Point prevalence of suboptimal footwear features among ambulant older hospital patients: implications for fall prevention
Satyan R. Chari A B K , Prue McRae C , Matthew J. Stewart D , Joan Webster E F , Mary Fenn G and Terry P. Haines H I JA Safety and Quality Unit, Royal Brisbane and Women’s Hospital, Metro North Hospital and Health Service, Level 7, Block 7, Herston, Qld 4029, Australia.
B School of Primary Health, Faculty of Medicine, Nursing and Allied Health Sciences, Building H, McMahon Road, Monash University, Frankston, Vic. 3199, Australia.
C Safety and Quality Unit, Royal Brisbane and Women’s Hospital, Metro North Hospital and Health Service, Level 7, Block 7, Herston, Qld 4029, Australia. Present Address: Internal Medicine Research Unit, 7th Floor, UQ Health Sciences Building, Royal Brisbane and Women’s Hospital, Metro North Hospital and Health Service, Herston, Qld 4029, Australia. Email: prue.mcrae@health.qld.gov.au
D Department of Physiotherapy, Allied Health Services, Royal Brisbane and Women’s Hospital, Metro North Hospital and Health Service, Ned Hanlon Building, Herston, Qld 4029, Australia. Email: matthew.stewart@health.qld.gov.au
E Centre for Clinical Nursing, Royal Brisbane and Women’s Hospital, Metro North Hospital and Health Service, Herston, Qld 4029, Australia. Email: joan.webster@health.qld.gov.au
F School of Nursing and Midwifery, Queensland University of Technology, Kelvin Grove, Qld 4059, Australia.
G Patient Flow Unit, Lower Ground Floor, Ned Hanlon Building, Royal Brisbane and Women’s Hospital, Metro North Hospital and Health Service, Herston, Qld 4029, Australia. Email: mary.fenn@health.qld.gov.au
H Southern Clinical School, Physiotherapy Department, Monash University, Frankston, Vic. 3199, Australia. Email: terrence.haines@monash.edu
I Allied Health Research Unit, Kingston Centre, Monash Health, Warrigal Road, Cheltenham, Vic. 3192, Australia.
J School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Qld 4067, Australia.
K Corresponding author. Email: srcha5@student.monash.edu.au
Australian Health Review 40(4) 399-404 https://doi.org/10.1071/AH14168
Submitted: 24 September 2014 Accepted: 17 August 2015 Published: 12 October 2015
Abstract
Objective The aim of the present study was to establish the point prevalence of ‘suboptimal’ features in footwear reported to have been used by older hospital patients when ambulating, and to explore underpinning factors for their choice of footwear.
Method A cross-sectional investigation was undertaken on 95 of 149 eligible in-patients across 22 high fall-risk wards in a large metropolitan hospital in Brisbane, Australia.
Results Over 70% of participants experienced an unplanned admission. Although most participants had access to some form of footwear in hospital (92%), nearly all reported ambulating in footwear with ‘suboptimal’ features (99%). Examples included slippers (27%), backless slippers (16%) or bare feet (27%). For patients who ambulated in bare feet, only one-third reported ‘lack of access to footwear’ as the primary cause, with others citing foot wounds, pain, oedema and personal choice as the main reason for bare foot ambulation.
Conclusions Admitted patients frequently use footwear with ‘suboptimal’ features for ambulation in hospital. While some footwear options (for example well-fitting slippers) could be suited for limited in-hospital ambulation, others are clearly hazardous and might cause falls. Since footwear choices are influenced by multiple factors in this population, footwear education strategies alone may be insufficient to address the problem of hazardous footwear in at-risk patients. Footwear requirements may be more effectively addressed within a multidisciplinary team approach encompassing foot health, mobility and safety.
What is known about the topic? Accidental falls while ambulating are an important health and safety concern for older people. Because certain footwear characteristics have been negatively linked to posture and balance, and specific footwear types linked to falls among seniors, the use of footwear with fewer suboptimal characteristics is generally recommended as a means of reducing the risk of falling. While footwear usage and choices have been explored in older people in the community and in residential care settings, there is little comparable data on acutely unwell older hospital patients.
What does this paper add? This paper provides prevalence data on the use of footwear with suboptimal characteristics among ambulant older hospital patients, and identifies concurrent factors that may be relevant to patient footwear choices.
What are the implications for practitioners? Pain, foot pathology and a desire to retain independence are important concerns for hospitalised patients and are likely to influence their choice of footwear used to ambulate with. Pragmatic team-based approaches that remain sensitive to key patient concerns may be more successful in optimising patient footwear usage than footwear education strategies alone.
