Evaluation of footwear worn at the time of fall in a Maltese long-term elderly facility

Abstract

Aim: The aim of this study was to investigate the relationship between footwear design and risk of falling in a sample of older adults living in a long-term care facility. Research Design and Method: A quantitative, post-positive study was conducted in Malta’s largest long-term care residence. This study consisted of 3 phases. Phase 1 evaluated footwear characteristics and fit worn by residents to provide an overview of the typical footwear worn in this population. A nonexperimental approach was utilised with 135 residents selected through random sampling. The most commonly worn footwear was analysed using the Footwear Assessment Form, and its fit was assessed by measuring the footwear’s length and width and comparing these to the participants’ foot measurements. Phase 2 focused on evaluating the footwear worn at the time of falls. Employing a prospective design, this phase recorded any falls sustained over a period of 9 months, resulting in 76 eligible falls. Details about each fall and the footwear worn at the time were documented using the same methodology as in Phase 1. Phase 3 aimed to evaluate the functional stability and balance of participants when wearing the footwear worn at the time of fall versus ‘adequate’ footwear as recommended by the literature. An experimental design was used, involving 41 eligible participants from Phase 2. Participants completed two clinical balance and stability tests, the Functional Reach Test (FRT) and Time Up and Go (TUG), with both sets of footwear. The goal was to determine if adequate footwear provided better balance and stability than the footwear worn at the time of fall. Results: Participants who sustained a fall were more likely to wear footwear with sub-optimal features such as heel height of more than 2.5cm and footwear having no fixation. Sandals were the most common type of footwear worn. Only 9.2% of participants who fell were wearing well-fitted footwear in terms of length and width. Participants performed significantly better in the TUG test when wearing ‘adequate’ footwear compared to the footwear worn at the time of fall. However, there was no significant difference in the FRT between the two types of footwear. Furthermore, none of the footwear characteristics were found to significantly impact the FRT and TUG test results. Conclusion: This study demonstrates that inadequate footwear increases the risk of falling among a geriatric population living in a long-term care facility. Footwear worn at the time of fall negatively affected the participants' balance during walking, as evidenced by the TUG test. However, participants’ stability over a fixed base of support, measured by the FRT test, was not affected when wearing ‘adequate’ footwear highlighting the importance of appropriate footwear for walking stability. None of the footwear characteristics significantly impacted changes in stability and balance during clinical balance tests. A plausible explanation for this, is that these tests are capable of detecting major changes between different types of footwear (e.g. adequate vs inadequate) but may not be capable of identifying subtle modifications in footwear design. Therefore, more research is required to better understand the impact of footwear on fall risk.