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Effekter av stötdämpande golv som fallskadepreventiv åtgärd för äldre på särskilt boende
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences (from 2013).ORCID iD: 0000-0003-4840-6424
2018 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Compliant flooring as a fall-injury prevention measure for elderly in residential care (English)
Abstract [sv]

Fallskador är den vanligaste orsaken till skada i alla åldrar men är en skadetyp som blir vanligare ju äldre personen blir. Av de som läggs in på sjukhus för en skada till följd av ett fall är cirka 70 % över 65 år. Förutom det lidande som en fallskada utgör för den som drabbas finns också en utmaning kopplad till den pågående demografiska förskjutningen mot en allt äldre befolkning, vilket gör att omfattningen av problemet förutspås öka.

Stötdämpande golv är en relativt ny intervention, framtagen i syfte att minska risken för fallskador bland äldre. Behovet av ett dämpande golv för att förebygga fallskador bland äldre personer på särskilda boenden bottnar i problemets stora omfattning och det faktum att det visat sig vara synnerligen svårt att förhindra fallskador i denna population. Principen att använda stötdämpande material för skademinskning har dock använts inom många områden, både länge och framgångsrikt. Genom att lägga ett dämpande material mellan kroppen och den yta som kroppen riskerar att stöta samman med minskar risken för skada.

Utformning, testning och implementering av stötdämpande golv i vårdmiljöer har på senare år tagit fart, men studier i klinisk miljö är fortfarande få. Även om interventionen är teoretiskt välgrundad går det inte att fullt ut veta vilka effekter den kommer att få innan den testas i sin tänkta kontext. När det gäller stötdämpande golv finns en farhåga om att det skulle påverka balansen och på så sätt öka risken för fall. Andra aspekter är funktionen utifrån ett arbetsmiljöperspektiv och inte minst som en del av boendemiljön för de äldre. Därför är syftet med denna avhandling att undersöka den fallskadepreventiva effekten för äldre av ett stötdämpande golv på särskilt boende. Vidar undersöks också den befarade effekten på fallrisk samt eventuell effekten på arbetsmiljön för personalen och  boendemiljön för de äldre.

Resultaten i denna avhandling visar att stötdämpande golv har potentialen att minska risken för fallskador bland äldre på särskilt boende, en population där det hittills varit svårt att finna och implementera effektiva åtgärder. När det gäller den befarade oönskad bieffekt att golvet skulle leda till ökad fallrisk så tyder resultaten inte på någon sådan effekt, även om risken inte helt kan uteslutas.

Undersköterskorna som arbetar på boendet upplever att golvet avdramatiserat fallen och att ljudnivån dämpats, aspekter de uppfattar som positiva. De upplever också att vissa utmaningar är förknippade med golvet. Främst att det tog tid att vänja sig vid att gå på det dämpande golvet och att tunga hjälpmedel (exempelvis lyftar) blev svårare att flytta. Resultaten tyder på att stötdämpande golv kan vara en framkomlig väg för fallskadeprevention riktat mot en äldre och skör population. Undersköterskorna var positiva till interventionen som påverkade deras arbetsmiljö på flera sätt, en aspekt som behöver undersökas vidare.

Ett antal oväntade bieffekter uppstod som ett resultat av golvet. Från ett positivt perspektiv påverkade det dämpande golvet ljudbilden till det bättre, en faktor som underlättade implementeringen och acceptansen. Samtidigt identifierades problem som behöver lösas. Den ökade fysiska arbetsbelastning som personalen upplevde när de gick på det dämpande golvet samt det ökade rullmotståndet vid hantering av hjälpmedel behöver studeras vidare. Likaså behöver framtida utvecklingen av stötdämpande golv ta hänsyn till de unika förutsättningar som finns inom hälso- och sjukvården med avseende på slitage, hjälpmedel och hygien. I detta arbete behöver det etableras vilka dämpande egenskaper ett golv bör ha för att uppnå en optimal skademinskning i relation till annan funktionalitet.

Att personalen upplever sig handfallna inför problemet med fall och fallskador, samt att de äldre är tämligen ointresserade av aktiva interventioner förstärker uppfattning om att stötdämpande golv kan ha stor potential. Framtiden får utvisa om dessa problem kan finna en lösning och  om stötdämpande golv implementeras i stor skala och därmed bidra till att minska omfattningen av fallskador bland sköra äldre.

