Intrinsic factors
Tinetti et al4
conducted a prospective in-
vestigation that identified a combination of
characteristics that predispose some elderly
persons to falling. After physical examina-
tion, questionnaire, and balance and gait
evaluations, the investigators identified nine
risk factors associated with falling among 79
skilled nursing facility residents. The sub-
jects were grouped into the following catego-
ries: low fall risk (up to three risk factors),
intermediate fall risk (four to six risk factors),
and high fall risk (seven to nine risk factors).
Almost all recurrent fallers in this study dem-
onstrated the following risk factors: poor
back flexibility, decreased lower-extremity
strength, and poor distant vision.
Other risks associated with recurrent fall-
ing were decreased mental status, hearing
problems, poor endurance, decreased knee
strength, and postural hypotension. Among
one-time fallers, poor mental status, de-
creased vision, and poor mobility or ADLs
score were the common factors. Balance and
gait evaluations revealed that many subjects
also had difficulty with rising or sitting, in-
stability on first standing, staggering on turn-
ing, and short, discontinuous steps. There-
fore, Tinetti et al4
concluded that a balance
and gait evaluation is useful but not adequate
to discriminate between all fallers and
nonfallers and emphasized that more risk
factors must be assessed.