Falls among seniors are a major cause of disability and death, but
knowing what led to a split-second fall can often be difficult to figure out
after a person is found sprawled on the ground.
So researchers used strategically placed video cameras in long-term care
facilities to capture spills among residents so they could analyze the
mechanics of various falls, with the goal of improving prevention. “We’ve known
for a long time that falls are the number 1 cause of injury in older adults,
including 90 per cent of hip fractures and 60 per cent of head injuries.
They’re also the number 1 cause of injury-related deaths,” said Stephen
Robinovitch, a researcher at Simon Fraser University who specializes in injury
prevention and mobility biomechanics. “So there’s been a great deal of research
focusing on the cause of falls, prevention of falls and fall-related injuries,”
Robinovitch, who led the study published in this week’s issue of the Lancet,
said from Burnaby, B.C. “But really up until now, we’ve had no objective
evidence on how and why these events occur.”
To get a better sense of what happens when someone takes a tumble,
researchers set up video cameras in hallways, public dining halls and lounges
in two B.C. long-term care residences. They analyzed recordings of 227 falls
involving 130 individuals, separating the falls into three stages: initiation,
descent and impact. “So what we found was that about 20 per cent of falls were
due to trips and 10 per cent were due to being bumped or nudged by someone
else, or hit by a door closing,” he said. “But the remaining 70 per cent — and
the reason why we think falls are so common in this population of frailer
individuals in long-term care — they basically occurred during a failed attempt
at performing daily activities like walking, sitting down and even just
standing quietly. “And they were most often due to what we call incorrect
weight shifting,” he said, explaining that the person leaned too far past their
centre of gravity, losing their base of support between the feet and the
ground.
“So this might occur when you’re turning or reaching. It also occurred
when people stood up from sitting, but failed to achieve a stable final
position.”
Although not discussed in the Lancet paper, Robinovitch said the
research shows 37 per cent of falls involved hitting the head, even though
three-quarters of these elderly residents who toppled over did get their arms
out in an attempt to break their fall. “But this didn’t affect their risk for
head impact,” he said. “In a sense it’s not bad news. We see people getting
their arms out to protect themselves. But perhaps it’s the lack of strength
that is making it ineffective. And strength is one thing that we actually can
target successfully through exercise, through resistance training. “So maybe
that’s a future avenue to explore.”
Geoff Fernie, director of the Toronto Rehab Research Institute, said the
B.C. study is important because it reinforces and expands on similar work done
by his group published in the early 1990s. That research found that tipping
past the centre of balance due to incorrect weight shifting was the most common
cause of falls among the elderly. However, the study analyzed only about 25
falls using less sophisticated videotaping equipment, he said. The B.C. study
also found that 25 per cent of trips occurred when a person’s foot got caught
on a table or chair leg, suggesting that furniture in long-term care facilities
could be designed with a central base rather than legs to prevent tripping
falls.
Fernie said walkers can also be a problem because when an individual
begins leaning past their centre of gravity, they tend to step sideways to
steady their base of support. But the legs of the walker are in the way,
preventing a sidestep and leading to a fall tangled up in the supportive
device, a spill that could conceivably cause even greater injury. In a
commentary accompanying the Lancet study, Dr. Clemens Becker of the Robert
Bosch Hospital in Stuttgart, Germany, said many assumptions about falls and
prevention strategies have been based on subjective information. “This absence
of understanding is one of the reasons why efforts to prevent falls have had
little success, although some progress has been achieved.”
The Canadian study provides objective analyses of the mechanics of
falling. However, Becker said one limitation is that researchers looked only at
falls in public areas, which are thought to account for just half of all falls
among long-term care residents. “To study falls in the community, we will need
a technological shift,” he writes. “Evidence provided by Robinovitch and
colleagues of the movement patterns that lead to falls is helpful in guiding
the design of sensor-based fall monitoring systems. “The next step will require
co-ordinated action and possibly an open-access database that would allow
real-world fall data, obtained through different sensors, to be shared.”
Figuring out how to prevent falls among seniors is an important public
health goal, said Robinovitch. Almost a third of older people who live
independently and about half of those residing in long-term care facilities
fall at least once each year. “Falls are often the thing that breaks the
camel’s back,” he said. “Someone who’s at risk for falls could have multiple conditions.
They could be taking medications, they could have diabetes or Parkinson’s, or a
history of stroke that put them at risk. “But having said that, individuals
will often be functioning perfectly well, living independently in the community
or functioning well in residential care and it is the fall that causes a
downward spiral,” he said, adding that even fear of falling can lead to
diminished health because people become less active and their muscles weaken. “So
it really is a serious problem. When you think about it, any fall from standing
is a life-threatening event for anyone.”
Metro News Canada
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