Falls are a leading cause of injury and accidental death among older adults, but identifying the location of risks outside is labour and time-intensive.
In our new research, we have created a tool using Google Street View to audit the places where people walk.
The goal of our new tool – Fall-SAFE – is to identify the risks in New Zealand’s built environments and create a database for local councils and community groups to understand where an older person might fall – and why.
A costly risk
Annually, one in three people over 65 are injured in a fall. This figure rises to one-in-two for people over 80.
In 2023 alone, ACC received 236,985 new claims for falls from people over the age of 60. Many of these falls resulted in serious injury, such as a hip fracture, hospitalisation or even death.
It’s not just older people who are at risk of falling – though they are, by far, the largest group. Last year, the Accident Compensation Corporation paid out $2.15 billion to cover claims for falls.
The flow-on effect from falls extends further than just medical recovery. Older people who have fallen outside, or who fear falling due to perceived risks, may be less willing to go for walks. They then miss out on the physical, mental and social benefits of this sort of activity.
Assessing the environment
Using data from ambulance service Hato Hone St John, we identified 2117 falls between July 2016 and June 2018 in urban areas involving adults aged 65 and over. Wellington was excluded as the city uses a different ambulance service.
Auditors then used Google Street View to assess the locations of these falls and identify risks in the built environment that might have contributed. These risks included trip hazards, uneven footpaths, obstructions (such as overgrown bushes) and slopes.
Auditors used a “drop-and-spin” approach to their assessment, where they completed a 360 degree audit of the fall location. The Google Maps imagery was set to be as close to the date of the accident as possible.
Drop-and-spin virtual audits are quicker than physical audits, but similarly reliable. Furthermore, drop-and-spin virtual audits enable assessment over large geographic areas that would be difficult to examine in person.
Understanding NZ’s streets
After examining the different fall sites, we gained a better understanding of where falls happened and the hazards that could have contributed to the falls.
Half of all the falls had occurred in residential locations (49.1%) and one-quarter occurred in commercial locations (22.4%). A further 16.2% of the falls had occurred in “other” locations (such as rural or industrial areas).
Over 60% of fall sites had at least one trip hazard due to poorly maintained footpaths. The most common obstructions were manholes, service covers or grates (71.5%), poles (65.4%), utility boxes (46.6%) and overhanging vegetation (39.5%). Other obstructions such as bus shelters, chairs and tables, or drains were noted at 64.5% of the sites.
Three-quarters of the falls had occurred in locations that had a flat or gentle slope (76.3%). Only 15.5% of the falls had occurred on a moderate slope, while 8.2% had occurred on a steep slope.
Most (95.6%) of the fall locations had a normal kerb height (10cm). Few locations had no kerbs (2.3%) or storm drains (2%). Streetlights were present in most fall locations, either on one side of the street (including partial or very sparse locations) (54%) or on both sides (44%). Streetlights were not visible in 0.9% of sites.
Of all the locations we assessed, just under 6% had no obvious risk whatsoever. This seems to indicate that external hazards were a contributing factor to the vast majority of falls – though without information from the person who fell, it is hard to know for sure.
A cheaper and faster option
The current approach to assessing the safety of urban environments – sending people out to physically look at a footpath to identify issues – can be time-consuming and costly.
And the money to do the work is simply unavailable. Several councils, including Hamilton and Masterton, have announced significant cuts in funding from the NZ Transport Agency to maintain and repair footpaths and cycle lanes.
Another problem is that these assessors may not fully understand the experiences of older people in these locations. A hazard for someone aged 65+ may not seem like one for someone in their 30s or 40s.
Understanding the factors that contribute to a fall for older people – such as obstructions and trip hazards – allows city planners to address problems in the built environment.
Our free auditing tool provides a way for councils and advocacy groups to look at environments to understand the risks. Our research applied this to places where we know people had fallen, but the tool can be used to assess the risk of any environment.
Investing the time and effort now to address these fall risks early could save money – and lives – further down the track.
