Falls


Reducing falls in care homes with inclusive design


Fiona Walsh, co-founder and principal architect at DDS Architects, looks at how targeted, informed building design can reduce the incidence of falls in care homes


If falls were a new disease, we would consider them an epidemic. There would be glitzy campaigns to fund urgent research into reducing them and vast public health messaging into how to avoid this deadly new threat. But since they are neither new nor mono-causal, far less attention is paid to them.


But no one in the care system needs to be


told how deadly a fall can be. It is estimated that, in Europe, total deaths and disability-adjusted life years due to falls have increased steadily since 1990.1 The Global Burden of Disease study reported nearly 17 million years of life lost from falls in 2017. Related societal and economic consequences are substantial.


In high income countries, approximately one per cent of health care costs are ‘fall-related expenditures’. A recent study predicted that ‘the number of falls and related injuries will likely further increase, partly as there are more older adults, but also because of increasing prevalence of multimorbidity, polypharmacy and frailty among them’.2 In the UK, hip fractures caused by falls are the top cause of accident-related deaths in older people.3


Thirty per cent of older


people who have a hip fracture from a fall die within a year - 20 per cent within just four months4


- and aside from the deaths,


these fractures result in a rapid loss of independence and routine that can be devastating for an individual, their families and carers. The personal, emotional and financial burden of older age falls are immense to both the individual and society as a whole.


Falls are not rare. About a third of those 24


With the right understanding, an environment can be both aesthetically pleasing and cognitively and perceptually enabled.


aged over 65 will have a fall this year, and half of those over 80.5


While not all of these


will result in a hip fracture, about five per cent in those over 65 will.6


Those that do not


result in a death can also be debilitating – 80 per cent of women aged 75 or over in one survey said they would rather be dead than deal with the lack of independence that a fall could cause.7


Despite these dangers, falls continue


to frustrate the wider health and social care systems, with some believing they are inevitable. This is not the case. There is


In the UK, hip fractures caused by falls are the top cause of accident-related deaths in older people


more we can do to stop older people falling – not with more medication or monitoring gadgets, but with targeted, informed building design.


Falls are far more likely in those with reduced capacity


Falls are neither simple nor monocausal. A huge range of interrelated factors are at play, such as polypharmacy, sedation, symptomatic orthostatic hypotension, physical frailty, physical inactivity, delirium, chronic conditions, dementia, along with environment and design. But one of the key risk factors is something that affects many in care homes: reduced cognitive and sensory abilities. Some level of sensory impairment is extremely common among older people – with 94 per cent of older Americans having some kind of sensory impairment.8


www.thecarehomeenvironment.com February 2023


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