THE ROLE OF ENVIRONMENTAL-FACTORS IN CAUSING INJURY THROUGH FALLS IN PUBLIC PLACES

The physical and environmental factors leading to domestic falls in th e elderly have been assessed in many published studies; only one inclu des some assessment of environmental factors causing the elderly to fa ll outside their homes (Consumer Safety Unit, 1986). Many patients of all ages attend Accident and Emergency Departments with injuries susta ined through such falls. This prospective study was undertaken to dete rmine the frequency with which uneven surface or inadequate lighting w as thought by the patients to have contributed to falls in public plac es, and to survey injuries sustained. Two hundred and thirty seven con secutive patients attending the Accident and Emergency Department were entered into the study, information being obtained by patient questio nnaire and from A&E records. An average of 7 patients were entered int o the study each day. The ratio of women to men was 1.7:1. Patients of both sexes were most commonly aged between 15 and 34 years, with a se cond peak in women over 55 years. Two thirds of falls occurred on pave ments. Uneven surface underfoot or inadequate street lighting was impl icated in over half the falls. Injuries were mostly sprains and bruise s, but facial lacerations and upper limb fractures were also common. S ixty eight per cent of fractures occurred in women over 55 years of ag e. Medical follow up was required in 40% of all cases. Uneven paving a nd inadequate lighting in public places are potentially avoidable fact ors in causing falls which lead to appreciable morbidity in large numb ers of young and elderly patients attending A&E Departments.