Ang SGM, O'Brien AP, Wilson A. Carers' concern for older people falling at home: an integrative review. Singapore Med J.. 2020; 61:(5)272-280

Aromataris E, Fernandez R, Godfrey C, Holly C, Kahlil H, Tungpunkom P. Summarizing systematic reviews: methodological development, conduct and reporting of an Umbrella review approach. Int J Evid Based Health. 2015; 13:(3)132-140

Bainbridge D, Hale L, Renfro M, Maring J. Addressing the Issue of Fall Risk for All Adults with Intellectual Developmental Disabilities: Part III: Creating Solutions with Community Fall Prevention and Inclusive Recreation Programs for Adults with Intellectual Developmental Disabilities. GeriNotes. 2017; 24:(5)16-20

Bakker-van Gijssel EJ, Lucassen PLBJ, Olde Hartman TC Health assessment instruments for people with intellectual disabilities-A systematic review. Res Dev Disabil.. 2017; 64:12-24

Cox CR, Clemson L, Stancliffe RJ, Durvasula S, Sherrington C. Incidence of and risk factors for falls among adults with an intellectual disability. J Intellect Disabil Res. 2010; 54:(12)1045-1057

Critical Skills Appraisal Programme. CASP Checklists. 2013. (accessed 4 April 2023)

Finlayson J, Morrison J, Jackson A, Mantry D, Cooper S-A. Injuries, falls and accidents among adults with intellectual disabilities. Prospective cohort study. J Intellect Disabil Res.. 2010; 54:(11)966-998

Finlayson J, Morrison J, Skelton DA, Ballinger C, Mantry D, Jackson A, Cooper S-A. The circumstances and impact of injuries on adults with learning disabilities. The British Journal of Occupational Therapy. 2014; 77:(8)400-409

Injury and fall prevention for people with learning disabilities: a resource guide for people who care for, or support, people with learning disabilities. 2016. (accessed 4 April 2023)

Finlayson J. Fall prevention for people with learning disabilities: key points and recommendations for practitioners and researchers. Tizard Learning Disability Review. 2018; 23:(2)91-99

Hale LA, Mirfin-Veitch BF, Treharne GJ. Prevention of falls for adults with intellectual disability (PROFAID): a feasibility study. Disabil Rehabil.. 2016; 38:(1)36-44

Hermans H, Evenhuis HM. Multi-morbidity in older adults with intellectual disabilities. Res Dev Disabil.. 2014; 35:(4)776-83

Ho P, Bulsara M, Patman S, Downs J, Bulsara C, Hill AM. Incidence and associated risk factors for falls in adults with intellectual disability. J Intellect Disabil Res.. 2019; 63:(12)1441-1452

Hsieh K, Rimmer J, Heller T. Prevalence of falls and risk factors in adults with intellectual disability. Am J Intellect Dev Disabil.. 2012; 117:442-454

Maring J, Hale L, Renfro M, Bainbridge D. Addressing the issue of fall risk for all adults with intellectual developmental disabilities. Part II. Geri Notes. 2017; 24:(5)12-15

Mencap. How common is learning disability in the UK?. (accessed 4 April 2023)

National Institute for Health and Care Excellence. Falls in older people: assessing risk and prevention. Clinical guideline. 2013. (accessed 4 April 2023)

O'Dwyer M, McCallion P, McCarron M, Henman M. Medication use and potentially inappropriate prescribing in older adults with intellectual disabilities: a neglected area of research. Ther Adv Drug Saf.. 2018; 9:(9)535-557

Oppewal A, Hilgenkamp TI, van Wijck R, Schoufour JD, Evenhuis HM. The predictive value of physical fitness for falls in older adults with intellectual disabilities. Res Dev Disabil.. 2014; 35:(6)1317-1325

Pal J, Hale L, Mirfin-Veitch B, Claydon L. Injuries and falls among adults with intellectual disability: a prospective New Zealand cohort study. J Intellect Disabil Res.. 2013; 39:35-44

Petropoulou E, Finlayson J, Hay M, Spencer W, Park R, Tannock H, Galbraith E, Godwin J, Skelton D. A. Injuries reported and recorded for adults with intellectual disabilities who live with paid support in Scotland: a comparison with Scottish adults in the general population. J Appl Res Intellect Disabil.. 2017; 30:(2)408-415

Pope J, Truesdale M, Brown M. Risk factors for falls among adults with intellectual disabilities: A narrative review. J Appl Res Intellect Disabil.. 2021; 34:274-285

Public Health England (PHE). Preventing falls in people with learning disabilities: making reasonable adjustments. 2019. (accessed 4 April 2023)

Smulders E, Enkelaar L, Schoon Y, Geurts AC, van Schrojenstein Lantman-de Valk H, Weerdesteyn V. Falls prevention in persons with intellectual disabilities: development, implementation, and process evaluation of a tailored multifactorial fall risk assessment and intervention strategy. Res Dev Disabil.. 2013; 34:(9)2788-2798

Snooks H, Cheung WY, Gwini SM, Humphreys I, Sanchez A, Sirwardena N. Can older people who fall be identified in the ambulance call centre to enable alternative responses or care pathways?. Emerge Med J.. 2011; 28:(3)

World Health Organization. Better health, better lives: children and young people with intellectual disabilities and their families. 2010. (accessed 4 April 2023)

World Health Organization. Factsheet: falls. 2021. (accessed 4 April 2023)

Review of risk factors and preventative strategies for fall related injuries in people with intellectual disabilities. 2010.

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

02 May 2023
Volume 28 · Issue 5


Commentary on: Pope J, Truesdale M, Brown M. Risk factors for falls among adults with intellectual disabilities: A narrative review. J Appl Res Intellect Disabil. 2021; 34: 274–285. 10.1111/jar.12805

Falls are a serious and common problem for people with intellectual disabilities (ID). Whilst there is available evidence on falls risk factors for the general population, there is a lack of awareness and understanding of the contributing risk factors for this population. This commentary critically appraises a recent narrative review which sought to identify the risk factors for falls among people with ID. Clinical practice implications: Community nurses may identify people with ID at risk of falls, and work alongside other healthcare professionals and carers to provide tailored multidisciplinary falls-prevention interventions for individuals with ID living in the community.

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).

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