Elsevier

The Lancet

Volume 381, Issue 9860, 5–11 January 2013, Pages 47-54
The Lancet

Articles
Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study

https://doi.org/10.1016/S0140-6736(12)61263-XGet rights and content

Summary

Background

Falls in elderly people are a major health burden, especially in the long-term care environment. Yet little objective evidence is available for how and why falls occur in this population. We aimed to provide such evidence by analysing real-life falls in long-term care captured on video.

Methods

We did this observational study between April 20, 2007, and June 23, 2010, in two long-term care facilities in British Columbia, Canada. Digital video cameras were installed in common areas (dining rooms, lounges, hallways). When a fall occurred, facility staff completed an incident report and contacted our teams so that we could collect video footage. A team reviewed each fall video with a validated questionnaire that probed the cause of imbalance and activity at the time of falling. We then tested whether differences existed in the proportion of participants falling due to the various causes, and while engaging in various activities, with generalised linear models, repeated measures logistic regression, and log-linear Poisson regression.

Findings

We captured 227 falls from 130 individuals (mean age 78 years, SD 10). The most frequent cause of falling was incorrect weight shifting, which accounted for 41% (93 of 227) of falls, followed by trip or stumble (48, 21%), hit or bump (25, 11%), loss of support (25, 11%), and collapse (24, 11%). Slipping accounted for only 3% (six) of falls. The three activities associated with the highest proportion of falls were forward walking (54 of 227 falls, 24%), standing quietly (29 falls, 13%), and sitting down (28 falls, 12%). Compared with previous reports from the long-term care setting, we identified a higher occurrence of falls during standing and transferring, a lower occurrence during walking, and a larger proportion due to centre-of-mass perturbations than base-of-support perturbations.

Interpretation

By providing insight into the sequences of events that most commonly lead to falls, our results should lead to more valid and effective approaches for balance assessment and fall prevention in long-term care.

Funding

Canadian Institutes for Health Research.

Introduction

Falls are the most frequent cause of unintentional injuries in elderly people (aged ≥65 years), accounting for 90% of hip1 and wrist fractures2 and 60% of head injuries.3 About 30% of elderly people living independently and 50% of those in long-term care fall at least once each year.4, 5 Clearly, prevention of falls in elderly adults is a public health priority.

An important unrecognised challenge to care providers in prevention of falls is the scarcity of objective evidence of the mechanisms of falls—ie, how and why they occur. Few previous studies have measured movements of the body during actual falls.6 Instead, understanding of the circumstances of falls is based on interviews or incident reports, which rely on the recall accuracy of the faller or witness, if any, to describe the event,7, 8, 9, 10 or on laboratory-based simulations in which participants (typically healthy young adults) are made to trip or slip.11 This scarcity of information makes accurate diagnosis of the cause of falls difficult, and impairs development of improved environments for elderly people, valid fall assessment instruments, and fall prevention programmes.

We aimed to address this barrier by providing objective evidence of the cause and circumstances of falls in elderly adults, on the basis of analysis of real-life falls captured on video in two long-term care facilities.

Section snippets

Study design and participants

We did this observational study between April 20, 2007, and June 23, 2010, at two long-term care facilities in Canada: Delta View, a 312 bed facility in Delta, BC; and New Vista, a 236 bed facility in Burnaby, BC. We selected these facilities on the basis of their existing networks of video surveillance cameras and operational ties to the Fraser Health Authority. All residents were eligible and included if they had a fall captured on video during the study period.

The study was approved by the

Results

Residents with electronic health records at New Vista (n=180) had a mean age of 81 years (SD 12), 67% were women, and 17% were diagnosed with Alzheimer's disease (table 1). Residents at Delta View (n=191) had a mean age of 82 years (SD 10), 61% were women, and 38% were diagnosed with Alzheimer's disease. In 2010, at Delta View, 45% of falls documented on incident report occurred in common areas, of which 65% were captured on video. At New Vista, 34% of documented falls occurred in common areas,

Discussion

This study provides long-missing objective evidence of the cause and circumstances of falls in elderly adults, and shows new avenues for prevention of fall injury in long-term care. Our results show that incorrect weight shifting was the most common cause of falls, and that three major classes of activities—walking, sitting down, and standing—were the most common precipitants of falls. Our findings emphasise the need to target each of these activities in fall risk assessment and prevention

References (31)

  • PW Overstall et al.

    Falls in the elderly related to postural imbalance

    Br Med J

    (1977)
  • D Prudham et al.

    Factors associated with falls in the elderly: a community study

    Age Ageing

    (1981)
  • MC Nevitt et al.

    Type of fall and risk of hip and wrist fractures: the study of osteoporotic fractures

    J Am Geriatr Soc

    (1993)
  • AK Topper et al.

    Are activity-based assessments of balance and gait in the elderly predictive of risk of falling and/or type of fall?

    J Am Geriatr Soc

    (1993)
  • M Herman et al.

    The evolution of seniors' falls prevention in British Columbia

    (2006)
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