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Huang Q, Zhou Z, Kleiven S. Effectiveness of energy absorbing floors in reducing hip fractures risk among elderly women during sideways falls. J Mech Behav Biomed Mater 2024; 157:106659. [PMID: 39029349 DOI: 10.1016/j.jmbbm.2024.106659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/27/2024] [Accepted: 07/10/2024] [Indexed: 07/21/2024]
Abstract
Falls among the elderly cause a huge number of hip fractures worldwide. Energy absorbing floors (EAFs) represent a promising strategy to decrease impact force and hip fracture risk during falls. Femoral neck force is an effective predictor of hip injury. However, the biomechanical effectiveness of EAFs in terms of mitigating femoral neck force remains largely unknown. To address this, a whole-body computational model representing a small-size elderly woman with a biofidelic representation of the soft tissue near the hip region was employed in this study, to measure the attenuation in femoral neck force provided by four commercially available EAFs (Igelkott, Kradal, SmartCells, and OmniSports). The body was positioned with the highest hip force with a -10∘ trunk angle and +10∘ anterior pelvis rotation. At a pelvis impact velocity of 3 m/s, the peak force attenuation provided by four EAFs ranged from 5% to 19%. The risk of hip fractures also demonstrates a similar attenuation range. The results also exhibited that floors had more energy transferred to their internal energy demonstrated greater force attenuation during sideways falls. By comparing the biomechanical effectiveness of existing EAFs, these results can improve the floor design that offers better protection performance in high-fall-risk environments for the elderly.
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Affiliation(s)
- Qi Huang
- Division of Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden.
| | - Zhou Zhou
- Division of Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Svein Kleiven
- Division of Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
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Cleworth T, Tondat A, Goomer K, Kalra M, Laing AC. Effects of flooring on static and dynamic balance in young and older adults. Gait Posture 2024; 107:42-48. [PMID: 37734190 DOI: 10.1016/j.gaitpost.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 05/30/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Reducing fall-related injuries is difficult due to the multi-factorial nature of falls, and challenges in implementing injury-preventative strategies. While safety floors are effective at absorbing energy and reducing fall-related impact forces, the low stiffness component of these floors may impair an individual's balance and mobility, thereby increasing fall risk. RESEARCH QUESTION Therefore, the objective of this study was to investigate the influence of compliant flooring (i.e., safety flooring) on balance and mobility in young and older adults. METHODS Kinematics were measured with inertial measurement units from 20 young and 10 older adults. Static balance was evaluated during quiet stance on three flooring surfaces (traditional, safety, foam) with three stance positions (regular, tandem, one-legged). Mobility was evaluated using the 3 m timed-up-and-go test on two flooring surfaces (traditional, safety). RESULTS All participants were able to complete quiet standing trials on normal and safety flooring surfaces; however, most older adults could not complete one-legged stance trials or standing on foam. Significant age-related effects were observed for several balance and mobility tasks, particularly during the more challenging tandem stance condition, and the dynamic timed-up-and-go mobility test. In contrast, the introduction of safety flooring (compared to traditional flooring) had limited effects on balance/mobility (1 of 16 outcome variables showed negative effects). SIGNIFICANCE Overall, the findings demonstrate minimal effects of a novel safety floor compared to the age-related differences, and provide insights to assist researchers, consumers, and industry stakeholders in the development of environments that support safe movement and maintained independence for older adults.
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Affiliation(s)
- Taylor Cleworth
- School of Kinesiology and Health Science, York University, Toronto, Canada; York University Centre for Aging Research and Education, York University, Toronto, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | - Alyssa Tondat
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada
| | - Kanishk Goomer
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada
| | - Mayank Kalra
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | - Andrew C Laing
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Canada.
