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Defining a fall and reasons for falling: comparisons among the views of seniors, health care providers, and the research literature.

School of Kinesiology, The University of Western Ontario, London, ON, N6A 3K7 Canada.
The Gerontologist (Impact Factor: 2.48). 07/2006; 46(3):367-76. DOI: 10.1093/geront/46.3.367
Source: PubMed

ABSTRACT The purpose of this study was (a) to obtain information about the perceptions held by seniors and health care providers concerning what constitutes a fall and potential reasons for falling, and (b) to compare these perceptions to the research literature.
As part of a larger telephone survey, interviewers asked 477 community-dwelling seniors to define a fall and to provide reasons for falling. In addition, we interviewed 31 health care providers from the community on the same topics. In order to capture patterns in conceptualized thinking, we used content analysis to develop codes and categories for a fall definition and reasons for falling. We reviewed selected articles in order to obtain a comprehensive overview of fall definitions currently used in the research and prevention literature.
A fall had different meanings for different groups. Seniors and health care providers focused mainly on antecedents and consequences of falling, whereas researchers described the fall event itself. There were substantial differences between the reasons for falling as reported by seniors and the risk factors as identified in the research literature.
If not provided with an appropriate definition, seniors can interpret the meaning of a fall in many different ways. This has the potential to reduce the validity in studies comparing fallers to nonfallers. Research reports and prevention programs should always provide an operational definition of a fall. In communication between health care providers and seniors, an appropriate definition increases the possibility for early detection of seniors in greater need of care and services.

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    ABSTRACT: Objective Incident reports guide fall prevention efforts in long-term care (LTC) facilities, often based on descriptions of how falls occurred. The validity of these reports is poorly understood. We examined agreement on fall characteristics between fall incident reports and analysis of video footage of real-life falls in LTC. Design/Setting/Participants Video capture of 863 falls (by 309 individuals) over 6 years in common areas of 2 LTC facilities in British Columbia. Measurements We reviewed each fall video with a previously validated questionnaire to determine the cause of imbalance leading to the fall, activity at the time of falling, and use of mobility aids. These data were compared with corresponding information recorded by staff on fall incident reports. Results There was agreement between video analysis and incident reports on the cause of imbalance in 45.5% of falls (kappa = 0.25), on activity at time of falling in 45.1% of falls (kappa = 0.22), and on use of mobility aids in 79.5% of falls (kappa = 0.59). When compared with video analysis, incident reports overreported falls due to slips, and falling while rising and while using a wheelchair or walker. Incident reports also underreported falls due to hit/bump and loss-of-support, and falling while standing and sitting down. Conclusion In more than 50% of falls, we found discrepancies between fall incident reports and analysis of video footage on the cause of imbalance and activity while falling. Emerging technologies incorporating video capture or wearable sensors should improve our ability to understand the mechanisms and improve the prevention of falls in LTC.
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