title: The physical environment as a fall risk factor in older adults: Systematic review and meta-analysis of cross-sectional and cohort studies.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada. lettsl@mcmaster.ca
authors.forename: Lori
authors.initials: L
authors.lastname: Letts
authors.forename: Julie
authors.initials: J
authors.lastname: Moreland
authors.forename: Julie
authors.initials: J
authors.lastname: Richardson
authors.forename: Liliana
authors.initials: L
authors.lastname: Coman
authors.forename: Mary
authors.initials: M
authors.lastname: Edwards
authors.forename: Kathleen Martin
authors.initials: KM
authors.lastname: Ginis
authors.forename: Seanne
authors.initials: S
authors.lastname: Wilkins
authors.forename: Laurie
authors.initials: L
authors.lastname: Wishart
mesh_terms: D000058:Accidental Falls; D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004779:Environment Design; D006801:Humans; D012111:Residence Characteristics