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Incorrect weight-shifting most common cause of falls in long-term care

Clinical Question:
What are the causes of falls in elders residing in long-term care facilities?

Bottom Line:
The 2 most frequent causes of falls in elders living in long-term care facilities are incorrect weight-shifting and tripping. The data in this study gives insight to approaches that may decrease falls in this at-risk population. For readers interested in falls among elders, the authors provide nice descriptions of factors related to falls, illustrative examples from videos, and a link to online videos. (LOE = 2b)

Reference:
Robinovitch SN, Feldman F, Yang Y, et al. Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study. Lancet 2013;381(9860):47-54.  [PMID:23083889]

Study Design:
Cohort (prospective)

Funding:
Government

Setting:
Nursing home/extended care facility

Synopsis:
These researchers evaluated videotapes obtained from common areas of 2 long-term care facilities (dining rooms, hallways, lounges) in British Columbia. The facilities had established video-surveillance networks. Whenever a fall occurred (unintentional coming to rest on the ground, floor, or other lower level), the staff completed a structured event report and at least 3 members of the research staff evaluated the corresponding video to ascertain the cause of the fall. The authors delineate 7 causes of fall and give explicit operational definitions for each. Two teams independently evaluated 15 randomly selected videos and reported 87% agreement between the teams. Additionally, 1 year after the first assessment, each team re-analyzed 15 videos and had 93% agreement. During 1 year of observation, of the 371 elders residing in the facilities, 130 elders sustained 227 falls that were captured by the video system. The most common causes of falls were incorrect weight-shifting (41% of falls, half the patients) and tripping or stumbling (21% of falls). The teams were unable to determine the cause in only 3% of falls. Of the falls caused by tripping or stumbling, 33% were attributable to the foot catching on the ground, 30% from the foot catching on equipment (wheelchairs or carts), and 25% from the foot catching on furniture. For readers interested in falls among elders, the paper inculdes a nice description of factors related to falls, illustrative examples from videos, and a link to online videos.

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