Search

Background: Falls are the leading cause of injuries in older adults. Environmental objects (such as furniture, walls, and handrails) may act as hazards or facilitators to balance maintenance and safe landing. There is lack of objective evidence on how older adults interact with objects during falls. We addressed this gap by characterizing body part contacts with objects other than the floor during real-life falls in long-term care., Methods: We analyzed videos of 1759 falls experienced by 584 residents to characterize the prevalence of contacts with objects before, during, and after fall initiation. Using generalized estimating equations, we compared the prevalence of falls with versus without contact to objects after fall initiation. Using linear mixed models, we tested for differences across body parts in the probability of contacting objects after fall initiation., Results: In nearly one-third of falls, interactions with objects (e.g., trips over objects, loss of support with objects) or with other people (e.g., being pushed by another person) had a primary role in causing imbalance and initiating the fall. After fall initiation, participants contacted objects in 60% of falls, with intentional hand contacts to objects via reach-to-grasp or bracing being the most common type of interaction (Probability ± SE = 0.32 ± 0.01), followed by unintentional impacts to the torso (0.21 ± 0.01) and head (0.16 ± 0.01). Intentional hand contact to an object was more common during forward than backward falls (p < 0.001), while head and torso contacts to objects were more common during backward and sideways falls than forward falls (multiple p values ≤ 0.003). The hand most often contacted chairs, wheelchairs or couches, followed by tables or counters, walls, other people, walkers, and handrails. The head, torso, and shoulder most often contacted a wall., Conclusions: Most falls in long-term care involved contacts with objects other than the ground, indicating that complex environments often accompany falls in long-term care. Higher probabilities of intentional hand contacts in forward falls, versus unintentional head and torso impacts in backward and sideways falls may reflect the influence of being able to visualize and adjust one's falling patterns to nearby objects., (© 2024. The Author(s).)

Background: Falls are the leading cause of injuries in older adults. However, most falls in older adults do not cause serious injury, suggesting that older adults may fall in a manner that reduces the likelihood of impact to body sites that are most vulnerable to injury. In this observational study of falls in long-term care (LTC), we tested whether body parts differed in their probability of impact and injury., Methods: We recorded and analyzed videos of 2388 falls by 658 LTC residents (mean age 84.0 (SD = 8.1); 56.4% female). We used Linear Mixed Models to test for differences between body parts in the probability of impact and injury, and injury when impacts occurred., Results: Injuries were reported in 38.2% of falls, and 85.9% of injuries involved direct impact to the injured body part. Impact occurred most often to the hip/pelvis (probability (standard error) = 0.95 (0.01); p < .001 relative to other body parts), and least often to the head (0.35 (0.01)). Conversely, injury occurred most often to the head (p < .001 relative to other body parts). The probability of injury when impacts occurred was 0.40 (0.01) for the head, and 0.11 or less for all other body parts., Conclusion: Our results help to explain why most falls by older adults in LTC do not cause serious injury: residents land on body parts that are the most resilient to injury. The high susceptibility of the head to injury reinforces the need to enhance upper limb protective responses for fall arrest. The dominant role of direct impact as the mechanism of injury supports approaches to attenuate impact forces through strategies like protective clothing and compliant flooring., (© 2022. The Author(s).)