Characterizing Head Impacts and Injury Patterns in Long-Term Care Facility Falls

Falls are the leading cause of injury-related morbidity and mortality among older adults, particularly those residing in long-term care (LTC) facilities. Although head impacts are common during falls, the relationship between impact occurrence, injury characteristics, and hospital transport remains poorly defined.

We performed a secondary analysis of an open-source observational video dataset capturing falls in two LTC facilities in British Columbia, Canada. The cohort included 118 residents (61 male, 57 female; age 58–98 years) and 300 recorded falls. Three independent raters reviewed each video to determine the presence of head impact. Injury and transport data were extracted from the dataset, and falls were characterized using the Fall Video Analysis Questionnaire. Generalized estimating equations evaluated demographic and fall-related predictors of head injury. Logistic regression was used to identify predictors of hospital transport following head impact.

Of 300 falls, 118 (39%) involved head impact. Among these, 59 (50%) resulted in a reported head injury, most commonly cuts or scrapes (53%) and bruising (39%). Fourteen falls resulted in hospital transport; 10 (71%) involved head impact with associated injury. Cuts or scrapes (OR 13.0, p<0.001) and bruising (OR 6.1, p=0.032) were significantly associated with hospital transport, whereas demographic and functional measures were not.

Head impacts occur in nearly 40% of LTC falls and are frequently underrecognized when relying on reported injury alone. Among transported patients, visible head injuries (particularly abrasions and bruising) were the strongest predictors of hospital transfer, while demographic and functional characteristics were not. These findings suggest that subtle external signs of head injury may disproportionately influence prehospital and ED triage decisions following LTC falls. Improved recognition and standardized assessment of head impact in LTC and prehospital settings may help emergency clinicians better risk-stratify older adults after falls and avoid both missed injury and unnecessary transport.