Prevention of Unintentional Injuries Among Seniors

Workshop on Healthy Aging:
November 28-30, 2001

Table I: Direct and Indirect Risk Factors for Falls
and Fall-related Injuries Among Older Adults

Biological factors

Injuries, in particular falls, are more common among those with decreased visual acuity, slowed protective reflexes, declining muscle strength and mass, and osteoporotic changes. Certain chronic diseases, such as cerebrovascular, cardiovascular and neurological disorders, also present increased risk. Problems with gait and balance are also associated with falls; however, these problems may be related to increased frailty, disease processes, medication use or malfunctioning of basic body systems.

A consistent finding in the literature is that age and gender are important issues in relation to falling. For example, women 65 years of age or older fall twice as often as their male counterparts. The gender gap, however, decreases in progressively older age groups. Women who experience multiple falls tend to be older, have poorer vision and are more likely to have osteoporosis and be wearing poorly designed high-heeled shoes. Between 1983 and 1992, falls were the second leading cause of hospitalization among women 65 years of age or older. In 1998, deaths attributed to fall-related injuries among men 85 years of age or over were 20 times higher than the rate for men between the ages of 65 and 74. Among women of the same ages, the rate was 44 times higher.

An analysis of the 1996 National Population Health Survey found that although more women are injured than men, men and women are equal in terms of the most serious injury due to falls. Other studies have also shown that whereas more women are injured in falls, more men die from fall-related injuries.

However, it should be noted that it is not the age or gender per se that increases the risk of falling but presence of illness or disability, and the symptoms or limitations imposed by these conditions, that contribute to the risk.

Behavioural factors

Behavioural factors are most often considered those under the control of the person at risk of falling. However, for many of these factors, changes in the behaviours of others have the potential to lessen the risk (e.g. therapists and retailers who provide information for seniors on the safe and appropriate use of mobility aids and physicians who monitor seniors' prescriptions for side effects that increase the risk of falling).

It is well known that medication use increases with advancing age due to the greater prevalence and severity of health problems among seniors. In addition to taking more drugs, older people also develop a heightened sensitivity to drug effects. Drug interactions, side effects and polypharmacy are all associated with increased risk of falling and injury among older persons. The class of drugs with the most well-established link to fall-related injuries among seniors is benzodiazepines (sedatives and tranquilizers). One study found that seniors taking psychotropic drugs have a 70% to100% increase in the risk of hip fracture. Drugs most commonly associated with increased risk injury due to motor vehicle crashes among older drivers are anti-depressants and opioid analgesics.

Alcohol, like medication, is known to attain higher levels in the blood stream of older people compared to younger people who have consumed equal amounts. Prolonged and heavy use is also linked to neurological impairments and is suspected of contributing to decreased bone density in older persons - both known risk factors for fall-related injuries. A recent study in the United States showed that over three years, half of the 7,772 trauma patients 65 years of age or older tested positive for alcohol; of these, 50% were involved in a fall and 37% in a motor vehicle crash.

The health benefits from exercise are well documented. However, seniors are not a homogeneous group, and the most appropriate exercise type, duration and intensity for reducing falls and fall injuries among seniors is not well understood. One of the few exercise programs that has been directly linked to a reduction in falls is the Chinese martial art exercise known as Tai Chi. Unfortunately, there are few studies that address the availability of exercise programs for seniors in the lower income brackets or exercise programs adapted to meet the needs of persons who use mobility aids such as wheelchairs or scooters. An additional challenge to promoting exercise among seniors are self-imposed activity limitations commonly found among those who have already experienced a fall, due to a fear of falling again.

Environmental factors

Environmental factors account for one third to one half of all falls among seniors. Outdoor risks for falling include stairs, low-lying objects, cracked and icy sidewalks, rapid changes in illumination and glare. Indoor risks include poor lighting, objects in pathways, lack of stair handrails, slippery rugs and surfaces, and poorly maintained walking aids and equipment. There is a lack of research on links between inadequate policies governing safety in the built environment and injuries due to falls. Few studies point to the responsibility of those who design and construct built environments for creating safe environments for seniors.

Environmental factors also concern policies designed to regulate the physical environment. For the prevention of burn injuries due to scalding and fires, one study showed that changes in legislation were the most effective means of reducing the rate of injury. This included the mandatory lowering of the temperature for hot water tanks, and regulations regarding fire alarms and sprinkler systems in seniors' housing.

Social and economic factors

The relationship between income status and injuries has been identified as indirect, possibly resulting from the relationship between low income and the development of sensory disabilities. For example, the low income of seniors, particularly senior women, may be one contributing factor toward seniors developing sensory disabilities, and impaired vision and hearing may be direct factors for seniors falling. In addition, cost was also one of the most common reasons given by seniors with disabilities for not having a needed assistive device (e.g. walker or cane), thereby further contributing to their risk of falling. A recent study also found that people with lower incomes had more chronic illness; this, in turn, was related to a greater likelihood of falling.

A review of the literature indicates that under-utilization of assistive devices by older adults can be linked to the broader social environment. For example, ageism and negative socio-cultural values concerning loss of independence, functional decline and device use may be barriers to use of such devices among seniors.

Low socio-economic status has also been shown to be one of the strongest risk factors for deaths from residential fires, particularly among seniors.

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