Non-syncopal falls in the elderly in relation to home environments

Methods of prevention of falls in the home may differ for healthy and frail individuals. We therefore sought to determine whether measures of health and functioning in older persons are more useful in predicting falls at home not involving home hazards (non-environmental falls) than falls at home related to home hazards (environmental falls), and whether these relationships differ among those who fell once and those who fell multiple times during follow-up. Data for this analysis are from a 1-year prospective cohort study of 325 community-dwelling volunteers aged 60–93 years who had fallen during the year before baseline. In general, associations were stronger between poor functional ability and non-environmental falls than between poor functional ability and environmental falls. Independent predictors of non-environmental first falls during follow-up included Parkinson's disease (adjusted odds ratio (AOR) 7.66, 95% confidence interval (95% CI) 1.15–51.1) and being home alone 10 or more hours per day (AOR 2.36, 95% CI 1.20–4.61); independent predictors of environmental first falls during follow-up included arthritis (AOR 2.60, 95% CI 1.32–5.09) and poor depth perception (AOR 0.73, 95% CI 0.59–0.89, for each unit increase in depth perception score). Also, associations between poor function and falls were generally stronger among participants who fell repeatedly than among individuals who fell only once during the follow-up year. In conclusion, poor function predisposes to non-environmental falls at home in older persons and, to a lesser extent, environmental falls in those who fall repeatedly. Certain functional characteristics such as poor depth perception may predispose to environmental falls to a greater extent than do other disabilities.