Using Video to Investigate Causes of Falls in Long-Term Care
Using Video to Investigate Causes of Falls in Long-Term Care
TIPS has established a unique library of more than 900 video-captured falls experienced by older adults, acquired through a network of 264 cameras installed in the communal areas (i.e., hallways, living room, dining room) of two LTC facilities in Greater Vancouver (Robinovitch et al., 2013; Yang, Schonnop, Feldman, & Robinovitch, 2013). No falls have been captured in bedrooms or bathrooms, and no audio was collected with the video recordings. As mandated by the British Columbia Health Act, care personnel at the facilities were required to complete a fall incident report for each known occurrence of a fall. TIPS researchers reviewed incident reports on a weekly basis to identify falls in common areas and retrieve corresponding video footage.
The video footage of falls were utilized within distinct subprojects of TIPS all investigating the causes and contributory factors of falls in LTC using four unique approaches: (a) questionnaire-driven observational group analysis; (b) video-stimulated recall interviews and focus groups with LTC staff; (c) video observations of the resident 24hr before the fall; and (d) video incorporated within a comprehensive systemic falls investigative method (SFIM).
All project team members (4 project leads and 16 researchers) engaged in ongoing, collaborative discussion on the application of the four methods. The rationale for engaging in collaborative dialog was to share experiences across projects, engage in multidisciplinary working (cross-cutting the disciplines of kinesiology, gerontology, and health sciences) and to identify "what works" in a practice context. Engaging in collaborative dialog provided the means to share individual experiences (transfer of knowledge), reflect upon them in a group setting (cooperative inquiry) and place them in their broader context and meaning (Feldman, 1999), that is, to establish how the methods can be developed and applied within a practice context. This form of collaborative dialog has been used as a means to better understand the application of a method or approach such that it can be improved in the future (Fouche and Light, 2011). Forms of collaboration and reflective dialog practiced within the research team included the following: meetings with the entire TIPS team of academics and emerging researchers to discuss the development and issues arising from application of each approach; meetings of the individual subprojects to discuss ongoing findings (e.g., working papers, project documents) and the added value of video; and de-briefing sessions conducted between researchers working in the field. Reflective, collaborative discussion was then undertaken involving all subproject leads and research team members to identify the key advantages and disadvantages of each method. The collaborative discussion was practiced before, throughout and following the application of each of the methodological approaches. Although no structured collaborative dialog was applied to all subprojects, regular meetings and discussions were held at monthly time points, and the collaborative dialog was overseen by each subproject lead who was tasked with deciding on the type, intensity, and regularity of the dialog.
The study was approved by research ethics boards at Simon Fraser University and Fraser Health Authority. At the time of admission, each resident or proxy provided permission to the LTC facility to acquire video footage in common areas, for the purpose of resident safety. These data were shared as secondary data with the TIPS team. Additional ethical approval was sought from individual residents and/or proxies for use of videos and images for educational purposes. To minimize identifiers, faces were blurred from the video images using editing software. The research team evaluated the ability of each individual resident to provide consent based on their capacity to follow and understand the information letter and consent form. In all cases where the participant was deemed unable to provide consent (i.e., because they did not understand the nature of the study or what they were being asked to do), their next of kin was approached and asked to provide consent on their behalf. Written informed consent was also received from all LTC staff prior to engaging them as participants in the research. The consent covered participation in the interviews and focus groups and reproduction of the comments of LTC staff. An additional approval was obtained from the research ethics board at the Western University to retain de-identified data in the SFIM database.
Methods
TIPS has established a unique library of more than 900 video-captured falls experienced by older adults, acquired through a network of 264 cameras installed in the communal areas (i.e., hallways, living room, dining room) of two LTC facilities in Greater Vancouver (Robinovitch et al., 2013; Yang, Schonnop, Feldman, & Robinovitch, 2013). No falls have been captured in bedrooms or bathrooms, and no audio was collected with the video recordings. As mandated by the British Columbia Health Act, care personnel at the facilities were required to complete a fall incident report for each known occurrence of a fall. TIPS researchers reviewed incident reports on a weekly basis to identify falls in common areas and retrieve corresponding video footage.
The video footage of falls were utilized within distinct subprojects of TIPS all investigating the causes and contributory factors of falls in LTC using four unique approaches: (a) questionnaire-driven observational group analysis; (b) video-stimulated recall interviews and focus groups with LTC staff; (c) video observations of the resident 24hr before the fall; and (d) video incorporated within a comprehensive systemic falls investigative method (SFIM).
All project team members (4 project leads and 16 researchers) engaged in ongoing, collaborative discussion on the application of the four methods. The rationale for engaging in collaborative dialog was to share experiences across projects, engage in multidisciplinary working (cross-cutting the disciplines of kinesiology, gerontology, and health sciences) and to identify "what works" in a practice context. Engaging in collaborative dialog provided the means to share individual experiences (transfer of knowledge), reflect upon them in a group setting (cooperative inquiry) and place them in their broader context and meaning (Feldman, 1999), that is, to establish how the methods can be developed and applied within a practice context. This form of collaborative dialog has been used as a means to better understand the application of a method or approach such that it can be improved in the future (Fouche and Light, 2011). Forms of collaboration and reflective dialog practiced within the research team included the following: meetings with the entire TIPS team of academics and emerging researchers to discuss the development and issues arising from application of each approach; meetings of the individual subprojects to discuss ongoing findings (e.g., working papers, project documents) and the added value of video; and de-briefing sessions conducted between researchers working in the field. Reflective, collaborative discussion was then undertaken involving all subproject leads and research team members to identify the key advantages and disadvantages of each method. The collaborative discussion was practiced before, throughout and following the application of each of the methodological approaches. Although no structured collaborative dialog was applied to all subprojects, regular meetings and discussions were held at monthly time points, and the collaborative dialog was overseen by each subproject lead who was tasked with deciding on the type, intensity, and regularity of the dialog.
Ethics
The study was approved by research ethics boards at Simon Fraser University and Fraser Health Authority. At the time of admission, each resident or proxy provided permission to the LTC facility to acquire video footage in common areas, for the purpose of resident safety. These data were shared as secondary data with the TIPS team. Additional ethical approval was sought from individual residents and/or proxies for use of videos and images for educational purposes. To minimize identifiers, faces were blurred from the video images using editing software. The research team evaluated the ability of each individual resident to provide consent based on their capacity to follow and understand the information letter and consent form. In all cases where the participant was deemed unable to provide consent (i.e., because they did not understand the nature of the study or what they were being asked to do), their next of kin was approached and asked to provide consent on their behalf. Written informed consent was also received from all LTC staff prior to engaging them as participants in the research. The consent covered participation in the interviews and focus groups and reproduction of the comments of LTC staff. An additional approval was obtained from the research ethics board at the Western University to retain de-identified data in the SFIM database.
