Can fall risk be reduced by special flooring?

Can special flooring reduce fall injuries for elderly?

Published April 09, 2015  
Special impact-absorbing flooring reduced fall injuries by nearly 60 percent in a new study of women in Swedish nursing homes, though the soft floors may also be linked to more falls, according to the authors. 
"Falls are extremely common in nursing home residents, approximately 70 percent are fallers and they fall on average three to four times per year," said lead author Johanna Gustavsson of Karlstad University in Sweden. "The consequences are often very serious, for example resulting in hip fractures or head injuries. 
In the U.S., one of every three adults over age 65 falls each year, with about one quarter of those sustaining moderate to severe injuries that "make it hard for them to get around or live independently, and increase their risk of early death," according to the Centers for Disease Control and Prevention. 
The direct medical costs of falls by seniors are estimated at $34 billion annually, according to CDC. 
The idea of reducing force to reduce the risk of injuries in an accident is by no means new, it has been tested in many fields like traffic and sports, Gustavsson said. 
But impact-absorbing floors have not been widely tested, and the reduction in injury rate in the new study was greater than she and her coauthors expected.  
The researchers collected fall and injury data from a nursing home in Sweden with 60 apartments divided into six wards. Six of the 60 apartments had New Zealand-manufactured Kradal brand 12-millimeter flexible impact absorbing tiles installed. This flooring is not approved for wet areas and was not installed in any bathrooms. 
The half-inch thick tiles have a spongy polyurethane/polyurea interior. According to the manufacturer, they reduce the force of an impact by 65-85 percent, compared to concrete floors. 
Between late 2011 and early 2014, 57 female nursing home residents with an average age of 85 participated in the study, 39 of whom fell at least once. Nursing home staff recorded 254 falls on regular flooring and 77 on impact absorbing flooring. 
Almost 17 percent of falls on the special flooring resulted in an injury, compared to 30 percent of falls on regular flooring, according to results in Injury Prevention. 
Most injuries were relatively minor, with between one and two percent resulting in hip fracture. Major injuries were equally common on both types of flooring, but minor injuries were less common on the soft floors. 
Although fall injuries were less common on the impact absorbing floors, falls seemed to be more common. 
"If indeed flooring was in less than 10 percent of the areas, then 10 percent of the falls would have occurred on the impact absorbing areas, but more than twice that many were on the impact absorbing floors," said Dr. Peter M. Layde of the Medical College of Wisconsin in Milwaukee, who was not a part of the new study. 
"It raises the possibility that softer flooring might actually increase risk of falling," Layde told Reuters Health by phone. 
However, in this and other studies, there is a chance that nursing home staff moved patients who were more likely to fall into the softer flooring areas, Gustavsson said. 
"We have indications that this was also the case in our study with staff moving elderly that were prone to fall to the areas with the special flooring in order to protect them, as they perceived that the flooring 'worked'," she said. "This was out of our control and nothing we could (or wanted) to prevent. 
M. Clare Robertson of the Dunedin School of Medicine at the University of Otago in New Zealand was involved with the initial testing of Kradal, and found no difference in standing, balance, walking or stability compared with standard vinyl or carpeted floors. . 
Over the three-year period of the study, only six women fell on the impact absorbing floors and three fell on both types of floor, which means only nine individuals fell on the new flooring, Layde said. Such a small group limits how much the results can be interpreted, he said. 
Bathrooms are a frequent location of falls, but the special flooring is not applicable there, he noted. 
Still, the idea is "tantalizing" and deserves more investigation, Layde said. 
"The use of this type of flooring is still in an experimental stage but there are some ongoing trials across the world," Gustavsson said. 
There will need to be more tests to find the best mix of injury prevention and usability, she said. 
"Many aspects have to be considered for floorings in care settings: work environment, maintenance and hygiene to mention a few," she said. The staff of this particular nursing home did appreciate the improved acoustic environment with the new floors, she noted.