Environmental hazards and the risk of nonsyncopal falls in the homes of community-living older persons

Abstract

Background: Identifying and eliminating environmental hazards in the home has high face validity but little empirical support for fall prevention.

Objective: The objective of this study was to determine whether environmental hazards increase the risk of nonsyncopal falls in the homes of community-living older persons.

Research design: This was a prospective cohort study.

Participants: The study included 1,088 men and women from a probability sample of 1,103 persons > or =72 years of age.

Measures: A room-by-room assessment for 13 potential trip or slip hazards was completed at baseline and 1 year later by a trained research nurse using a standard instrument. Falls were ascertained monthly for 3 years using a fall calendar and follow-up phone calls.

Results: The numbers of participants with a nonsyncopal fall (by room) were as follows: 88 (kitchen), 144 (living room), 41 (hallway), 136 (bedroom), and 59 (bathroom). The risk of a nonsyncopal fall was significantly elevated for only 1 of the 13 trip or slip hazards. For exposure to > or =1 hazards per room, the relative risks adjusted for age, gender, and housing type were 0.91 (95% CI, 0.58-1.43) for the kitchen, 1.30 (95% CI, 0.92-1.83) for the living room, 1.73 (95% CI, 0.93-3.22) for the hallway, 1.29 (95% CI, 0.90-1.84) for the bedroom, and 0.57 (95% CI, 0.32-1.00) for the bathroom. No consistent association was found between the 13 trip or slip hazards and nonsyncopal falls, even after participants were categorized by impairments in vision, balance/gait, and cognition.

Conclusions: Our findings do not support an association between environmental hazards and nonsyncopal falls.