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1. In an analysis of 227 falls collected from long-term care facilities (mean age of 78), head impact was detected in 37% of falls, and significantly more often in forward falls as opposed to backward falls.
2. Hand impact to mitigate head damage in fall was ineffective in this group; however rotating backwards during descent was associated with reduced head impact.
3. Head impact during fall was not associated with age, however was more likely to occur women.
Evidence Rating Level: 2 (Good)
Study Rundown: Falls from standing height is associated with substantial morbidity as well as mortality in adults 65 years or older, largely due to traumatic brain injuries. The authors of this study attempted to quantify the prevalence of head trauma in falls from standing height or lower at 2 long-term care facilities and to analyze the factors which are associated with head trauma in falls.
By analyzing video footage of falls in two long term-care facility, the researchers found that residents who had a fall initially directed forward were 2.70 (95% CI 1.3-5.9) times more likely to sustain head trauma compared to falls that were initially directed backwards (p=.01). Interestingly, no diagnosis of concussions were made, although the authors speculate this may be due to difficulty in distinguishing cognitive defects due to head injury or due to previously present dementia. The study also found that the use of upper limbs to break the fall was not effective in preventing head trauma; this was hypothesized to be due to decreased strength and muscle activation often observed in the elderly. Rotating backwards during fall descent was observed to be protective against head trauma. As covariates, woman had a greater likelihood of head impact with falls. Age was not associated with head impact during fall. Given the nature of the study, the researchers were unable to measure head injury severity of velocity of impact. It must be noted that only 37 patients provided consent to access patient charts, therefore important physiologic risk factors could not be adequately assessed. Lastly, this data may not translate to environments outside of long-term care facilities.
Click to read the study in CMAJ
Relevant Reading: Preventing Falls in Elderly Persons
In-Depth [retrospective cohort]: This retrospective cohort study analyzed video footage recorded from two long-term care facilities and captured 227 incidents of falls from standing height. Three trained evaluators analyzed each footage to determine consensus on the mechanism and impact of each fall. Head trauma occurred in 37% of the falls, with 85% of head trauma occurring on rigid flooring (vinyl or linoleum). Rotating backwards during the fall was protective against head trauma (OR 0.2, 95% CI 0.04-0.8) compared to no change in the initial direction of falling. Hand impact was detected in 74% of falls, however, was also observed in 97% of initial forward falls which resulted in head trauma. As covariates, woman had a greater likelihood of head impact with falls (p=.03-.06), whereas age was not associated with head impact.
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