Injuries from falls by older adults in long-term care captured on video: Prevalence of impacts and injuries to body parts

Age-related changes in muscle coordination patterns of stepping responses to recover from loss of balance

INTRODUCTION

Reactive stepping capacity to recover from a loss of balance declines with aging, which increases the risk of falling. To gain insight into the underlying mechanisms, we investigated whether muscle coordination patterns of reactive stepping differed between healthy young and older individuals.

METHODS

We performed a cross-sectional study between 15 healthy young and 14 healthy older adults. They recovered from 200 multidirectional platform translations that evoked reactive stepping responses. We determined spatiotemporal step variables and used muscle synergy analysis to characterize stance- and swing-leg muscle coordination patterns from the start of perturbation until foot landing.

RESULTS

We observed delayed step onsets in older individuals, without further spatiotemporal differences. Muscle synergy structure was not different between young and older individuals, but age-related differences were observed in the time-varying synergy activation patterns. In anterior-posterior directions, the older individuals demonstrated significantly enhanced early swing-leg synergy activation consistent with non-stepping behavior. In addition, around step onset they demonstrated increased levels of synergy coactivation (mainly around the ankle) in lateral and anterior directions, which did not appear to hamper foot clearance.

CONCLUSION

Although synergy structure was not affected by age, the delayed step onsets and the enhanced early synergy recruitment point at a relative bias towards non-stepping behavior in older adults. They may need more time for accumulating information on the direction of perturbation and making the corresponding sensorimotor transformations before initiating the step. Future work may investigate whether perturbation-based training improves these age-related deficits.

Characteristics and Consequences of Falls in People Who Use Wheelchairs in Long-Term Care Settings

OBJECTIVES

The purpose of this study was to understand the characteristics and consequences of falls in individuals using wheelchairs in long-term care settings.

DESIGN

Observational analysis of real-world falls in long-term care.

SETTING AND PARTICIPANTS

Residents using wheelchairs from 2 long-term care facilities in British Columbia, Canada (n = 32 participants, mean age = 84.7 years, 12 women).

METHODS

Two raters used the validated Falls Video Analysis Questionnaire, adapted from the original version, to assess the causal, behavioral, and environmental aspects of falls from wheelchairs.

RESULTS

A total of 58 wheelchair fall videos were identified out of 300 total videos that were collected from 2007 to 2014. Wheelchair falls were most often caused by incorrect transfer or shift of body weight (70.7%). Participants most often fell backward with 89.7% striking their pelvis. Individuals using wheelchairs had limited protective response, with only 10.3% demonstrating a step response. Improper brake position contributed to 67.2% of falls. No serious fall-related injuries were reported.

CONCLUSIONS AND IMPLICATIONS

The findings highlight the unique nature of falls in older adults who use wheelchairs in long-term care settings. Overall, the results of this study support clinical practice and the critical need for developing specialized fall prevention and fall detection interventions for individuals who use wheelchairs in long-term care.

Footwear and Falls in Long-Term Residential Aged Care Facilities: An Analysis of Video Capture Data

INTRODUCTION

Several footwear characteristics have been shown to affect balance and gait patterns and may therefore influence the risk of falling in older adults. However, attributing a link between footwear and falls is inherently difficult as it often relies on self-report which may be inaccurate.

METHODS

Archival video recordings of falls that occurred in two long-term residential aged care facilities were initially screened to determine whether the footwear worn at the time (barefoot, socks, slippers/sandals, or shoes) could be documented. These falls were then independently evaluated by three additional assessors and a meeting was held to obtain consensus in relation to whether the footwear could have potentially contributed to the fall, and what mechanism may have been responsible. Cross-tabulations were performed in relation to footwear type and fall characteristics (proposed mechanism and fall direction).

RESULTS

There were 300 falls experienced by 118 older adults aged 58 years-98 years (mean age 82.8 years, SD 7.6). Of these falls, footwear could be ascertained in 224 (75%). After the consensus meeting, the proportion of falls considered to be potentially related to footwear was 40 (18%). The likelihood of footwear contributing to the fall was highest when participants were wearing socks (14/19 falls; 74% of all footwear-related falls), followed by being barefoot (2/6 falls; 33%), wearing slippers/sandals (17/100 falls; 17%), and wearing shoes (7/99 falls, 7%).

CONCLUSION

Footwear could be a potential contributor to a substantial number of falls in residential aged care. Wearing socks would appear to place an older person at risk of future falls and should therefore be avoided in this population.

