Abstract The occurrence of injuries in the home environment is common to older adults, especially elderly women, in most developed countries. The research literature on this subject is reviewed. This paper also identifies some of the situations that occur that lead to injury and that could also be responsive to preventive efforts

David Beasley

Ph.D Dale O Ritzel

RN, BS Jerilu Flynn

RN, BS Maureen Liefer

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The International Electronic Journal of Health Education, 2001; 4:64-66
http://www.iejhe.org 
Injuries to Elderly Women in the Home Environment:  A
Research Review
Dale O. Ritzel, Ph.D.1; David Beasley2; Jerilu Flynn, RN, BS2;
Maureen Liefer, RN, BS2
1 Professor of Health Education, Southern Illinois University; 2 Graduate Students, Health Education, Southern
Illinois University
Corresponding author: Dale O. Ritzel, Department of Health Education and Recreation, Southern Illinois
University at Carbondale, Pulliam 307, MS 4632 Carbondale, IL 62901; phone: 618.453.2777; fax: 618.453.1829;
email: DRITZEL@SIU.EDU 
Abstract
The occurrence of injuries in the home environment is common to older adults, especially elderly women, in most
developed countries.  The research literature on this subject is reviewed.  This paper also identifies some of the
situations that occur that lead to injury and that could also be responsive to preventive efforts.
Introduction
Several of the studies assessed fear of falling as
impacting on quality of life.  Lawrence et al. (1998)
cited approximately one third of older persons report
a fall in a given year.  Many of these elderly people
end up seeking care in emergency departments, where
the focus is on the injury sustained, rather than on
future prevention. A suggestion found in several
articles is a need for a comprehensive and
multidisciplinary approach to prevention of falls and
injuries.
Brown and Mulley (1997) cite that informed
caregivers of elderly patients sometimes suffer injuries
when handling or lifting their relatives or patients at
home.  Injuries to both the caregiver and the patients
have occurred during the transfer process. Most
caregivers receive no training in lifting or handling
heavy objects, including their loved ones.  Many of
these caregivers have health problems themselves.
This study was based on in-depth interviews of 41
caregivers of patients admitted to an inpatient setting
for respite care.  The injuries of the caregivers included
musculoskeletal pain and hernias.  Sixteen patients
were injured whilst being handled by their caregivers,
with 14 falling and two being knocked into equipment.
These injuries ranged from dislodged teeth and
fractured coccyx to non-serious injuries (Brown &
Mulley, 1997). 
Brown and Mulley (1997) go on to indicate that
many caregivers also suffer from problems like fatigue
and depression.  This, plus other health-related
problems, impacts the caregiver’s ability to provide
long term care.  Toileting was found to be the single
most difficult task since it involves numerous
maneuvers and the timing on this is so unpredictable.
Many injuries occur in the bathroom, where no
padding is available for bathtubs, sinks, and other
fixtures.  This article suggests periodic reassessment of
caregivers and patients, especially during respite
admissions.  Instruction in lifting and handling is
especially effective.
Injuries from falls are a significant risk for the
elderly, and it is estimated that between 30% and 50%
of the elderly population in Australia fall in their
homes each year (Smith & Widiatmoko, 1998).  Those
who fall may suffer severe non-fatal injuries like hip
fractures, other fractures, and severe lacerations.  Hip
fracture is a significant fall-related event, especially for
women.  This severely limits function and many
elderly suffering from this type injury never regain
their pre-fall level of functioning.
With this number of elderly falling each year,
many of which require treatment, the burden to the
health care system is staggering.  Common risk factors
for falls appear to be nutritional status, environmental
hazards, poly-pharmacy, lack of exercise, mental or
physical changes associated with medical conditions,
and aging (Smith & Widiatmoko, 1998).  Finally, this
study attempted to provide some indications
concerning the cost effectiveness of an assessment and
home modification program for independent elderly.
They found that interventions might reduce the
severity of the injuries received during a fall in the
home.
Campbell, Robertson, Gardner, Norton, and
Bucher (1999) assessed the effectiveness of a home-
based exercise program in women over the age of 80.
The focus was on strength and balance retraining in
this population of women.  After two years in the
study, the rate of falls in the exercise group was
significantly lower than in the control group.  The
exercises were prescribed for each individual by a
physiotherapist during 4 home visits in the first two
months of the study.  The physiotherapist then
maintained telephone contact to follow the individual
and keep them motivated.  Compliance and benefit
may be greater if the program is offered through a
general practice with reinforcement by the practice
staff.
Braun (1998) assessed the perception of falling as
a health problem and identified personal
characteristics and attitudes associated with perceived
importance of fall-related risk factors among
community-dwelling elderly people.  Risk factors for
Injuries to Elderly Women... Ritzel, Beasley, Flynn, & Liefer
The International Electronic Journal of Health Education, 2001; 4:64-66
