Agreement between video footage and fall incident reports on the circumstances of falls in long-term care

Incident reports guide fall prevention efforts in long-term care (LTC) facilities, often based on descriptions of how falls occurred. The validity of these reports is poorly understood. We examined agreement on fall characteristics between fall incident reports and analysis of video footage of real-life falls in LTC.

Video capture of 863 falls (by 309 individuals) over 6 years in common areas of 2 LTC facilities in British Columbia.

We reviewed each fall video with a previously validated questionnaire to determine the cause of imbalance leading to the fall, activity at the time of falling, and use of mobility aids. These data were compared with corresponding information recorded by staff on fall incident reports.

There was agreement between video analysis and incident reports on the cause of imbalance in 45.5% of falls (kappa = 0.25), on activity at time of falling in 45.1% of falls (kappa = 0.22), and on use of mobility aids in 79.5% of falls (kappa = 0.59). When compared with video analysis, incident reports overreported falls due to slips, and falling while rising and while using a wheelchair or walker. Incident reports also underreported falls due to hit/bump and loss-of-support, and falling while standing and sitting down.

In more than 50% of falls, we found discrepancies between fall incident reports and analysis of video footage on the cause of imbalance and activity while falling. Emerging technologies incorporating video capture or wearable sensors should improve our ability to understand the mechanisms and improve the prevention of falls in LTC.