Falls From Beds Among Elderly Outpatients: Injuries and Outcomes

Introduction Falls from beds (FFBs) among outpatient elderly individuals are a prevalent issue, particularly for those aged 65 and above. This presents a notable health challenge with consequences that extend beyond personal well-being, placing a considerable strain on healthcare systems. Fall-related injuries often result in reduced independence, increased morbidity, and, in severe instances, fatalities. It is crucial to address these outpatient falls to safeguard the health and independence of the elderly population. Methods This review presents data sourced from a trauma registry covering admissions from March 31, 2016, to December 27, 2021, at Desert Regional Medical Center, a Level 1 Trauma Center in Palm Springs, USA. Over this period, 3,148 patients sought emergency care following falls. The study specifically investigates cases following FFBs, revealing 164 admissions out of the total. Furthermore, it contrasts patient demographics, injury types, and outcomes with existing literature. Results This retrospective analysis found that, among the 164 patients admitted to the emergency department over a five-year and eight-month period due to FFBs, 143 were classified as elderly, aged 65 and above. The mean age of those admitted was 76, whereas those not admitted had a mean age of 71. A significant majority, 87%, were hospitalized; within this group, 16% required intensive care. Surgical intervention was necessary for 27 individuals, and there were three fatalities. Soft tissue hematomas were the most common injuries, representing 24% of injuries at admission, closely followed by upper extremity fractures at 21%. Over half of these patients could not return home post-hospitalization, with 41% being transferred to skilled nursing facilities (SNF). Conclusions As the aging population in the United States continues to grow, the incidence of falls is on the rise, resulting in injuries like fractures and head trauma. The objectives of this review are to provide an overview of the current literature on FFBs, as well as to emphasize the significant impact of such injuries on the elderly population. Additionally, it includes an analysis of a dataset detailing injuries resulting from bed-related falls, offering a comparison to existing research.

The characteristics and risk factors of fatal falls among adults aged 60 and above in Southwest China

Falls constitute a leading cause of unintentional injury deaths among older adults. This study aimed to examine the comprehensive characteristics of fatal falls among older individuals in Yunnan Province, China, to highlight the challenges faced in elderly care. A total of 22,798 accidental fall-related deaths were extracted from China's National Disease Surveillance Points System aged 60 and above between 2015 and 2019. Quantitative and textual data were analyzed to assess the incidence rates of initiating factors, locations, symptoms, and overall survival (OS) outcomes after falling. Hypertension emerged as the most significant intrinsic factor, especially among individuals aged between 70 and 79, female older adults, and urban residents (P < 0.001). Home was identified as the most common location where fatal falls occurred (61.19%). The head was the most commonly injured body region (58.75%). The median of OS for all fatal falls was 2 days (0.13, 30), of which deaths occurred within 24 h [9287 (49.36%)]. There were instances where timely discovery after falling did not occur in 625 cases; their median of OS was significantly shorter compared to those discovered promptly after falling (P < 0.001). Targeted interventions focusing on fall prevention and post-fall care are equally crucial for the well-being of older adults.

Retrospective Analysis of Circumstances of Falls and Related Injuries across Levels of Care in Older Adult Retirement Home Facilities

Towards developing more effective interventions for fall-related injuries, this study analysed a novel database from six retirement home facilities over a 4-year period comprising 1,877 fallers and 12,445 falls. Falls were characterized based on location, activity, injury site, and type, and the database was stratified across four levels of care: Independent Living, Retirement Care, Assisted Care, and Memory care. Falls most occurred within the bedroom (62.8%), and during unknown (38.1%), walking (20.2%), and transfer tasks (14.6%). Approximately one in three (37%) of all falls resulted in an injury, most commonly involving the upper limb (31.8%), head (26.3%), and lower limb (22.2%), resulting in skin tears (35.3%), aches/pains (29.1%), or bruises (28.0%). While fall location, activity, and injury site were different across levels of care, injury type was not. The data from this study can assist in targeting fall-related injury prevention strategies across levels of care within retirement facilities.

Association Between Falls, Head Impacts, and Mortality Among Older Adults in Long-Term Care

OBJECTIVES

Residents in long-term care (LTC) are at high risk for falls, and falls in LTC often result in impact to the head, with clinical consequences that may be challenging to detect. We examined whether the survival of LTC residents associates with falls and fall-related head impacts.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

This study was conducted in 2 Vancouver-area LTC homes where falls were captured on video from surveillance cameras. A total of 232 participants (133 females, 99 males) experienced at least 1 fall captured on video, among whom 84% (n = 194) died between January 2011 and January 2020. The mean age at death was 86.5 (SD = 8.5) years, and the mean survival time after enrollment to this study was 3.8 (SD = 2.1) years.

METHODS

Univariable and multivariable models were used to determine how survival time depended on the rate of falls (falls per 365 days), the percentage of falls on video involving head impact, sex, age at death, and baseline physical and cognitive status.

