Study explores how and why seniors fall

SFU professor analyzes hours of videos

By Alison Roach
Photos by PAMR

A new study analyzed videos of 227 falls experienced by 130 elderly individuals, at an average age of 78 years old, to better understand the causes and effects of these falls. The study was co-authored by SFU professor of BPK and engineering science Stephen Robinovitch and Fraser Health Authority manager of senior fall and injury prevention Fabio Feldman. The study took video footage shot at two long-term care facilities located in the lower mainland, New Vista in New Westminster and Delta View in Delta, and analyzed over 600 videos in total. Most of the research done in this area previously relied on first-person accounts of fall experiences, so this study is novel in its objectivity and its comprehensive approach to the analysis of each video.

The aim was to determine what the person was doing at the time of the fall, and the particular potential causes of injury associated with the fall. Of the study’s perspective, Robinovitch said “It considers what we think about as three stages: initiation, descent, and the impact stage.” The report, which was published in The Lancet journal, focused on the initiation of these falls, what the person was doing at the time, and how they lost their balance from a mechanics perspective. Feldman, Robinovitch, and a team of undergraduate and graduate students analyzed each video in teams of three people, analyzing 15 falls per week on average.

From the videos, the team was able to determine some surprising results. From previous research in the area it was believed that most falls would be caused by slips and trips, however slips were found to be very rare in reality, causing only three per cent of falls. Trips were more common at 20 per cent, but by far the largest cause of falls was incorrect weight-shifting, causing 41 per cent of falls. Also, Robinovitch said that “we thought that most falls would occur during walking, and it was common, but there were two other activities that were just as frequent: sitting down and standing.” It was acknowledged as well that many seniors in long-term care use walkers or wheelchairs for mobility, and there is a danger period during the transition from those assisting devices to other chairs, such as in the dining room or living room.

A disturbing fact about the types of injuries caused by falls was unearthed by the study. “The alarming thing that we’re finding . . . is that over a third of falls in this setting involve impact to the head. This is the most striking thing, and it surprised us how frequent impact to the head is,” said Robinovitch. Whereas a younger person would automatically protect their head during a fall by putting out their arms, a senior doing the same thing does not have the same effect. Due to a lack of muscle strength, even though three quarters of seniors did get their arms out in time, it had no effect on their wrist or head impact. This finding emphasizes a need for strengthening in arm muscles on top of core strength to help prevent falls.

Feldman’s work with Fraser Health Authority gives the team valuable relationships with the actual stakeholders, such as care facilities and their residents. One thing they’re working on now is a new type of compliant flooring being installed at New Vista, a one-inch thick sub-layer beneath the floor’s surface. The flooring is being installed in some rooms but not others, and will be monitored by the team to see how it impacts injury from falls, and whether its usefulness makes it cost-effective.

According to Robinovitch, the next challenge for the research team is to start linking clinical data to their findings, to see if there are correlations between certain diseases or medications and the frequency of falls. Robinovitch hopes to involve more clinical experts with a variety of medical expertise in the project. Of the research’s future, Robinovitch said, “The goal really is to continue to work with these partners as a way to develop and test and refine interventions to prevent falls, and to also improve our understanding of the cause of falls and fall-related injuries.”