Is compliant flooring a feasible intervention for preventing fall-related injuries in long-term care?
To address this question, Drs. Chantelle Lachance, Dawn Mackey, and Fabio Feldman hosted an interactive symposium to gather perceptions about the feasibility of compliant flooring in long-term care from key stakeholders.
The one-day symposium was held at the Fraser Health Authority in Surrey, BC. It brought together 23 stakeholders representing health care, industry and research. There was one thing all stakeholders had in common: an integral role and commitment to actively participate in creating positive change for our aging population in long-term care settings. Stakeholders discussed the advantages and disadvantages of implementing compliant flooring in long-term care, and along the way, they established pressing questions about its feasibility for future research to address. Funding for the symposium was provided by a grant from the Canadian Institutes of Health Research.
For those not familiar with compliant flooring, it is a type of safety flooring designed to decrease the stiffness of the ground and the forces applied to the body parts that impact the ground. Accordingly, compliant flooring is an intervention targeted at preventing the adverse consequences of fall events, including fall-related injuries.
The findings from the symposium were recently published in a policy and practice note in the Canadian Journal on Aging and are summarized below.
Top Advantages of Compliant Flooring
- Reducing injuries in residents who have fallen. Stakeholders highlighted that compliant flooring may reduce both the number and severity of fall-related injuries should a fall occur, including serious hip fractures and head injuries.
- Potential benefits to care staff. If residents have fewer fall-related injuries following the implementation of compliant flooring, staff may experience reduced stress and workload (i.e., fewer injuries result in reduced paperwork and post-fall investigations), and may have more time to focus their energy on other quality issues.
- Potential increases in quality of life for residents. Stakeholders suggested that compliant flooring may improve resident autonomy by replacing other interventions that residents and staff may not want to use (e.g., bedside mats that may cause tripping, hip protectors that residents may not want to wear, and pharmaceutical interventions).
Top Disadvantages of Compliant Flooring
- Financial considerations. Cost was described in many contexts, including the cost of the material itself, installation, maintenance, and additional costs to account for the differences in flooring stiffness versus standard flooring (e.g., purchase of motor-driven floor-based lifts to replace conventional floor-based lifts).
- Lack of research evidence. Stakeholders believed that more research on balance, long-term utility (i.e., how well it works in real life), and clinical effectiveness needs to be performed before considering widespread implementation of compliant flooring in long-term care.
- Challenges with installation. Stakeholders remarked that installing compliant flooring in an existing care home would be disruptive for residents and staff.
Future Research Needs
- Cost-effectiveness. Stakeholders suggested that future economic analyses should include potential cost savings resulting from prevention of other injuries in addition to hip fractures (e.g., head injuries, wrist fractures), since most cost analyses have been performed by considering only hip fractures.
- Clinical effectiveness. Stakeholders stated that longer and larger randomized controlled trials are needed to see more results from trials conducted with the population of interest (i.e., older adults in long-term care) and multiple types of injuries (e.g., hip fractures, head injuries, and wrist fractures).
Taken together, these findings suggest that stakeholders perceive compliant flooring to potentially benefit the long-term care setting, but there are currently informational and financial barriers to realizing those benefits.