Abstract
BackgroundFalls are the number one cause of injuries in older adults, and are particularly common in long-term care (LTC). Lack of objective evidence on the mechanisms of falls in this setting is a major barrier to prevention. Video capture of real-life falls can help to address this barrier, if valid tools are available for data analysis. To address this need, we developed a 24-item fall video analysis questionnaire (FVAQ) to probe key biomechanical, behavioural, situational, and environmental aspects of the initiation, descent, and impact stages of falls. We then tested the reliability of this tool using video footage of falls collected in LTC.MethodsOver three years, we video-captured 221 falls experienced by 130 individuals in common areas (e.g., dining rooms, hallways, and lounges) of two LTC facilities. The FVAQ was developed through literature review and an iterative process to ensure our responses captured the most common behaviours observed in preliminary review of fall videos. Inter-rater reliability was assessed by comparing responses from two teams, each having three members, who reviewed 15 randomly-selected videos. Intra-rater reliability was measured by comparing responses from one team at baseline and 12 months later.ResultsIn 17 of the 24 questions, the percentage of inter- and intra-rater agreement was over 80% and the Cohen's Kappa was greater than 0.60, reflecting good reliability. These included questions on the cause of imbalance, activity at the time of the fall, fall direction, stepping responses, and impact to specific body sites. Poorer agreement was observed for footwear, contribution of clutter, reach-to-grasp responses, and perceived site of injury risk.ConclusionsOur results provide strong evidence of the reliability of the FVAQ for classifying biomechanical, behavioural, situational, and environmental aspects of falls captured on video in common areas in LTC. Application of this tool should reveal new and important strategies for the prevention and treatment of falls and fall-related injuries in this setting.
Highlights
Falls are the number one cause of injuries in older adults, and are common in long-term care (LTC)
The present study addresses this need by developing and evaluating the inter-rater and intra-rater reliability of a 24-item questionnaire for analyzing fall mechanisms from video footage of falls captured in common areas of LTC facilities
Video capture of falls Between March 2007 and June 2010, we collected video footage of 221 falls experienced by 130 different residents from networks of digital video cameras installed in common areas in two LTC facilities in the Greater Vancouver area: Delta View Life Enrichment Centre, a 312-bed multi-level facility located in Delta, BC, and New Vista Society Care Home, a 236-bed facility located in Burnaby, BC
Summary
Falls are the number one cause of injuries in older adults, and are common in long-term care (LTC). Lack of objective evidence on the mechanisms of falls in this setting is a major barrier to prevention. Video capture of real-life falls can help to address this barrier, if valid tools are available for data analysis. Developing improved strategies to prevent these events is an essential health priority This is especially true for the long-term care (LTC) environment, where the complex medical status of residents causes rates of falls to be 2–3 fold higher than among community dwelling seniors [3,4], and creates unique challenges to prevention [5]. An important barrier to fall prevention is lack of objective evidence on the mechanisms of these events how and why they occur. Fallers may tend to rationalize falls as being due to an external, unavoidable cause to avoid the perception of vulnerability [10,11,12,13]
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