The SAFEST Review: The Shock-Absorbing Flooring Effectiveness SysTematic Review including older adults and staff in care settings

Injurious falls in hospitals and care homes are a life-limiting and costly international issue. Shock-absorbing flooring may offer part of the solution; however, evidence is required to inform decision-making. This project entailed a mixed-methods systematic review of experimental, observational, qualitative and economic studies evaluating flooring in care settings targeting older adults and/or staff. We included 22 studies, 20 of which assessed our review outcomes, and they focussed on novel floors (n = 12), sports floors (n = 5), carpet (n = 5) and wooden subfloors (n = 1).

The aim of this study was to summarise what is known about shock-absorbing flooring for reducing injurious falls in hospitals and care homes. From literature searches, we identified relevant studies on shock-absorbing flooring use in hospitals and care homes. We gathered data on the quality of the studies’ methods, what and who the studies involved, and the study findings. Members of the public were involved throughout the project. They helped improve the clarity of the reporting and collaborated in meetings to help guide the study team.

One high-quality study in a care home found that vinyl overlay with novel shock-absorbing underlay was no better at reducing injuries than vinyl overlay with plywood underlay on concrete subfloors. We found very low-quality evidence that shock-absorbing flooring may reduce injuries in hospitals and care homes, without increasing falls; if this were true, then economic evidence suggested that shock-absorbing flooring would be the best-value option for patients (lower cost and improved outcomes). There was insufficient evidence to determine the effects of shock-absorbing flooring on fractures or head injuries, although wooden subfloors resulted in fewer hip fractures than concrete subfloors. Shock-absorbing flooring made it harder for staff to move equipment such as beds and trolleys, and led to staff changing how they work.