RESULTS

On average, participants experienced 6.2 (SD = 7.0) falls per 365 days, and 36.9% (SD = 36.3) of video-captured falls resulted in head impact. In multivariable analyses, an increase of 1 fall per 365 days resulted in a 4.2% higher risk of death [hazard ratio (HR) = 1.042, 95% CI 1.023-1.062, P < .001]. A 1% increase in falls involving head impact resulted in an 0.5% higher risk of death (HR 1.005, 95% CI 1.001-1.010, P = .015). Participants who experienced head impact in all video-captured falls had a 50% higher risk for death than those who always avoided head impact.

CONCLUSIONS AND IMPLICATIONS

Survival in LTC is associated with the rate of falls and percentage of falls involving head impact. Improved efforts are required to prevent falls in LTC, and reduce the frequency and consequences of head impacts during falls (eg, through compliant flooring).

Relationship Between Depression and Falls Among Nursing Home Residents: Protocol for an Integrative Review

BACKGROUND

Aging exposes individuals to new health disorders and debilitating chronic diseases, yet most older adults, even in functional decline, do not want to leave their homes. Nevertheless, for many, institutionalization in a nursing home (NH) may become essential to ensure their continued safety and health. Depression is one of the most common psychiatric disorders among older adults, especially among those who are institutionalized. Depressed NH residents face a high risk of future functional decline and falls, decreasing their quality of life. The relationship between depression and falls is complex and bidirectional. Previous reviews have focused on home-dwelling older adults or explored the relationship between antidepressant drugs and falls. To the best of our knowledge, no integrative literature reviews have explored the relationship between depression and falls among NH residents.

OBJECTIVE

Analyze studies on the relationship between depression and falls among NH residents.

METHODS

We will conduct an integrative literature review of published articles in relevant scientific journals on the relationship between depression and depressive symptomatology and falls among NH residents. As usually defined, we will consider NH residents to be people aged 65 years and older who can no longer live safely and independently in their homes. We will also consider older adults on short-term stays in an NH for rehabilitation after hospital discharge. Retrieved articles will be screened for eligibility and analyzed following previously reported steps. The most pertinent bibliographical databases will be examined for qualitative, quantitative, and mixed methods studies, from inception until August 31, 2023, thus ensuring that all relevant literature is included. We will also hand-search the bibliographies of all the relevant articles found and search for unpublished studies in any language. If appropriate, we will consider conducting a meta-analysis of the studies retrieved.

RESULTS

A first round of data collection was completed in March 2023. We retrieved a total of 2276 references. A supplementary literature search to ensure the most up-to-date evidence is ongoing. We anticipate that the review will be completed in late September 2023, and we expect to publish results at the end of December 2023.

CONCLUSIONS

This integrative review will increase knowledge and understanding of the complex relationship between depression and falls in NH environments. Its findings will be important for developing integrated, multidisciplinary models and care recommendations, adaptable to each NH resident's situation and health status, and for creating preventive interventions to help them maintain or recover optimal health stability.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/46995.

Mortality Trends due to Falls in the Group of People in Early (65-74 Years) and Late (75+) Old Age in Poland in the Years 2000-2020

The aim of the study was to assess mortality trends due to falls in early (65-74 years) and late (75+) old age groups in Poland in 2000-2020. The study used a database of all deaths due to falls in two age groups. Per 100,000 men in early old age, the crude death rate (CDR) increased from 25.3 in 2000 to 25.9 in 2020. After 2012, a statistically significant decrease was observed (annual percentage change (APC) = -2.3%). Similar trends were noted for standardized death rates (SDR). Among men 75 years and older, the CDR values between the years 2000 and 2005 decreased (APC = -5.9%; p < 0.05), while after 2005, they increased (1.3%; p < 0.05). The SDR value decreased from 160.6 in 2000 to 118.1 in 2020. Among women aged 65-74, the CDRs values between 2000-2020 decreased from 13.9 and 8.2 per 100,000 women. The SDR value decreased from 14.0 to 8.3, respectively (2000-2007: APC = -7.2%; p < 0.05). Among women aged 75+, the CDR value decreased from 151.5 to 111.6 per 100,000 but after 2008, they began to increase (APC = 1.9%; p < 0.05). SDR decreased from 188.9 to 98.0 per 100,000 women. Further research on the mortality in falls is needed in order to implement preventive programs.

Compensatory stepping responses during real-life falls in older adults

BACKGROUND

Laboratory studies of postural responses suggest that stepping is a common strategy for balance recovery. Yet little is known about the frequency and characteristics of stepping responses during real-life falls in older adults.

