Causes of falls

Experience gained through video recordings

Background

Falls in the elderly represent a serious health problem, especially in long-term care settings. There is, however, little objective evidence available on how and why falls occur in this population. The aim of our work was to provide such evidence by analysing real falls through video recordings made in long-term care facilities.

Methods

From 20 April 2007 to 23 June 2010 we conducted an observational study in two long-term care facilities in British Columbia (Canada). Digital video cameras were installed in the common areas (dining rooms, lounges, corridors). Each time a fall occurred, the facility staff completed an incident report and contacted our teams so that we could retrieve the filmed sequence. A team reviewed each video concerning a fall using a validated questionnaire aimed at analysing the cause of the loss of balance and the activity being carried out at the time of the fall. We then tested whether there were differences in the proportion of participants who fell from various causes and while they were engaged in different activities, using linear models, logistic regression for repeated measures and log-linear Poisson regression.

Results

We recorded 227 falls by 130 subjects (average age 78 years, SD 10). The most frequent cause of falls was an incorrect shifting of weight, which accounted for 41% of the falls (93 out of 227), followed by tripping (48, 21%), being hit or struck (25, 11%), loss of support (25, 11%) and collapse (24, 11%). Slips accounted for only 3% of the falls (6). The three activities associated with the highest proportion of falls were: walking forward (54 falls out of 227, 24%), standing up (29 falls, 13%) and sitting down (28 falls, 12%). Compared with reports previously carried out in long-term care facilities, we identified a higher occurrence of falls while standing up or during transfers, a lower occurrence while walking and a higher proportion due to alterations of the centre of gravity rather than to alterations of the base of support.

Interpretation

By providing indications on the sequences of events that most frequently cause falls, our results should lead to more valid and effective approaches for the assessment of balance and for the prevention of falls in long-term care facilities.

See attached study