Falls cause high morbidity and mortality rates in elderly persons (Rubenstein, 2006). In the community-dwelling elderly population, one-third of all individuals fall at least once a year (Close et al., 2005 and Tinetti et al., 1988). Approximately 10% of these falls result in injuries, half of which are fractures. Furthermore, falling can often have psychosocial consequences such as fear of falling (Berg et al., 1997 and Tinetti and Williams, 1997). Consequently, this may lead to a reduction in physical activity, which in turn may result in (further) functional decline and a loss of independence (Tinetti et al., 1988 and Wagemans and Cluitmans, 2006).
Elderly persons with intellectual disabilities (ID) seem to be at an even higher risk of falling and experiencing fall-related injuries than their mentally healthy peers (Cox et al., 2010, Finlayson et al., 2010, Grant et al., 2001, Hsieh et al., 2001 and Wagemans and Cluitmans, 2006). The reported percentage of ‘fallers’ (i.e. persons who fall at least once during the observation period) range from 34% to as high as 70% (Cox et al., 2010, Finlayson et al., 2010, Grant et al., 2001 and Hsieh et al., 2001). In the aforementioned studies, the observation period ranged from one year up to five years. Injuries have been attributed to falls in 50–62% of cases (Hsieh et al., 2001 and Sherrard et al., 2001). Nevertheless, our understanding of the factors that underlie the increased risk of falling among persons with ID is rather limited.
In the general elderly population, the risk factors associated with falling have been studied extensively (Close et al., 2005 and Tinetti et al., 1988). These risk factors can be divided into extrinsic (e.g. environmental factors such as obstacles and support surface) and intrinsic (e.g. personal factors related to the physical and/or cognitive status of the individual) factors (Close et al., 2005). In the elderly population, the primary intrinsic risk factors for falling are mobility problems (e.g. impaired balance and/or gait), advanced age, limitations in activities of daily living, sensorimotor impairments, medication use (e.g. polypharmacy and/or psychoactive drugs), and medical conditions such as (pre-)dementia, stroke and Parkinson's disease (Close et al., 2005).
Elderly persons with ID encounter the same extrinsic risk factors for falling. The aforementioned intrinsic risk factors may also apply to persons with ID, but perhaps to a different degree, as several fall risk factors are more prevalent among persons with ID. A recent review has indicated that balance and gait impairments occur more often and start at a younger age in persons with ID (Enkelaar, Smulders, van Schrojenstein Lantman-de Valk, Geurts, & Weerdesteyn, 2012). Moreover, visual impairments and polypharmacy are more prevalent among persons with ID (Evenhuis et al., 2001 and Straetmans et al., 2007). Finally, impaired cognition itself is a known risk factor for falling (Close et al., 2005 and Tinetti et al., 1988).
Several exploratory studies have been performed to investigate intrinsic risk factors for falling among persons with ID (Cox et al., 2010, Finlayson et al., 2010, Grant et al., 2001 and Hale et al., 2007). Although a recent review identified advanced age, impaired mobility, epilepsy, medication use, and behavioural problems as risk factors for falling among persons with ID, the authors concluded that additional research is needed to prospectively investigate these factors in this population (Willgoss, Yohannes, & Mitchell, 2010). Indeed, most of the data regarding fall incidents in previous studies has been collected from retrospective reports, medical records, or client records (Cox et al., 2010, Finlayson et al., 2010, Grant et al., 2001 and Wagemans and Cluitmans, 2006), and a retrospective assessment of falls often leads to an underestimation of the fall rate (Ganz, Higashi, & Rubenstein, 2005). Therefore, the Prevention of Falls Network Europe (ProFaNe) recommends prospectively monitoring falls for a follow-up period of at least one year (Lamb, Jorstad-Stein, Hauer, & Becker, 2005). However, to the best of our knowledge, no such prospective study has investigated risk factors for falling among the elderly ID population.
The aim of this study was to identify the specific risk factors that underlie falling among elderly persons with mild-to-moderate ID. In addition, we tested whether differences in risk factors exist between persons who fall indoors and persons who fall outdoors, as in community-dwelling older people, their characteristics have been shown to differ distinctly (Kelsey et al., 2012).
