Compliant flooring for fall injury prevention in long-term care

A promising strategy for reducing the incidence and severity of fall-related injuries in long-term care (LTC) is to decrease the ground surface stiffness, and the subsequent forces applied to the body parts at impact, through installation of compliant flooring. Evidence about the feasibility of compliant flooring in LTC is extremely limited. My PhD research addresses this gap by conducting a comprehensive, multimethod evaluation of compliant flooring. Specifically, I investigate the feasibility of compliant flooring for fall injury prevention in LTC by synthesizing the available evidence (study 1), determining the effects of compliant flooring on external hand forces exerted by LTC staff when pushing wheeled equipment (study 2), and examining the barriers to and facilitators of implementing compliant flooring as perceived by key stakeholders (studies 3 and 4). In my first study, I conducted a scoping review to describe the extent, range, and nature of research activity on compliant flooring, and to identify research gaps and directions for future research. I found compliant flooring is a promising strategy for preventing fall-related injuries from a biomechanical perspective. Additional research is required, however, to determine whether compliant flooring prevents fall-related injuries in real-world settings, is a cost-effective intervention strategy, and can be installed without negatively affecting workplace safety. My second study compared the effects of flooring system and resident weight on the forces required by LTC staff to push floor-based lifts used to transfer residents. Compared to the conventional lift, the motor-driven lift substantially reduced forces in all experimental conditions and thus may help to address risk of work-related musculoskeletal injury. My third study examined the feasibility of compliant flooring from the perspective of organizational-level LTC stakeholders. My interview findings provide new evidence about facilitators and barriers that stakeholders consider in deciding to install compliant flooring in LTC, such as staff’s openness (or resistance) to change and flooring performance. My fourth study sought input about compliant flooring from additional stakeholders through a symposium. My findings suggest that while stakeholders perceive compliant flooring to add value to the LTC setting, there also remain significant informational and financial barriers to the uptake of compliant flooring. Overall, my thesis should inform planners and architects in the development of safer environments for vulnerable older adults, and improve policies and programs for fall injury prevention in LTC.