The physical environment as a fall risk factor in older adults: Systematic review and meta-analysis of cross-sectional and cohort studies

Background/aim: Evidence that the physical environment is a fall risk factor in older adults is inconsistent. The study evaluated and summarised evidence of the physical environment as a fall risk factor. Methods: Eight databases (1985-2006) were searched. Investigators evaluated quality of two categories (cross-sectional and cohort) of studies, extracted and analysed data. Results: Cross-sectional: falls occur in a variety of environments; gait aids were present in approximately 30% of falls. Cohort: Home hazards increased fall risk (odds ratio (OR) = 1.15; 95% confidence interval (CI): 0.97-1.36) although not significantly. When only the high quality studies were included, the OR 1.38 (95% CI: 1.03-1.87), which was statistically significant. Use of mobility aids significantly increased fall risk in community (OR 2.07; 95% CI: 1.59-2.71) and institutional (OR 1.77; 95% CI: 1.66-1.89) settings. Conclusions: Home hazards appear to be a significant risk factor in older community-dwelling adults, although they may present the greatest risk for persons who fall repeatedly. Future research should examine relationships between mobility impairments, use of mobility aids and falls.