Environmental hazards and the risk of nonsyncopal falls in the homes of community-living older persons

BACKGROUND. Identifying and eliminating environmental hazards in the home has high face validity but little empirical support for fall prevention. OBJECTIVE. The objective of this study was to determine whether environmental hazards increase the risk of nonsyncopal falls in the homes of community-living older persons. RESEARCH DESIGN. This was a prospective cohort study. PARTICIPANTS. The study included 1,088 men and women from a probability sample of 1,103 persons greater than or equal to 72 years of age. MEASURES. A room-by-room assessment for 13 potential trip or slip hazards was completed at baseline and I year later by a trained research nurse using a standard instrument. Falls were ascertained monthly for 3 years using a fall calendar and follow-up phone calls. RESULTS. The numbers of participants with a nonsyncopal fall (by room) were as follows: 88 (kitchen), 144 (living room), 41 (hallway), 136 (bedroom), and 59 (bathroom). The risk of a nonsyncopal fall was significantly elevated for only 1 of the 13 trip or slip hazards. For exposure to greater than or equal to1 hazards per room, the relative risks adjusted for age, gender, and housing type were 0.91 (95% CI, 0.58-1.43) for the kitchen, 1.30 (95% CI, 0.92-1.83) for the living room, 1.73 (95% CI, 0.93-3.22) for the hallway, 1.29 (95% CI, 0.90-1.84) for the bedroom, and 0.57 (95% CI, 0.32-1.00) for the bathroom. No consistent association was found between the 13 trip or slip hazards and nonsyncopal falls, even after participants were categorized by impairments in vision, balance/gait, and cognition. CONCLUSIONS. Our findings do not support an association between environmental hazards and nonsyncopal falls.