I'm not aware of research regarding helmets and fall-related injury in the elderly. Most data about helmet effectiveness comes from sports. As an avid motorcyclist, I always wear a helmet and full-length suit manufactured by Aerostich in Duluth, MN with armor at hips, knees, spine, elbows, and shoulders . . . the data for motorcycle helmets are strongest for reducing risk of skull fracture and somewhat less robust for reducing intracranial bleed.
The forces generated in a fall on an adult head can be considerable. Helmets disperse that energy over the surface of the skull, but the momentum is still there for the smaller brain of the elderly patient to move inside the skull – which usually leads to bleeds by tearing the already-stretched superficial vessels. Thus the prospective benefit may be lessened . . .
James Loeffelholz, MD, CPE, FACP, FAAPL
System Director of Clinical Value
BOZEMAN HEALTH
915 Highland Boulevard
Bozeman, MT 59715
Tel: 406.414.5124
Cell: 406.581.2726
Fax: 406.414.1070
jloeffelholz@bozemanhealth.org
www.bozemanhealth.org
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Original Message:
Sent: 11/12/2020 4:50:00 PM
From: Robert Bell
Subject: RE: Important new study from BMJ
Good information. Do helmets in repeated falls stop cerebral hemorrhages in the elderly?
Any information from overseas?
Rob
Original Message:
Sent: 11/12/2020 4:21:00 PM
From: James Loeffelholz
Subject: RE: Important new study from BMJ
Hello,
While I've observed these discussions for some time, this is my first occasion weighing in.
I happened to have looked up hip pads recently in the Cochrane database. Indeed, they may minimally reduce risk of hip fracture from fall but compliance is poor even in the midst of concerted efforts to the contrary. I'm not aware of their regular use in this country but can't speak of elsewhere in the world.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001255.pub5/full
I don't have any information regarding helmets.
James Loeffelholz, MD, CPE, FACP, FAAPL
System Director of Clinical Value
BOZEMAN HEALTH
915 Highland Boulevard
Bozeman, MT 59715
Tel: 406.414.5124
Cell: 406.581.2726
Fax: 406.414.1070
jloeffelholz@bozemanhealth.org
www.bozemanhealth.org
Confidentiality Notice: This communication is confidential to Bozeman Health and is intended solely for the use of the individual or organization to whom it is addressed. It may contain privileged information. If you have received this message in error, please notify the originator immediately. If you are not the intended recipient, you should not use, copy, alter, or disclose the contents of this message. All information or opinions expressed in this message and/or any attachments are those of the author and are not necessarily those of Bozeman Health. Bozeman Health accepts no responsibility for loss or damage arising from its use.
Original Message:
Sent: 11/12/2020 4:09:00 PM
From: Teresa Graedon
Subject: RE: Important new study from BMJ
Hi Rob,
There are special hip pads that older people can use to try to protect their hip joints if they fall. I have not done a thorough review, but the research I have seen shows they aren't very effective.
Original Message:
Sent: 11/12/2020 2:54:00 PM
From: Robert Bell
Subject: RE: Important new study from BMJ
Are special clothing or helmets used to prevent some of the more serious effects in the elderly after falling?
Are they used widely anywhere around the world?
Are they effective?
Rob Bell
Original Message:
Sent: 11/12/2020 12:39:00 PM
From: Helene Epstein
Subject: Important new study from BMJ
Sharing a recent retrospective study from England. Link below and PDF attached
Incidence, nature and causes of avoidable significant harm in primary care in England: retrospective case note review
https://qualitysafety.bmj.com/content/qhc/early/2020/11/03/bmjqs-2020-011405.full.pdf
"14 407 primary care patients registered with 12 randomly selected general practices from three regions in England (total list size: 92 255 patients).
Main outcome measures The incidence of significant harm considered at least 'probably avoidable' and the nature of the safety incidents.
Results The rate of significant harm considered at least probably avoidable was 35.6 (95% CI 23.3 to 48.0) per 100 000 patient-years (57.9, 95% CI 42.2 to 73.7, per 100 000 based on a sensitivity analysis). Overall, 74 cases of avoidable harm were detected, involving 72 patients. Three types of incident accounted for more than 90% of the problems: problems with diagnosis accounted for 45/74 (60.8%) primary incidents, followed by medication-related problems (n=19, 25.7%) and delayed referrals (n=8, 10.8%). In 59 (79.7%) cases, the significant harm could have been identified sooner (n=48) or prevented (n=11) if the GP had taken actions aligned with evidence-based guidelines."
Best,
Helene