ArticlesVideo capture of the circumstances of falls in elderly people residing in long-term care: an observational study
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
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Joint primary authors