Does the type of flooring affect the risk of hip fracture?

Background: the number of hip fractures occurring worldwide in 1990 was estimated at 1.7 million and is predicted to rise to 6.3 million by 2050. The vast majority occur as a result of simple falls and the impact of the femoral trochanter with the floor. Previous studies have addressed the problem from the patient’s side of the impact. Little research has been carried out on the other surface involved in the impact, the floor. Study location: 34 residential care homes. Methods: (1) The mechanical properties of the floor were measured with force transducers. (2) The number and location of falls and fractures on the various floors were recorded prospectively for 2 years. The threshold for reporting falls in different care homes was assessed using a standardised set of scenarios. Results: a total of 6,641 falls and 222 fractures were recorded. Wooden carpeted floors were associated with the lowest number of fractures per 100 falls. The risk of fracture resulting from a fall was significantly lower compared to all other floor types (odds ratio 1.78, 95% CI 1.33–2.35). The mean impact force was significantly lower on wooden carpeted floors: 11.9 kN compared to the other floor types. Discussion: the possible implications of our findings are considerable. Residents of homes are typically frail and many have a propensity to falls. In designing safer environments for older people, the type of floor should be chosen to minimise the risk of fracture. This may result in a major reduction in fractures in the elderly.