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Drahota A, Felix LM, Raftery J, Keenan BE, Lachance CC, Mackey DC, Markham C, Laing AC, Farrell-Savage K, Okunribido O. Shock-absorbing flooring for fall-related injury prevention in older adults and staff in hospitals and care homes: the SAFEST systematic review. Health Technol Assess 2022; 26:1-196. [PMID: 35089119 DOI: 10.3310/zowl2323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Injurious falls in hospitals and care homes are a life-limiting and costly international issue. Shock-absorbing flooring may offer part of the solution; however, evidence is required to inform decision-making. OBJECTIVES The objectives were to assess the clinical effectiveness and cost-effectiveness of shock-absorbing flooring for fall-related injury prevention among older adults in care settings. REVIEW METHODS A systematic review was conducted of experimental, observational, qualitative and economic studies evaluating flooring in care settings targeting older adults and/or staff. Studies identified by a scoping review (inception to May 2016) were screened, and the search of MEDLINE, AgeLine and Scopus (to September 2019) was updated, alongside other sources. Two independent reviewers assessed risk of bias in duplicate (using Cochrane's Risk of Bias 2.0 tool, the Risk Of Bias In Non-randomized Studies - of Interventions tool, or the Joanna Briggs Institute's qualitative tool). RESULTS Of the 22 included studies, 20 assessed the outcomes (three randomised controlled trials; and seven observational, five qualitative and five economic studies) on novel floors (n = 12), sports floors (n = 5), carpet (n = 5) and wooden subfloors (n = 1). Quantitative data related to 11,857 patient/resident falls (nine studies) and 163 staff injuries (one study). Qualitative studies included patients/residents (n = 20), visitors (n = 8) and staff (n = 119). Hospital-based randomised controlled trial data were too imprecise; however, very low-quality evidence indicated that novel/sports flooring reduced injurious falls from three per 1000 patients per day on vinyl with concrete subfloors to two per 1000 patients per day (rate ratio 0.55, 95% confidence interval 0.36 to 0.84; two studies), without increasing falls rates (two studies). One care home-based randomised controlled trial found that a novel underlay produces similar injurious falls rates (high-quality evidence) and falls rates (moderate-quality evidence) to those of a plywood underlay with vinyl overlays and concrete subfloors. Very low-quality data demonstrated that, compared with rigid floors, novel/sports flooring reduced the number of falls resulting in injury in care homes (26.4% vs. 33.0%; risk ratio 0.80, 95% confidence interval 0.70 to 0.91; three studies) and hospitals (27.1% vs. 42.4%; risk ratio 0.64, 95% confidence interval 0.44 to 0.93; two studies). Fracture and head injury outcomes were imprecise; however, hip fractures reduced from 30 per 1000 falls on concrete to 18 per 1000 falls on wooden subfloors in care homes (odds ratio 0.59, 95% confidence interval 0.45 to 0.78; one study; very low-quality evidence). Four low-quality economic studies concluded that shock-absorbing flooring reduced costs and improved outcomes (three studies), or increased costs and improved outcomes (one study). One, more robust, study estimated that shock-absorbing flooring resulted in fewer quality-adjusted life-years and lower costs, if the number of falls increased on shock-absorbing floors, but that shock-absorbing flooring would be a dominant economic strategy if the number of falls remained the same. Staff found moving wheeled equipment more difficult on shock-absorbing floors, leading to workplace adaptations. Staff injuries were observed; however, very low-quality evidence suggests that these are no less frequent on rigid floors. LIMITATIONS Evidence favouring shock-absorbing flooring is of very low quality; thus, much uncertainty remains. CONCLUSIONS Robust evidence is lacking in hospitals and indicates that one novel floor may not be effective in care homes. Very low-quality evidence indicates that shock-absorbing floors may be beneficial; however, wider workplace implications need to be addressed. Work is required to establish a core outcome set, and future research needs to more comprehensively deal with confounding and the paucity of hospital-based studies, and better plan for workplace adaptations in the study design. STUDY REGISTRATION This study is registered as PROSPERO CRD42019118834. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Amy Drahota
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Lambert M Felix
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - James Raftery
- Wessex Institute, University of Southampton, Southampton, UK
| | | | | | - Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Chris Markham
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Andrew C Laing
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