Abstract [en]

Fall-injuries pose a considerable public health problem in the globally growing elderly population. Reducing energy in order to prevent injuries has been successfully applied in many injury prevention fields, though less so within fall injury prevention. Compliant flooring 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 thesis is therefore to investigate the primary injury reducing effect of complaint flooring, as well as secondary effects such as the influence on fall frequency, work environment for the staff and living conditions for the elderly in residential care.

Falls, and the injury outcome, were registered at a residential care facility in Sweden in which some areas had compliant flooring and other areas had PVC flooring. In two quantitative studies, the difference in the outcomes of falls was studied as well as the effect on the risk of falls depending upon the flooring surface in which the event occurred. In addition, in two qualitative studies, the staff and residents were interviewed on their views on fall prevention and compliant flooring. 

The results indicate that although the evidence is not fully conclusive, compliant flooring seems to reduce the risk of fall-injuries by over 50% without increasing the risk of falls. Results from the interviews showed that staff appreciated the compliant flooring in that it defused the falls as well as leading to greatly improved acoustics. However, there were also some challenges associated with the compliant flooring, especially the maneuvering of heavy equipment. The elderly also appreciated the intervention, even though the general interest for fall prevention was minimal.

The results from this thesis indicates that for a frail elderly population, compliant flooring has the potential to be an effective injury prevention measure, without increasing the risk of falls. Furthermore, the results show that with some adjustments, it could also work well from the perspective of residents and staff.

Abstract [sv]

Fallskador är ett omfattande problem bland äldre på vårdboenden och något som visat sig mycket svårt att förebygga. Det som vid en sammanstötning orsakar skada är den energi som uppstår vid händelsen och genom att placera ett dämpande material som tar upp en del av stöten minskar risken för skada. I denna avhandling har effekten av ett stötdämpande golv som fallskadeförebyggande åtgärd på vårdboende undersökts. Förutom den avsedda fallskadepreventiva effekten för de boende samt den befarade bieffekten på fallrisk, har även påverkan på boendemiljön samt arbetsförhållanden undersökts. Resultatet visar att det dämpande golvet har potential att minska risken för skador vid fall för äldre på vårdboende, utan att påverka risken för fall. Utifrån de boendes perspektiv har det dämpande golvet stora fördelar jämfört med andra förebyggande åtgärder då det inte kräver en beteendeförändring för att ha effekt. Också personalen uppfattade golvet som positivt, inte minst utifrån ett ljuddämpande perspektiv. Dock verkar golvet öka den fysiska arbetsbelastningen för personalen, något som behöver undersökas vidare.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2018. , p. 73
Series
Karlstad University Studies, ISSN 1403-8099 ; 2018:13
Keywords [en]
Accidental falls, residential care, nursing staff, injury prevention, elderly safety, compliant flooring
Keywords [sv]
äldre, fall, skador, stötdämpande golv, höftfraktur, undersköterskor
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Risk and Environmental Studies
Identifiers
URN: urn:nbn:se:kau:diva-66827ISBN: 978-91-7063-843-5 (print)ISBN: 978-91-7063-938-8 (electronic)OAI: oai:DiVA.org:kau-66827DiVA, id: diva2:1193268
Public defence
2018-05-04, Nyqvistsalen 9C 203, Universitetssgatan 2, Karlstad, 09:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Civil Contingencies Agency, 2013-4176Länsförsäkringar AB, P1/13
Note

Paper No. 4 was in manuscript form at the time of the defense.

Available from: 2018-04-16 Created: 2018-03-26 Last updated: 2019-07-10Bibliographically approved
List of papers
1. Investigating the fall-injury reducing effect of impact absorbing flooring among female nursing home residents: initial results
Open this publication in new window or tab >>Investigating the fall-injury reducing effect of impact absorbing flooring among female nursing home residents: initial results
2015 (English)In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 21, no 5, p. 320-32-Article in journal (Refereed) Published
Abstract [en]

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.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Risk and Environmental Studies; Public Health Science
Identifiers
urn:nbn:se:kau:diva-34772 (URN)10.1136/injuryprev-2014-041468 (DOI)000362779600006 ()25833258 (PubMedID)
Available from: 2014-12-12 Created: 2014-12-12 Last updated: 2018-05-22Bibliographically approved
2. Effects of Impact-Absorbing Flooring in Residential Care from the Perspectives of Enrolled Nurses
Open this publication in new window or tab >>Effects of Impact-Absorbing Flooring in Residential Care from the Perspectives of Enrolled Nurses
2017 (English)In: Journal of Housing for the Elderly, ISSN 0276-3893, E-ISSN 1540-353X, Vol. 31, no 4, p. 367-381Article in journal (Refereed) Published
Abstract [en]