References
[1] Healey F, Scobie S, Oliver D, Pryce A, Thomson R, Glampson B. Falls in English and Welsh hospitals: a national observational study based on retrospective analysis of 12 months of patient safety incident reports. Qual Saf Health Care 2008; 17 424–30.| Falls in English and Welsh hospitals: a national observational study based on retrospective analysis of 12 months of patient safety incident reports.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1cjpsVCitQ%3D%3D&md5=7297414e92e8689642468fa48021a7ebCAS | 19064657PubMed |
[2] Cameron ID, Murray GR, Gillespie LD, Robertson MC, Hill KD, Cumming RG, Kerse N. Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database Syst Rev 2010; 1 CD005465
| 20091578PubMed |
[3] Haines TP, Bennell KL, Osborne RH, Hill KD. Effectiveness of targeted falls prevention programme in subacute hospital setting: randomised controlled trial. BMJ 2004; 328 676
| Effectiveness of targeted falls prevention programme in subacute hospital setting: randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 15031238PubMed |
[4] Healey F, Monro A, Cockram A, Adams V, Heseltine D. Using targeted risk factor reduction to prevent falls in older in-patients: a randomised controlled trial. Age Ageing 2004; 33 390–5.
| Using targeted risk factor reduction to prevent falls in older in-patients: a randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 15151914PubMed |
[5] Stenvall M, Olofsson B, Lundstrom M, Englund U, Borssen B, Svensson O, Nyberg L, Gustafson Y. A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture. Osteoporos Int 2007; 18 167–75.
| A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2s%2FitVWmtQ%3D%3D&md5=e1e15b62fb82b8ae92204c178a20c6f0CAS | 17061151PubMed |
[6] Oliver D, Healey F, Haines TP. Preventing falls and fall-related injuries in hospitals. Clin Geriatr Med 2010; 26 645–92.
| Preventing falls and fall-related injuries in hospitals.Crossref | GoogleScholarGoogle Scholar | 20934615PubMed |
[7] Fonda D, Cook J, Sandler V, Bailey M. Sustained reduction in serious fall-related injuries in older people in hospital. Med J Aust 2006; 184 379–82.
| 16618235PubMed |
[8] Krauss MJ, Tutlam N, Costantinou E, Johnson S, Jackson D, Fraser VJ. Intervention to prevent falls on the medical service in a teaching hospital. Infect Control Hosp Epidemiol 2008; 29 539–45.
| Intervention to prevent falls on the medical service in a teaching hospital.Crossref | GoogleScholarGoogle Scholar | 18476777PubMed |
[9] Chari S, McRae P, Varghese P, Ferrar K, Haines TP. Predictors of fracture from falls reported in hospital and residential care facilities: a cross-sectional study. BMJ Open 2013; 3
| Predictors of fracture from falls reported in hospital and residential care facilities: a cross-sectional study.Crossref | GoogleScholarGoogle Scholar | 23906949PubMed |
[10] Jessup RL. Foot pathology and inappropriate footwear as risk factors for falls in a subacute aged-care hospital. J Am Podiatr Med Assoc 2007; 97 213–7.
| Foot pathology and inappropriate footwear as risk factors for falls in a subacute aged-care hospital.Crossref | GoogleScholarGoogle Scholar | 17507530PubMed |
[11] Burns SL, Leese GP, McMurdo MET. Older people and ill fitting shoes. Postgrad Med J 2002; 78 344–6.
| Older people and ill fitting shoes.Crossref | GoogleScholarGoogle Scholar | 12151688PubMed |
[12] Menz HB, Sherrington C. The Footwear Assessment Form: a reliable clinical tool to assess footwear characteristics of relevance to postural stability in older adults. Clin Rehabil 2000; 14 657–64.
| The Footwear Assessment Form: a reliable clinical tool to assess footwear characteristics of relevance to postural stability in older adults.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M7gsVOitg%3D%3D&md5=058d120c5356fbf2a296a95cecdae165CAS | 11128742PubMed |
[13] Robbins S, Waked E, Allard P, McClaran J, Krouglicof N. Foot position awareness in younger and older men: the influence of footwear sole properties. J Am Geriatr Soc 1997; 45 61–6.
| Foot position awareness in younger and older men: the influence of footwear sole properties.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2s7kslOitQ%3D%3D&md5=2eeb821d595fb3a4cf4de2375631d35fCAS | 8994489PubMed |
[14] Koepsell TD, Wolf ME, Buchner DM, Kukull WA, LaCroix AZ, Tencer AF, Frankenfeld CL, Tatutvydas M, Larson EB. Footwear style and risk of falls in older adults. J Am Geriatr Soc 2004; 52 1495–501.
| Footwear style and risk of falls in older adults.Crossref | GoogleScholarGoogle Scholar | 15341551PubMed |
[15] Tencer AF, Koepsell TD, Wolf ME, Frankenfeld CL, Buchner DM, Kukull WA, LaCroix AZ, Larson EB, Tatutvydas M. Biomechanical properties of shoes and risk of falls in older adults. J Am Geriatr Soc 2004; 52 1840–6.