RESEARCH QUESTIONS

(1) Among falls experienced by older adults in long-term care (LTC), what is the prevalence of attempts to recover balance by stepping? (2) How often are steps aligned to the direction of the fall? (3) Do the prevalence and characteristics of steps associate with intrinsic and situational factors?

METHODS

We collected and analyzed video footage of 1516 falls experienced by 515 residents of LTC (of mean age 82.7 years). Using generalized estimating equations, we tested whether the prevalence, direction and size of steps associated with sex, age, fall direction, activity at the time of falling, cause of imbalance, and holding or grasping objects.

RESULTS

Stepping after imbalance was observed in 76% of falls, and 80% of these cases involved multiple steps. The direction of steps aligned with the initial fall direction in 81% of cases. The size of the first step was less than one-half foot length in 64% of cases. Secondary steps tended to be similar in size to the first step. Steps were more common for falls during walking than standing, and for sideways falls. Steps were less common in falls involving held objects, and steps were less likely to be aligned with the fall direction when reach-to-grasp responses were observed.

SIGNIFICANCE

Older adults in LTC tended to respond to falls with multiple compensatory steps. Steps were tailored to the direction of the fall, but small in size (less than one-half foot length in size). Exercise programs for fall prevention in older adults should focus on increasing step size to enhance the effectiveness of step recovery responses.

Circumstances of Falls During Sit-to-Stand Transfers in Older People: A Cohort Study of Video-Captured Falls in Long-Term Care

OBJECTIVE

To characterize the circumstances of falls during sit-to-stand transfers in long-term care (LTC), including the frequency, direction, stepping and grasping responses, and injury risk, based on video analysis of real-life falls.

DESIGN

Cohort study.

SETTING

LTC.

PARTICIPANTS

We analyzed video footage of 306 real-life falls by 183 LTC residents that occurred during sit-to-stand transfers, collected from 2007 to 2020. The mean age was 83.7 years (SD=9.0 years), and 93 were female (50.8%).

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

We used Generalized Estimating Equations to test for differences in the odds that a resident would fall at least once during the rising vs stabilization phases of sit-to-stand and to test the association between the phase of the transfer when the fall occurred (rising vs stabilization) and the following outcomes: (1) the initial fall direction; (2) the occurrence, number, and direction of stepping responses; (3) grasping of environmental supports; and (4) documented injury.

RESULTS

Falls occurred twice as often in the rising phase than in the stabilization phase of the transfer (64.0% and 36.0%, respectively). Falls during rising were more often directed backward, while falls during stabilization were more likely to be sideways (odds ratio [OR]=1.95; 95% confidence interval [CI]=1.07-3.55). Falls during rising were more often accompanied by grasping responses, while falls during stabilization were more likely to elicit stepping responses (grasping: OR=0.30; 95% CI=0.14-0.64; stepping: OR=8.29; 95% CI=4.54-15.11). Injuries were more likely for falls during the stabilization phase than the rising phase of the transfer (OR=1.73; 95% CI=1.04-2.87).

CONCLUSION

Most falls during sit-to-stand transfers occurred from imbalance during the rising phase of the transfer. However, falls during the subsequent stabilization phase were more likely to cause injury.

Stair-related falls in the USA: traumatic brain injury and the role of alcohol intoxication

INTRODUCTION

Falls are a leading cause of head injury in the USA. Stair-related fall injuries are common and often more serious than same level falls. Alcohol is a known contributor to unintentional injuries, and often associated with fall-related injuries, specifically falls occurring on stairs. The objective was to examine the association between alcohol use and head injuries (traumatic brain injuries (TBIs) or craniomaxillofacial (CMF) injuries) among persons aged 15-64 presenting to an emergency department (ED) with an injury resulting from a fall on stairs.

METHODS

Using the 2019 National Electronic Injury Surveillance System, US ED records were examined. Injuries due to falling on stairs were retrieved, with the role of alcohol in the outcome of TBI and CMF injuries examined. Prevalence ratios (PR), adjusted for covariates (blood alcohol level screening, patient demographics, drug use, disposition) were obtained from average marginal predictions derived from logistic regression models.

RESULTS

An estimated 687 902 patient visits related to falls on stairs occurred during the study period. Patients who presented with alcohol intoxication had a higher prevalence of TBI (PR 2.7 95% CI 2.3 to 3.1) and CMF injuries (PR 2.5; 95% CI 2.3 to 2.8). PRs were more pronounced among patients with blood alcohol concentration ≥0.1, as was hospital admission.

CONCLUSIONS

Stair-related falls represent a common cause of ED visits for falls in the USA. Alcohol intoxication had a detrimental effect on the prevalence of TBI and CMF. A multimodal treatment approach may be beneficial given the complex interrelationship between the injury type and alcohol.