Inadequate Footwear in Older Medical Inpatients: An Overlooked Target for Falls Prevention and Mobility Promotion

Introduction
Inpatient falls are among the most common and preventable adverse events in acute hospitals. Appropriate footwear is a simple, low-cost intervention that may reduce falls and deconditioning. This study evaluated footwear worn by older medical inpatients and explored associations between footwear adequacy, falls, mobility and cognition.

Methods
We conducted a cross-sectional review of a sample of patients aged ≥65 yrs on general medical wards, excluding those in critical care, clinically unstable or end of life. Demographics, reason for admission, mobility, cognitive impairment, ward falls, attire and provision of alternative footwear were obtained by bedside assessment and chart review. Footwear was rated for grip, cushioning, wear and fastening using a tool adapted from Vass et al. (2015), yielding a total score (4–20) and a dichotomous classification of adequate versus inadequate footwear. Analyses were descriptive with exploratory cross-tabulations.

Results
One-hundred patients were included (mean age 82.9 ± 7.7 yrs, 48% female); 24% were admitted following a fall. Cognitive impairment was present in 46%. Overall, 62% had no footwear or footwear rated inadequate. Inadequate footwear was more common in women (68%) than men (55%) and in those with cognitive impairment (71% vs 56%). Adequate footwear rates were similar in fall and non-fall admissions (39% vs 38%) and in those with and without ward falls. Attire was strongly related to footwear: 65% of patients in day clothes had adequate footwear. Only 5% of patients with inadequate footwear were provided with an alternative.

Conclusion

Nearly two-thirds of older medical inpatients were mobilising in footwear judged inadequate for safety, particularly those with cognitive impairment and those not changed into day clothes. Footwear assessment and provision of safe footwear are not embedded into routine practice in Irish hospitals, representing a missed opportunity for low-cost falls prevention. Larger studies should evaluate the impact of structured footwear assessment and provision on falls and deconditioning.

Vass, Catherine & Edwards, Claire & Smith, Alexandra & Sahota, Opinder & Drummond, Avril. (2015). What do patients wear on their feet? A service evaluation of footwear in elderly patients. International Journal of Therapy And Rehabilitation. 22. 225-232. 10.12968/ijtr.2015.22.5.225.