Exploring the potential of using real life video capture to investigate the circumstances of falls among older adults in long-term care

Purpose: Falls are the leading cause of injury for residents living in longterm care (LTC) facilities, representing a significant cost burden and compromising the independence and autonomy of the older person^1,2. Research into the causes of falls in LTC is limited by inaccurate reporting procedures³. To overcome these limitations, innovative methodological approaches are needed to establish a better understanding of how and why falls occur. While video has proven beneficial for monitoring the health and well-being of older adults6, this potential has been less well explored in studying falls. This paper discusses the opportunities and challenges of using video monitoring of fall events in LTC facilities. Method: The paper reports on ongoing work from a Canadian Institute for Health Research-funded research project on the use of video to identify the causes and prevention of falls in two LTC facilities in Metro Vancouver, Canada^4,5. We discuss the opportunities and challenges of using video in observations of falls, illustrated through four methodological approaches: questionnaire- driven observational group analysis; video-stimulated recall interviews and focus groups; video observations of the resident 24 hours before the fall; and video incorporated within a comprehensive Systemic Falls Investigative Method (SFIM)³. Results & Discussion: Analysis of the video data provided the opportunity for in-depth and nuanced understanding of how and why older adults fall in LTC. Video allowed a detailed analysis of fall incidents and enabled a broad range of contributory factors to be identified: intrinsic factors (gait and balance); extrinsic factors (trip hazards and physical layout of the LTC); and broader situational and organizational influences (workplace practices). As a tool for practice change, video may provide a means to identify targeted, context-specific interventions and the potential for knowledge transfer and education among caregivers. However, the use of surveillance video also raises practical and ethical challenges which need to be better understood and articulated in the application and development of video monitoring of older adults.