Fatal falls in an ethnically diverse urban community: the link between demographic factors and the circumstances surrounding fatal falls

Examining undetermined and accidental deaths as source of 'under-reported-suicide' by age and sex in twenty Western countries

OBJECTIVES

'Undetermined' (UnD) and accidental deaths (AccD) are explored as possible sources of 'under-reported-suicides' (URS) in 20 Western countries.

METHODS

WHO mortality rates per million of AccD, UnD and suicides analysed. UnD:suicides ratios of <1:5 calculated as likely URS versus ratios >1:10 unlikely URS and all correlated by sex and age.

RESULTS

Male URS likely in 7 countries and in 11 for females. URS in AccD likely in 5 countries for both sexes only UnD and suicide rates the elderly (75+) significantly correlated.

CONCLUSION

Strong indication of URS in the UK, Portugal, Switzerland, Sweden, Denmark and Germany with likely URS in AccD in Greece, Portugal, Switzerland and USA. These findings have important implications, indicating that, with the exception of France and Japan, official reported suicide rates contain a degree of under-reporting, and especially for women yet it is essential to have accurate suicide data to ensure adequate service provision.

Fatal falls from height in Taiwan

This study conducts an investigation of fatal falls from height, examines gender differences, and compares our findings with those of Western countries. We review deaths in Taiwan caused by falls from height that underwent forensic autopsy from 1994 to 2010. Among the examined cases, 182 were suicide, 156 were accidents, and 18 were homicides. Men who fell from greater heights had a lower probability of fatal head trauma (p = 0.045), and women exhibited a lower fatal head trauma rate when falling from heights of between 10 and 25 m in accident group (p = 0.003). There was no significant difference between cases of falling from greater and lower heights within the suicide group (p = 0.834). Psychiatric illness was only reported in 20.3% and 28.8% cases in suicide and accident groups. Only in male cases was the use of psychotropic substances higher in the suicide groups than in the accident groups (p = 0.047).

Characteristics of outdoor falls among older people: a qualitative study

Background

Falls are a major threat to older people’s health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people’s experiences of outdoor falls to develop understanding of how they may be prevented.

Methods

We conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses.

Results

Forty-four adults aged 65 – 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week.

Conclusions

This exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people.