Johanna Gustavsson

Trends in hip fracture incidence rates among the elderly in Sweden 1987–2009

BACKGROUND Previous trend studies have shown large increases in hip fracture incidence rates among the elderly. International research, however, suggests a levelling off, or decline, of hip fracture incidence rates, although for Sweden this remains to be studied. METHODS Data were obtained regarding hip fractures among individuals 65 years and above from 1987 to 2009. Analysis was performed in three steps. First, age- and sex-specific trends in hip fracture rates per 100 000 and the mean age when sustaining a hip fracture were analysed. Secondly, the annual percentage change was used to compare time periods that helped to quantify changes in secular trends. Finally, linear and Poisson regression models were used to examine the trend data and observed rates. RESULTS The absolute number of hip fractures among the elderly in Sweden has largely remained constant between 1987 and 2009, while incidence rates have decreased for all age- and sex-specific groups, with the largest changes in the younger age groups and among women. The mean age of sustaining a hip fracture has increased for both men and women. CONCLUSIONS This study supports other international studies in showing a decrease in hip fracture incidence rates among the elderly, especially since the mid-1990s.

Investigating the fall-injury reducing effect of impact absorbing flooring among female nursing home residents: initial results

Background Fall-related injuries affect the lives of elderly to a substantial degree. This quasi-experimental study investigates the fall-injury reducing effect of impact absorbing flooring among female nursing home residents. Methods The intervention site is a nursing home in Sweden where impact absorbing flooring was installed in parts of one of six wards (six out of 10 apartments (excluding bathrooms), the communal dining-room and parts of the corridor). The impact absorbing flooring is a 12 mm thick closed cell flexible polyurethane/polyurea composite tile (500×500 mm) with an exterior surface of polyurethane/polyurea. A generalised linear model (log-binomial) was used to calculate the RR of injury from falls on impact absorbing flooring compared to falls on regular flooring, adjusted for age, body mass index, visual and cognitive impairments. Results During the study period (1 October 2011 to 31 March 2014), 254 falls occurred on regular flooring and 77 falls on impact absorbing flooring. The injury/fall rate was 30.3% for falls on regular flooring and 16.9% for falls on impact absorbing flooring. Adjusted for covariates, the impact absorbing flooring significantly reduced the RR of injury in the event of a fall by 59% (RR 0.41 (95% Cl 0.20 to 0.80)). Conclusions This is, to our knowledge, the first study evaluating the injury-reducing effect of impact absorbing flooring in a nursing home showing statistically significant effect. The results from this study are promising, indicating the considerable potential of impact absorbing flooring as a fall-related injury intervention among frail elderly.

Preventing fall injuries among elderly by shock absorbing flooring

Background Within nursing homes, the fall-related fracture incidence rate is between 5 and 10%. For those living in nursing homes there are limited options for active fall injury prevention, due to physical impairments and diseases. Instead, passive fall injury prevention is a more realistic alternative. Shock absorbing flooring has been suggested as a potential passive safety measure for this group of individuals. Aims/Objectives/Purpose To evaluate the fall injury reducing effect of shock absorbing flooring in a nursing home setting in Sunne, Sweden. Methods The study is case controlled, with the shock absorbing flooring installed on one ward with a maximum of 12 residents and the other five wards are controls. The total number of residents including control wards is approximately 60. Baseline measurements are made with estimates of the risk of falling as well as the risk of fall-related injury. Results/Outcome After 1 year, there has been 22 falls on the shock absorbing flooring, with no resulting injury compared to 130 falls and four fractures on the control wards. An unexpected finding is that the acoustic environment has improved considerably, creating a calmer environment for the elderly. Significance/Contribution to the Field To our knowledge, this is the first time a shock absorbing flooring has been tested and evaluated as a means of injury prevention in a nursing home. Although this is a pilot study, it contributes towards improved passive safety for this frail group of elderly.

A quasi-experimental evaluation of compliant flooring in a residential care setting

Background Fall injuries affect the lives of older people to a substantial degree. This quasi-experimental observational study investigates the potential fall injury reducing effect of a compliant flooring in a residential care setting. Methods The allocation of the compliant flooring was non-random. Data on fall-events and individual characteristics were collected in a residential care unit during a period of 68 months. The primary outcome was the fall injury rate per fall, and a logistic regression analysis was used to test for the effect of complaint flooring. Falls per 1000 bed days was the secondary outcome, used to measure the difference in fall risk on compliant flooring versus regular flooring. Results The event dataset is an unbalanced panel with repeated observations on 114 individuals, with 70% women. The mean age was 84.9 years of age, the average Body Mass Index (BMI) was 24.7, and there was a mean of 6.57 (SD: 15.28) falls per individual. The unadjusted effect estimate showed a non-significant relative risk injury reduction of 29% per fall (RR 0.71 [95% CI: 0.46–1.09]) compared to regular flooring. Re-estimating, excluding identified outliers, showed an injury risk reduction of 63% (RR 0.37 [95% CI: 0.25–0.54]). Falls per 1000 bed days showed that individuals living in apartments with compliant flooring had a fall rate of 5.3 per 1000 bed days compared to a fall rate of 8.4 per 1000 bed days among individuals living in regular apartments. This corresponds to an incidence rate ratio (IRR) of 0.63 (95% exact Poisson CI: 0.50–0.80). Conclusion The results of this non-randomized study indicate that compliant flooring has the potential to reduce the risk of fall injury without increasing the fall risk among older people in a Swedish residential care setting.

