Developing an understanding of the risk factors for falls among adults with intellectual disabilities: a commentary

Falls are a common and serious problem for older people in the general population and the human costs include pain, loss of confidence, loss of independence and mortality (National Institute for Health & Care Excellence (NICE), 2013). Even if the person is not injured, they may have a fear of falling, which may result in avoidance of social activities, reduced mobility, and increased frailty (Public Health England (PHE), 2019). Falls also affect the carers of older people who fall (Ang et al, 2020), including costs in terms of carer time and absence from work (Snooks et al, 2011). Falls in the general population cost the National Health Service (NHS) more than £2.3 billion per year (NICE, 2013).

While there is evidence for older people at risk of falls in the general population, there is limited research investigating falls among those with intellectual disabilities (ID) who may share many of the same risk factors, and which may increase their risk of falls from a younger age (Cox et al, 2010). The term ID (used throughout this paper) is an internationally recognised term to define people who may be classed as having learning disabilities (LD). ID refers to individuals with a significantly reduced ability to understand new or complex information and to learn and apply new skills (impaired intelligence), which started before adulthood and results in a reduced ability to cope independently (impaired social functioning) (World Health Organization (WHO), 2010). People with mild-to-moderate ID often live independently and are usually able to communicate most of their needs, but they may need support to understand complex issues. People with severe-to-profound ID may require a higher level of support. There are many conditions associated with ID, for example, Down's syndrome, Williams syndrome, and Fragile X syndrome (Mencap, 2022). It is estimated that 1.5 million people in the UK have an ID (approximately 2% of the UK's population), with the majority living independently in their local communities or with families or paid support (WHO, 2010; Mencap, 2022). However, the exact numbers are unknown, as they may not be registered with health or social care related services. Falls and fall-related injuries are a common and serious problem for people with ID. Research from various studies suggest that 25-40% of people with ID experience at least one fall per year (Hsieh et al, 2012; Petropoulou et al, 2017; Finlayson et al, 2010). Around one-third of falls involving people with intellectual disabilities result in injury, with the rate of fractures higher than in the general population, which may be due to an increased risk of osteoporosis (PHE, 2019). It is commonly understood that people with intellectual disabilities may be considered ‘older adults’ (from the age of 40 years onwards) (Hermans and Evenhuis, 2014). Given this, their risk of falls and subsequent injury may occur earlier than in the general population and over a longer period of time (Cox et al, 2010; Pal et al, 2013; Oppewal et al, 2014).