Compliant flooring not the answer to preventing fall-related injuries

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Researchers expected that a 25 mm thick, rubber sublayer would decrease injuries due to falls in long-term care.

A resident bedroom with study flooring installed (25 mm thick rubber sublayer with 2 mm thick vinyl overlay).

July 02, 2019

An SFU team of scientists and patient safety experts from the Fraser Health Authority have been working to prevent a serious health concern for older adults in long-term care – injuries sustained from falls.

Studies using compliant (low-stiffness) flooring in laboratory settings and preliminary studies in clinical settings showed promising results in preventing fall-related injuries. The team was anxious to find out whether a more rigorous, multi-year study in a real-world setting would support the same conclusion.

The Flooring for Injury Prevention (FLIP) Study saw 150 resident bedrooms at a long-term care home in Burnaby randomly assigned to renovation and installation of either one-inch think compliant flooring or one-inch thick rigid flooring, both covered with identical hospital-grade vinyl. The compliant flooring that was selected for the study reduces impact forces to the hip by about 35 per cent and to the head by about 70 per cent during simulated falls in the laboratory.

After analyzing results of their four-year randomized trial, the team discovered that compliant flooring was not the effective solution they had hoped for.

Lead investigator Dawn Mackey says she was surprised by the results.

“It appears that the impact force reduction provided by the compliant flooring product we studied simply was not large enough to reduce the frequency of fall-related injuries that we could measure in long-term care resident bedrooms.”

The team’s ability to measure injuries may have been impacted by the use of hip protectors, which are effective at preventing hip fractures when worn during falls – hip protectors were worn in more than 40 per cent of falls, resulting in only four hip fractures.

“It may also have been difficult to measure the effect of compliant flooring on concussion,” adds co-author Stephen Robinovitch, of SFU’s Mobility and Injury Prevention Lab, “because of the challenges in separating the effects of concussion from baseline dementia, which was present in 55 per cent of residents.”

The team expects that newer flooring technologies that provide greater reduction in impact force may be effective. They also speculate that it may be useful to pad other surfaces in resident bedrooms in addition to the ground, including walls and edges of furniture.

The study was published in PLOS Medicine.