Abstract
Background: Fall incidents in long-term care facilities are complex events, involving an interplay of factors at the individual and organisational level. However, research and care interventions have primarily focussed on examining specific intrinsic and extrinsic risk factors, rather than capturing a holistic understanding of the fall event. As a result, there is a paucity of research which has captured the contributory factors of falls at the personal, interpersonal and organisational level. Such understandings are important for broadening the evidence base and developing effective interventions which address potential causes at all levels. Methods: An ecological, systems based approach to analysing falls in long-term care allows a more holistic and systemic understanding of the fall event to emerge. This chapter applies a fuzzy cognitive map (FCM) modelling approach to understanding falls within long-term care, using an ecological analysis to demonstrate the inter-relationships between the various contributory factors at the micro individual level. The model is driven by case study data collected of a fall incident taking place in a long-term care facility in Greater Vancouver. Results: For experimentation, various real-life scenarios have been created to test the model. The results demonstrate that FCM models provide a potentially valuable tool for conceptualising the complexity of falls within long-term care, providing a means for better educating healthcare practitioners and designing targeted interventions. Conclusions: The ecological model provides the framework for analysing falls at various levels within the context of the long-term care facility and beyond (e.g., culture of falls prevention and falls prevention policy). The FCM technique provides a tool for visually conceptualising this complexity, highlighting the inter-relationships between individual factors and presenting the results in such a way that can be easily interpreted by academicians, practitioners and support staff.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Anderson, R.A., Issel, L.M.: Nursing homes as complex adaptive systems: relationship between management practice and resident outcomes. Nurs. Res. 52(1), 12 (2003)
Berk, L.E.: Child Development, 5th edn. Allyn & Bacon, Needham Heights (2000)
Bronfenbrenner, U.: Ecology of the family as a context for human development: research perspectives. Dev. Psychol. 22(6), 723–725 (1986)
Browne, J., Covington, B., Davila, Y.: Using information technology to assist in redesign of a fall prevention program. J. Nurs. Care Qual. 19(3), 218–225 (2004)
Cameron, K.: The role of medication modification in fall prevention. NCOA falls free: Promoting a national falls prevention action plan: Research review papers pp. 29–39 (2005)
Campbell, A.J., Borrie, M.J., Spears, G.F., Jackson, S.L., Brown, J.S., Fitzgerald, J.L.: Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. Age Ageing 19(2), 136–141 (1990)
Campbell, A., Robertson, M., Gardner, M., Norton, R., Buchner, D., et al.: Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial. J. Am. Geriatr. Soc. 47(7), 850 (1999)
Carvalho, J.P.: On the semantics and the use of fuzzy cognitive maps and dynamic cognitive maps in social sciences. Fuzzy Sets Syst. 214(0), 6–19 (2013) (Soft Computing in the Humanities and Social Sciences)
Chan, H., Zheng, H., Wang, H., Gawley, R., Yang, M., Sterritt, R.: Feasibility study on iphone accelerometer for gait detection. In: Pervasive Computing Technologies for Healthcare (PervasiveHealth), 2011 5th International Conference on, pp. 184–187. IEEE (2011)
Falls among older adults: An overview. Technical report, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention (2012)
Feldman, F., Robinovitch, S.N.: Reducing hip fracture risk during sideways falls: evidence in young adults of the protective effects of impact to the hands and stepping. J. Biomech. 40(12), 2612–2618 (2007)
Giabbanelli, P.J., Torsney-Weir, T., Mago, V.K.: A fuzzy cognitive map of the psychosocial determinants of obesity. Appl. Soft. Comput. 12(12), 3711–3724 (2012)
Gillespie, L., Gillespie, W., Robertson, M., Lamb, S., Cumming, R., Rowe B.: Interventions for preventing falls in elderly people. Cochrane Database Syst. Rev. 15(2), CD000340 (2009)
Heinrich, S., Rapp, K., Rissmann, U., Becker, C., König, H.H.: Cost of falls in old age: a systematic review. Osteoporos. Int. 21(6), 891–902 (2010)
Jensen, J., Lundin-Olsson, L., Nyberg, L., Gustafson, Y.: Falls among frail older people in residential care. Scandinavian J. Public Health 30(1), 54–61 (2002)
Kearns, W., Fozard, J., Becker, M., Jasiewicz, J., Craighead, J., Holtsclaw, L., Dion, C.: Path tortuosity in everyday movements of elderly persons increases fall prediction beyond knowledge of fall history, medication use, and standardized gait and balance assessments. J. Am. Med. Dir. Assoc. 13, 665.e7 (2012)
