restriction of mobility, reduction of activity and participation, and generalized decreases

in independence were fall related consequences [56].

 Long-term care admissions. Donald and Bulpitt completed a longitudinal

prospective cohort study to assess fall related deaths and long-term care admissions [57].

Risk of death increased at both one and three years for recurrent fallers. However, all

who fell demonstrated loss of function and independence, consequently increasing long-

term care facility admissions. Tinetti et al. reported 40% of all nursing home admissions

as being fall related [46].

 Fractures as a consequence of falls. Approximately 360,000 adults suffer a fall

related hip fracture each year [49]. Half of those who suffer a hip fracture will never

regain their prior level of functioning. Hip fractures are a significant concern as they are

related to more deaths, disability, and medical costs than all other osteoporotic fractures

combined [58].

 Falls are an independent risk factor and contribute to 90% of all hip fractures [59,

60]. Minor injuries such as bruises and abrasions occur after 30%-55% of falls [48, 51,

61] and about 4%-6% of falls end in a fracture, often of the hip [46, 48, 61, 62]. Death is

uncommon following a fall; however, fall related hip fractures are the leading cause of

death for those over the age of 65 [63, 64].

Multifactorial risk factors

 A review of the literature indicates fall risks are considered multi-factorial [46, 51,

52, 65-75]. Meta-analyses and predictive models have been used to determine many of

the evidence based risk factors. An epidemiological study determined that over 400 fall

risk factors exist [76]. Factors may differ between community dwelling individuals and

those residing in long term care facilities [66]. Table 2-1 provides a list of common falls