WASHINGTON — More often than not, elderly patients who fall in long-term care facilities do not trip or stumble while walking, but rather are transitioning from standing still or initiating a new activity at the time of their fall, according to an analysis of video-recorded falls.
“These results challenge traditional assumptions regarding the cause and circumstance of falls in older adults living in long-term care,” Stephen N. Robinovitch, Ph.D., said at the meeting.
About half of older adults living in long-term care facilities fall each year, whereas the annual incidence is about 30% among older adults living in the community, said Dr. Robinovitch of the department of biomedical physiology and kinesiology at Simon Fraser University, Burnaby, B.C.
Studies of self-reported falls have suggested that about half of all falls result from slips and trips, while the rest are ascribed to losing balance, changing posture, or a leg giving way. In these studies, the most common activities at the time of a fall were walking, turning, transferring, and reaching.
As part of the ongoing Vancouver Fall Mechanisms Study, Dr. Robinovitch and his colleagues are working with two long-term care facilities in British Columbia to develop “real-life laboratories” where they can witness activity before and during falls instead of relying on self-reports.
In common areas throughout the two facilities (each with about 230 beds), the investigators used 270 digital video cameras to record 184 falls by 124 residents during a 2-year period. Three expert reviewers classified the key characteristics of each fall. “A lot of what our data are suggesting is that falls among this population are highly variable,” Dr. Robinovitch said in an interview.
Unlike previous studies of falls, the videos indicated that an incorrect transfer of weight caused most falls (51%). Trips were estimated to account for 22% of falls, and slips for only 4%. Hitting or bumping something caused 21% of falls, collapsing was to blame in 10% of falls, and losing support from an external object was the cause in 13%. Each fall could have multiple causes. At the time of a fall, four activities were significantly more common than others: walking forward (26%), standing quietly (22%), sitting down or lowering (16%), and initiating walking (16%).
Initial fall direction was equally divided among forward, backward, and sideways, but many fallers turned during descent, causing backward landings to be more common than forward or sideways impacts. The video analysis revealed that a fall starting forward is just as likely as a sideways fall to result in an impact to the hip.
Dr. Robinovitch noted that many older adults, especially older women, are unable to react quickly enough to take a corrective step or can't break a fall with their hands. In the video study, residents hit their head in 30% of falls, their hip in 46%, and their hands in 54%.
Impact to the hands did not affect the probability of impact to the head, suggesting that although older adults do use their hands to arrest a fall, strengthening exercises are warranted to improve the effect of this response, he said.