Kerse, N., Butler, M., Robinson, E., Todd, M.: Fall prevention in residential care: a cluster, randomized, controlled trial. J. Am. Geriatr. Soc. 52(4), 524–531 (2004)
Kosko, B.: Fuzzy cognitive maps. Int. J. Man Mach. Stud. 24(1), 65–75 (1986)
Lee, I., Kim, H., Cho, H.: Design of activation functions for inference of fuzzy cognitive maps: application to clinical decision making in diagnosis of pulmonary infection. Healthc. Inform. Res. 18(2), 105–114 (2012)
Mago, V., Woolrych, R., Sixsmith, A.: Understanding fall events in long term care using fuzzy cognitive map. Gerontechnology 11(2), 343 (2012)
Mago, V.K., Bakker, L., Papageorgiou, E.I., Alimadad, A., Borwein, P., Dabbaghian, V.: Fuzzy cognitive maps and cellular automata: an evolutionary approach for social systems modelling. Appl. Soft. Comput. 12(12), 3771–3784 (2012)
Mago, V.K., Mehta, R., Woolrych, R., Papageorgiou, E.I.: Supporting meningitis diagnosis amongst infants and children through the use of fuzzy cognitive mapping. BMC Med. Inform. Decis. Mak. 12(1), 98 (2012)
Marks, R., Allegrante, J.P., Ronald MacKenzie, C., Lane, J.M.: Hip fractures among the elderly: causes, consequences and control. Ageing Res. Rev. 2(1), 57–93 (2003)
Miskelly, F.: Assistive technology in elderly care. Age Ageing 30(6), 455–458 (2001)
Nevo, B.: Face validity revisited. J. Educ. Meas. 22(4), 287–293 (2005)
Norton, R., Campbell, A.J., Reid, I.R., Butler, M., Currie, R., Robinson, E., Gray, H.: Residential status and risk of hip fracture. Age Ageing 28(2), 135–139 (1999)
Nowak, A., Hubbard, R.E.: Falls and frailty: lessons from complex systems. JRSM 102(3), 98–102 (2009)
Pratt, S.F., Giabbanelli, P.J., Jackson, P., Mago, V.K.: Rebel with many causes: A computational model of insurgency. In: Intelligence and Security Informatics (ISI), 2012 IEEE International Conference on, pp. 90–95. IEEE (2012)
Prevention of falls and injuries among the elderly. Technical report, A Special Report from the Office of the Provincial Health Officer, British Columbia, Canada (2004)
Ramnemark, A., Nyberg, L., Borssen, B., Olsson, T., Gustafson, Y.: Fractures after stroke. Osteoporos. Int. 8(1), 92–95 (1998)
Robinovitch, S.N., Feldman, F., Yang, Y., Schonnop, R., Leung, P.M., Sarraf, T., Sims-Gould, J., Loughin, M.: Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study. The Lancet 381(9860), 47–54 (2013)
Rowe, S.M., Song, E.K., Kim, J.S., Lee, J.Y., Park, Y.B., Bae, B.H., Hur, C.I.: Rising incidence of hip fracture in gwangju city and chonnam province, korea. J. Korean Med. Sci. 20(4), 655–658 (2005)
Rubenstein, L.Z., Josephson, K.R., et al.: Falls and their prevention in elderly people: what does the evidence show? Med. Clin. North Am. 90(5), 807–824 (2006)
Seniors and aging—preventing falls in and around your home. Technical report, Health Canada (2006)
Series on seniors: Seniors and falls. Technical report, Canadain Institute of Health Information, Ottawa (2010)
Shaw, F., Bond, J., Richardson, D., Dawson, P., Steen, I., McKeith, I., Kenny, R.: Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial. Br. Med. J. 326(7380), 73 (2003)
Sran, M., Stotz, P., Normandin, S., Robinovitch, S.: Age differences in energy absorption in the upper extremity during a descent movement: implications for arresting a fall. J. Gerontol. A Biol. Sci. Med. Sci. 65(3), 312 (2010)
Tsadiras, A.: Comparing the inference capabilities of binary, trivalent and sigmoid fuzzy cognitive maps. Inform. Sci. 178(20), 3880–3894 (2008)
Vu, M., Weintraub, N., Rubenstein, L.: Falls in the nursing home: are they preventable? J. Am. Med. Dir. Assoc. 5(6), 401–406 (2004)
You can prevent falls! Technical report, Public Health Agency of Canada (2011)
Zecevic, A.A., Salmoni, A.W., Lewko, J.H., Vandervoort, A.A., Speechley, M.: Utilization of the seniors falls investigation methodology to identify system-wide causes of falls in community-dwelling seniors. The Gerontologist 49(5), 685–696 (2009)
Acknowledgments
We thank Gerontology Research Centre and MoCSSy program at SFU for providing financial support for the project. The authors are also grateful to the IRMACS Centre, Simon Fraser University, BC, Canada for the technical support.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Mago, V.K., Woolrych, R., Robinovitch, S.N., Sixsmith, A. (2014). Determining the ‘Fault Zone’ of Fall Events in Long Term Care. In: Mago, V., Dabbaghian, V. (eds) Computational Models of Complex Systems. Intelligent Systems Reference Library, vol 53. Springer, Cham. https://doi.org/10.1007/978-3-319-01285-8_5
Download citation
DOI: https://doi.org/10.1007/978-3-319-01285-8_5
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-01284-1
Online ISBN: 978-3-319-01285-8
eBook Packages: EngineeringEngineering (R0)