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Drahota A, Felix LM, Raftery J, Keenan BE, Lachance CC, Mackey DC, Markham C, Laing AC. The SAFEST review: a mixed methods systematic review of shock-absorbing flooring for fall-related injury prevention. BMC Geriatr 2022; 22:32. [PMID: 34991466 PMCID: PMC8739972 DOI: 10.1186/s12877-021-02670-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 11/19/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Shock-absorbing flooring may minimise impact forces incurred from falls to reduce fall-related injuries; however, synthesized evidence is required to inform decision-making in hospitals and care homes. METHODS This is a Health Technology Assessment mixed methods systematic review of flooring interventions targeting older adults and staff in care settings. Our search incorporated the findings from a previous scoping review, MEDLINE, AgeLine, and Scopus (to September 2019) and other sources. Two independent reviewers selected, assessed, and extracted data from studies. We assessed risk of bias using Cochrane and Joanna Briggs Institute tools, undertook meta-analyses, and meta-aggregation. RESULTS 20 of 22 included studies assessed our outcomes (3 Randomised Controlled Trials (RCTs); 7 observational; 5 qualitative; 5 economic), on novel floors (N = 12), sports floors (N = 5), carpet (N = 5), and wooden sub-floors (N = 1). Quantitative data related to 11,857 patient falls (9 studies), and 163 staff injuries (1 study). One care home-based RCT found a novel underlay produced similar injurious falls rates (high-quality evidence) and falls rates (moderate-quality evidence) to a plywood underlay with vinyl overlay and concrete sub-floors. Very low-quality evidence suggested that shock-absorbing flooring may reduce injuries in hospitals (Rate Ratio 0.55, 95% CI 0.36 to 0.84, 2 studies; 27.1% vs. 42.4%; Risk Ratio (RR) = 0.64, 95% CI 0.44 to 0.93, 2 studies) and care homes (26.4% vs. 33.0%; RR 0.80, 95% CI 0.70 to 0.91, 3 studies), without increasing falls. Economic evidence indicated that if injuries are fewer and falls not increased, then shock-absorbing flooring would be a dominant strategy. Fracture outcomes were imprecise; however, hip fractures reduced from 30 in 1000 falls on concrete to 18 in 1000 falls on wooden sub-floors (OR 0.59, 95% CI 0.45 to 0.78; one study; very low-quality evidence). Staff found moving wheeled equipment harder on shock-absorbing floors leading to workplace adaptations. Very low-quality evidence suggests staff injuries were no less frequent on rigid floors. CONCLUSION Evidence favouring shock-absorbing flooring is uncertain and of very low quality. Robust research following a core outcome set is required, with attention to wider staff workplace implications. TRIAL REGISTRATION PROSPERO CRD42019118834 .
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Affiliation(s)
- Amy Drahota
- School of Health and Care Professions, University of Portsmouth, St. Andrew's Court, St. Michael's Road, Portsmouth, PO1 2PR, UK.
| | - Lambert M Felix
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - James Raftery
- Wessex Institute, University of Southampton, Alpha House, Enterprise Road, Southampton, SO16 7NS, UK
| | - Bethany E Keenan
- School of Engineering, Cardiff University, Queen's Buildings, The Parade, Cardiff, CF24 3AA, UK
| | - Chantelle C Lachance
- School of Health and Care Professions, University of Portsmouth, St. Andrew's Court, St. Michael's Road, Portsmouth, PO1 2PR, UK
| | - Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive East, Burnaby, British Columbia, V5A 1S6, Canada
| | - Chris Markham
- School of Health and Care Professions, University of Portsmouth, St. Andrew's Court, St. Michael's Road, Portsmouth, PO1 2PR, UK
| | - Andrew C Laing
- Department of Kinesiology, University of Waterloo, B.C. Matthews Hall, Waterloo, Ontario, N2L 3G1, Canada
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Keenan BE, Hallas K, Drahota AK, Evans SL. A comparison of floor surfaces for injury prevention in care settings: impact forces and horizontal pulling force required to move wheeled equipment. Osteoporos Int 2020; 31:2383-2394. [PMID: 32647950 DOI: 10.1007/s00198-020-05520-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/25/2020] [Indexed: 12/12/2022]
Abstract
UNLABELLED Shock-absorbing flooring is one potential solution to prevent fall-related injuries. No standards exist to characterize shock-absorbing healthcare flooring. This study explores two mechanical tests for impact force reduction and horizontal force required to move wheeled objects. An appropriately designed rubber underlay can reduce peak impact by 25% compared with 1% with standard vinyl. INTRODUCTION Severe falls often occur in hospitals and care homes. Shock-absorbing flooring is one potential solution to prevent fall-related injuries; however, no standards exist for characterizing flooring as an injury prevention measure. Shock-absorbing flooring use in high-risk settings may influence both patients (injury-saving potential) and staff (manoeuvring equipment). We aimed to explore two tests to characterize floors, to determine shock absorbency and horizontal pulling force required to move wheeled objects. METHODS Mechanical testing was performed according to the Canadian Standards Association Z325 Hip Protectors document. This test was developed for hip protectors but is applicable to compliant surfaces that form part of the floor. Tests were performed on commercially available floor materials (suitable for care settings) to assess the force required to initiate movement of a wheeled object across the floor. We explored the relationships between horizontal force required to pull wheeled objects, impact force, floor thickness, and core material. RESULTS Considerable differences were identified between floor samples in their ability to reduce the peak impact force (range 0.7-25%). A peak force reduction of up to 25% can be achieved with a specially designed rubber underlay. Horizontal pulling force increased with floor thickness but was lower for rubber floors. There was no direct relationship between impact attenuation and horizontal pulling force. Whilst thickness and core material explain some variations (66.5% for wheel movement; 82.3% for impact), other unmeasured factors clearly influence floor performance. CONCLUSIONS These results can inform the development of flooring and the establishment of standards needed to underpin practice, research, and development in this field.
