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There have been extensive studies into which risk factors have the greatest association with falls. This section discusses falls risk factors, why they are important and how to identify them at an individual, organisational and community level. It also includes information on individual falls risk screening tools and community falls risk awareness tools.
A risk factor is something that increases your chance of falling [114]. Falls commonly result from a combination of risk factors [77] as 'the risk of falling increases with the number of risk factors that are present' [115]. The number of risk factors increases as a person ages [115].
Risk factors can be classified in a number of ways [56]. One of the well-known methods is to classify them as either personal (intrinsic) or environmental (extrinsic). Personal risk factors include individual characteristics such as age, gender, ability and health conditions [115]. Environmental risk factors refer to hazards found in and around the home and in public places, such as uneven surfaces and the lack of hand or grab rails [115].
Identifying and modifying the risk factors that individuals and the whole community are exposed to can reduce the risk of falls [114]. As falls are caused by a number of risk factors, it is necessary to identify and modify multiple risk factors at one time in order to reduce falls. This is known as a multi-factorial approach.
However, not all risk factors can be modified. For example, age is a falls risk factor that cannot be changed, whereas reduced lower limb strength is a falls risk factor that can be improved.
The Queensland Stay On Your Feet® Community Good Practice Guidelines lists the risk factors currently linked with falls according to their strength of association and the ability for the risk factor to be modified [56]. The risk factors considered to have a high association with falls, which are also modifiable, include:
At an individual level, health care professionals can identify risk factors using risk-screening tools and by using risk assessment tools as appropriate. Falls risk screening is of no value if there is already an identified risk, and a falls risk assessment is of no value if interventions are not followed through with action [12, 56].
To identify individuals at risk of falling use a falls risk screening tool or specific tests. The following falls risk screening tools and tests are recommended by systematic reviews or the Queensland Stay On Your Feet® Community Good Practice Guidelines [56]:
Elderly Fall Screening Test (EFST)
Use this five item test to divide subjects into low and high risk, based on falls history and observations of walking speed and gait style. It is available on the Saskatoon Health Region website.
Geriatric Postal Screening Survey (GPSS)
Use this 10 item screening tool to screen for specific geriatric conditions including falls and balance problems, urinary incontinence, depression, memory loss, mobility issues, weight loss, polypharmacy, and pain. It is available by clicking on the following link Geriatric Postal Screening Survey (permission granted by Geriatric Research, Education and Clinical Centre, Veterans Affairs, Greater Los Angeles Healthcare System).
Falls Risk for Older People - Community Setting (FROP-Com Screen)
This screening tool is an abbreviated version of the Falls Risk for Older People in the Community (FROP-Com) tool. This three item tool takes less time than the full FROP-Com and will be suitable for busy settings, such as emergency departments. The screening tool will help to determine those at greatest risk of future falls and who need a more comprehensive falls risk assessment. This risk screening tool and guidelines are available for use from the National Ageing Research Institute.
The following two tools are used to detect other risk factors associated with falls, such as a person's fear of falling and level of depression:
The Stanford University website features an online Geriatric Depression Scale (no copyright) allowing you to load responses to the 15 item scale and generate results which can then be downloaded.
Once risk factors have been identified, a health care professional should complete a comprehensive falls risk assessment and ensure that relevant interventions are arranged with the older person, their family and/or carer.
At an organisational level, there are three issues that may need to be considered:
1. Falls risk management for employees and clients
A booklet 'Slips, trips and fall prevention' produced by the Department of Employment and Industrial Relations is a useful resource.
2. Falls risk screening tools for health organisations
Health organisations determining the falls risk of their clients may find falls risk screening tools useful. Falls risk screening tools should:
To access falls risk screening tools that meet the above criteria, refer to Risk Factor Screening for Individuals.
3. Falls risk screening for all organisations who work with older people
Many organisations who work with older people can contribute to falls prevention by addressing particular falls risk factors related to their core business or through promoting healthy active ageing. Organisations need to consider their current actions and what else could be done within their sphere of influence.
Ideally, the best way to prevent falls would be to protect the whole community from risk factors in the first place [77]. To do this, it is necessary to identify why these risk factors occur. These underlying reasons are known as:
At a community level, it is important to address the underlying reasons why these risk factors occur in the whole community over the course of a person's life. The focus could be on:
When working at the community level, use a falls risk awareness tool such as a checklist.
A falls risk awareness checklist is a self-administered education tool designed to raise awareness of falls and their risk factors and can also be used to test knowledge about falls [31]. Such a checklist helps to alert older people to their personal risk and/or environmental hazards that they need to address. Using a checklist is a way to make the issues of falls prevention and healthy active ageing more important and relevant to older people.
You could use checklists at awareness raising events such as education sessions, displays and expos. Note: These tools do not rate the risk of falls and are not assessed against the same criteria as a more rigorous risk-screening tool. For a short Queensland Stay On Your Feet® risk awareness checklist, refer to the Will I stay active and independent? checklist.
More detailed checklists may include personal and/or environmental hazards in and around the home. These checklists are either self-administered or completed with the assistance of a health professional. This encourages older people to check their risk factors and rectify the hazards in and around their home by following simple suggestions to reduce the risk of falls. For the detailed Queensland Stay On Your Feet® risk awareness checklist, refer to the How to Stay On Your Feet® checklist.
The Queensland Stay On Your Feet® Community Good Practice Guidelines [56 ] has condensed relevant research about falls risk factors into one document. For more in-depth information about falls risk factors, risk awareness, risk screening and assessment methods, refer to the Queensland Stay On Your Feet® Community Good Practice Guidelines.
There are also a number of other key publications that can be reviewed for further understanding of the role of risk factors play in falls, including:
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