5. Determinants related to the physical environment
Factors related to the physical environment are the most common cause of falls in older age.
Physical environment plays a significant role in many falls in older age. Factors related to the physical environment are the most common cause of falls in older people, responsible for between 30 to 50% of them (11). A number of hazards in the home and public environment that interact with other risk factors, such as poor vision or balance, contribute to falls and fall-related injuries. For example, stairs can be problematic – studies show that unsafe features of stairs can be frequently identified including uneven or excessively high or narrow steps, slippery surfaces, unmarked edges, dis- continuous or poorly-fitted handrails, and inadequate or excessive lighting. Since approximately half of falls occurs indoor, the home environment is critical for avoiding them. A high particular risk to falls was found in homes with irregular sidewalks to the residence, loose carpets on the kitchen and bathroom floors, loose elec- trical wires, and inconvenient doorsteps. Poor surroundings around home such as garden paths and walks that are cracked or slippery from rain, snow or moss are also dangerous. Entrance stairs and poor night lighting can also pose risks.
Factors related to the public environment are also frequent causes of fall in older age. Even walking on a familiar route can lead to falls as a consequence of poor building design and inadequate consideration. Most problematic factors are cracked or uneven sidewalks, unmarked obstacles, slippery surfaces, poor lighting and lengthy distanc- es to sitting areas and public restrooms.
6. Determinants related to the social environment
Social connection and inclusion are vital to health in older age. Social interaction is in- versely related to the risk of falls.
Isolation and loneliness are commonly experiences by older people particularly among those who lose their spouse or live alone. They are much more likely than other groups to experience disability and the physical, cognitive, and sensory limita- tions that increase the risk of falls. Isolation and depression triggered by lack of social participation increase fear of fall- ing, and vice versa. Fear of falling can in- crease the risk of falls through a reduction in social participation and loss of personal contact - which in turn increase isolation and depression. Providing social support and opportunities for older people to par- ticipate in social activities to help maintain active interaction with others may decrease their risk of falls.