Epidemiological Studies on Shoes for Elderly Adults in a Geriatric Unit

Abstract

To the Editor: Each year, one in three people aged 65 and older is going to fall. The worst consequence of falling is death, in the short or long term. A fall is a multifactorial mechanism, and risk factors are well defined.1 Footwear for elderly people is one of them.2, 3 In clinical practice, this element is easy to spot at a glance, and recommendations are available. Some shoe features that can help to avoid falls have been offered.4 Six footwear features may be important in terms of prevention of falls (supported heel collar, fastening mechanism, low heel height, beveled heel, thin firm midsole, slip-resistant soles). The aim of this study was to describe the prevalence of inappropriate footwear in a geriatric unit, and to determine which style of footwear could help reduce the risk of falling. This was a cross-sectional observational study conducted from August 1, 2011, to October 31, 2011, in a geriatric unit of Grenoble University Hospital, Grenoble, France. Screening for inappropriate footwear was systematically offered to every hospitalized individual aged 75 and older, whatever the reason for admission, unless they were unable to speak, or their survival prognosis was limited. Information on shoe characteristics, medicosocial information, and fall history was collected through clinical examination and medical records. The shoe features were detailed according to those outlined previously.4 If individuals had several pairs of shoes, all were examined; for the analysis of shoes, especially regarding the number of features, only the best pairs were considered. All characteristics are shown in Table 1. Logistic regression using the Fischer model was performed to determine which types of shoes had the maximum number of quality items. R 2.15.2 (www.R-project.org) and Excel (Microsoft Corp., Redmond, WA) were used for statistical evaluation and database management. One hundred two individuals were included in the study (mean age 86.7 ± 5.6; n = 47, 46.8%, male). Four (4.1%) shoes were found to have all of the appropriate features. Athletic shoes were more likely to receive higher scores than other footwear (odds ratio (OR) = 5.33, 95% confidence interval (CI = 3.13–8.39, P < .001)), whereas the OR of slippers was 0.49 (95% CI = 0.30–0.89, P < .01). There was no other statistical association between the sum of the criteria and footwear style (lace-up oxfords, OR = 0.83, 95% CI = 0.46–1.56; loafers, OR = 0.77, 95% CI = 0.43–1.44; canvas shoes, OR = 0.56, 95% CI = 0.20–1.37; sandals, OR = 0.55, 95% CI = 0.31–1.01; others, boots, high heels, OR = 0.63, 95% CI = 0.27–1.36). No association was found between footwear style and fall history, and no association was found between the criteria and history of falling. Considering the criteria,4 the prevalence of inappropriate footwear is important because only 4.1% of shoes had all the items. Systematic screening and intervention in a geriatric unit during hospitalization could greatly improve the quality of footwear and might reduce the risk of falling in the hospital or after discharge into the community, although individual needs must also be considered, which the standardization of the criteria does not. There was a significant chance that sport shoes would have more recommended features for fall prevention than others, which supports the results of another study that showed that athletic shoes were associated with lower risk of falling outdoors or at home.5 In the current study, athletic shoes were worn less frequently than other types (Table 1). Slippers are the most common footwear in this population but have significantly fewer quality features than other footwear. The population of the current study was older and included more “fallers” than in other populations in previous studies. Furthermore, they were dependant, at risk of malnutrition, and cognitively impaired.2, 5, 6 Inpatients wore inappropriate footwear, and without screening and clinical intervention, this risk factor was not corrected. No association was found between footwear style or the criteria and history of falling. This could be due to multifactorial mechanisms of falling and bias of information in history of fall. Nevertheless, there is no evidence to show that inpatient footwear is the same as outpatient footwear in the community. Interventional studies are needed to determine whether clinical prevention with intervention on footwear at hospital discharge decreases the risk of falling in the community. Geriatricians must be vigilant and must educate their patients about optimal footwear. We would like to thank Katharine Di Silvestro. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: All authors: study concept and design, acquisition of subjects and data, analysis and interpretation of data, and preparation of manuscript. Sponsor's Role: No sponsors.