The role of environmental factors in causing injury through falls in public places.

The physical and environmental factors leading to domestic falls in the elderly have been assessed in many published studies; only one includes some assessment of environmental factors causing the elderly to fall outside their homes (Consumer Safety Unit, 1986). Many patients of all ages attend Accident and Emergency Departments with injuries sustained through such falls. This prospective study was undertaken to determine the frequency with which uneven surface or inadequate lighting was thought by the patients to have contributed to falls in public places, and to survey injuries sustained. Two hundred and thirty seven consecutive patients attending the Accident and Emergency Department were entered into the study, information being obtained by patient questionnaire and from A&E records. An average of 7 patients were entered into 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 second peak in women over 55 years. Two thirds of falls occurred on pavements. Uneven surface underfoot or inadequate street lighting was implicated in over half the falls. Injuries were mostly sprains and bruises, but facial lacerations and upper limb fractures were also common. Sixty eight per cent of fractures occurred in women over 55 years of age. Medical follow up was required in 40% of all cases. Uneven paving and inadequate lighting in public places are potentially avoidable factors in causing falls which lead to appreciable morbidity in large numbers of young and elderly patients attending A&E Departments.