Reporter Volume 25, No.6 October 7, 1993

By LOIS BAKER
News Bureau Staff
A UB study to determine when, where, why and how often relatively
healthy residents of a senior-citizen facility experience falls has
shown that even in a setting well-known by its inhabitants and
designed specifically for their safety, more than a quarter of the
residents have fallen at least once.
	Half of the falls were attributed to environmental factors,
the study showed, and the walker, a device designed to help provide
stability, was named as the culprit in 15 percent of the falls.
Furniture was mentioned as the culprit in half of the cases. 
	These findings, combined with data from an earlier UB study
showing a direct association between muscle weakness and the number of
times nursing-home residents fell, led the researchers to recommend
muscle rehabilitation as part of standard care for older adults, and
to call for better-designed assistive devices.
	"What really surprised us about this study was that things
residents were very familiar with and were designed to help them, or
at least were designed to be safe, were the things they fell over, not
hazards like loose rugs or rough floors," said Beth Erasmus Fleming,
UB clinical assistant professor of physiology and principal author of
the study.
	David R. Pendergast, professor of physiology, is co-author of
the study, which is published in Archives of Physical Medicine and
Rehabilitation.
	Falls contribute to 40 percent of all nursing-home admissions
in the United States, Erasmus Fleming said. Statistics show that
one-third of persons older than 75 living independently fall at least
once, and a quarter suffer serious injury.
	In the UB study, the researchers analyzed 294 falls reported
over three years and involving 95 residents of an adult-care facility,
and interviewed persons currently living in the facility about their
falls. They noted the location and time that each accident occurred,
and categorized them according to cause:
	% Environmental (furniture, wheelchairs, walkers, canes,
vehicles, floor surfaces)
	% Physical condition of the resident (dizziness, arthritis,
loss of balance, medications)
	% Physical activity of the resident (rising from a chair or on
stairs, bending, walking, making bed)
 	More than 50 percent of the falls were caused by objects or
conditions in the environment, results showed, with furniture
mentioned as the culprit in half of the cases. Walkers were the second
most-frequently mentioned environmental cause, followed closely by
floor finish.
	Nearly a quarter of all falls were attributed to the
resident's physical condition, with loss of balance, dizziness and
collapsed knees accounting for 81 percent of the falls. 
	Physical activities precipitated only 7.9 percent of the
falls. No clear indication of cause was reported in 17 percent of the
accidents.
	A majority of the fallsQ57 percentQtook place in residents'
rooms, with about 16 percent happening in bathrooms. The remainder
took place in hallways, outdoor sidewalks, dining rooms and
elevators--areas where residents would be circulating or congregating.
Erasmus Fleming said stairways, presumed to be a hazard for older
adults, caused only 4 percent of the falls in this study. 
	More falls occurred in the morning than in the afternoon or
the evening, results showed, although rates were fairly constant
throughout the day. Nearly one-quarter of the accidents occurred
during the night. 
	Because few falls occurred as a result of physical activity,
and the accidents occurred fairly uniformly over a 24-hour period in
situations and settings very familiar to the residents, the
researchers concluded an elderly person's frail physical condition was
a primary cause of many of the accidents.
	"Although 50 percent of the falls were precipitated by the
environment in this study," Erasmus Fleming said, "we conclude that a
large percentage of these may be caused by physical limitations that
prevented residents from interacting safely with their environment."