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Affiliation(s)
- B E Keenan
- School of Engineering, Cardiff University Queen's Buildings, The Parade, Cardiff, CF24 3AA, UK.
| | - K Hallas
- Science Division, Health & Safety Executive (HSE), Harpur Hill, Derbyshire, Buxton, SK17 9JN, UK
| | - A K Drahota
- School of Health & Care Professions, University of Portsmouth, Hampshire, Portsmouth, PO1 2PR, UK
| | - S L Evans
- School of Engineering, Cardiff University Queen's Buildings, The Parade, Cardiff, CF24 3AA, UK
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Valipoor S, Pati D, Kazem-Zadeh M, Mihandoust S, Mohammadigorji S. Falls in Older Adults: A Systematic Review of Literature on Interior-Scale Elements of the Built Environment. JOURNAL OF AGING AND ENVIRONMENT 2020. [DOI: 10.1080/02763893.2019.1683672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Shabboo Valipoor
- Department of Interior Design, College of Design, Construction and Planning, University of Florida, Gainesville, FL, USA
| | - Debajyoti Pati
- Department of Design, College of Human Sciences, Texas Tech University, Lubbock, TX, USA
| | - Mahshad Kazem-Zadeh
- Rinker School of Construction Management, College of Design, Construction and Planning, University of Florida, Gainesville, FL, USA
| | - Sahar Mihandoust
- Department of Design, College of Human Sciences, Texas Tech University, Lubbock, TX, USA
| | - Soheyla Mohammadigorji
- Department of Interior Design, College of Design, Construction and Planning, University of Florida, Gainesville, FL, USA
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Pretty SP, Armstrong DP, Weaver TB, Laing AC. The influence of increased passive stiffness of the trunk and hips on balance control during reactive stepping. Gait Posture 2019; 72:51-56. [PMID: 31146190 DOI: 10.1016/j.gaitpost.2019.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 04/19/2019] [Accepted: 05/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Age-related changes, which include increased trunk and hip stiffness, negatively influence postural balance. While previous studies suggest no net-effect of trunk and hip stiffness on initial trip-recovery responses, no study to date has examined potential effects during the dynamic restabilisation phase following foot contact. RESEARCH QUESTION Does increased trunk and hip stiffness, in isolation from other ageing effects, negatively influence balance during the restabilisation phase of reactive stepping. METHODS Balance perturbations were applied using a tether-release paradigm, which required participants to react with a single-forward step. Sixteen young adults completed two blocks of testing: a baseline and an increased stiffness (corset) condition. Whole-body kinematics were utilized to estimate spatial step parameters, center of mass (COM), COM incongruity (peak - final position) and time to restabilisation, in anteroposterior (AP) and mediolateral (ML) directions. RESULTS In the corset condition, peak COM displacement was increased in both directions (p < 0.024), which drove reductions in minimum margins of stability (p < 0.032) as step width and length were unchanged (p > 0.233). Increased passive stiffness also increased the magnitude and variability of peak shear ground reaction force, COM incongruity, and time to restabilisation in the ML (but not AP) direction (p < 0.027). SIGNIFICANCE In contrast to previous literature, increased stiffness resulted in greater peak COM displacement in both directions. Our results suggest increased trunk and hip stiffness have detrimental effects on dynamic stability following a reactive step, particularly in the ML direction. Observed increases in magnitude and variability of COM incongruity suggest the likelihood of a sufficiently large loss of ML stability - requiring additional steps - was increased by stiffening of the hips and trunk. The current findings suggest interventions aiming to mobilize the trunk and hips, in conjunction with strengthening, could improve balance and reduce the risk of falls.
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Affiliation(s)
- Steven P Pretty
- Injury Biomechanics and Aging Laboratory, Department of Kinesiology, University of Waterloo, 200 University Ave West, Waterloo, Ontario, N2L 3G1, Canada
| | - Daniel P Armstrong
- Injury Biomechanics and Aging Laboratory, Department of Kinesiology, University of Waterloo, 200 University Ave West, Waterloo, Ontario, N2L 3G1, Canada
| | - Tyler B Weaver
- Injury Biomechanics and Aging Laboratory, Department of Kinesiology, University of Waterloo, 200 University Ave West, Waterloo, Ontario, N2L 3G1, Canada
| | - Andrew C Laing
- Injury Biomechanics and Aging Laboratory, Department of Kinesiology, University of Waterloo, 200 University Ave West, Waterloo, Ontario, N2L 3G1, Canada.
