The multiple risk factors that cause falls require an evidence-based fall prevention program specifically tailored to the needs of the population requiring the intervention. Identifying individuals at risk for falls is important in effective program planning.
Older adults are categorized according to their functional status based on their sensory, cognitive, and physical functions. In Tokyo, Japan, Centenarians were categorized as exceptional, normal, frail, and fragile. Individuals were considered exceptional if they were completely independent with their basic ADLs, had intact vision and hearing, and had excellent cognitive functioning. Participants were considered normal if they were somewhat independent with basic ADLs and had good cognitive functioning. Participants were categorized as frail if they demonstrated deficits with basic ADLs or had impaired cognitive functioning. Finally, individuals were categorized as fragile if they were utterly dependent on basic ADLs and had significantly impaired cognitive functioning. Considering older adults' functional status is important as it may also influence their risk factors for falls.
Fallers can be categorized by their frailty level. Frailty is "a geriatric syndrome resulting from cumulative age-related decline across multiple physiologic systems, impaired homeostatic reserve, and reduced capacity to resist stress (Mohler et al., 2016, p 655)." Frailty can be assessed using the components of the Fried Frailty Phenotype criteria that include (Buckinx, 2015):
- Self-reported unintentional weight loss of at least 10 pounds in the previous year
- Weakness based on grip strength testing
- Slow walking speed
- Self-reported exhaustion and low energy expenditure
Individuals are considered non-frail if they do not meet any of the criteria, pre-frail if they meet one or two criteria, and frail if they meet three or more criteria (Buckinx, 2015). In his article, Kojima (2015) conducted a systematic review of literature and meta-analysis from 2010 to April 2015, examining future fall risk according to frailty among community-dwelling older adults with no language restrictions. Among community-dwelling older adults, frailty was a significant predictor of future fall risks, and frailty appeared to be higher in men than in women (Manning & Wolfson, 2017).
Fallers can also be categorized into first-time and recurrent fallers. In a 2010 study involving 1066 French community-dwelling adults age 65 and older, participants were separated into four groups: individuals who had:
- Not fallen
- Experienced one fall
- Experienced two falls
- Experienced more than two falls
Of the 1066 participants, 37.1% were fallers, 27.3% experienced one fall, and 9.8% were recurrent (two or more). That study found that institutionalization, age, taking several medications, and muscle weakness were related to falls but no recurrence. However, the study also concluded that poor vision, lower limb proprioception, fear of falling, and being female were all fall markers.
A 2015 prospective cohort study with 248 community-dwelling older adults examined the connection between frailty and short-term incident future falls among community-dwelling older adults (Kokima et al., 2015). All participants were 65 years old or older and did not have a history of more than three falls (Kokima et al., 2015). Frailty was a significant and independent predictor of short-term future falls among community-dwelling older people who had volunteered for a physical activity study (Kokima et al., 2015).
This research can be used to customize fall prevention programs for individuals who have not experienced falls and for recurrent fallers. The research from this study can be used to develop programs for one-time and recurrent fallers (Kokima et al., 2015).