Fall Injury Prevention Research Articles

Injuries. Prevention of fall injuries requiring hospital treatment among community-dwelling elderly

Background: To reduce the number of fall injuries requiring hospital treatment among community-dwelling elderly a community-based intervention programme was set up. The study was designed as a prospective intervention study with the intervention consisting of information and home visits with follow-up, removing physical hazards, treating somatic and psychiatric illnesses and dealing with improper drug consumption, diet insufficiencies and physical and mental inactivity. The setting was five municipalities of the county of Vejle, Denmark (intervention area) with 12,905 community-dwelling elderly (greater than or eq to 65 years) and four other municipalities in the same county (control area) with 11,460 community-dwelling elderly (greater than or eq to 65 years) from 1 January 1986 to 31 March 1988. Method: A separate injury register at hospitals, with catchment areas for the above study population, was established to collect information on fall-related injuries among the community dwelling elderly who were referred to out-patient treatment or hospitalization. The fall injuries requiring treatment were registered for nine months prior to the intervention and for 18 months during the implementation of the intervention programme. Results: The prevented fraction was estimated for all fractures, lower extremity fractures and hip fractures. A non-significant reduction of 14% in the number of all fractures was found in the intervention group compared with the control group. The reduction of lower extremity fractures in the intervention group was found to be significantly greater: 33% (95% CI: 3-63%), due to a highly significant reduction among women: 46% (95% CI: 8-84%), but without reduction among men. Similarly a high, although non-significant, reduction of hip fractures among women was found: 43% (95% CI: -2 - 88%). The reductions appeared to be highest in the last nine months of the intervention period and highest among women living alone. Conclusion: It is possible to reduce the number of major fall-related fractures among elderly with a well-integrated, community-based intervention programme having information, home visits and follow-up as major components and utilizing existing health personnel in a municipality.

Environmental factors associated with fall-related injuries among elderly people

Objective The objective of the current study was to investigate the environmental factors associated with fall injuries among elderly people. Population and methods We used data from the Norwegian Injury Sample Register, a prospective ongoing registration system of injuries that occur in the defined population of four cities in Norway. For this study we selected information about all fall-related injuries that had occurred among people aged 65 years and older from 1990 to 1997, a total of 10,696 cases. Results Loss of balance was the most common cause of injury (35%), followed by slipping (21%), and stumbling (16%). The following environmental factors were involved in occurrence of injuries: indoor stairs (7%), doorstep (1%), ladders (1%), floor carpets (2%), bathroom floor (2%), loose cables (<1%), bathtub/shower (<1%), floor indoors 16%, icy outdoor surface 13%, other specified factors 40%, unknown (19%). There have been significant variations in environmental factors associated with occurrence of injury by age and nature of injury. Conclusions Commonly targeted home hazards account for a small fraction of injuries. Improvements in home safety are unlikely to result in significant gains in preventing fall injuries among elderly people. Icy outdoor surfaces represent a significant health hazard and a possible target for fall prevention measures.

Prevention of Falls and Fall Injuries in Elderly Persons: A Research Agenda

In summary, falls and fall injuries represent common and potentially preventable causes of functional disability, morbidity, and increased health care utilization among elderly persons. While much has been learned about falls and fall injuries over the past decade, much further information is needed in order to identify the optimal prevention strategies. Some of the important questions that remain to be answered are listed in Table 1. While certainly not exhaustive, the topics listed in Table 1 and discussed in this paper provide a beginning template for a research agenda for fall and injury prevention among elderly persons.

Rampway Safety: Foot Forces as a Function of Rampway Angle

The objective of this study was to determine the effect of rampway angle on forces at the shoe/floor interface. Force plate measurements were taken on normal subjects (18–28years) while walking up and down a rampway at angles from 0 to 20° in 4°-intervals. Shear forces and forces normal to the surface were collected. These data then were used to estimate the required coefficient of friction (RCOF) by dividing the shear forces by the normal forces over time. Peak RCOFs were identified from each trial. Step lengths and walking speed also were recorded. Regression analysis showed a significant linear relationship between peak RCOF and rampway angle. Peak RCOF ranged from 0.15 for a flat surface to over 0.6 for a 20° incline and was consistently higher for walking upwards. Foot force analysis showed that for downward walking, shear forces increased on initial contact and remained elevated through longer portions of the step as the ramp angle increased. This suggests that slips at heelstrikes are of particular concern on inclined surfaces due to increased shear force levels that continue through the midstance phase of a slip. The results—although from a small population consisting of normal, young adults—indicate that the use of steep ramps in the workplace may require significant slip-resistance characteristics to prevent fall injuries.