In reply: Risk of falls

In Reply: The query regarding bicycle helmet use as a preventive measure in elderly people at high risk of recurrent falls is interesting. Prior to our article going to press, we reviewed the literature and found no quality studies of helmet use in preventing brain injury at home or in residential facilities. The few studies of helmet use vs no helmet use focused on sports and suggested that the benefit of current helmet design may be more limited than previously thought. Although sports helmets reduce the risk of linear impact causing death, major injury, skull fracture, and (if a facial portion is present) facial injury, there is little protection against injury from rotational forces. Concussion, a form of mild brain injury, does not appear to be reduced by helmet use in sports.¹ Additionally, 77% of soldiers hospitalized with traumatic brain injury were wearing a helmet at the time of injury.²

In addition to questioning the effectiveness of helmets in recurrent fallers, one has to consider the ability of a helmet to be fitted properly (for example, the fit will change after a haircut or change in hairstyle), the willingness of the individual to wear it, the ability of the patient or caregiver to attach it, and the impact of wearing a helmet on psychosocial interactions. Helmet use in a recurrent faller would have to be considered an individualized intervention amenable to caregiver and patient but without proven benefit.

In Reply: The query regarding bicycle helmet use as a preventive measure in elderly people at high risk of recurrent falls is interesting. Prior to our article going to press, we reviewed the literature and found no quality studies of helmet use in preventing brain injury at home or in residential facilities. The few studies of helmet use vs no helmet use focused on sports and suggested that the benefit of current helmet design may be more limited than previously thought. Although sports helmets reduce the risk of linear impact causing death, major injury, skull fracture, and (if a facial portion is present) facial injury, there is little protection against injury from rotational forces. Concussion, a form of mild brain injury, does not appear to be reduced by helmet use in sports.¹ Additionally, 77% of soldiers hospitalized with traumatic brain injury were wearing a helmet at the time of injury.²

In addition to questioning the effectiveness of helmets in recurrent fallers, one has to consider the ability of a helmet to be fitted properly (for example, the fit will change after a haircut or change in hairstyle), the willingness of the individual to wear it, the ability of the patient or caregiver to attach it, and the impact of wearing a helmet on psychosocial interactions. Helmet use in a recurrent faller would have to be considered an individualized intervention amenable to caregiver and patient but without proven benefit.

In Reply: The query regarding bicycle helmet use as a preventive measure in elderly people at high risk of recurrent falls is interesting. Prior to our article going to press, we reviewed the literature and found no quality studies of helmet use in preventing brain injury at home or in residential facilities. The few studies of helmet use vs no helmet use focused on sports and suggested that the benefit of current helmet design may be more limited than previously thought. Although sports helmets reduce the risk of linear impact causing death, major injury, skull fracture, and (if a facial portion is present) facial injury, there is little protection against injury from rotational forces. Concussion, a form of mild brain injury, does not appear to be reduced by helmet use in sports.¹ Additionally, 77% of soldiers hospitalized with traumatic brain injury were wearing a helmet at the time of injury.²

In addition to questioning the effectiveness of helmets in recurrent fallers, one has to consider the ability of a helmet to be fitted properly (for example, the fit will change after a haircut or change in hairstyle), the willingness of the individual to wear it, the ability of the patient or caregiver to attach it, and the impact of wearing a helmet on psychosocial interactions. Helmet use in a recurrent faller would have to be considered an individualized intervention amenable to caregiver and patient but without proven benefit.