Technology for Injury Prevention in Seniors (TIPS) Fabio Feldman, - PowerPoint PPT Presentation

Technology for Injury Prevention in Seniors (TIPS) Fabio Feldman, PhD Manager, Seniors Falls and Injury Prevention Fraser Health Adjunct Professor, Biomedical Physiology and Kinesiology Simon Fraser University

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 comfort • appearance • geometry • ease of putting on • materials • Laundering • mis-positioning • staff commitment • Compliance Biomechanical Effectiveness (adherence) Clinical Effectiveness

Biomechanical Testing of Hip Protectors

Simon Fraser University Hip Impact Simulator

Biomechanical Pad touch Length Width Wearing Prices Shell Type Performance GT (mm) (mm) height (mm) (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

Hip Protector Placement

Some hip protectors do not cover the greater trochanter Source : Minns et al., Age and Ageing, 2007 31

Hip protectors cannot prevent fracture in all circumstances:  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

BARRIERS AND FACILITATORS TO HIP PROTECTOR COMPLIANCE IN LONG-TERM CARE FACILITIES: A SYSTEMATIC REVIEW

Barriers and facilitators emerged at different socio-ecological levels

Key messages  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

The Bottom Line  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 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 Force reduction provided by SmartCells during a by SmartCells during a simulated fall on the head simulated fall on the hip averaged 70% averaged 34% 34% Laing et al., Accident Analysis & Prevention, 2009

Compliant floors reduce peak force with minimal influence on balance or mobility of older women 15 women ranging in age from 65 - 90  yrs (mean = 75, SD = 8)

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 Common areas will Exclude 86 rooms - 49 Willow Grove (non-ambulatory) NOT be modified. Thus, - 37 floor cannot be raised 1” 3’ long transition ramps are required between 150 single-occupancy rooms across 4 villages hallways and common will be randomized within villages areas Intervention (INT) flooring Control (CON) flooring CON will also be installed 1” SmartCells w/ vinyl cover 1” plywood w/ vinyl cover in adjacent hallways Notification & Installation Primary outcome 16 rooms/wk for ~10 wks • moderate/severe fall-related injuries Secondary outcomes Assess baseline characteristics • all fall-related injuries • falls Track outcomes for 4 years

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