel obesity rates. FRI treatment was most strongly and consistently related to more favorable county economic conditions, suggesting differences in treatment or preferences for treatment for FRIs among older individuals in communities of varying resource levels. Using population health data on FRIs, policy makers may be able to remove barriers unique to local contexts when implementing falls prevention educational programs and built environment modifications. (Population Health Management 2015;18:437-448)

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Risk Assessment and Prevention of Falls in Older Community-Dwelling Adults

Colón-Emeric,

McDermott,

Lee

et al. 2024

JAMA

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ImportanceFalls are reported by more than 14 million US adults aged 65 years or older annually and can result in substantial morbidity, mortality, and health care expenditures.ObservationsFalls result from age-related physiologic changes compounded by multiple intrinsic and extrinsic risk factors. Major modifiable risk factors among community-dwelling older adults include gait and balance disorders, orthostatic hypotension, sensory impairment, medications, and environmental hazards. Guidelines recommend that individuals who report a fall in the prior year, have concerns about falling, or have gait speed less than 0.8 to 1 m/s should receive fall prevention interventions. In a meta-analysis of 59 randomized clinical trials (RCTs) in average-risk to high-risk populations, exercise interventions to reduce falls were associated with 655 falls per 1000 patient-years in intervention groups vs 850 falls per 1000 patient-years in nonexercise control groups (rate ratio [RR] for falls, 0.77; 95% CI, 0.71-0.83; risk ratio for number of people who fall, 0.85; 95% CI, 0.81-0.89; risk difference, 7.2%; 95% CI, 5.2%-9.1%), with most trials assessing balance and functional exercises. In a meta-analysis of 43 RCTs of interventions that systematically assessed and addressed multiple risk factors among individuals at high risk, multifactorial interventions were associated with 1784 falls per 1000 patient-years in intervention groups vs 2317 falls per 1000 patient-years in control groups (RR, 0.77; 95% CI, 0.67-0.87) without a significant difference in the number of individuals who fell. Other interventions associated with decreased falls in meta-analysis of RCTs and quasi-randomized trials include surgery to remove cataracts (8 studies with 1834 patients; risk ratio [RR], 0.68; 95% CI, 0.48-0.96), multicomponent podiatry interventions (3 studies with 1358 patients; RR, 0.77; 95% CI, 0.61-0.99), and environmental modifications for individuals at high risk (12 studies with 5293 patients; RR, 0.74; 95% CI, 0.61-0.91). Meta-analysis of RCTs of programs to stop medications associated with falls have not found a significant reduction, although deprescribing is a component of many successful multifactorial interventions.Conclusions and RelevanceMore than 25% of older adults fall each year, and falls are the leading cause of injury-related death in persons aged 65 years or older. Functional exercises to improve leg strength and balance are recommended for fall prevention in average-risk to high-risk populations. Multifactorial risk reduction based on a systematic clinical assessment for modifiable risk factors may reduce fall rates among those at high risk.

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The physical environment as a fall risk factor in older adults: Systematic review and meta‐analysis of cross‐sectional and cohort studies

Abstract: Home hazards appear to be a significant risk factor in older community-dwelling adults, although they may present the greatest risk for persons who fall repeatedly. Future research should examine relationships between mobility impairments, use of mobility aids and falls.

Cited by 80 publications

References 79 publications

Assessing the quality of the indoor environment of senior housing for a better mobility: a Swedish case study

Assessing the quality of the indoor environment of senior housing for a better mobility: a Swedish case study

Examining Contextual Influences on Fall-Related Injuries Among Older Adults for Population Health Management

Risk Assessment and Prevention of Falls in Older Community-Dwelling Adults

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