Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
Institute for Neuroscience and Neurotechnology, Simon Fraser University, Burnaby, BC, Canada.
BMC Geriatr. 2024 Sep 2;24(1):726. doi: 10.1186/s12877-024-05306-5.
Falls are the leading cause of injuries in older adults. Environmental objects (such as furniture, walls, and handrails) may act as hazards or facilitators to balance maintenance and safe landing. There is lack of objective evidence on how older adults interact with objects during falls. We addressed this gap by characterizing body part contacts with objects other than the floor during real-life falls in long-term care.
We analyzed videos of 1759 falls experienced by 584 residents to characterize the prevalence of contacts with objects before, during, and after fall initiation. Using generalized estimating equations, we compared the prevalence of falls with versus without contact to objects after fall initiation. Using linear mixed models, we tested for differences across body parts in the probability of contacting objects after fall initiation.
In nearly one-third of falls, interactions with objects (e.g., trips over objects, loss of support with objects) or with other people (e.g., being pushed by another person) had a primary role in causing imbalance and initiating the fall. After fall initiation, participants contacted objects in 60% of falls, with intentional hand contacts to objects via reach-to-grasp or bracing being the most common type of interaction (Probability ± SE = 0.32 ± 0.01), followed by unintentional impacts to the torso (0.21 ± 0.01) and head (0.16 ± 0.01). Intentional hand contact to an object was more common during forward than backward falls (p < 0.001), while head and torso contacts to objects were more common during backward and sideways falls than forward falls (multiple p values ≤ 0.003). The hand most often contacted chairs, wheelchairs or couches, followed by tables or counters, walls, other people, walkers, and handrails. The head, torso, and shoulder most often contacted a wall.
Most falls in long-term care involved contacts with objects other than the ground, indicating that complex environments often accompany falls in long-term care. Higher probabilities of intentional hand contacts in forward falls, versus unintentional head and torso impacts in backward and sideways falls may reflect the influence of being able to visualize and adjust one's falling patterns to nearby objects.
跌倒 是老年人受伤的主要原因。环境物体（如家具、墙壁和扶手）可能是平衡维持和安全着陆的障碍或促进因素。关于老年人在跌倒过程中与物体的相互作用，缺乏客观证据。我们通过在长期护理中描述现实生活中跌倒时与地板以外的物体的身体部位接触情况来解决这一差距。
我们分析了 584 名居民经历的 1759 次跌倒的视频，以描述跌倒开始前、期间和之后与物体接触的发生率。使用广义估计方程，我们比较了跌倒开始后与物体接触和未与物体接触的跌倒发生率。使用线性混合模型，我们测试了跌倒开始后身体各部位接触物体的概率差异。
在近三分之一的跌倒中，与物体（例如，绊倒物体、失去物体支撑）或与其他人（例如，被他人推搡）的相互作用在导致失衡和引发跌倒方面起着主要作用。跌倒开始后，60%的跌倒中参与者与物体接触，通过伸手抓握或支撑来与物体进行有意的手部接触是最常见的互动类型（概率±标准误=0.32±0.01），其次是躯干（0.21±0.01）和头部（0.16±0.01）的非故意撞击。与向后跌倒相比，向前跌倒时更常见有意的手部接触物体（p<0.001），而向后和侧向跌倒时头部和躯干与物体接触更常见，而向前跌倒时则较少见（多个 p 值≤0.003）。最常接触椅子、轮椅或沙发的是手，其次是桌子或柜台、墙壁、其他人、助行器和扶手。头、躯干和肩部最常接触墙壁。
长期护理中的大多数跌倒都涉及与地面以外的物体接触，这表明复杂的环境通常伴随着长期护理中的跌倒。向前跌倒时更有可能发生有意的手部接触，而向后和侧向跌倒时更有可能发生无意识的头部和躯干撞击，这可能反映了能够观察和调整自己的跌倒模式以适应附近物体的影响。
