Fall-related upper body injuries in the older adult: a review of the biomechanical issues
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.
References (105)
- et al.
The effects of composition, structure and age on the torsional properties of the human radius
Journal of Biomechanics
(1983) - et al.
Ground reaction forces in distance running
Journal of Biomechanics
(1980) - et al.
Prediction of upper extremity impact forces during falls on the outstretched hand
Journal of Biomechanics
(1998) - et al.
Effect of elbow flexion on upper extremity impact forces during a fall
Clinical Biomechanics
(2001) - et al.
Fractures in the elderlyepidemiology and demography
Baillieres Best Practice Research in Clinical Endocrinology and Metabolism
(2000) - et al.
Fall arrest strategy affects peak hand impact force in a forward fall
Journal of Biomechanics
(2002) - et al.
Biomechanical simulations of forward fall arrestseffects of upper extremity arrest strategy, gender and aging-related declines in muscle strength
Journal of Biomechanics
(2003) - et al.
Pre-innervation and stretch responses of triceps brachii in man falling with and without visual control
Brain Research
(1978) - et al.
Direct dynamics simulation of the impact phase in heel-toe running
Journal of Biomechanics
(1995) - et al.
A comparative study of impact dynamicswobbling mass model versus rigid body models
Journal of Biomechanics
(1998)
Epidemiology of bone loss with aging
Clinics in Geriatric Medicine
Assessment of fracture risk by bone density measurements
Seminars in Nuclear Medicine
Head injury patients admitted to general hospitals in Merseyside
Injury
Age-related bone changes
Experimental Gerontology
A multifactorial approach to reducing injurious falls
Clinics in Geriatric Medicine
Age and sex-related changes in the structure and strength of the human femoral shaft
Journal of Biomechanics
Epidemiology of osteoporosis
Rheumatic Diseases Clinics of North America
The effect of muscle stiffness and damping on simulated impact force peaks during running
Journal of Biomechanics
Fracture of the distal forearmepidemiological developments in the period 1971–1995
Injury
Impact severity in self-initiated sits and falls associates with center- of-gravity excursion during descent
Journal of Biomechanics
The cost of injury
Emergency Medicine Clinics of North America
Active responses decrease impact forces at the hip and shoulder in falls to the side
Journal of Biomechanics
Unintentional injuries among elderly peopleincidence, causes, severity and costs
Accident; Analysis and Prevention
Disturbance type and gait speed affect fall direction and impact location
Journal of Biomechanics
The cost and frequency of hospitalization for fall-related injuries in older adults
American Journal of Public Health
Epidemiology of fractures of the forearm
Journal of Bone and Joint Surgery. American Volume
Prediction of fracture load and different skeletal sites by geometric properties of the cortical shell
Journal of Bone and Mineral Research
Sex differences in geometry of the femoral neck with aginga structural analysis of bone mineral data
Calcified Tissue International
Circumstances and consequences of falls in independent community-dwelling older adults
Age and Ageing
Falls by elderly people at homeprevalence and associated factors
Age and Ageing
Age-related differences in cross-sectional geometry of the forearm bones in healthy women
Calcified Tissue International
Severity of contraction-induced injury is affected by velocity only during stretches of large strain
Journal of Applied Physiology
Injury to muscle fibres after single stretches of passive and maximally stimulated muscles in mice
Journal of Physiology (London)
Occupational slip, trip, and fall-related injuries—can the contribution of slipperiness be isolated?
Ergonomics
Fall frequency and characteristics and the risk of hip fractures
Journal of the American Geriatrics Society
Epidemiology of hip fractures
Epidemiologic Reviews
Risk factors for hip fracture in white women. Study of osteoporotic fractures research group
New England Journal of Medicine
How quickly can healthy adults move their hands to intercept an approaching object? Age and gender effects
Journals of Gerontology A, Biological Sciences & Medical Sciences
Biomechanical factors affecting the peak hand reaction force during the bimanual arrest of a moving mass
ASME Journal of Biomechanical Engineering
Interaction between pre-activity and stretch reflex in human triceps brachii during landing from forward falls
Journal of Physiology
Incidence of fractures in a geographically defined population
Journal of Epidemiology and Community Health
Economic dimensions of slip and fall injuries
Journal of Forensic Sciences
Outcome of falls in womenendogenous factors associated with fracture
Age and Ageing
Human arm stiffness characteristics during the maintenance of posture
Experimental Brain Research
Fracture of the distal radius including sequelae-shoulder-hand-finger syndromedisturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study
Acta Orthopaedica Scandinavica
Biomechanical analysis of the effectiveness of in-line skating wrist guards for preventing wrist fractures
American Journal of Sports Medicine
Dynamic impact response of human cadaveric forearms using a wrist brace
American Journal of Sports Medicine
Impact near the hip dominates fracture risk in elderly nursing home residents who fall
Calcified Tissue International
Cited by (80)
Perioperative Morbidities in Distal Radius Fractures Treated Using Locking Plates in the Super-Elderly Population: A Retrospective Study
2023, Journal of Hand Surgery Global OnlineAn analytical comparison of datasets of Real-World and simulated falls intended for the evaluation of wearable fall alerting systems
2022, Measurement: Journal of the International Measurement ConfederationAge differences in upper extremity joint moments and strength during a laboratory-based tether-release forward fall arrest in older women
2022, Journal of BiomechanicsCitation Excerpt :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).
- 1
Current address: Elizabethtown College, Elizabethtown, PA, USA.
- 2
Current address: 208 Westridge Court, Chapin, SC 29036-8725, USA.