A Systematic Review of Interventions to Reduce Falls and Improve Staircase Safety for Older People

3577
Joanna Wootton1; Toni Hall 1,2; Constantinos Maganaris 1; Theodoros M. Bampouras 1; Richard J. Foster 1; Mark Hollands 1; Vasilios Baltzopoulos 1; Thomas O’Brien 1
1. Research Institute for Sports and Exercise Sciences, Faculty of Science, Liverpool John Moores University, UK; 2. National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) Northwest Coast, University of Liverpool, UK
Scientific Research
SP - Falls
Falls

Abstract

Background

Stairs are a serious safety hazard for older adults, with stair falls being the leading cause of accidental death [1,2]. Mechanistic, proof-of-principle, research has examined the development of interventions to improve staircase safety. The aims of this systematic review are to synthesise and evaluate stair fall interventions and identify those showing effectiveness and to establish a pathway to implementation for these interventions.

Methods

Five databases were searched for interventions seeking to reduce risk or occurrence of falls on stairs. Quality of the studies was assessed using the Cochrane RoB-2 tool as well as a modified tool, adapted for proof-of-principle studies. Findings were synthesised to evaluate the studies’ effectiveness, and to recommend research priorities for progressing interventions along a pathway to implementation (adapted from MRC Complex Intervention Framework [3]).

Results

Only one of the 57 interventions included was tested in a real-world environment [4], and none used fall rate as an outcome measure. Therefore, further translational research is required before implementation of any intervention can be supported. The pathway to implementation signposts future development by synthesising the current research landscape. Step-edge highlighters, step dimensions, and handrails have limited evidence and yet are already implemented in the real-world; thus, evaluation in real-world settings is required to provide the evidence supporting and optimising their application. Interventions of wall and step décor, and lighting should also be prioritised due to their lower cost and ease of application.

Conclusion

No interventions were found to directly improve stair fall rates. Instead, research has been conducted in the laboratory, proving effectiveness on measures of stair fall risk. The interventions included require targeted translational research for implementation in real-world environments. Interventions found to be effective may then be used to inform healthcare and policies improving safety and reducing falls on stairs in older people. 

References

  1. Startzell, J.K., et al. Journal of the American Geriatrics Society, 48, 567-580, 2000.
  2. Jacobs, J.V. Gait & Posture, 49, 159-167, 2016.
  3. Skivington, K. et al. British Medical Journal, 374, n2061, 2021.
  4. Brown, C.B., et al. Ergonomics, 66, 1219-1228, 2023.

Comments

Hello. Thank you for your poster looking into this home hazard. What wearable sensors would you propose using and how would they detect issues that people have on stairs? How many times would people need to go up / down stairs before potentially coming to harm?

Submitted by alasdair.macrae on

Permalink

Thank you for your question.

I am currently working with several commercial devices as well as an in-house developed device which all utilise gyroscope and pressure detecting sensors. Gyroscopes can be used to assess the negotiation pattern during both ascent and descent, for example the internal or external rotation of the foot in order to safely house the foot within the bounds of the step. Pressure sensors located over the sole of the foot can be used to assess the foot contact length on each step, investigating the amount of overhang which we know can increase the risk of a slipping event. We are currently in the stage of validating these devices against motion capture (Vicon) data in a laboratory environment but we hope that they will be effective in the identification of these known risk factors for falls on stairs. The next study of my PhD will utilise these devices in a naturalistic environment to assess interventions' effect on altering stepping behaviours.

Many factors interact that can cause a person to came to harm on stairs including personal behaviour, the environment or the stairs themselves. I'd be happy to discuss this further with you here today should you be interested.

Thank you.

Submitted by j.wootton_41844 on

Permalink

Thank you for your poster, from your research what are your thoughts on what poses as a barrier to implementing any safety interventions for stairs?

Submitted by samdavidolden_27620 on

Permalink

Thank you for your question.

Acceptability and feasibility is a large barrier for the implementation of stair interventions. An example of this is altering the step dimensions by increasing the going length of a step may increase staircase safety, but the reconstruction of a staircase may not be acceptable to a homeowner due to disruption and cost. Interventions such as altering the lighting or the addition of step-edge highlighters are less invasive and so may be more acceptable to individuals as interventions are only effective if they are utilised which is why it is important to prioritise the development of these interventions. The next study of my PhD will be an intervention-based study investigating these environmental interventions which are easily applied and can be retrofitted to stairs in the home environment and that we hope are more acceptable to individuals and are feasible to be implemented.

I'd be happy to discuss these with you further in person today should you be interested.

Thank you

Hello, 

Why do you think there is such little evidence of interventions being tested in the real-world rather than laboratory?

Submitted by jannah.holmes2… on

Permalink

Thank you for your question.

I think this is largely due to the practical complexities of collecting stair based data in a real-world environment in the ability to collect data for the outcome measures we assess in the laboratory. In the laboratory we can collect data using a variety of technologies including marker-based motion capture data while applying an intervention and manipulating the environment. This is more difficult in a real-world environment, which is why I am now working with commercial devices to validate their usage on stairs so that we might use these to assess the same outcome measures that we can in the laboratory, in the home environment. Using these devices we plan next to collect data investigating interventions to improve staircase safety in a naturalistic environment.

Thank you