http://www.iejhe.org 65
falls among elderly people include environmental
hazards, housing characteristics, and deterioration of
the neuromuscular system.  Individual factors that
increase risk of falling include being female, older age,
medications, co-morbidities, physical and mobility
limitations, limited vision, dizziness, and cognitive
impairments.
Braun (1998) found the vast majority of
respondents in the sample considered falling to be a
major preventable health problem for the elderly.
Sidewalk and pavement maintenance are most likely to
cause falls.  Poor judgment, distraction, and mental
impairment were least likely to be cited as increasing
the likelihood of falling.  A limitation noted in this
study was the time of the year the study was done and
also the location in the country.  The elderly
participants were surveyed during winter in an area
that has subzero temperatures and extensive snowfalls.
It was felt that results of the survey might differ if the
data were collected in different geological areas or
during different times of the year.
Over one-third of emergency room visits are due
to injuries (Braus, 1995).  Tripping and falling from
stairs and ladders are the most common reason for
injury-related trips to the emergency room.   Adults
over the age of 65 are most likely to seek emergency
room care for treatment of a fall-related injury.  Older
people should be encouraged to modify their homes to
make them safer and prevent injuries.
Mumford has found that elderly peoples’ homes
can be modified to improve safety.  This article focused
on the kitchen, bathroom, stairwells, and on alarms
both in the homes of elderly people and their family
members.  It gave straightforward and adaptable
suggestions for common trouble spots around the
home.
Lawrence, Tennstedt, Kasten, and Smith (1998)
assessed the intensity and correlates fear of falling and
hurting oneself among community-dwelling older
persons whom report a basic concern about falling.
The findings support interventions aimed at learning
ways to avoid falls and handle falls when falls are
experienced.  The findings of the study also provide
additional support to the growing recognition that fear
of falling may compromise quality of life through the
restriction of one’s activity. A multifaceted approach
should include enhanced function and attention to the
potential contribution of generalized fearfulness.
Improvements included a significant reduction in fear
of falling for the tai chi intervention group as opposed
to the control group.
An interdisciplinary approach is beneficial in
preventing falls in elderly people (Close, Ellis, Hooper,
& Glucksman, 1999).  The cost of falling is high to
both the individual and to health services.  Most of the
current assessment focuses on the fall and the injuries
received rather than on prevention.  This article
summarizes a randomized controlled study to
determine if a structured interdisciplinary assessment
of people who have fallen is beneficial in terms of
preventing further falls.  A complete medical and
occupational therapy assessment was performed on
members of the intervention group.  The most common
environmental hazards include uneven outdoor
surfaces, changes in surface levels, ramp, steps,
inappropriate floor covering, and unsuitable footwear.
The authors conclude that incorporating falls and
injury prevention strategies into routine clinical service
is beneficial.
Campbell, Robertson, Gardner, and Norton (1997)
evaluated an individually tailored program of strength
and balance retraining exercise that was implemented
in a randomly selected group of women aged 80 and
older.  The trial assessed whether or not this program
was effective in reducing the number of falls and
injuries related to falls. The exercise group showed
improvement in balance and Tai Chi had the most
benefit in preventing several falls.  This study suggests
that an individual program of physical activity may
reduce the risk of falls and also may improve the
individual’s health in other ways. 
An article by Leslie and St. Pierre (1999) suggests
the incorporation of an integrated risk assessment to
examine the most common and influential factors that
contribute to falls in the elderly population.  A
multidisciplinary approach can then offer strategies to
reduce and prevent falls.  The assessment must be
inclusive of concurrent medical conditions,
medications, and functional capacity. The assessment
also should question any previous falls and causes
related to these past falls.  The majority of falls are due
to complex problems.  The most common
environmental factors affecting the risk of falling
include footwear, lighting, floor and walking surfaces,
and tripping hazards such as pets, furniture, and stairs.
Specific chronic conditions like Parkinson’s disease,
arthritis, osteoporosis, cardiovascular disease, stroke,
depression, and sensory deficits affect falls.  The fall
assessment requires a team approach that involves all
members of the health care profession.  Preventing
falls is one way to enhance the quality of life for the
elderly population.
Gill, Williams, Robison, and Tinetti (1999) looked
at environmental hazards present in the homes of older
persons and determined that age-restricted housing
appears to be less hazardous than community housing.
Grab bars in the tub or shower were absent in most of
the community housing compared with age-restricted
housing.  This was thought to be the first study to
report population-based estimates of environmental
hazards using a standardized assessment instrument
