Development and Validation of a Questionnaire for Analyzing Real-Life Falls in Long-Term Care Captured On Video

Background Falls are the number one cause of injuries in older adults, and are particularly common in long-term care (LTC). Lack of objective evidence on the mechanisms of falls in this setting is a major barrier to prevention. Video capture of real-life falls can help to address this barrier, if valid tools are available for data analysis. To address this need, we developed a 24-item fall video analysis questionnaire (FVAQ) to probe key biomechanical, behavioural, situational, and environmental aspects of the initiation, descent, and impact stages of falls. We then tested the reliability of this tool using video footage of falls collected in LTC. Methods Over three years, we video-captured 221 falls experienced by 130 individuals in common areas (e.g., dining rooms, hallways, and lounges) of two LTC facilities. The FVAQ was developed through literature review and an iterative process to ensure our responses captured the most common behaviours observed in preliminary review of fall videos. Inter-rater reliability was assessed by comparing responses from two teams, each having three members, who reviewed 15 randomly-selected videos. Intra-rater reliability was measured by comparing responses from one team at baseline and 12 months later. Results In 17 of the 24 questions, the percentage of inter- and intra-rater agreement was over 80% and the Cohen\u27s Kappa was greater than 0.60, reflecting good reliability. These included questions on the cause of imbalance, activity at the time of the fall, fall direction, stepping responses, and impact to specific body sites. Poorer agreement was observed for footwear, contribution of clutter, reach-to-grasp responses, and perceived site of injury risk. Conclusions Our results provide strong evidence of the reliability of the FVAQ for classifying biomechanical, behavioural, situational, and environmental aspects of falls captured on video in common areas in LTC. Application of this tool should reveal new and important strategies for the prevention and treatment of falls and fall-related injuries in this setting

Understanding contextual factors in falls in long-term care facilities

Purpose – Despite the growing area of research involving falls in the residential care setting, the link between contextual and environmental factors in falls is poorly understood. This paper aims to draw upon existing research being undertaken in long-term care (LTC) in Metro Vancouver, Canada, with a particular focus on identifying contextual factors contributing to fall events. Design/methodology/approach – This paper presents the results of a qualitative observational analysis of video-captured data collected through a network of high-quality video systems in two LTC facilities. The research comprised workshops involving experienced researchers who reviewed six video sequences of fall events. The outcome of the workshops was a written narrative summarizing the discussion and researchers’ interpretation of fall sequences. Findings – The analysis indicates that there are a broad range of environmental, behavioral and situational factors that contribute to falls in LTC. This suggests that a limited conceptualization of a fall as an outcome of the person's impairment and environmental hazards fails to convey the complexity of potential contributory factors typical of most fall incidents. Research limitations/implications – Broadening our understanding of falls provides the potential to make recommendations for falls prevention practice across multiple levels, including the individual, social and organizational context. Originality/value – The paper evaluates the potential of video-based data in fall analysis and points to the development of a case study approach to analyzing fall incidents to capture the complex nature of contributory factors beyond research that focuses solely on intrinsic and extrinsic risk factors. </jats:sec