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


  • Lori Letts PhD, OT Reg, (Ont.); Associate Professor. Julie Moreland MSc, BHSc(PT); Associate Clinical Professor, Research Therapist. Julie Richardson PhD, BSc (PT); Associate Professor. Liliana Coman MSc, BHSc (PT); Assistant Professor. Mary Edwards MHSc, BSc(OT), OT Reg. (Ont.); Assistant Professor. Kathleen Martin Ginis PhD; Associate Professor. Seanne Wilkins PhD, OT Reg. (Ont.); Associate Professor. Laurie Wishart PhD, MSc, BSc(PT); Associate Professor.

Lori Letts, School of Rehabilitation Science, Institute for Applied Health Sciences Building, 4th floor, 1400 Main Street West, Hamilton, Ontario, Canada L8S 1C7. Email:


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.