Compliant flooring to prevent fall-related injuries in older adults: A scoping review of biomechanical efficacy, clinical effectiveness, cost-effectiveness, and workplace safety

Abstract

BackgroundCompliant flooring, broadly defined as flooring systems or floor coverings with some level of shock absorbency, may reduce the incidence and severity of fall-related injuries in older adults; however, a lack of synthesized evidence may be limiting widespread uptake.MethodsInformed by the Arksey and O’Malley framework and guided by a Research Advisory Panel of knowledge users, we conducted a scoping review to answer: what is presented about the biomechanical efficacy, clinical effectiveness, cost-effectiveness, and workplace safety associated with compliant flooring systems that aim to prevent fall-related injuries in healthcare settings? We searched academic and grey literature databases. Any record that discussed a compliant flooring system and at least one of biomechanical efficacy, clinical effectiveness, cost-effectiveness, or workplace safety was eligible for inclusion. Two independent reviewers screened and abstracted records, charted data, and summarized results.ResultsAfter screening 3611 titles and abstracts and 166 full-text articles, we included 84 records plus 56 companion (supplementary) reports. Biomechanical efficacy records (n = 50) demonstrate compliant flooring can reduce fall-related impact forces with minimal effects on standing and walking balance. Clinical effectiveness records (n = 20) suggest that compliant flooring may reduce injuries, but may increase risk for falls. Preliminary evidence suggests that compliant flooring may be a cost-effective strategy (n = 12), but may also result in increased physical demands for healthcare workers (n = 17).ConclusionsIn summary, compliant flooring is a promising strategy for preventing fall-related injuries from a biomechanical perspective. Additional research is warranted to confirm whether compliant flooring (i) prevents fall-related injuries in real-world settings, (ii) is a cost-effective intervention strategy, and (iii) can be installed without negatively impacting workplace safety. Avenues for future research are provided, which will help to determine whether compliant flooring is recommended in healthcare environments.

Healing built-environment effects on health outcomes: environment–occupant–health framework

“…For example, the (dis)advantages of (de)centralized nursing unit layouts has to be discussed by staff and/or considered from the patients' point of view (Pati, Harvey, Redden, Summers, & Pati, 2015;Rashid, 2015); the optimal number of beds in a patient's room requires further studies (Chaudhury, Mahmood, & Valente, 2005;Van de Glind et al, 2007), while Yildirim and Yalcin (2016) discuss the benefits of single rooms. Studies indicated that using carpets, or other low-impact flooring solutions, did not show significant differences in reducing the risk of falls compared with a vinyl flooring (Hanger, 2017;Warren & Hanger, 2013); while Lachance et al's (2017) review concluded that compliant flooring was a promising strategy for preventing fall-related injuries. On the other hand, it is clear that ergonomic furniture, fixtures and equipment (FF&E), and anti-slip facilities are necessary to reduce falls, back pain and increase social interactions, and for safety reasons (Carayon, Xie, & Kianfar, 2014;Clarkson et al, 2004;Reiling et al, 2004).…”

There is more to life than risk avoidance – elderly people’s experiences of falls, fall-injuries and compliant flooring

“…Although a review of complex multifactorial intervention programs has shown a reduction of recurrent fallers (Vlaeyen et al, 2015), there are considerable barriers for implementation outside the highly controlled circumstances of a study (Vlaeyen et al, 2017). As an alternative to active interventions, compliant flooring, defined as a flooring with some level of shock absorbency, has been suggested as a potential method for reducing the risk of fall-injuries among a frail elderly population (Lachance et al, 2017). …”

Fall Risk in Older Adults Transitioning between Different Flooring Materials

“…The reduced toe clearance might be due to the weak elasticity of the carpet. There is evidence [21] that a floor covering, such as carpet, significantly reduces the impact forces, so greater energy absorption is likely to be observed. Thus, when the participants stepped on a carpeted floor and tried to take their toe off, the energy to push off might have been absorbed due to the higher compliance of the carpet.…”