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Tanel MR, Weaver TB, Laing AC. Standing Versus Stepping-Exploring the Relationships Between Postural Steadiness and Dynamic Reactive Balance Control. J Appl Biomech 2018; 34:488-495. [PMID: 29989471 DOI: 10.1123/jab.2017-0205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 04/20/2018] [Accepted: 06/05/2018] [Indexed: 11/18/2022]
Abstract
While the literature has characterized balance control during quasi-static and/or dynamic tasks, comparatively few studies have examined relationships across paradigms. This study investigated whether quiet-stance postural steadiness metrics were associated with reactive control parameters (during both stepping and restabilization phases) following a lean-and-release perturbation. A total of 40 older adults participated. Postural steadiness (center of the pressure range, root mean square, velocity, and frequency) was evaluated in "feet together" and "tandem stance" positions. During the reactive control trials, the step length, step width, movement time, and reaction time were measured, in addition to the postural steadiness variables measured during the restabilization phase following the stepping response. Out of 64 comparisons, only 10 moderate correlations were observed between postural steadiness and reactive spatio-temporal stepping parameters (P ≤ .05, r = -.312 to -.534). However, postural steadiness metrics were associated with the center of pressure velocity and frequency during the restabilization phase of the reactive control trials (P ≤ .02, r = .383 to .775 for velocity and P ≤ .01, r = .386 to .550 for frequency). Although some elements of quasi-static center of pressure control demonstrated moderate associations with dynamic stepping responses, relationships were stronger for restabilization phase dynamics after foot-contact. Future work should examine the potential association between restabilization phase control and older adult fall-risk.
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Gustavsson J, Jernbro C, Nilson F. There is more to life than risk avoidance - elderly people's experiences of falls, fall-injuries and compliant flooring. Int J Qual Stud Health Well-being 2018; 13:1479586. [PMID: 29869973 PMCID: PMC5990953 DOI: 10.1080/17482631.2018.1479586] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Falls are the most common cause of injury in all ages and are especially difficult to prevent among residential care residents. Compliant flooring that absorbs energy generated within the fall, has been proposed as a measure to prevent fall-injury, however little is known regarding the implementation aspects in clinical settings. The aim of this study is to explore the experiences of falls, the risk of fall-injury, prevention in general and specifically compliant flooring as an injury preventative measure amongst frail elderly people living in a residential care facility with compliant flooring. Through this, generate a theory that further explains the underlying barriers of active prevention amongst elderly people. METHOD We used the grounded theory method and conducted semi-structured in-depth interviews with eight elderly people in residential care (data collected between February and December 2017). RESULTS The identified categories were Falling as a part of life, Fearing the consequences and A wish to prevent falls and injuries. Through the results it was clear that There is more to life than risk avoidance, permeated the interviews, therefore forming the grounded theory. The interviewees viewed falls as something common and normal, and were uninterested in focusing on the risk of falls. Although they wanted to prevent falls, it was often difficult to integrate preventative measures into their everyday life. They embraced the idea of an injury-reducing compliant flooring, however their main interests lay elsewhere, preferring to focus on social interaction and issues concerning daily activities. CONCLUSIONS The theory generated in this paper proposes explanations on the obstacles of implementing fall prevention measures in an elderly frail population. The findings give insights as to why interest and compliance for active fall prevention measures are low. We conclude that complaint flooring, from the perspective of the residents, can work well in residential care.
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Affiliation(s)
- Johanna Gustavsson
- Centre for Public Safety, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Carolina Jernbro
- Centre for Public Safety, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Finn Nilson
- Centre for Public Safety, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
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A quasi-experimental evaluation of compliant flooring in a residential care setting. PLoS One 2018; 13:e0201290. [PMID: 30048517 PMCID: PMC6062098 DOI: 10.1371/journal.pone.0201290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 07/12/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Fall injuries affect the lives of older people to a substantial degree. This quasi-experimental observational study investigates the potential fall injury reducing effect of a compliant flooring in a residential care setting. METHODS The allocation of the compliant flooring was non-random. Data on fall-events and individual characteristics were collected in a residential care unit during a period of 68 months. The primary outcome was the fall injury rate per fall, and a logistic regression analysis was used to test for the effect of complaint flooring. Falls per 1000 bed days was the secondary outcome, used to measure the difference in fall risk on compliant flooring versus regular flooring. RESULTS The event dataset is an unbalanced panel with repeated observations on 114 individuals, with 70% women. The mean age was 84.9 years of age, the average Body Mass Index (BMI) was 24.7, and there was a mean of 6.57 (SD: 15.28) falls per individual. The unadjusted effect estimate showed a non-significant relative risk injury reduction of 29% per fall (RR 0.71 [95% CI: 0.46-1.09]) compared to regular flooring. Re-estimating, excluding identified outliers, showed an injury risk reduction of 63% (RR 0.37 [95% CI: 0.25-0.54]). Falls per 1000 bed days showed that individuals living in apartments with compliant flooring had a fall rate of 5.3 per 1000 bed days compared to a fall rate of 8.4 per 1000 bed days among individuals living in regular apartments. This corresponds to an incidence rate ratio (IRR) of 0.63 (95% exact Poisson CI: 0.50-0.80). CONCLUSION The results of this non-randomized study indicate that compliant flooring has the potential to reduce the risk of fall injury without increasing the fall risk among older people in a Swedish residential care setting.
