Prospective study on risk factors for falling in elderly persons with mild to moderate intellectual disabilities Lotte Enkelaar a, *, Ellen Smulders a , Henny van Schrojenstein Lantman-de Valk b , Vivian Weerdesteyn a,c , Alexander C.H. Geurts a,c a Radboud University Medical Centre, Nijmegen Centre for Evidence Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands b Radboud University Medical Centre, Department of Primary and Community Health Care, Nijmegen, The Netherlands c Sint Maartenskliniek, Research, Development & Education, Nijmegen, The Netherlands 1. Introduction Falls cause high morbidity and mortality rates in elderly persons (Rubenstein, 2006). In the community-dwelling elderly population, one-third of all individuals fall at least once a year (Close, Lord, Menz, & Sherrington, 2005; Tinetti, Speechley, & Ginter, 1988). Approximately 10% of these falls result in injuries, half of which are fractures. Furthermore, falling can often have psychosocial consequences such as fear of falling (Berg, Alessio, Mills, & Tong, 1997; Tinetti & Williams, 1997). Consequently, this may lead to a reduction in physical activity, which in turn may result in (further) functional decline and a loss of independence (Tinetti et al., 1988; Wagemans & Cluitmans, 2006). Elderly persons with intellectual disabilities (ID) seem to be at an even higher risk of falling and experiencing fall-related injuries than their mentally healthy peers (Cox, Clemson, Stancliffe, Durvasula, & Sherrington, 2010; Finlayson, Morrison, Jackson, Mantry, & Cooper, 2010; Grant, Pickett, & Lam, 2001; Hsieh, Heller, & Miller, 2001; Wagemans & Cluitmans, 2006). Research in Developmental Disabilities 34 (2013) 3754–3765 A R T I C L E I N F O Article history: Received 6 February 2013 Received in revised form 21 July 2013 Accepted 30 July 2013 Available online 9 September 2013 Keywords: Intellectual disabilities Prospective study Risk factors Falling A B S T R A C T Elderly persons with intellectual disabilities (ID) are at increased risk for falls and fall- related injuries. Although there has been extensive research on risk factors for falling in the general elderly population, research on this topic in persons with ID is rather sparse. This is the first study to prospective investigate risk factors for falling among elderly persons with mild to moderate ID. Seventy-eight ambulatory persons with mild to moderate ID (mean age 62.8 Æ 7.6 years; 44 (56%) men; 34 (44%) mild ID) participated in this study. This longitudinal cohort study involved extensive baseline assessments, followed by a one-year follow-up on fall incidents. Falls occurred in 46% of the participants and the fall rate was 1.00 falls per person per year. The most important risk factors for falling in elderly persons with mild to moderate ID were (mild) severity of ID, (high) physical activity, (good) visuo-motor capacity, (good) attentional focus and (high) hyperactivity-impulsiveness, which together explained 56% of the fall risk. This pattern of risk factors identified suggests a complex interplay of personal and environmental factors in the aetiology of falls in elderly persons with ID. We recommend further research on the development of multifactorial screening procedures and individually tailored interventions to prevent falling in persons with ID. ß 2013 Elsevier Ltd. All rights reserved. * Corresponding author at: Radboud University Medical Centre, Department of Rehabilitation (898), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. Tel.: +31 24 366 8426; fax: +31 24 361 9839. E-mail address: l.enkelaar@reval.umcn.nl (L. Enkelaar). Contents lists available at ScienceDirect Research in Developmental Disabilities 0891-4222/$ – see front matter ß 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ridd.2013.07.041