Effect of Holding Objects on the Occurrence of Head Impact in Falls by Older Adults: Evidence from Real-Life Falls in Long-Term Care

Background: Falls cause approximately 80% of traumatic brain injuries in older adults, and nearly one third of falls by residents in long-term care (LTC) result in head impact. Holding objects during falls, such as mobility aids, may affect the ability of LTC residents to avoid head impact by arresting the fall with their upper limbs. We examined the prevalence of holding objects and their effect on risk for head impact during real-life falls in older adults living in LTC. Methods: We analyzed videos of 1105 real-life falls from standing height by 425 LTC residents, using a validated questionnaire to characterize the occurrence of head impact and whether the resident held objects during descent and impact. We classified objects as either "weight-bearing"(via contact to the fixed environment, eg, chairs and walkers) or "non-weight-bearing"(eg, cups) and tested their effect on odds for head impact with generalized estimating equations. Results: Residents held objects in more than 60% of falls. The odds for head impact were reduced for falls where weight-bearing objects were held or grasped during descent (odds ratio = 0.52; 95% confidence interval = 0.39-0.70) or maintained throughout the fall (odds ratio = 0.34; 95% confidence interval = 0.23-0.49). The most commonly held objects were chairs/wheelchairs (23% of cases), tables/counters (10% of cases), and walkers/rollators (22% of cases); all reduced the odds of head impact when held during descent. Holding non-weight-bearing objects did not affect the odds of head impact (odds ratio = 1.00; 95% confidence interval = 0.64-1.55). Conclusion: Our results show that older adults in LTC use held, weight-bearing objects to reduce their risk for head impact during falls.