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11
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Jung HY, Kim SH, Lee SC, Kim S, Cho GC, Kim MJ, Lee JS, Han C. Relating factors to severe injury from outdoor falls in older people. Geriatr Gerontol Int 2017; 18:80-87. [PMID: 28776901 DOI: 10.1111/ggi.13144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 06/16/2017] [Accepted: 06/27/2017] [Indexed: 11/30/2022]
Abstract
AIM The aim of the present study was to evaluate the clinical characteristics, including floor characteristics and factors, related to severe injury from outdoor falls in older adults. METHODS Patients were divided into two groups based on injury severity: the severe group and non-severe group. The clinical and general characteristics were compared between the two groups, and factors associated with severe injury were investigated. RESULTS Approximately 5% (364/7635) of older people involved in outdoor falls were classified into severe injury. The proportion of men and the rate of alcohol ingestion were higher in the severe group compared with that in the non-severe group. Falling from stairs was a more frequent mechanism of fall in the severe group compared with that in the non-severe group. Non-slippery floor condition had a higher proportion in the severe group than that in the non-severe group. Head and neck were the predominantly injured regions in both groups. Discharge was the most common result of emergency department treatment in the non-severe group, whereas admission to intensive care unit was the main result in the severe group. Multivariate logistic analysis showed that male sex and falls from stairs rather than slipping down on the same level were associated with severe injury. CONCLUSIONS Floor characteristics did not influence injury severity; however, the risk of severe injury from outdoor falls in older adults was high in men and those who fell from stairs. Geriatr Gerontol Int 2018; 18: 80-87.
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Affiliation(s)
- Hey Youn Jung
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Sun Hyu Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Sang Cheal Lee
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Sunpyo Kim
- Department of Emergency Medicine, College of Medicine, Chosun University, Gwangju, Korea
| | - Gyu Chong Cho
- Department of Emergency Medicine, School of Medicine, Hallym University, Seoul, Korea
| | - Min Joung Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Sook Lee
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Chul Han
- Department of Emergency Medicine, Ewha Womans University, School of Medicine, Seoul, Korea
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12
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Gustavsson J, Rahm G, Jernbro C, Nilson F. Effects of Impact-Absorbing Flooring in Residential Care from the Perspectives of Enrolled Nurses. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/02763893.2017.1335670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Johanna Gustavsson
- Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - GullBritt Rahm
- Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Carolina Jernbro
- Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Finn Nilson
- Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
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13
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Hanger HC. Low-Impact Flooring: Does It Reduce Fall-Related Injuries? J Am Med Dir Assoc 2017; 18:588-591. [PMID: 28279604 DOI: 10.1016/j.jamda.2017.01.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 01/17/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare fall rates and injuries from falls on low-impact flooring (LIF) compared with a standard vinyl flooring. DESIGN Prospective, observational, nonrandomized controlled study. SETTING Subacute Older Persons Health ward (N = 20 beds). PARTICIPANTS Older inpatients. INTERVENTION Three different types of LIF. MEASUREMENTS All falls in the ward were prospectively monitored using incident reporting, noting location and consequences of each fall. Fall rates (per 1000 bed days) and injuries, were compared between bedroom falls on LIF against those occurring on standard vinyl flooring (controls). RESULTS Over 31 months, there were 278 bedroom falls (from 178 fallers). The bedroom fall rate (falls per 1000 bed days occupied) did not differ between the LIF and control groups (median 15 [IQR 8-18] versus 17 [IQR 9-23], respectively; P = .47). However, fall-related injuries were significantly less frequent when they occurred on LIFs (22% of falls versus 34% of falls on control flooring; P = .02). Fractures occurred in 0.7% of falls in the LIF cohort versus 2.3% in the control cohort. Rolling resistance when moving heavier equipment, such as beds or hoists, was an issue for staff on LIF. CONCLUSIONS LIF significantly reduced fall-related injuries compared with a standard vinyl flooring, whereas they did not alter the overall risk of falling.