| Biomechanical properties of shoes and risk of falls in older adults.Crossref | GoogleScholarGoogle Scholar | 15507060PubMed |
[16] Menant JC, Steele JR, Menz HB, Munro BJ, Lord SR. Effects of walking surfaces and footwear on temporo-spatial gait parameters in young and older people. Gait Posture 2009; 29 392–7.
| Effects of walking surfaces and footwear on temporo-spatial gait parameters in young and older people.Crossref | GoogleScholarGoogle Scholar | 19041245PubMed |
[17] Menant JC, Steele JR, Menz HB, Munro BJ, Lord SR. Optimizing footwear for older people at risk of falls. J Rehabil Res Dev 2008; 45 1167–81.
| Optimizing footwear for older people at risk of falls.Crossref | GoogleScholarGoogle Scholar | 19235118PubMed |
[18] Sherrington C, Menz HB. An evaluation of footwear worn at the time of fall-related hip fracture. Age Ageing 2003; 32 310–14.
| An evaluation of footwear worn at the time of fall-related hip fracture.Crossref | GoogleScholarGoogle Scholar | 12720618PubMed |
[19] Kerse N, Butler M, Robinson E, Todd M. Wearing slippers, falls and injury in residential care. Aust NZ J Public Health 2004; 28 180–7.
| Wearing slippers, falls and injury in residential care.Crossref | GoogleScholarGoogle Scholar |
[20] Munro BJ, Steele JR. Household-shoe wearing and purchasing habits. A survey of people aged 65 years and older. J Am Podiatr Med Assoc 1999; 89 506–14.
| Household-shoe wearing and purchasing habits. A survey of people aged 65 years and older.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c%2FhtlOntw%3D%3D&md5=b32cf5b0af4d03b292952e728b7c0564CAS | 10546422PubMed |
[21] Dunne RG, Bergman AB, Rogers LW, Inglin B, Rivara FP. Elderly persons’ attitudes towards footwear: a factor in preventing falls. Public Health Rep 1993; 108 245–8.
| 1:STN:280:DyaK3s3hvFGiuw%3D%3D&md5=944aa7e1127e0413e9e7cc7b5f05eae5CAS | 8464983PubMed |
[22] Morse JM, Tylko SJ, Dixon HA. Characteristics of the fall-prone patient. Gerontologist 1987; 27 516–22.
| Characteristics of the fall-prone patient.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL2szgsFKmtQ%3D%3D&md5=31db4f191b1af101615f72848d8d8737CAS | 3623149PubMed |
[23] Hung LK, Ho YF, Leung PC. Survey of foot deformities among 166 geriatric inpatients. Foot & Ankle Res 1985; 5 156–64.
| Survey of foot deformities among 166 geriatric inpatients.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL287ms1WntA%3D%3D&md5=b932dc6753db6b5d26b7c18e4dfc5146CAS |
[24] Chari S, Haines T, Varghese P, Economidis A. Are non-slip socks really ‘non-slip’? An analysis of slip resistance. BMC Geriatr 2009; 9 39
| Are non-slip socks really ‘non-slip’? An analysis of slip resistance.Crossref | GoogleScholarGoogle Scholar | 19706167PubMed |
[25] Naccarato M, Chiodo Grandi F, Dennis M, Sandercock PA. Physical methods for preventing deep vein thrombosis in stroke. Cochrane Database Syst Rev 2010; 8 CD001922
| 20687069PubMed |
[26] Sachdeva A, Dalton M, Amaragiri SV, Lees T. Elastic compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev 2010; 7 CD001484
| 20614425PubMed |
[27] Hatton AL, Sturnieks DL, Lord SR, Lo JCM, Menz HB, Menant JC. Effects of nonslip socks on the gait patterns of older people when walking on a slippery surface. J Am Podiatr Med Assoc 2013; 103 471–9.
| Effects of nonslip socks on the gait patterns of older people when walking on a slippery surface.Crossref | GoogleScholarGoogle Scholar | 24297983PubMed |
[28] Hübscher M, Thiel C, Schmidt J, Bach M, Banzer W, Vogt L. Slip resistance of non-slip socks: an accelerometer-based approach. Gait Posture 2011; 33 740–2.
| Slip resistance of non-slip socks: an accelerometer-based approach.Crossref | GoogleScholarGoogle Scholar | 21440441PubMed |
[29] Australian Centre for Health Services Innovation (AusHSI). News and events. Kelvin Grove: AusHSI; 2014. Available at: http://www.aushsi.org.au/news-and-events/2014-grant-winners-announced [verified 11 February 2015].
