Risk Factors for Intracranial Haemorrhage in Accidents Associated with the Shower or Bathtub

Grab Bar Use Influences Fall Hazard During Bathtub Exit

OBJECTIVE

This study evaluated the hazard (risk of unrecovered balance loss and hazardous fall) and strategies associated with grab bar use, compared to no grab bar use, during unexpected balance loss initiated whilst exiting a bathtub.

BACKGROUND

While independent bathing is critical for maintaining self-sufficiency, injurious falls during bathing transfer tasks are common. Grab bars are recommended to support bathing tasks, but no evidence exists regarding fall prevention efficacy.

METHOD

Sixty-three adults completed a hazardous bathtub transfer task, experiencing an unpredictable external balance perturbation while stepping from a slippery bathtub to a dry surface. Thirty-two were provided a grab bar, while 31 had no grab bar available. Slips and grab bar use were recorded via four video cameras. Slip occurrence and strategy were identified by two independent video coders.

RESULTS

Participants who had a grab bar were 75.8% more likely to recover their balance during the task than those who did not have a grab bar. Successful grab bar grasp was associated with balance recovery in all cases. Attempts to stabilize using other environmental elements, or using internal strategies only, were less successful balance recovery strategies. Grab bar presence appeared to cue use of the environment for stability. Proactive grasp and other strategies modified grasping success.

CONCLUSION

Grab bars appear to provide effective support for recovery from unexpected balance loss. Grab bar presence may instigate development of fall prevention strategies prior to loss of balance.

APPLICATION

Bathroom designs with grab bars may reduce frequency of fall-related injuries during bathing transfer tasks.

Obstacle clearance performance in individuals with high body mass index

The objective of this study was to quantify performance in an obstacle clearance task among individuals with excess body weight or body mass index (BMI). Task performance was operationalized as the maximum obstacle height cleared, four duration measures of successful task completion and compensatory movements used in the process of task completion. Eighteen participants with a BMI exceeding 30 kg/m² completed a laboratory experiment that required stepping over seven lightweight obstacles. Obstacle heights were sequentially increased from 36 cm in 5 cm increments until participants were unsuccessful or unable to clear the obstacle up to 66 cm. Successful task completions decreased from 100% at an obstacle height of 36 cm to 66.1% at 66 cm. Higher obstacle heights were associated with significantly fewer task completions, longer leading and trailing leg stance and overall task duration, and more frequent use of compensatory movements for successful obstacle clearance. Cox PH regression was used to test the association between probability of obstacle clearance and normalized obstacle height adjusting for BMI, standing balance, and type of compensatory movement used, namely, hover and pivot motions involving the leg, and hands for bracing. The probability of successful task completion significantly decreased with increases in BMI (hazard ratio, HR = 1.14, 95% CI: 1.05-1.25), and increased with use of a leg pivot motion (HR = 0.30, 95% CI: 0.09-0.96) during task completion, after adjusting for standing balance and other types of compensatory movements. Overall, the results demonstrated that obstacle clearance performance is affected by an individual's BMI and the use of compensatory behaviors for regaining stability. The ability to recruit internal and external stabilization techniques could potentially serve as a clinical indicator of reduced fall risk and be the focus of fall prevention interventions. Implications for evaluating stability, fall risk, and identifying modifiable factors for fall prevention in the obese population are discussed.

Falls in the Bathroom: A Mechanism of Injury for All Ages

BACKGROUND

When ground-level falls occur in the bathroom, there is particular potential for morbidity and mortality given the high density of hard surfaces. Risk factors are not clearly defined by the existing literature. The objective of this study was to define the epidemiology, injury patterns, and outcomes after falls in the bathroom.

MATERIALS AND METHODS

All patients presenting to LAC+USC Medical Center (01/2008-05/2015) after a fall in the bathroom (ICD-9 code E884.6) were included. Demographics, injury data, investigations, procedures, and outcomes were collected.

RESULTS

Fifty-seven patients were included, with mean age 45 y (range 0-92). All ages were affected, with ages 41-60 y at highest risk. Common comorbidities included cardiovascular disease (n = 23, 40%), neuromuscular disorders (n = 13, 23%), and diabetes (n = 9, 16%). Ten patients (18%) were intoxicated. Home medications included antihypertensives (n = 18, 32%), antipsychotics (n = 9, 16%), and anticoagulants (n = 8, 14%). Common investigations included X-rays (n = 41, 72%) and CT scans of the head (n = 20, 35%). The most frequent injuries were contusion/laceration (n = 45, 79%), fracture (n = 12, 21%), and traumatic brain injury (n = 7, 12%). Most patients did not require hospital admission (n = 46, 81%), although 4 (7%) needed intensive care unit care and operative intervention (ORIF [n = 2, 4%] or craniectomy [n = 2, 4%]). Mortality was low (n = 1, 2%). Most patients were discharged home (n = 40, 70%).

CONCLUSIONS

All ages, especially 41-60 y, are susceptible to falls in the bathroom. Despite the potential for serious injury, most do not require hospital admission. Risk factors include drugs/alcohol, cardiovascular disease, neuromuscular disorders, and diabetes. Efforts to minimize fall risk should be directed toward these individuals.