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Affiliation(s)
- H Carl Hanger
- Older Persons Health Specialist Service, Canterbury District Health Board; and Christchurch School of Medicine, University of Otago, Christchurch, New Zealand.
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Lachance CC, Jurkowski MP, Dymarz AC, Robinovitch SN, Feldman F, Laing AC, Mackey DC. Compliant flooring to prevent fall-related injuries in older adults: A scoping review of biomechanical efficacy, clinical effectiveness, cost-effectiveness, and workplace safety. PLoS One 2017; 12:e0171652. [PMID: 28166265 PMCID: PMC5293217 DOI: 10.1371/journal.pone.0171652] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/24/2017] [Indexed: 11/18/2022] Open
Abstract
Background Compliant flooring, broadly defined as flooring systems or floor coverings with some level of shock absorbency, may reduce the incidence and severity of fall-related injuries in older adults; however, a lack of synthesized evidence may be limiting widespread uptake. Methods Informed by the Arksey and O’Malley framework and guided by a Research Advisory Panel of knowledge users, we conducted a scoping review to answer: what is presented about the biomechanical efficacy, clinical effectiveness, cost-effectiveness, and workplace safety associated with compliant flooring systems that aim to prevent fall-related injuries in healthcare settings? We searched academic and grey literature databases. Any record that discussed a compliant flooring system and at least one of biomechanical efficacy, clinical effectiveness, cost-effectiveness, or workplace safety was eligible for inclusion. Two independent reviewers screened and abstracted records, charted data, and summarized results. Results After screening 3611 titles and abstracts and 166 full-text articles, we included 84 records plus 56 companion (supplementary) reports. Biomechanical efficacy records (n = 50) demonstrate compliant flooring can reduce fall-related impact forces with minimal effects on standing and walking balance. Clinical effectiveness records (n = 20) suggest that compliant flooring may reduce injuries, but may increase risk for falls. Preliminary evidence suggests that compliant flooring may be a cost-effective strategy (n = 12), but may also result in increased physical demands for healthcare workers (n = 17). Conclusions In summary, compliant flooring is a promising strategy for preventing fall-related injuries from a biomechanical perspective. Additional research is warranted to confirm whether compliant flooring (i) prevents fall-related injuries in real-world settings, (ii) is a cost-effective intervention strategy, and (iii) can be installed without negatively impacting workplace safety. Avenues for future research are provided, which will help to determine whether compliant flooring is recommended in healthcare environments.
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Affiliation(s)
- Chantelle C. Lachance
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michal P. Jurkowski
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Ania C. Dymarz
- W.A.C. Bennett Library, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Stephen N. Robinovitch
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fabio Feldman
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
- Patient Safety and Injury Prevention, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Andrew C. Laing
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Dawn C. Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
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15
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Lachance CC, Korall AMB, Russell CM, Feldman F, Robinovitch SN, Mackey DC. External Hand Forces Exerted by Long-Term Care Staff to Push Floor-Based Lifts: Effects of Flooring System and Resident Weight. HUMAN FACTORS 2016; 58:927-943. [PMID: 27098263 DOI: 10.1177/0018720816644083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 03/17/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of flooring type and resident weight on external hand forces required to push floor-based lifts in long-term care (LTC). BACKGROUND Novel compliant flooring is designed to reduce fall-related injuries among LTC residents but may increase forces required for staff to perform pushing tasks. A motorized lift may offset the effect of flooring on push forces. METHOD Fourteen female LTC staff performed straight-line pushes with two floor-based lifts (conventional, motor driven) loaded with passengers of average and 90th-percentile resident weights over four flooring systems (concrete+vinyl, compliant+vinyl, concrete+carpet, compliant+carpet). Initial and sustained push forces were measured by a handlebar-mounted triaxial load cell and compared to participant-specific tolerance limits. Participants rated pushing difficulty. RESULTS Novel compliant flooring increased initial and sustained push forces and subjective ratings compared to concrete flooring. Compared to the conventional lift, the motor-driven lift substantially reduced initial and sustained push forces and perceived difficulty of pushing for all four floors and both resident weights. Participants exerted forces above published tolerance limits only when using the conventional lift on the carpet conditions (concrete+carpet, compliant+carpet). With the motor-driven lift only, resident weight did not affect push forces. CONCLUSION Novel compliant flooring increased linear push forces generated by LTC staff using floor-based lifts, but forces did not exceed tolerance limits when pushing over compliant+vinyl. The motor-driven lift substantially reduced push forces compared to the conventional lift. APPLICATION Results may help to address risk of work-related musculoskeletal injury, especially in locations with novel compliant flooring.
