Household Hazards Are Not, as Commonly Believed, The Leading Cause of Falls By the Elderly

Slippery showers, loose throw rugs, obstructed pathways and other environmental hazards are not the leading cause of falls by the elderly living at home, a study by Yale researchers shows.

“We found, surprisingly, no relationship between potential hazards in the home and the occurrence of falls,” said Thomas Gill, M.D., associate professor of medicine and geriatrics at the Yale School of Medicine. “It’s been common wisdom that these conditions do cause falls. That’s why they are called hazards. But there is actually very little evidence to support that linkage.”

Gill, principal investigator of the study published in the December issue of the journal Medical Care, said the significance of the results is that money spent making homes of the elderly safer probably could be better utilized.

“Home safety assessments have been promoted as an important mechanism to prevent falls by the elderly,” he said. “Our study suggests that if you have a set amount of money, it would be better to target areas we already know are effective in preventing falls by the elderly, things like increasing muscle strength, improving gait and balance, proper use of assistive devices, correct footwear, and monitoring of medications.”

Falls are common among the elderly and often lead to loss of independence or even death. The rate of falls among persons 65 and older is about 30 percent, and among persons 80 or older, 50 percent. Of those elderly who do fall, about 10 percent sustain a serious injury, such as a fracture, joint dislocation, or severe head injury. Falls and fall related injuries also are associated with pain, loss of confidence, functional decline, and placement in a nursing home.

Gill and his co-researchers evaluated 1,088 New Haven residents 72 and older and performed home safety assessments to determine whether 13 potential trip or slip hazards were present. These included hazards such as loose throw rugs, obstructed pathways, and slippery bathtubs. They then contacted participants each month for three years asking if they had fallen, and, if they had, what were the circumstances.

Half of the participants had at least one fall over the three-year period that was not related to blacking out or losing consciousness, which is known as a “syncopal fall.” Inside the home, the falls occurred most commonly in the living room, bedroom and kitchen. But there was no consistent association between any of the 13 potential trip or slip hazards and the occurrence of a nonsyncopal fall.

“One of the reasons the study is important is because it goes against common wisdom and current practice,” Gill said. “While our findings should not be used to condone cluttered living spaces or to thwart sensible efforts to promote home safety, they do suggest that formal home safety assessments may not be a particularly effective strategy to prevent falls.”

A co-author of the study, Mary Tinetti, M.D., professor in the Departments of Internal Medicine, Geriatrics, and Epidemiology and Public Health, completed a study about six years ago showing that a multi-component program targeting primarily muscle weakness, poor balance, vision loss, proper footwear, and monitoring medications, among other precautions, was most effective in preventing falls by the elderly.

“Dr. Tinetti showed you can prevent falls in a cost effective way,” Gill said.

The study was co-authored by Tinetti and Christianna Williams, a senior analyst at the Yale Program on Aging.

The research was supported by grants from the National Institute on Aging, the Robert Wood Johnson Foundation, and the Paul Beeson Physician Faculty Scholar Program.