There is more to life than risk avoidance – elderly people’s experiences of falls, fall-injuries and compliant flooring

ABSTRACT Purpose: Falls are the most common cause of injury in all ages and are especially difficult to prevent among residential care residents. Compliant flooring that absorbs energy generated within the fall, has been proposed as a measure to prevent fall-injury, however little is known regarding the implementation aspects in clinical settings. The aim of this study is to explore the experiences of falls, the risk of fall-injury, prevention in general and specifically compliant flooring as an injury preventative measure amongst frail elderly people living in a residential care facility with compliant flooring. Through this, generate a theory that further explains the underlying barriers of active prevention amongst elderly people. Method: We used the grounded theory method and conducted semi-structured in-depth interviews with eight elderly people in residential care (data collected between February and December 2017). Results: The identified categories were Falling as a part of life, Fearing the consequences and A wish to prevent falls and injuries. Through the results it was clear that There is more to life than risk avoidance, permeated the interviews, therefore forming the grounded theory. The interviewees viewed falls as something common and normal, and were uninterested in focusing on the risk of falls. Although they wanted to prevent falls, it was often difficult to integrate preventative measures into their everyday life. They embraced the idea of an injury-reducing compliant flooring, however their main interests lay elsewhere, preferring to focus on social interaction and issues concerning daily activities. Conclusions: The theory generated in this paper proposes explanations on the obstacles of implementing fall prevention measures in an elderly frail population. The findings give insights as to why interest and compliance for active fall prevention measures are low. We conclude that complaint flooring, from the perspective of the residents, can work well in residential care.

Can the provision of a home help service for the elderly population reduce the incidence of fall-related injuries? A quasi-experimental study of the community-level effects on hospital admissions in Swedish municipalities.

Background Fall-related injuries are a global public health problem, especially in elderly populations. The effect of an intervention aimed at reducing the risk of falls in the homes of community-dwelling elderly persons was evaluated. The intervention mainly involves the performance of complicated tasks and hazards assessment by a trained assessor, and has been adopted gradually over the last decade by 191 of 290 Swedish municipalities. Methods A quasi-experimental design was used where intention-to-treat effect estimates were derived using panel regression analysis and a regression discontinuity (RD) design. The outcome measure was the incidence of fall-related hospitalisations in the treatment population, the age of which varied by municipality (≥65 years, ≥67 years, ≥70 years or ≥75 years). Results We found no statistically significant reductions in injury incidence in the panel regression (IRR 1.01 (95% CI 0.98 to 1.05)) or RD (IRR 1.00 (95% CI 0.97 to 1.03)) analyses. The results are robust to several different model specifications, including segmented panel regression analysis with linear trend change and community fixed effects parameters. Conclusions It is unclear whether the absence of an effect is due to a low efficacy of the services provided, or a result of low adherence. Additional studies of the effects on other quality-of-life measures are recommended before conclusions are drawn regarding the cost-effectiveness of the provision of home help service programmes.

98 Preventing fall injuries with impact absorbing flooring in nursing homes – a study of the effects on injuries and work environment

Background Fall injuries pose a global public health problem. Whilst all elderly are at risk of fall injuries, the risk of injury is 10 times as high amongst elderly living in nursing homes. An injury occurs when body tissue is subjected to external kinetic energy exceeding the tissue’s tolerance. Reducing this energy in order to prevent injuries has been successfully applied in many fields. A impact absorbing floor as an energy reducing measure to prevent fall injuries has been evaluated. The aim of this study is to investigate the potential fall injury reducing effects of impact absorbing flooring in a nursing home, as well as the staff’s experience of working in premises with impact absorbing flooring. Methods The intervention site is a nursing home in Sweden where impact absorbing flooring was installed. To investigate the fall injury reducing effect falls on impact absorbing flooring were compared to falls on regular flooring. To describe how the staff presided working in premises with special flooring a qualitative focus group interview study were conducted. Results The results show that for women the risk of injury following a fall on the impact absorbing flooring was 59% less compared to falls on ordinary floors, after adjustment for age, BMI, vision impairments, and cognitive impairment. With regards to the staff’s experience of the impact absorbing flooring, the nurses felt that the floor defused the falls and in that way reduced the risk of injury. They were also positively surprised by the change in acoustics. There were also some challenges associated with the floor, for example, adapting to walking on the floor and manoeuvring equipment (eg hoists). Conclusions The results suggest that for an elderly and frail population, impact absorbing flooring seems to be an effective injury prevention measure. The intervention was generally perceived as positive by the staff, even though some negative aspects were observed. These aspects need to be studied further.

Trends in hip fracture incidence rates among elderly in Sweden 1987-2009

Background Falls are the most common cause of injury related hospital admission among elderly in Sweden and with an ageing population fears have been raised that fall-related admissions will increase, with large societal costs as a result. Hip fractures are the most common type of hospitalised, fall-related injuries. Aims/Objectives/Purpose Previous studies in Sweden have shown large increases in hip fracture incidence rates. International research, however, suggests a levelling off, or decline, of hip fracture incidence rates though for Sweden this remains to be studied. Method Data was obtained regarding hip fractures among individuals 65 years and above from 1987 to 2009. Age and sex specific trends in hip fracture rates per 100 000 and mean age when sustaining a hip fracture were analysed. Secondly, annual percentage change (APC) was used to compare time periods that helped to quantify changes in secular trends. Results/Outcomes The absolute number of hip fractures among elderly in Sweden has largely remained constant between 1987 and 2009 while incidence rates have decreased for all age and sex specific groups, with the largest changes in the younger age groups and among women. The mean age of sustaining a hip fracture has increased for both men and women. Significance/Contribution to the Field This study supports other international studies in showing a decrease in hip fracture incidence rates among elderly, especially since the mid 1990s. The causes behind this decrease are most likely a combination of healthier individuals with improved functional ability and increased BMI rather than national programmes or osteoporosis management.