rather than self-reported information or loosely
structured home evaluations. Based on the findings of
this study, it would be a mistake to presume that age-
restricted housing is inherently safe and devoid of
potential hazards.
Injuries to Elderly Women... Ritzel, Beasley, Flynn, & Liefer
The International Electronic Journal of Health Education, 2001; 4:64-66
http://www.iejhe.org 66
Discussion
The readings suggest that health care workers
incorporate a complete medical and physical
assessment into their preventive approach.  A number
of factors have been found to influence individuals
having falls, including co-morbidity, medications, and
environmental factors.  A home safety assessment is
also required to gain the most knowledge in prevention
and to identify and correct hazards known to promote
falls.
Depending on their health status, elderly people
live in a variety of settings outside of their personal
homes. A skilled care facility, a board and care home,
a special care facility, or even an alley may be
considered “home” for some elderly people. Each
setting has its own concern for the safety and well
being of the elderly. 
Falls seems to be the primary safety concern for
older people. Factors that contribute to falls can be
divided into two categories: internal and external.
Internal factors include the aging process, certain
disease processes, orientation status, side effects of
medications, balance problems, and diminished vision
External factors, those over which we have more
control, include obstacles, footwear, trip-hazards,
condition of equipment, and type of floor coverings.
Regardless of the reason for the fall, a fall is
devastating to the elderly individual. A fall often
produces psycho-social effects that last a lifetime,
possibly contributing to more falls.
The numbers of homeless older people will
continue to increase as the baby boomer generation
ages. Although safety concerns for older people who
live on the streets are unique, they may be remarkable
similar to some of the safety concerns of older people
living in facilities. Personal safety and security are
basic human needs.
Also as the baby boomer generation ages, so will
the age of the workforce. Older workers have special
needs on the job. Worksite health promotion programs
can provide an avenue for safety awareness for both the
older worker and for management. 
Safety and freedom are both very important factors
in the autonomy of the elderly. Safety and freedom
versus risk is often regulated by an outside source.
Nursing homes are inspected by a variety of regulating
bodies to ensure resident safety. Alternative care
facilities strive to be free of restraints. Facilities use
managed risk contracting in informed risk-taking.
Personal decision, autonomy, safety, freedom, and who
is responsible if an elderly person is injured, are all
items that need to be addressed.  Is this a quality of life
issue?
Falls, a very interesting and costly public health
concern, require more research to define the issues so
that the best possible approach can be identified.  A
streamlined format is advisable because of the limited
time that health care workers spend with the elderly
population and also because our elderly population is
growing at a very fast rate.  
Safety and injury prevention is a priority at any
age. It is critical for the older person. We need to
minimize the effects of internal factors that affect the
safety of the elderly and to strive to eliminate external
factors, balancing the person’s right to autonomy and
personal choice.
References
Braun, B.J. (1998). Knowledge and perception of
fall-related risk factors and fall-reduction techniques
among community-dwelling elderly individuals.
Physical Therapy, 78(12), 1262-1276.
Braus, P. (1995). Who’s crashing and smashing.
American Demographics, 17(10), 16.
Brown, A.R., & Mulley, G.P (1997).  Injuries
sustained by caregivers of disabled elderly people. Age
and Ageing, 26(1) p21-23.
Campbell, A.J., Robertson, M.C., Gardner, M.M.,
Norton, R.N., & Bucher, D.M. (1999). Falls prevention
over 2 years: A randomized controlled trial in women
80 years old and older. Age and Ageing,28(6) 513-518.
Campbell, A.J., Robertson, M.C., Gardner, M.M.,
& Norton, R.N. (1997). Randomised controlled trial of
a general practice programme of home based exercise
to prevent falls in elderly women.  British Medical
Journal, 315,(7115), 1065-1069. 
Close, J., Ellis, M., Hooper, R., & Glucksman, E.
(1999). Prevention of falls in the elderly trial
(PROFET): A randomized controlled trial. The Lancet,
353(9147), 93-97.
Gill, T.M., Williams, C.S., Robison, J.T., &
Tinetti, M.E. (1999). A population-based study of
environmental hazards in the homes of older persons.
American Journal of Public Health, 89(4), 553-556. 
Harrison, A.L. (1999). Falls in older persons:
prevention and management. Journal of Applied
Gerontology, 18(2), 265-267.
Lawrence, R.H., Tennstedt, S.L., Kasten, L.E., &
Shih, J. (1998). Intensity and correlates of fear of
falling and hurting oneself in the next year. Journal of
Aging & Health, 10(3), 267-286.
Leslie, M., & St Pierre, R. W. (1999). An
integrated risk assessment approach to fall prevention
among community-dwelling elderly. American Journal
of Health Studies, 15(2), 57-62.
Mumford, S. (1998). Your elderly parents’ safety.
Better Homes and Gardens, 76, (11), 120-124.
Smith, R.D., & Widiatmoko, D. (1998).  The cost
effectiveness of home assessment and modification to
reduce falls in the elderly.  Australian and New
Zealand Journal of Public Health, 22(4), 436-440.
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