For the elderly, all falls are not the same

Researchers find risks for indoor and outdoor falls in older adults differ; targeted prevention needed

By Sandra Gray

UMass Medical School Communications

June 10, 2011

Wenjun Li
  Wenjun Li, PhD

The numbers are startling: approximately 35 to 40 percent of adults aged 65 and older living in their community (distinct from those in nursing homes and other institutions) fall each year, and complications from falls is the fifth-leading cause of death in older adults. Often resulting in impaired function, reduced quality of life, earlier admission to nursing homes as well as premature death, falls among the elderly is a public health issue of growing importance.

At the latest Department of Medicine Research Lecture on June 8, Wenjun Li, PhD, associate professor of medicine in the Division of Preventive and Behavioral Medicine, shared findings from “Neighborhood Risk Factors for Falls in the Elderly,” the four-year, $1.4 million study funded by the National Institute on Aging of which he is principal investigator. Most significant was the finding that the risks for indoor and outdoor falls in older adults differ, and targeted prevention efforts are needed. 

Analyzing data from the Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly of Boston (MOBILIZE) Study which measured multiple attributes that might positively or negatively impact an individual’s risk of falling, investigators found that indoor falls were associated with disability, poor health and an inactive lifestyle, while outdoor falls were associated with an active lifestyle and average or better-than-average health. Only a few attributes, including history of falls in the past year, depression and high educational level, were associated with both indoor and outdoor falls.

Li, Jennifer Kelsey, PhD, professor of medicine, and their collaborators from the Institute for Aging Research, Hebrew SeniorLife and Harvard Medical School published the results in the November 2010 issue of the Journal of the American Geriatrics Society. The authors observed that most elderly fall prevention efforts have focused on trying to make the home environment less hazardous—despite the fact that at least half of falls in community-dwelling older people occur outdoors.

The analysis also found that rates of indoor and outdoor falls varied from neighborhood to neighborhood, suggesting the need for further analysis of how the external environment, for example types of paving materials and the presence and quality of sidewalks, and socioeconomic factors such as poverty level and the presence of crime in a neighborhood, can be addressed to improve the risk of falls for older adults in varied geographic settings.

They concluded that prevention recommendations would be more effective if targeted differently for frail, inactive older people at high risk for indoor falls and relatively active, healthy people at high risk for outdoor falls. Acknowledging that the interrelationships between the many potential risk factors and attributes are complex, and that the research thus far raises many more questions to answer, Li hopes to conduct further studies that will help prevent falls in those elders at highest risk by taking into consideration the neighborhoods in which they live, as well as strengths and weaknesses in their intrinsic physical and mental health.

“Community-based intervention strategies that consider both individual and neighborhood environmental factors are likely to be more effective in promoting active aging, preventing fall injuries, and reducing medical care costs among the elders,” he said.

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