Falls are the leading cause of injury for older adults, and about half of older adults in long-term care (LTC) experience a fall in any given year. Attempts to reduce the number of falls are limited by a lack of observational evidence of how they occur; interviews or incident reports about actual falls depend on accurate recall, and laboratory-based simulations of falls (which usually involve a healthy younger adult simulating a fall in a controlled setting) provide little insight into the actual circumstances of falls. To address this lack of evidence, a team of researchers obtained three years of video evidence of falls in common areas of two LTC communities in British Columbia, Canada.
The data was collected by over 200 cameras set up in dining rooms, lounges, and hallways of the two communities. When a fall occurred, staff alerted the research team, who determined whether the cameras were able to collect footage of the event. Available footage was analyzed by teams of the researchers who attempted to identify the cause of the imbalance and the type of activity that led to the fall.
The researchers devised seven categories of causes of falls (such as incorrect transfer of bodyweight, tipping, or loss of consciousness) and 11 categories of activities occurring at the time of the fall (like walking forward, getting up from a seated position, standing and turning).
The most common cause was incorrect shifting of bodyweight (basically, loss of balance), which caused 41 percent of the recorded falls. Tripping or stumbling was the cause of 21 percent of the falls observed, followed by being hit or bumped, losing support from an external object (such as a walker), or collapsing. In addition to getting one’s foot caught on the ground, tipping was often caused by difficulty in raising the foot, in getting in caught on equipment (such as a walker or food cart), or on furniture. Slipping was the cause of only three percent of all recorded falls.
This study has important implications about falls in the LTC environment. Because so many falls resulted from loss of balance, balance and strength programs may be an important aspect of falls prevention. It is worthy to note, as the authors do, that so many more falls were caused by tripping than by slipping, as it is often slipping that is assessed in laboratory studies of falls. The high rate of tripping falls also suggests the need for further improvements to the design and use of space in LTC environments.
Robinovitch SN, Feldman F, Yang Y, et al. Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study. The Lancet (2012); online ahead of print. DOI: 10.1016/S0140-6736(12)61263-X.