Environmental and behavioral circumstances associated with falls at home among healthy elderly individuals

Objective: To conduct an in-depth examination of the environmental and behavioral circumstances associated with falls and near-falls experienced by elderly individuals and to evaluate the usefulness of reenactment as a method for studying falls. Design: Observational and self-report data of incidents were obtained through a reenactment procedure. Environmental characteristics were documented with physical measurements, visual inspection, and photography. Setting: Incidents occurred inside participants' homes, and reenactments were conducted at incident sites. Participants: Subjects were 15 community-dwelling, relatively healthy individuals, age 70 to 81 years. Main Outcome Measures: Incidents were analyzed to determine patterns of interaction of individuals' personal characteristics, environmental use behaviors, and environmental characteristics. Results: Seven patterns were identified: collisions in the dark, failing to avoid temporary hazards, preoccupation with temporary conditions, frictional variations between shoes and floor coverings, excessive environmental demands, habitual environmental use, and inappropriate environmental use. Conclusions: There is a dynamic interaction between environmental conditions and behavior involving use of the environment and its implications for falls in older people. Although some incidents involved familiar environmental and behavioral risk factors, less familiar factors also were critical contributors to the incidents. Successful elimination of these factors is likely to be closely related to an individual's perception that an environmental or environmental use problem is correctable, motivation to undertake changes in the environment, and a desire to integrate changes into daily activities. (C) 1997 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.