Falls in Elderly on Video Show Weight Shift Is Main Problem
Falls in Elderly on Video Show Weight Shift Is Main Problem
October 16, 2012 — Footage from video cameras placed strategically around 2 long-term care facilities challenge the conventional wisdom of what causes residents to fall.
Prevention programs and interventions based on previous studies suggest slips are the greatest danger. However, these events led to only 3% of the 227 falls in an observational study by Professor Stephen N. Robinovitch, PhD, from the Department of Biomedical Physiology and Kinesiology at Simon Fraser University in Burnaby, British Columbia, Canada, and colleagues published online October 17 in the Lancet.
In contrast, the incorrect transfer or shifting of body weight preceded 41% of the falls recorded over the course of more than 3 years.
"Our results show that the causes of falls in this population are different than described previously, with most being due to self-induced weight shifting, and occurring with equal frequency during walking, transferring, and standing," the authors note. These findings, based on video evidence, differ from the conclusions of most previous research that relies on resident or witness recall.
After weight shifting or transfer, the next most common causes of falls were trips or stumbles (21%) and loss of support with an external object, hit or bump, or collapse or loss of consciousness (each 11%). "Our findings emphasise the need to target each of these activities in fall risk assessment and prevention strategies," the authors write.
Researchers matched standard fall incident reports to a corresponding video when possible. A team of 3 or more experts reached consensus on the cause of each fall, with 87% agreement between the teams (Cohen's κ, 0.79; 95% confidence interval, 0.53 - 1.0).
Walking forward was the most common activity at the time of a fall, occurring during 54 of 227 falls (24%). Standing quietly, sitting down or lowering, and initiation of walking also were common activities.
The 227 falls occurred in 130 residents. A total of 86 patients had 1 recorded fall, 26 experienced 2 falls, 9 had 3 falls, and another 9 experienced 4 or more such events. Mean age in this group was 78 years, and 52% were women. Most falls occurred in the midafternoon.
"With a well-defined protocol, they were able to match staff incident reports of falls to video footage, making this a unique study," Clemens Becker, MD, from the Robert Bosch Hospital, Stuttgart, Germany, and Lorenzo Chiari, PhD, from the University of Bologna, Italy, write in an accompanying editorial.
"Robinovitch and colleagues' report provides some important findings. Among these is the high occurrence of falls caused by incorrect weight shifting...and external perturbations such as hit or bump events."
The editorialists also noted that "independent seniors probably have different risk factors and environmental cofactors that contribute to falls. Thus, the findings might not be applicable to community-dwelling seniors."
An association between medical status and fall mechanism could not be made because not enough residents who granted access to their medical records subsequently fell. This is a potential limitation of the study, the authors note. In addition, because cameras were placed only in common areas, they were unable to account for falls in bedrooms or bathrooms.
This study was supported by grants from the Canadian Institutes for Health Research. Dr. Robinovitz also received a Canada Research Chair award in Injury Prevention and Mobility Biomechanics. The authors and the editorialists have disclosed no relevant financial relationships.
Lancet. Published online October 17, 2012.
October 16, 2012 — Footage from video cameras placed strategically around 2 long-term care facilities challenge the conventional wisdom of what causes residents to fall.
Prevention programs and interventions based on previous studies suggest slips are the greatest danger. However, these events led to only 3% of the 227 falls in an observational study by Professor Stephen N. Robinovitch, PhD, from the Department of Biomedical Physiology and Kinesiology at Simon Fraser University in Burnaby, British Columbia, Canada, and colleagues published online October 17 in the Lancet.
In contrast, the incorrect transfer or shifting of body weight preceded 41% of the falls recorded over the course of more than 3 years.
"Our results show that the causes of falls in this population are different than described previously, with most being due to self-induced weight shifting, and occurring with equal frequency during walking, transferring, and standing," the authors note. These findings, based on video evidence, differ from the conclusions of most previous research that relies on resident or witness recall.
After weight shifting or transfer, the next most common causes of falls were trips or stumbles (21%) and loss of support with an external object, hit or bump, or collapse or loss of consciousness (each 11%). "Our findings emphasise the need to target each of these activities in fall risk assessment and prevention strategies," the authors write.
Researchers matched standard fall incident reports to a corresponding video when possible. A team of 3 or more experts reached consensus on the cause of each fall, with 87% agreement between the teams (Cohen's κ, 0.79; 95% confidence interval, 0.53 - 1.0).
Walking forward was the most common activity at the time of a fall, occurring during 54 of 227 falls (24%). Standing quietly, sitting down or lowering, and initiation of walking also were common activities.
The 227 falls occurred in 130 residents. A total of 86 patients had 1 recorded fall, 26 experienced 2 falls, 9 had 3 falls, and another 9 experienced 4 or more such events. Mean age in this group was 78 years, and 52% were women. Most falls occurred in the midafternoon.
"With a well-defined protocol, they were able to match staff incident reports of falls to video footage, making this a unique study," Clemens Becker, MD, from the Robert Bosch Hospital, Stuttgart, Germany, and Lorenzo Chiari, PhD, from the University of Bologna, Italy, write in an accompanying editorial.
"Robinovitch and colleagues' report provides some important findings. Among these is the high occurrence of falls caused by incorrect weight shifting...and external perturbations such as hit or bump events."
The editorialists also noted that "independent seniors probably have different risk factors and environmental cofactors that contribute to falls. Thus, the findings might not be applicable to community-dwelling seniors."
An association between medical status and fall mechanism could not be made because not enough residents who granted access to their medical records subsequently fell. This is a potential limitation of the study, the authors note. In addition, because cameras were placed only in common areas, they were unable to account for falls in bedrooms or bathrooms.
This study was supported by grants from the Canadian Institutes for Health Research. Dr. Robinovitz also received a Canada Research Chair award in Injury Prevention and Mobility Biomechanics. The authors and the editorialists have disclosed no relevant financial relationships.
Lancet. Published online October 17, 2012.
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