Annals of Long Term Care

With the expanding population of older adults, falls, which are closely associated with considerable mortality, morbidity, and medical expense, have aroused much attention regarding concerns about reducing and preventing fall events in elderly individuals. This literature review discusses intrinsic and extrinsic contributing factors of fall events and presents some specific types of exercise programs beneficial for older adults. (Annals of Long-Term Care: Clinical Care and Aging 2009;17[11]:30-34)

A rapidly expanding aging population is one of the factors that will impact healthcare services around the globe. According to statistics from the U.S. Bureau of the Census,¹ the population of older people who are age 65 years or older numbered 35 million in 2000 and represented 12.4% of the U.S. population. By 2030, there will be approximately 70.3 million older adults, representing almost 20% of the entire population. Accordingly, research focused on older adults, especially regarding how to promote successful aging and enhance the overall quality of life in the older population, has garnered much attention in recent years.

Specifically, an increased possibility of falls has been a serious problem associated with the process of aging.² About 35% of older people living in the community are likely to fall at least once in a year, and about 10% of these falls result in severe injuries, fracture, and head trauma.³ In addition, falls have been identified as significant contributors to decreased physical and social functions and to increased risk of long-term care (LTC) facility admission.⁴ Well-designed and appropriately implemented intervention programs may yield vital information in geriatric practice and research.

The purpose of this review article is to identify and investigate risk factors for falls, including intrinsic and extrinsic factors, and to discuss a variety of therapeutic and preventive approaches that have been utilized to reduce the number of fall incidents in older adults.

Risk Factors

Risk factors for falls are generally classified into two categories: intrinsic and extrinsic factors. The following sections will investigate some specific risk factors in each category and discuss some recent research findings.

Intrinsic Factors

Intrinsic risk factors relate to the individual and are typically associated with medical diagnosis, medication effects, and some age-related physiological changes.⁵

Age. Age has long been considered as a strong risk factor for falls among older adults, especially for people over age 85.⁶ Specifically, Stolze and colleagues7 confirm from their longitudinal investigation that age is not only an important risk factor for ordinary community-dwelling older people, but also has significant effects on fall events among neurological inpatients. Furthermore, McGibbon and associates8 explored falls from biomechanical perspectives and support the tremendous effects of aging on falls. Results from this study suggest that some age-related changes in the control of lower trunk movement during gait requires higher mechanical energy demands of lower trunk musculature, and therefore may reduce the ability to recover from dynamic instability.

Medical diagnosis. Disease-related changes, which impair central processing, neuromotor function, vision and vestibular function, proprioception, musculoskeletal, and systemic function, precipitate the occurrence of fall events, especially among the elderly.⁹ For example, arthritis, diabetes, Parkinson’s disease, cardiovascular disease, dementia, peripheral vascular disease, and gait and balance disorders have long been identified as risk factors for falls.