Falls are a daily occurrence in nursing homes and few interventions for reducing fall-related injuries have proven to be effective. Impact absorbing flooring (IAF) in residential care has shown promising results in reducing fail-injuries and in the process of developing and implementing IAF all aspects are valuable to explore. Therefore, the aim of this qualitative study is to describe the enrolled nurses (ENs) experiences of IAF. We carried out focus group interviews with ENs and used content analysis to process the data. The ENs experienced both negative and positive aspects with the IAF. Importantly, the ENs perceived the IAF as effective in preventing fall-injuries. They also appreciated the improvements in acoustics. Negative aspects were that the flooring initially was challenging to walk on and that it made it harder to maneuver heavy equipment. A significant and transferable finding in this study was the importance of the ENs' perceived difficulty in preventing fall-injuries amongst elderly people living in nursing homes. This seemed to be a driving force to accept the intervention. Although IAF affects the working conditions in a nursing home, ENs are willing to accept these issues given the perceived effectiveness of the intervention.

Place, publisher, year, edition, pages
Routledge, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:kau:diva-65975 (URN)10.1080/02763893.2017.1335670 (DOI)000419504100004 ()
Note

Artikeln ingick i författarens licentiatuppsats, då med titeln Working in a nursing home with Impact Absorbing Flooring - a qualitative study on the experiences of licensed practical nurses.

Available from: 2018-01-25 Created: 2018-01-25 Last updated: 2019-07-10Bibliographically approved
3. There is more to Life than Risk Avoidance: Elderly Peoples Perspectives of Falls and Compliant Flooring
Open this publication in new window or tab >>There is more to Life than Risk Avoidance: Elderly Peoples Perspectives of Falls and Compliant Flooring
2018 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 13, no 1, p. 1-9, article id 1479586Article in journal (Refereed) Published
Abstract [en]

Background. Falls are the most common cause of injury in all ages and are especiallydifficult to prevent among residential care residents. Compliant flooring has beenproposed as a measure to prevent fall-injury, however little is known regarding theimplementation aspects in clinical settings. The aim of this study was to explore thefrail elderly person's view on falls, the risk of fall-injury, prevention in general andspecifically compliant flooring as an injury preventative measure. Methods. In this qualitative study, we used the grounded theory method and conductedin depths interviews with eight elderly people in residential care.Results. The identified categories were Falling as a part of life, Fearing theconsequences and A wish to prevent falls and injuries. Through the results is was clearthat There is more to life than risk avoidance, permeated the interviews, thereforeforming the grounded theory. The interviewees viewed falls as something common andnormal, and were uninterested in focusing on the risk of falls. Although they wanted toprevent falls, it was often difficult to integrate preventative measures into their everydaylife. They embraced the idea of an injury reducing compliant flooring, but their maininterests lie elsewhere.Conclusions. The results in this paper propose explanations on the obstacles ofimplementing fall prevention measures in an elderly frail population. The findings cangive us insights as to why interest, compliance for active fall prevention measures arelow, and on various factors that have to be taken under consideration in the process ofconstructing prevention. Compliant flooring is a passive fall injury prevention measurethat does not require the target group to make active decisions, adapt or activelyparticipate in the program. Therefore, we conclude that complaint flooring, from theperspective of the residents, can work well in residential care.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Injury Prevention; Impact-Absorbing Flooring; Low-Impact Flooring; Nursing Home;
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-66657 (URN)10.1080/17482631.2018.1479586 (DOI)000434312600001 ()
Funder
Swedish Civil Contingencies Agency, 2013-4176
Available from: 2018-03-13 Created: 2018-03-13 Last updated: 2019-08-15Bibliographically approved
4. A quasi-experimental evaluation of compliant flooring in a residential care setting
Open this publication in new window or tab >>A quasi-experimental evaluation of compliant flooring in a residential care setting
2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 7, article id e0201290Article in journal (Other academic) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
San Francisco: PLOS, 2018
Keywords
Nursing home; Elderly care; Sports flooring; Impact absorbing flooring; frail elderly
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-66659 (URN)10.1371/journal.pone.0201290 (DOI)000439952400069 ()
Funder
Swedish Civil Contingencies Agency, 2013-4176
Note

This article was part of Johanna Gustavssons thesis (as manuscript).

Available from: 2018-03-13 Created: 2018-03-13 Last updated: 2018-09-06

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