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I am a third year podiatry student and I am thinking of investigating about why people wear slipper for my research project as this is the cause of many falls in the elderly. i was wondering if any one out there has any advice as i may be barking up the wrong tree and if so does anyone have any other ideas for a third year research project i would be greatful.
Thankyou Nadia W.
Without wishing to dampen your enthusiasm, I was involved in a small pilot project in N. Yorks approx 3 years ago examining why elderly people fell. Conclusions drawn from this pilot did not "blame" slippers, but highlighted the fact that the significant majority of those persons who were at risk of falling were housebound. The respondents cited numerous reasons, not all of them footwear related for falling, eg poorly lit rooms, rugs, door threshes, overfurnished rooms, polypharmacy and medical conditions such as macular degeneration.
Thus, are housebound people more likely to fall, probably. But has anyone proved that?
You would need to speak to Dr Hylton Menz who has a research background in falls and falls prevention. Hylton subscribes to the Arean and will pick up your enquiry I dare say.
From the little I know causation of falls in the elderly are quite complex to analyse and there are different patterns from frail ambulent to communitry dwelling elderly. Men slip and women trip is a gross generalisation for the latter but Hylton should be able to give you chapter and verse. Most people fall backwards, falls tend to happen in the afternoon (when it is bright) and often the person is doing several things when the event occurs. Postural hypertension is not a major contribution in most falls (at least according to the literature I have read) and falling upstairs is less frequent than falling on flat surfaces. Men are more likely to change habits after a fall whereas women tend to carry on as before. Most of my reading has been on falls within the community dwelling elderly but speaking to Falls Prevention people the complexity of floor surfaces in frail ambulant accommodation where there may be more concentration given to cleaning surfaces than coefficient of friction, then slippers may contribuite to falls, but conditions apply.
There's actually not much solid evidence relating to footwear and falls. Here's an extract from a recent review conducted as part of a forthcoming textbook:
A number of studies have assessed footwear in older people who have fallen, and have implicated a wide range of shoe features which may have been responsible, such as narrow heels, slippery soles, inadequate fixation, poorly fitting shoes and soft heel counters [4-8]. However, the wearing of inadequate footwear is a common finding in this age group [9, 10], as many older people base their footwear selection primarily on comfort rather than safety [9, 11]. Stronger evidence comes from case-control or cohort studies, in which the footwear of fallers is compared to non-fallers. Four such studies have recently been undertaken, with varying results. Kerse et al  assessed footwear in 606 older people in residential care, and found that wearing slippers rather than shoes increased the risk of fractures during the 12 month follow-up period, but there was no association between footwear and falls once potential confounders were accounted for. Keegan et al  examined risk factors for various fall-related fractures in people aged over 45 years, and found that medium-high heeled shoes and shoes with a narrow heel significantly increased the likelihood of all types of fracture, while slip-on shoes and sandals increased the risk of foot fractures as a result of a fall. A study of 4281 people aged over 66 years by Larsen et al  found that those who had fallen in the last 24 hours were four times more likely to have been wearing socks or slippers without a sole. Finally, a nested case-control study of 654 people aged over 65 years by Koepsell et al  found that going barefoot or wearing stockings was associated with a ten-fold increased risk of falling, with athletic shoes being associated with the lowest risk. Further evaluation of footwear characteristics from this study found that increased heel height was associated with increased risk of falling, whereas greater sole contact area was associated with decreased risk . Although each of these studies suggests that there is some relationship between footwear, falls and fractures, the lack of a standard protocol when assessing footwear makes comparisons difficult.
4. Barbieri E: Patient falls are not patient accidents. Journal of Gerontological Nursing 1983; 9: 165-173.
5. Frey CC, Kubasak M: Faulty footwear contributes to why seniors fall. Biomechanics 1998; 5: 45-47.
6. Hourihan F, Cumming RG, Tavener-Smith KM, Davidson I: Footwear and hip fracture-related falls in the elderly. Australasian Journal on Ageing 2000; 19: 91-93.
7. Connell BR, Wolf SL: Environmental and behavioural circumstances associated with falls at home among healthy individuals. Archives of Physical Medicine and Rehabilitation 1997; 78: 179-186.
8. Sherrington C, Menz HB: An evaluation of footwear worn at the time of fall-related hip fracture. Age and Ageing 2003; 32: 310-314.
9. Finlay OE: Footwear management in the elderly care program. Physiotherapy 1986; 72: 172-178.
10. White E, Mulley G: Footwear worn by the over 80's: a community survey. Clinical Rehabilitation 1989; 3: 23-25.
11. Dunne RG, Bergman AB, Rogers LW, Inglin B, Rivara FP: Elderly persons' attitudes towards footwear - a factor in preventing falls. Public Health Reports 1993; 108: 245-248.
12. Kerse N, Butler M, Robinson E, Todd M: Wearing slippers, falls and injury in residential care. Australian and New Zealand Journal of Public Health 2004; 28: 180-187.
13. Keegan THM, Kelsey JL, King AC, Quesenberry CP, Sidney S: Characteristics of fallers who fracture at the foot, distal forearm, proximal humerus, pelvis, and shaft of the tibia/fibula compared with fallers who do not fracture. American Journal of Epidemiology 2004; 159: 192-203.
14. Larsen ER, Mosekilde L, Foldspang A: Correlates of falling during 24 h among elderly Danish community residents. Preventive Medicine 2004; 39: 389-398.
15. Koepsell TD, Wolf ME, Buchner DM, et al.: Footwear style and risk of falls in older adults. J Am Geriatr Soc 2004; 52: 1495-1501.
16. Tencer AF, Koepsell TD, Wolf ME, et al.: Biomechanical properties of shoes and risk of falls in older adults. Journal of the American Geriatrics Society 2004; 52: 1840-1846.
We have just completed a nested case-control study of 176 older people (presented at the Australasian Podiatry Conference last week), and found no difference in indoor or outdoor footwear characteristics between those who fell and those who did not over a 12 month follow-up period. However, older people who fell indoors were more likely to be barefoot compared to those who did not fall indoors. If you'd like any further information about this study, let me know.
Last edited by Hylton Menz : 7th September 2005 at 02:58 PM.
There are many reasons why older people fall.Among one of them is diabetic neuropathy.Another reason is poor nutrition.In addition,slip on shoes and sandals without backs contribute mightily to falling.This problem affects people in all social strata.