Risk Factors Continued

We can think of risk factors in several ways

Intrinsic risk factors

  • history of falls
  • comorbidities (eg, Parkinson disease, diabetes)
  • balance issues
  • decreased hearing
  • gait instability
  • recurrent falls

Extrinsic risk factors

  • environment
  • lighting
  • medication
  • footwear
  • time of day (afternoon is the most high-risk time)
  • more falls in winter and during the day


Reasons why ED patients present after a fall have also been studied. In a review of the article “Will my patient fall?” (Ganz JAMA 2007), researchers analyzed a common set of risk factors identifiable during a routine clinical exam that predict future falls. The conclusion was that the most positive likelihood ratios that predicted if a patient would fall were related to medication use (especially of benzodiazepines), dementia, Parkinson disease, and history of stroke. However, this was not an ED-based study.


Carpenter CR et al Acad Emerg Med. 2009;16(3):211–219.

Carpenter CR. Ann Emerg Med. 2009;53(3):398–400.

Bueno-Cavanillas A et al. Eur J Epidemiol. 2000;16(9):849–859.

Ganz DA et al. JAMA. 2007;297(1):77–86.