Older persons strongly prefer to stay in their own homes and communities and never move. Unfortunately, however, the settings where they live often have numerous hazards, dangerous areas and lack supportive features, all of which can contribute to accidents, reduce activities, and foster unnecessary dependence. Since persons with functional limitations have an increased risk of falling, we need to address both their current needs and to insure that future housing and communities provide greater safety, accessibility and support.
Falls not only have devastating consequences for older adults in terms of morbidity and mortality, but also are associated with high acute and long-term care costs. A number of studies have reported that 30 to 60 percent of community-dwelling older adults fall each year. The fall incidence rates for this population range from 0.2 to 1.6 falls per person per year, with a mean of about 0.7 falls per year.1 In 1994, fall injuries among people 65 and older had a total direct cost of $20.2 billion.2 Research indicates that falls result from a complex interaction between intrinsic (e.g., age-related physiological changes) and extrinsic factors (e.g., environmental hazards). In addition, studies have found that multi-factorial intervention programs that include environmental modifications can effectively prevent over one-third of falls among older adults, thereby improving their independent functioning and enhancing their quality of life.
This paper provides an overview of fall incidence among community-dwelling older adults in terms of frequency and location, as well as environmental risk factors associated with falls at home and in community settings. It analyzes the role of home modification and community intervention strategies in preventing falls. Finally, it discusses challenges and barriers related to the environment, along with recommendations for better integrating the environment as a component of fall prevention strategies.