Point prevalence of suboptimal footwear features among ambulant older hospital patients: implications for fall prevention

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.

Footwear and Falls in Long-Term Residential Aged Care Facilities: An Analysis of Video Capture Data

“…Enclosed shoes generally provide better slip resistance than slippers, socks, or going barefoot, and they may be protective against future falls. We acknowledge, however, that this recommendation may be difficult to implement, as many older people base their footwear purchases on comfort [9] and wear slippers indoors [9][10][11][12]. As a pragmatic solution, it may be possible for older people who are not prepared to wear shoes indoors to instead wear slippers designed to maintain balance, as backless slippers impair balance [49] and provide a greater risk of fall-related injury [15] than enclosed slippers.…”

“…One potentially modifiable risk factor that may contribute to falls in longterm care is footwear. The most frequently worn indoor footwear are slippers, which often comprise design features considered detrimental to balance, including lack of fixation, thick and soft midsoles, and smooth outersoles [9][10][11][12]. It has been shown that wearing slippers is a risk factor for falls [13][14][15] and fall-related injury [16][17][18][19].…”

Foot Problems in Older Adults Presenting to a Falls and Balance Clinic

“…The physician-led sixcomponent screening assessment included patient-reported foot and ankle pain or discomfort, footwear safety assessment, inspection for corns, calluses, and ulcers, paper grip testing, and neuropathy screening. These components were identified by the Royal Melbourne Hospital Podiatry team, following a MEDLINE literature review on foot-related risk factors associated with falls [30][31][32][33][34][35][36][37][38][39][40][41]. At the time of undertaking this study, there was literature available to suggest podiatry interventions were effective in addressing foot and ankle problems and consequently reduce falls risk.…”