Fabio Feldman, PhD Manager, Seniors Falls and Injury Prevention

Fraser Health

Adjunct Professor, Biomedical Physiology and Kinesiology Simon Fraser University

Technology for Injury

Prevention in Seniors (TIPS)

Journal of Biomechanics 40 (2007) 2612–2618

Collaborators: Stephen Robinovitch, PhD (SFU) - PI

Fabio Feldman, PhD (Fraser Health)

Dawn Mackey, PhD (SFU)

Andrew Laing, PhD (U. Waterloo)

Greg Mori, PhD (SFU)

Ed Park, PhD (SFU)

Teresa Lui-Ambrose, PT, PhD (UBC, CHHM)

Andrew Sixsmith, PhD (SFU)

Habib Chaudhury, PhD (SFU)

Joanie Sims-Gould, PhD (CHHM)

Aleks Zecevic, PhD (Western U)

Heather McKay, PhD (CHHM)

Vicky Scott, RN, PhD (BCIRPU)

Ming Leung, PT, MSc (Fraser Health)

Gina Gaspard (Fraser Health)

37% of falls caused head impact, unaffected by hand impact (which occurred in 71% of cases)

Head impact more likely in forward falls, no effect of hand impact

AGREEMENT BETWEEN VIDEO FOOTAGE AND FALL INCIDENT REPORTS ON

THE CIRCUMSTANCES OF FALLS IN LONG-TERM CARE

Agreement = 45.5%

AGREEMENT BETWEEN VIDEO FOOTAGE AND FALL INCIDENT REPORTS ON

THE CIRCUMSTANCES OF FALLS IN LONG-TERM CARE

Agreement = 45.2%

AGREEMENT BETWEEN VIDEO FOOTAGE AND FALL INCIDENT REPORTS ON

THE CIRCUMSTANCES OF FALLS IN LONG-TERM CARE

Agreement = 79.5%

Clinical Effectiveness of Hip Protectors: from evidence to practice

Hip Protectors (HP)

wearable pad or shield typically embedded in an undergarment or pant

reduces fracture risk by attenuating the force applied to the proximal femur at impact

“active” form of injury prevention; site-specific

effectiveness depends on acceptance and adherence among users in wearing the device, and biomechanical performance of the device

Two factors primarily determine clinical effectiveness

Compliance

(adherence)

Biomechanical Effectiveness

Clinical Effectiveness

• comfort • appearance • ease of putting on • Laundering • staff commitment

• geometry • materials • mis-positioning

Biomechanical Testing of

Hip Protectors

Simon Fraser University Hip Impact Simulator

Shell Type Pad touch

GT Length (mm)

Width (mm)

Wearing height (mm)

Prices (USD)

Soft Y 170 150 31 $45

Hard N 160 110 25 $72

Soft Y 170 160 22 $46

Hard N 190 95 31 $130

Soft Y 180 180 20 $129

Soft N 210 185 16.5 $122

Soft Y 220 200 19 $56

Hard Y 230 140 22 $76

Soft Y 180 180 16 $103

Soft Y 160 210 14.5 $98

Soft Y 165 140 13 $42

Soft Y 165 145 16 $20

Hard N 155 165 19 $75

Soft Y 155 140 24 $46

Soft Y 170 190 14 $29

Soft Y 160 150 18 $39

Soft Y 170 140 14 $54

Hard N 160 115 24 $122

Soft Y 195 165 21 $80

Soft Y 175 120 19 $21

Soft Y 195 145 17.5 $100

Soft Y 200 150 17 $128

Soft Y 205 135 7.5 $103

Soft Y 170 150 19 $85

Soft Y 193 137 16 $128

Soft Y 155 120 19 $124

Percent Femoral Force Attenuation with Respect to Unpadded Condition

Biomechanical Performance

Hip Protector Placement

31

Source: Minns et al., Age and Ageing, 2007

Some hip protectors do not cover the greater trochanter

use of hip protectors with poor biomechanical performance

incorrect placement

very week bones

impact other then directly to the hip

spontaneous fractures without obvious impact

Hip protectors cannot prevent fracture in all circumstances:

BARRIERS AND FACILITATORS TO HIP PROTECTOR COMPLIANCE IN LONG-TERM CARE

FACILITIES: A SYSTEMATIC REVIEW

Barriers and facilitators emerged at different

socio-ecological levels

Organizational commitment

Dedicated champion to motivate, mentor, and monitor

Involve everyone responsible for resident safety

Staff education of the benefits and correct use

Engage and educate residents and families

Choose from hip protector models with proven efficacy

Put in place protocols for ensuring adequate supply, variety of models, correct fit, and laundering

Key messages

Hip protectors are effective for those wearing the device at the time of the fall

Not all hip protectors are equally effective

User compliance heavily influences their clinical effectiveness

Many actions can be taken in LTC facilities to enhance compliance

The Bottom Line

www.agingisacontactsport.com

Development and Testing of a Novel

Adhesive Hip Protector pad for Acute

Care Patients

Benefits of novel adhesive hip protector pads

1. Pad secured

2. Continuous protection

3. Decrease staff workload

4. No laundry requirements

5. One size fits all

6. Not patient specific

7. Longer shelf life

8. Lower unit cost

Feedback

Positive feedback from patients and staff

No side effects reported due to the pad or adhesive tape

No complaints of pain when removing the pad

Demonstrates the feasibility of a stick-on hip protector in the hospital setting

Results will guide development of future pad prototypes

40

Next Steps

Conduct a clinical trial comparing compliance rates between traditional garment hip protectors currently in use within Fraser Health Hospitals

and the adhesive hip protector

Conduct focus groups with the nurse staff to obtain qualitative information regarding pros and cons to the adhesive hip protector in comparison to the traditional garment hip protector

Headgear

The Flooring for Injury Prevention (FLIP) Trial:

Can Compliant Flooring Reduce Injuries Due to

Falls in Long-Term Care?

Force reduction provided by SmartCells during a

simulated fall on the hip averaged 34%

Laing et al., Accident Analysis & Prevention, 2009

34%

Force reduction provided by SmartCells during a

simulated fall on the head averaged 70%

15 women ranging in age from 65 - 90

yrs (mean = 75, SD = 8)

Compliant floors reduce peak force with minimal influence on balance or mobility of older women

FLIP Trial will address 3 aims:

1. To determine the effect of compliant flooring on fall-related injuries in long-term care

2. To determine the effect of compliant flooring on healthcare utilization in long-term care

3. To assess perceptions about compliant flooring among key stakeholder groups

FLIP Trial Design

New Vista = 236 rooms

Exclude 86 rooms - 49 Willow Grove (non-ambulatory) - 37 floor cannot be raised 1”

150 single-occupancy rooms across 4 villages

will be randomized within villages

Intervention (INT) flooring

1” SmartCells w/ vinyl cover

Control (CON) flooring

1” plywood w/ vinyl cover

Track outcomes for 4 years

Notification & Installation

16 rooms/wk for ~10 wks

CON will also be installed

in adjacent hallways

Common areas will

NOT be modified. Thus,

3’ long transition ramps

are required between

hallways and common

areas

Primary outcome

• moderate/severe fall-related injuries

Secondary outcomes

• all fall-related injuries

• falls

Assess baseline characteristics

Acknowledgments

• Dr. Stephen Robinovitch

• Dr. Andrew Laing

• Dr. Dawn Mackey

• Alex Koral, PhD Candidate

• Chantelle Lachance, PhD Candidate

• Yijian Yang, MD

• Emily O’Hearn, MSc Candidate

• Fraser Health Falls Prevention team

• IPML members

Fabio.feldman@fraserhealth.ca