Video Surveillance Study Documents Causes of Falls in Nursing Home Common Areas

Falls are a leading cause of injury in elderly persons, accounting for 90% of hip and wrist fractures and 60% of head injuries. It is estimated that more than half of patients in long-term care (LTC) settings fall at least once every year. There are numerous factors that can put patients at risk of falls, but one of the major challenges to providing care to at-risk patients is that most falls are not witnessed, leading to incident reports that rely on subjective description by the patient. This challenge is unique to the LTC environment as a higher proportion of these patients have some degree of cognitive impairment than community-dwelling elders. To provide insight into the causes and activities that precipitate falls in elderly long-term care patients, Stephen Robinovitch, PhD, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Canada, and associates, conducted an observational study involving the use of video surveillance cameras to monitor falls. The results of their study were published recently in The Lancet.

            Between 2007 and 2010, Robinovitch and associates conducted their study in two LTC facilities in Canada. They installed digital video cameras in dining rooms, lounges, hallways, and other common areas only (216 cameras at one facility, 48 cameras at the other facility). When a fall occurred in a common area, care personnel completed an incident report, which was then analyzed in conjunction with the captured video footage. Between the two locations, 130 patients experienced a fall, many of whom experienced multiple on-camera falls (227 total falls). The researchers could determine based on the footage that forward walking was the most common activity that preceded the fall (24%), and the most common cause of falling was incorrect transfer or shifting of bodyweight during transitions of sitting down, getting up, walking forward, and initiating walking (21%). Robinovitch and associates generated a number of practical points based on the findings of this study, some of which can be implemented by staff and some of which require further research and administrative support, they discussed. For example, staff could prevent falls due to incorrect weight transfer by initiating exercise therapy to promote muscle strength and providing assistive devices for bodyweight support.

The researchers also observed that 25% of patients tripped due to their foot being caught on a chair or table leg, suggesting the potential to improve furniture design and room layout in LTC facilities. Tripping was the second most common cause of falls, they observed; however, they noted that clinical assessments of fall risk rarely include external forces (ie, externally-applied pushes, bumps, or collisions). Therefore, the results “show the need to develop and incorporate safe methods to simulate trips and bumpsinto routine clinical examinations—a new direction in assessment.” Although the study may have been limited by a small sample size and did not monitor falls occurring in patients’ bedrooms or bathrooms (due to privacy), it is difficult to conclude whether the participants captured on video falling in common areas were representative of all fallers in long-term care settings. Nonetheless, Robinovitch and associates concluded that building off this model of video surveillance of falls, future studies could conduct more in-depth analysis regarding the patients’ medical status, the amount of time spent on the activity preceding the fall, and the role of contributing environmental factors (eg, lighting) and secondary tasks (eg, talking).