Risk Factors

The multiple risk factors for falling can be categorized as intrinsic or extrinsic. Intrinsic risk factors include age-related physiologic changes and diseases that affect the risk of falling (Table 4-3). Extrinsic risk factors include medications and environmental obstacles. The risk of falling increases significantly in people with multiple risk factors. A prospective study found that 19% of older patients with one risk factor have a fall in a given year, compared with 60% of older patients with three risk factors (Tinetti et al., 1998).

Taking four or more prescription drugs is itself a risk factor for falling. Also, several medication classes have a higher potential to cause falls, including tricyclic antidepressants, neuroleptic agents, serotonin reuptake inhibitors, benzo-diazepines, and class 1A antiarrhythmic medications. Narcotic analgesics, antihistamines, and anticonvulsants are also associated with increased risk for falls (Ensrud et al., 2002; Rubenstein and Josephson, 2002).

Physical restraints have been used in an attempt to reduce falling. Although the focus here is on community-dwelling elderly persons, it is worth noting that use of physical restraint in the nursing home and hospital setting does not reduce the risk of falling and is instead associated with an increased risk of injury (Neufeld et al., 1999). Since the 1980s, the use of physical restraints has been appropriately and dramatically reduced.

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