title: Risk factors for hip impact during real-life falls captured on video in long-term care.
abstract: Hip fracture risk is increased by landing on the hip. We examined factors that contribute to hip impact during real-life falls in long-term care facilities. Our results indicate that hip impact is equally likely in falls initially directed forward as sideways and more common among individuals with dependent Activities of Daily Living (ADL) performance.
  
  
  BACKGROUND
  The risk for hip fracture in older adults increases 30-fold by impacting the hip during a fall. This study examined biomechanical and health status factors that contribute to hip impact through the analysis of real-life falls captured on video in long-term care (LTC) facilities.
  
  
  METHODS
  Over a 7-year period, we captured 520 falls experienced by 160 residents who provided consent for releasing their health records. Each video was analyzed by a three-member team using a validated questionnaire to determine whether impact occurred to the hip or hand, the initial fall direction and landing configuration, attempts of stepping responses, and use of mobility aids. We also collected information related to resident physical and cognitive function, disease diagnoses, and use of medications from the Minimum Data Set.
  
  
  RESULTS
  Hip impact occurred in 40 % of falls. Falling forward or sideways was significantly associated with higher odds of hip impact, compared to falling backward (OR 4.2, 95 % CI 2.4-7.1) and straight down (7.9, 4.1-15.6). In 32 % of sideways falls, individuals rotated to land backward. This substantially reduced the odds for hip impact (0.1, 0.03-0.4). Tendency for body rotation was decreased for individuals with dependent ADL performance (0.43, 0.2-1.0).
  
  
  CONCLUSIONS
  Hip impact was equally likely in falls initially directed forward as sideways, due to the tendency for axial body rotation during descent. A rotation from sideways to backward decreased the odds of hip impact 10-fold. Our results may contribute to improvements in risk assessment and strategies to reduce risk for hip fracture in older adults.
authors.affiliation: Technology for Injury Prevention in Seniors (TIPS) Program, Injury Prevention and Mobility Laboratory, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada. yijiany@sfu.ca.|Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. yijiany@sfu.ca.|Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada. yijiany@sfu.ca.
authors.forename: Y
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. dmackey@sfu.ca.|Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada. dmackey@sfu.ca.
authors.forename: D C
authors.initials: DC
authors.lastname: Mackey
authors.affiliation: Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada. teresa.ambrose@ubc.ca.|Department of Physical Therapy, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada. teresa.ambrose@ubc.ca.|Djavad Mowafaghian Centre for Brain Health, 2215 Wesbrook Mall, Vancouver, BC, V6S 0A9, Canada. teresa.ambrose@ubc.ca.
authors.forename: T
authors.initials: T
authors.lastname: Liu-Ambrose
authors.affiliation: Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. Fabio.Feldman@fraserhealth.ca.|Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada. Fabio.Feldman@fraserhealth.ca.|Fraser Health Authority, Surrey, BC, V3R 7K1, Canada. Fabio.Feldman@fraserhealth.ca.
authors.forename: F
authors.initials: F
authors.lastname: Feldman
authors.affiliation: Technology for Injury Prevention in Seniors (TIPS) Program, Injury Prevention and Mobility Laboratory, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada. stever@sfu.ca.|Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. stever@sfu.ca.|School of Engineering Science, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada. stever@sfu.ca.|Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada. stever@sfu.ca.
authors.forename: S N
authors.initials: SN
authors.lastname: Robinovitch
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D001955:British Columbia / Q000453:epidemiology; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D008134:Long-Term Care; D008297:Male; D015995:Prevalence; D011482:Protective Devices; D012307:Risk Factors; D012399:Rotation; D014741:Video Recording
keywords: Accidental falls; Fall mechanisms; Hip impact; Long-term care (LTC); Older adults; Video analysis