Elsevier

Journal of Biomechanics

Volume 36, Issue 7, July 2003, Pages 1043-1053
Journal of Biomechanics

Fall-related upper body injuries in the older adult: a review of the biomechanical issues

https://doi.org/10.1016/S0021-9290(03)00034-4Get rights and content

Abstract

Although the epidemiology of fall-related injuries is well established for the elderly population over 65 years of age, the biomechanics of how, when and why injuries do and do not occur when arresting a fall have received relatively little attention. This paper reviews the epidemiological literature in the MEDLINE data base pertinent to the biomechanics of fall-related injuries, including data on fall rates, fall-related injury rates, fall directions and types of injuries available. It also covers primary sources not listed on MEDLINE, along with the pertinent biomechanics literature. Many falls in older adults are in a forward direction, and as a result the upper extremities are one of the most commonly injured structures, presumably in protecting the head and torso. In this review emphasis is placed on what is, and what is not, known of the biomechanical factors that determine the impact forces and injury risk associated with upper extremity injuries in forward falls. While decreased bone mineral density may be contributory, it is not a reliable predictor of fracture risk. Evidence is presented that fall-related impact forces can be reduced by appropriate volitional arrest strategies. Further theoretical and experimental research is needed to identify appropriate fall-arrest strategies for the elderly, as well as the physical capacities and skills required to do so. Inexpensive interventions might then be developed to teach safe fall-arrest techniques to older individuals.

Section snippets

Introduction and epidemiology

Although the epidemiology of fall-related injuries is well established, the biomechanics of how individuals attempt to arrest a fall have received relatively little attention. Minimizing the risk for injury during a fall arrest can present substantial physical challenges at any age, but particularly for the elderly. For the purposes of this review older adults are defined as those over the age of 65 years. We shall review the epidemiological literature of fall-related injuries and then the

Biomechanical factors in injury severity

On the basis of studies we shall now review, we believe that new interventions should be developed to teach older individuals how to fall safely. However, research is needed to identify the groups of older individuals who may usefully be targeted in that they either have or can develop the physical and cognitive capacities to employ such strategies, and then to prove intervention efficacy and cost-effectiveness.

There are probably two main factors that determine the severity of injury when a

Summary

Cumming and Klineberg (1994) suggested that several age-related factors might be of importance, both with respect to an increased risk for falling and to a reduced ability to safely arrest a fall. The present review demonstrates that the biomechanics of the fall arrest are important in determining the loads on the musculoskeletal system. One must promptly decide on the arrest strategy to be employed, reconfigure the head, torso and extremities in preparation for impact, pre-activate an adequate

Acknowledgments

We are grateful for the support of PHS grants P01 AG10542 and P30 AG 08808, as well as Vennema Foundation funds.

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      A common strategy to break a forward fall is Falling On the Out-Stretched Hand (FOOSH) (Sran et al, 2010). The position of the upper extremity at impact affects body mass deceleration post-impact and could help to reduce risk of head and trunk injuries (DeGoede et al., 2003; Hsiao and Robinovitch, 1998; O’Neill et al., 1994). In 97% of falls occurring in a forward direction in long-term care, there was head impact, despite the majority also impacting with the hand, suggesting that older adults may be using an upper arm protective response that is ineffective in reducing head impact (Schonnop et al., 2013).

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    1

    Current address: Elizabethtown College, Elizabethtown, PA, USA.

    2

    Current address: 208 Westridge Court, Chapin, SC 29036-8725, USA.

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