Research shows that nearly one-third of adults aged 65 and older fall down each year. And although nearly half of these falls occur outdoors, the primary focus of most research has been on indoor rather than outdoor falls.
Now a new study, published in the journal Archives of Gerontology and Geriatrics, focused solely on the outdoor fall experiences of older adults living in New York City. The findings are being used to develop and pilot an outdoor fall prevention program.
While some risk factors for indoor and outdoor falls are the same, such as depression, fall history, and use of certain medications, there are also a number of differences. People at greater risk for outdoor falls tend to be younger, healthier, and more active, for example, while older, frail or homebound adults tend to be more likely to suffer indoor falls.
This is why many experts assert that combining the risks of indoor and outdoor falls, as is done in many studies, leaves out important information.
“Despite their frequency, outdoor falls receive little attention when it comes to education and prevention,” said Tracy Chippendale, assistant professor of occupational therapy at New York University (NYU) Steinhardt School of Culture, Education, and Human Development and the study’s lead author.
For the study, the researchers set out to investigate the experiences and fall prevention knowledge of older adults living in the community, not in housing for seniors. Using random digit telephone dialing, the researchers surveyed 120 adults age 55 and older across the five boroughs of New York City.
Of those surveyed, 71 percent (85 people) had fallen outdoors in their adult years. Of those who had experienced an outdoor fall, 28 had minor injuries such as scrapes and bruises, 18 had moderate injuries with prolonged pain or soreness, and nine had severe injuries such as fractures, rotator cuff injuries, or injuries requiring stitches or surgery.
Beyond physical injuries, respondents commonly described having an emotional response to the fall, including fear of falling again or embarrassment, the latter of which may affect one’s willingness to disclose a fall or seek medical attention.
A number of people surveyed reported their falls occurring during otherwise healthy activities such as exercising or walking a dog. For many participants, the falls were triggered by environmental factors, such as objects (metal post, branch, stones), surface conditions (slippery or uneven) or stairs, particularly at entranceways. Many participants attributed falls in part to their own practices, such as wearing ill-fitting or inappropriate shoes, not paying attention, or walking too fast.
In addition, those surveyed frequently described multiple factors that contributed to their fall, such as rushing on an icy surface or being distracted on an uneven surface.
Overall, the survey revealed a number of unmet education and training needs for outdoor fall prevention among community-dwelling older adults. For example, older adults should be educated on the importance of wearing single vision glasses and proper footwear, which have been flagged as common causes for falls. People should also be educated on the risks associated with recreation areas and parking lots or garages, since these have been shown to be common fall locations.
Adults could also benefit from training on fall prevention strategies, including safety during routine activities such as carrying items on uneven surfaces, going up and down stairs, and opening or closing doors. Education around safe outdoor walking strategies (avoiding distractions, navigating sloped and uneven surfaces, and walking slower) would also be beneficial.
“Programs to prevent outdoor falls should include information on outdoor fall risks, action planning for the adoption of prevention behaviors, and training in safe performance of everyday activities,” said Chippendale.
Source: New York University