(RxWiki News) Falling accounts for over half of hospital admissions for head trauma in older adults. So how can these adults protect their heads when they fall?
A recent study looked at how often older adults in long-term care facilities hit their heads when they fell down. The study also examined which factors were linked to older adults hitting their heads when they fell.
The researchers found that older adults were most likely to hit their head if they initially fell forward, and least likely to hit their head if they landed in a backwards position. The findings also showed that trying to brace the fall with one or both hands or arms did not protect against hitting one's head.
The researchers concluded that adults in this study often hit their head when they fell, and rotating backwards during the fall appeared to protect them in some instances. The researchers recommended that more attention should be given to strengthening older adults' arms and to teaching them how to rotate to a safer position during a fall.
"Tell a doctor if you have ever fallen."
This study was conducted by Rebecca Schonnop, BSc, and Yijian Yang, MD, both from the Injury Prevention and Mobility Laboratory in the Department of Biomedical Physiology and Kinesiology at Simon Fraser University in Burnaby, British Columbia, and their colleagues.
These researchers collected video footage from April 20, 2007 to June 23, 2010 of 227 falls among 133 residents from two different long-term care facilities in British Columbia. The average age of the participants was 78, and 52 percent were women. Ninety of the participants fell once, and 43 of the participants fell two or more times.
The researchers then analyzed each of the falls to determine how many of the participants hit their head when they fell, how often they tried to brace themselves with their hands or forearms, what the initial fall direction was, how the participants landed during each fall, if there were any objects being held at the time of the fall and if there were any biomechanical (relating to any structural or functional issue in the body) causes of imbalance in the participants.
The researchers found that participants hit their head in 37 percent of the 227 falls. Of those who hit their head, the participants' head hit the ground in 64 percent of the falls, hit a wall in 13 percent and hit a piece of furniture in 16 percent.
The researchers discovered that the initial direction of the fall and the landing configuration were the two most important factors associated with these adults hitting their head during a fall.
The findings showed that participants were 2.7 times more likely to hit their head if they initially fell forward rather than backwards, sideways or straight down. In addition, participants were 2.5 times more likely to hit their head if they landed forwards or sideways, rather than backwards.
The researchers realized that participants often rotated backwards during the fall, causing them to land in a different direction than the initial fall direction in 31 percent of all the falls. The participants were found to rotate backwards in 36 percent of the falls that were initially directed sideways — which led to a 20 percent reduced risk of head impact.
The participants were found to rotate forward in only 8 percent of falls that were initially sideways. The researchers also found that the participants rotated sideways in 33 percent of falls that were initially directed forward; however, this did not change the probability for hitting their heads during forward falls.
The researchers revealed that the participants tried to brace themselves with one or both hands/forearms in 74 percent of all the falls, and in 79 percent of all the falls when a participant hit their head.
The participants tried to brace themselves with their hand(s)/forearm(s) in 97 percent of the forward falls when they hit their head; in 56 percent of backwards falls when they hit their head; in 84 percent of sideways falls when they hit their head; and in 67 percent of the falls directed straight down.
However, the researchers determined that bracing oneself with hand(s)/forearm(s) provided no significant protection during a fall and thus did not help prevent participants from hitting their head. The researchers also found that holding objects or biomechanical causes of imbalance did not significantly affect the probability of participants hitting their head during a fall.
The rate or probability of participants hitting their head did not differ according to age, but women were found to experience head impact more than men, with 44 percent of women experiencing head impact versus 32 percent of men.
Overall, the researchers found that it was common for the participants to hit their head during observed falls, especially when the participant fell forward. Because backwards rotation during the fall was often a protective measure — and trying to block the fall with the hands/forearms was not — the researchers believe that older adults in long-term care facilities could benefit from learning falling strategies to protect themselves.
The authors noted a few limitations of their study.
First, the researchers did not include the level of severity of a head impact in the study analysis. Second, the researchers only observed falls in common areas of the facilities. Therefore, the study findings may not account for falls that happened or could have happened in a bathroom or bedroom.
Third, the researchers did not consider all of the participants' level of cognitive (basic mental ability) and physical function, disease status or if they were taking any medicine. As such, the calculated risks did not account for these variables.
This study was published online ahead-of-print on October 7 in CMAJ.
The Canadian Institutes of Health Research and the Canada Research Chairs Program provided funding.
