Case-control study of perceived environmental hazards associated with residents’ fall risks within senior independent living

Presented by: Daejin Kim, Margaret Portillo

The main purpose of this research was to identify the types and locations within in older residents’ living units where perceived environmental hazards increased the risk of falling. The aims of the study were threefold: (1) to explore consequences of falls by analyzing four years of fall history data within an independent senior living facility; (2) to examine significant differences in perceived environmental hazards based on the age and health status of the residents under study; and (3) to compare and contrast the prevalence of environmental hazards between the high fall rate building than in the low fall rate building. Using a case-control study approach, this research includes both a retrospective analysis of fall incident reports and resident interviews about falling hazards within their units in a senior retirement community located in north central Florida. An analysis of the facilities’ fall history data identified which buildings had the highest and lowest fall rates over a four-year period. After these two unit were identified, the first author conducted on-site interviews with older residents in the building which had the greatest frequency of falls (e.g., 371 falls) and the building with the fewest reported falls (e.g., 104 fall) from 2013 to 2015. The 94 participants, 28 males and 66 females with a mean age of 85.06, participated in the semi-structured interviews. The interviewer asked residents to: (1) describe environmental hazards that they thought increased the risk of falling in each space within the unit; (2) explain specific locations where they were concerned about falling; and (3) assess fear of their overall falling, perceived mobility level and general quality of health. Using a keyword-in-context analysis (Leech & Onwuegbuzie, 2007) with 94 resident interviews, the 591 different environmental hazards were collapsed into five design type features: floor (e.g., floor surface, covering, etc.) lighting (night light, dim light, etc.), space and proximity (space size or proximity), furniture (cabinet, storage, etc.), and equipment (grab bar, handrail, etc.). Research findings indicate those who were 85 years old and over perceived more environmental hazards than the younger residents, age 71 to 84. Further, a Pearson correlation coefficient also showed there was a corresponding decrease in the mean of environmental hazards with an increasing level of self-perceived mobility and health as well as decreasing level of fear of falling. The results of ANCOVA show residents in the high fall rate building were more likely to perceive environmental hazards related to lighting and spatial issues as influencing the rate of fall risks while controlling the following covariates variables: age, mobility, health and fear of falling. This research also identified a sigificant relationship between the number of perceived enironmental hazards and falling locations contributing to severity of injury and fear of falling. The fall history data showed that falls which occurred in the bathroom were more likely to cause severe injuries, and most of the residents across buildings were concerned about falling in the bathroom. From residents’ perception, the bathroom contained the highest number of environental hazards. Thus, fall prevention design strategies for reducing fall risks in the bathroom is critical to the end users. This research offers insights into potential environmental hazards relating to recorded falls and perceptions of hazards relating to key variables including the building type, resident population factors (e.g., age, mobility, health, and fear of falling as shown in appendix 1.


  • Leech, N. L., & Onwuegbuzie, A. J. (2007). An array of qualitative data analysis tools: A call for data analysis triangulation. School Psychology Quarterly, 22(4), 557–584.