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Seniors in long-term care homes have high risk of head injury from falls: study

Seniors living in long-term care facilities have a high risk of falling, and many of those who take a tumble end up striking their heads, a study has found.

Falls account for more than 60 per cent of hospital admissions for traumatic brain injury in seniors over age 65, and the incidence is on the rise, especially among those over 80, researchers say.

In a study published Monday in the Canadian Medical Association Journal, researchers at Simon Fraser University analysed video recordings of 227 falls among 133 residents at two B.C. long-term care homes. Video cameras had been set up in such public areas as hallways and lounges to capture falls among residents.

The researchers had previously studied what caused residents to fall; in this study, they looked at “how” they fell — in other words, the physical mechanics — and what part of the body took the brunt of impact.

They found that in 37 per cent of falls, people hit their heads — and contact was most often on the ground, said principal researcher Stephen Robinovitch, who specializes in injury prevention and mobility biomechanics.

Residents’ heads struck the ground in 64 per cent of cases, while 13 per cent smacked their head against a wall and 16 per cent into furniture.

One-third of those who banged their heads as the result of a fall were diagnosed with an injury, ranging from cuts and bruises to fractures.

Surprisingly, there were no concussions diagnosed, said Robinovitch, but noted it can be difficult to distinguish concussion symptoms like memory impairment from similar symptoms caused by dementia.

Most people tend to throw out their hands and arms in a bid to break a fall and limit injury — and the same was true of seniors videotaped during the 39-month study.

“We’re seeing that people continue to attempt that, but it’s not successful in these older adults,” he said Monday from Vancouver. “Three-quarters of the time they contact the ground with the hands, but that had no effect on risk for head injuries.

“They’re still hitting their heads.”

The fact that residents threw out their arms as they fell shows their protective reflexes remain intact, but their inability to change the outcome of the fall suggests their muscles are no longer strong enough, he said.

“And that’s something that we can improve across the lifespan (with exercise). We can even improve it in 80-year-old individuals, and that may give them the ability to … arrest the fall and prevent the head from striking.”

The study also found that residents who landed on their backs had a lower risk of hitting their heads.

“We were actually surprised that falling forwards is much more risky. You’re three times more likely to impact your head if you fall forward,” Robinovitch said. “We found your risk for head impact was five-fold lower if you land backward as opposed to sideways.”

Altering the environment can also limit harm from falls. Besides causing head trauma, taking a spill accounts for 95 per cent of debilitating and potentially life-shortening hip fractures.

Typically, most floors in long-term care homes are covered with hard-surface materials such as linoleum and tile. A soft material known as “compliant” flooring does not impair balance but could cushion a fall and help prevent head trauma, he said.

Robinovitch said researchers aren’t sure why falls that result in head trauma are on the rise among older people, but there may be several explanations.

One reason may be that many seniors are dealing with several health conditions and are taking multiple medications to treat them, which may increase their likelihood of falling.

“The same factors like medications that can impair balance and lead to falls may also impair safe-landing responses and increase the risk for head impact,” he said.

“We need larger studies to confirm that, but that’s very likely.”