Evaluating Environmental Fall Risks
- Health & Social Care Research, Big Data & Digital Health
In 2021, a survey was carried out by Newcastle University to evaluate environmental fall risks (see opportunity here). Prior to the survey being carried out, Dr Lisa Alcock met with the VOICE Research Support Group, to discuss the survey before it was released.
Read below to learn more about the background of the research, how VOICE supported the research and where this may go in the future.
Background and aims of project
From 2019 to 2020, the NHS reported around 78% of all fall-related hospital admissions in England occurred in those aged 60 years and above. The highest proportion of deaths due to falls also occurs in adults aged 60 years and above. Older adults are more likely to suffer serious injuries, such as broken bones and head injuries as a result of falling, thus are more likely admitted to hospital or long-stay institutions. Hospitalisation and healthcare associated with falls represents a severe cost to society, estimated at £2.3 billion per year in the UK.
The ability to walk safely around the home environment is critical for retaining independence, mobility and quality of life as we age. Many falls in older adults occur when negotiating obstacles or stairs in or around the home environment because of poor visibility, and typically result from inadequate foot clearance and/or compromised postural responses. Developing home-based low-cost interventions to reduce fall-risk, such as improving the visibility of trip hazards or step edges, are therefore imperative.
The danger of falls in the home environment is likely worsened by the ongoing COVID-19 pandemic, which placed unprecedented restrictions on our freedom and habitual activity since March 2020, forcing entire populations to self-isolate and live-in home-confinement for many months.
The primary aim of this survey was to explore the influence of environmental features within the home environment on falls and near-falls in older adults. The secondary aim of this survey was to explore the influence of the COVID-19 pandemic on older adult falls and near-falls within the home environment. To achieve these aims we developed an online survey which evaluates the features of the home environment which influence falls and near falls (i.e. trips, stumbles that do not result in a loss of balance).
We liaised with the VOICE Research Support Group (RSG) to gain valuable insights and relevant perspectives on the design, organisation and content of our online survey to evaluate environmental features within the home that influence fall risk.
Who did you involve in your project?
The RSG were fundamental in shaping the final text used in the online survey. The survey was also promoted through the VOICE website. We also disseminated the survey among a range of academic (researchers across a variety of institutions), community (i.e. Healthworks Newcastle, Elders Council, Sefton Older Peoples Forum), charity (i.e. PDUK, Age UK) and social media (i.e. research group website, twitter) networks.
How were VOICE members involved?
The RSG reviewed the survey questions and options for multiple choice questions prior to the survey going live online. VOICE members may also have completed the online survey, but the exact numbers are not known as individual responses were anonymised.
How did VOICE members help/influence your project?
We asked the RSG to review four key questions from the survey. We made several changes to the survey following their input. Comments, views, and suggestions were raised which influenced the terminology that was used, the content of the questions and multiple-choice options provided.
Firstly, we asked them to review the list of common activities provided which the individual may have been undertaking at the time of the fall or near-fall. Based on the responses, we added additional items to the list of activities at the time of a fall within the home environment, including
- Responding to the phone ringing or a knock at the door,
- Interacting with someone.
Second, we asked them to review the list of features of the home environment that may influence falls/ near falls. They provided a variety of additional options that may be included. This gave us a lot to think about!
In response we modified the survey structure to include an additional section related to “falling because of the floor surface characteristics” which accounts for factors such as wet, slippery, worn, or polished surfaces.
Lastly, we asked them to review the definitions provided which outline what constitutes a fall and a near fall. Based on the responses provided, we modified the definition of a fall and near-fall, and provided additional examples to improve clarity and remove any uncertainty/ ambiguity. This challenged us to consider the terminology used; for example, the word ‘inadvertently’ was replaced with ‘by accident’ and a working example was included. Moreover, the definition of a near fall received lots of consideration.
The VOICE Research Support Group were instrumental in solidifying the final definition which encompassed a working example and clear distinction between the two (fall and near fall).
Data analysis is ongoing. We had a fantastic response from adults aged over 60 years old across England. We also had a fantastic response from members of the Parkinson’s UK research mailing list. As such we have started to evaluate the responses in a group of adults over 60 years of age (193 individuals) and a group of adults over 60 years of age with Parkinson's disease (117 individuals).
What has been the overall impact of the public involvement on your research project and how have you found the experience?
The RSG were fundamental in shaping the final text used in the online survey. The survey was promoted through the VOICE website, and we had a huge number of respondents, above and beyond what we had anticipated.
Working with VOICE in developing and refining the survey, as well as liaising with the team to promote and distribute the survey has been a really positive experience. We look forward to working with VOICE again in the future.
What will happen next with your research and/or involvement with the public?
We have submitted two abstracts from our preliminary analysis of the survey responses which will be presented to a large audience of clinical and academic researchers with an interest in balance, gait and falls. This international meeting is usually attended by over 500 researchers from across the world. This year the conference will be held in Montreal, Canada in July, but will also be a hybrid conference ensuring greater reach and impact for researchers who are unable to attend in person.
Currently, we are undertaking further analyses before submitting the findings to a peer reviewed scientific journal. We plan to write further blogs and produce online material to disseminate the findings more widely once published.