Incidence and associated risk factors for falls in adults with intellectual disability.
Nearly half of community adults with ID fall every six months—screen for past falls and walking ability.
01Research in Context
What this study did
Fleury et al. (2019) asked one simple question: how often do adults with intellectual disability fall while living in the community?
They tracked a group of adults for six months and noted who fell. They also looked at what made a fall more likely.
What they found
Almost half of the adults, 46 %, had at least one fall during the six months.
People who had fallen before or who could walk on their own were more likely to fall again. Surprisingly, taking many medicines or having continence problems was linked to fewer falls, not more.
How this fits with other research
Higgins et al. (2021) extends these results. They clocked walking speed and found that adults with moderate ID or Down syndrome often walk slower than 2.16 km/h when going backward. That speed is the same cut-off doctors use to spot fall risk in frail elders. Slow backward walking gives you a quick motor test to add to your fall screen.
Storch et al. (2012) pulls the lens back. Their review shows that falls are only part of the picture. Older adults with ID also face under-treated pain and trouble getting hospice care. Pair fall data with checks for arthritis and medicine load to plan safer aging in place.
Roane et al. (2001) and Hattier et al. (2011) used the same community-tracking method for mental health. They prove the design works, so you can trust the fall numbers here.
Why it matters
If you serve adults with ID, add two quick items to every intake: "Any falls in the past year?" and "Can the person walk without help?" If the answer is yes to either, schedule a short backward-walking test from Higgins et al. (2021). Those two steps spot the highest-risk clients in under two minutes.
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02At a glance
03Original abstract
BACKGROUND: People with intellectual disability (ID) experience age-related changes earlier in life, and as such, falls among people with ID are of serious concern. Falls can cause injury and consequently reduce quality of life. Limited studies have investigated the incidence of falls among people with ID and the associated risk factors. The purpose of this study was to investigate the incidence of falls and risk factors for falling in people with ID living in the community. METHODS: A prospective observational cohort (n = 78) of community-dwelling adults with ID. Characteristics measured at baseline included falls history, medication use, balance and mobility. Falls were reported for 6 months using monthly calendars and phone calls. Data were analysed using univariate and multivariate logistic regression to identify risk factors associated with falling. RESULTS: Participants [median (interquartile range) age 49 (43-60) years, female n = 32 (41%)] experienced 296 falls, with 36 (46.2%) participants having one or more falls. The incidence of falls was 5.7 falls (injurious falls = 0.8) per person year (one outlier removed from analysis). A history of falls [adjusted odds ratio (OR): 6.37, 95% confidence interval (CI) (1.90-21.34)] and being ambulant [adjusted OR: 4.50, 95% CI (1.15-17.67)] were associated with a significantly increased risk of falling. Falls were significantly less frequent among participants taking more than four medications [adjusted OR: 0.22, 95% CI (0.06-0.83)] and participants who were continent [adjusted OR: 0.25, 95% CI (0.07-0.91)]. CONCLUSIONS: People with ID fall at a younger age compared with the broader community. The associated falls risk factors also differ to older community-dwelling adults. Health professionals should prioritise assessment and management of falls risk in this population.
Journal of intellectual disability research : JIDR, 2019 · doi:10.1111/jir.12686