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Affiliation(s)
- Chantelle C Lachance
- Simon Fraser University, Burnaby, CanadaOlder Adult Program, Fraser Health Authority, Surrey, CanadaSimon Fraser University, Burnaby Canada
| | - Alexandra M B Korall
- Simon Fraser University, Burnaby, CanadaOlder Adult Program, Fraser Health Authority, Surrey, CanadaSimon Fraser University, Burnaby Canada
| | | | - Fabio Feldman
- Older Adult Program, Fraser Health Authority, Surrey, Canada
| | - Stephen N Robinovitch
- Simon Fraser University, Burnaby, CanadaOlder Adult Program, Fraser Health Authority, Surrey, CanadaSimon Fraser University, Burnaby Canada
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16
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Lachance CC, Feldman F, Laing AC, Leung PM, Robinovitch SN, Mackey DC. Study protocol for the Flooring for Injury Prevention (FLIP) Study: a randomised controlled trial in long-term care. Inj Prev 2016; 22:453-460. [PMID: 27044272 DOI: 10.1136/injuryprev-2016-042008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/07/2016] [Accepted: 03/09/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND A promising strategy for reducing the incidence and severity of fall-related injuries in long-term care (LTC) is to decrease the ground surface stiffness, and the subsequent forces applied to the body parts at impact, through installation of compliant flooring that does not substantially affect balance or mobility. Definitive evidence of the effects of compliant flooring on fall-related injuries in LTC is lacking. The Flooring for Injury Prevention (FLIP) Study is designed to address this gap. METHODS The FLIP Study is a 4-year, parallel-group, 2-arm, randomised controlled superiority trial of flooring in 150 resident rooms at a LTC site. The primary objective is to determine whether compliant flooring reduces serious fall-related injuries relative to control flooring. Intervention (2.54 cm SmartCells compliant; 74 rooms) and control (2.54 cm plywood; 76 rooms) floorings were installed over the top of existing concrete floors and covered with identical 2.00 mm vinyl. The primary outcome is serious fall-related injury, defined as any impact-related injury due to a fall in a study room that results in Emergency Department visit or hospital admission. Secondary outcomes include minor fall-related injury, any fall-related injury, falls, number of fallers, fractures, and healthcare utilisation and costs for serious fall-related injuries. Randomisation of study rooms, and residents in rooms, was stratified by residential unit, and flooring assignments were concealed. Outcome ascertainment began September 2013. DISCUSSION Results from the FLIP Study will provide evidence about the effects of compliant flooring on fall-related injuries in LTC and will guide development of safer environments for vulnerable older adults. TRIAL REGISTRATION NUMBER NCT01618786.
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Affiliation(s)
- Chantelle C Lachance
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fabio Feldman
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada.,Fraser Health Authority, Surrey, British Columbia, Canada
| | - Andrew C Laing
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Pet Ming Leung
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - Stephen N Robinovitch
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
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Ayena JC, Zaibi H, Otis MJD, Menelas BAJ. Home-Based Risk of Falling Assessment Test Using a Closed-Loop Balance Model. IEEE Trans Neural Syst Rehabil Eng 2015; 24:1351-1362. [PMID: 26685258 DOI: 10.1109/tnsre.2015.2508960] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The aim of this study is to improve and facilitate the methods used to assess risk of falling at home among older people through the computation of a risk of falling in real time in daily activities. In order to increase a real time computation of the risk of falling, a closed-loop balance model is proposed and compared with One-Leg Standing Test (OLST). This balance model allows studying the postural response of a person having an unpredictable perturbation. Twenty-nine volunteers participated in this study for evaluating the effectiveness of the proposed system which includes seventeen elder participants: ten healthy elderly ( 68.4 ±5.5 years), seven Parkinson's disease (PD) subjects ( 66.28 ±8.9 years), and twelve healthy young adults ( 28.27 ±3.74 years). Our work suggests that there is a relationship between OLST score and the risk of falling based on center of pressure measurement with four low cost force sensors located inside an instrumented insole, which could be predicted using our suggested closed-loop balance model. For long term monitoring at home, this system could be included in a medical electronic record and could be useful as a diagnostic aid tool.
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Gustavsson J, Bonander C, Andersson R, Nilson F. Investigating the fall-injury reducing effect of impact absorbing flooring among female nursing home residents: initial results. Inj Prev 2015; 21:320-4. [DOI: 10.1136/injuryprev-2014-041468] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 03/08/2015] [Indexed: 11/03/2022]
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