A Review of Nonoccupational Ladder-Related Injuries in Victoria: As Easy As Falling Off a Ladder

Ladder Use Ability, Behavior and Exposure by Age and Gender

This study aimed to quantify and compare ladder use ability and behavior in younger and older men and women from three ladder use behavior experiments. The experimental tasks comprised (1) changing a lightbulb on a household stepladder under two cognitive demands (single and dual task), (2) clearing a simulated roof gutter on a straight ladder and (3) querying ladder choice in different exigency scenarios. Ladder use ability and behavior data were captured from recorded time, performance, motion capture and user choice data. In addition, this study surveyed ladder use frequency and habitual behaviors. The experimental findings indicate that older adults require more time to complete ladder tasks; younger adults display riskier ladder use behaviors; men and women display similar ladder use ability; and men are more willing to climb riskier ladders. The survey found older adults to report more frequent ladder use than younger adults, and men use straight ladders more frequently than women. These results suggest that the reported higher ladder fall rates experienced by older adults and men are linked to increased ladder use exposure and riskier ladder choice. This knowledge can help guide population-specific interventions to reduce ladder falls in both young and older people.

Ladder Use in Older People: Type, Frequency, Tasks and Predictors of Risk Behaviours

Ladder fall and injury risk increases with age. People who present to a hospital after an injurious ladder fall have been surveyed, but little is known about ladder use in the community. The purpose of this study was to: (1) document salient factors related to ladder safety, and (2) determine physical, executive function, psychological and frequency-of-use factors associated with unsafe ladder use in older people. One hundred and two older people (aged 65+ years) were recruited. Participants completed questionnaires on demographics, health, and ladder use (type, frequency, task, behaviours) and underwent assessments of physical and executive function ability. Results showed both older men and women commonly use step ladders (61% monthly, 96% yearly), mostly inside the home for tasks such as changing a lightbulb (70%) and decorating (43%). Older men also commonly use straight ladders (27% monthly, 75% yearly), mostly outside the home for tasks such as clearing gutters (74%) and pruning trees (40%). Unsafe ladder use was more common in males and individuals with greater ladder use frequency, greater quadriceps strength, better upper limb dexterity, better balance, better stepping ability, greater self-reported everyday risk-taking, a lower fear of falling, and fewer health problems compared to their counterparts (all p < 0.05). These findings document ladder use by older people and provide insight into unsafe ladder behaviours that may be amenable to interventions to reduce ladder falls and associated injuries.

Long term impact of ladder-related injuries as measured by the AQoL instrument

Introduction

Ladder-related falls are a common cause of patients presenting to emergency departments (ED) with serious injury. The impacts of ladder-related injuries were assessed at six-months post-injury using the quality of life, AQoL 4D Basic (AQoL) instrument.

Materials and methods

This was a prospective observational study, conducted and reported according to the STROBE statement. All adult patients with ladder-related injuries who presented to two EDs in southeast Queensland, Australia between October 2015 and October 2016 were approached. Initial participant interviews took place at the time of ED presentation or shortly thereafter, with follow-up telephone interview at six-months.

Results

There were 177 enrolments, 43 (24%) were lost to follow up. There were statistically significant changes post-injury for three of the four AQoL dimensions: independence, social relationships and psychological wellbeing, as well as the global AQoL. Twenty-four (18%) participants reported a clinically significant deterioration in independence, 26 (20%) participants reported a clinically significant deterioration in their social relationships, and 34 participants (40%) reporting a clinically significant deterioration in their psychological wellbeing. Nine of the twelve individual items (in AQoL dimension) deteriorated after injury, there was no change in two items (vision and hearing) and an improvement reported in one (communication). The largest changes (> 25% of participants) were reported with sleeping, anxiety worry and depression, and pain. Across the global AQoL dimension, 65 (49%) participants reported a clinically significant deterioration. The severity of injury as measured by the ISS was an independent predictor of the change in AQoL scores (p<0.001).

Conclusions

Injuries related to falls from ladders continue to have a profound impact on patients at six-months post-injury as measured using the AQoL instrument. This adds to previous research which has demonstrated considerable morbidity and mortality at the time of injury.

Prevention

Older males using ladders at home are at high risk for serious long-term injury. Injury prevention strategies and the safety instructions packaged with the ladder need to be targeted to this at-risk community group. There may also be a role for regulatory bodies to mandate a stabilising device to be included with the ladder at the time of purchase.

Characteristics of stepladder fall injuries: a retrospective study

BACKGROUND

Stepladders are used to work at heights in daily life, but their structure and usage differs from that of a ladder; stepladders can fold and stand without support, whereas ladders cannot fold and, thus, require support from other objects. We hypothesised that this difference made ladder and stepladder fall injuries to differ in characteristics. To clarify this hypothesis, we performed a retrospective cohort study on the stepladder fall injuries and compared their characteristics with that of ladder fall injuries.

MATERIALS AND METHODS

We conducted a retrospective cohort study of injuries sustained from either ladder or stepladder falls. In this study, data were retrieved from the computerised database of Teikyo University Chiba Medical Center. Patients admitted to the orthopaedic department because of injury from ladder or stepladder fall were included. The following data were retrieved from the patient records: sex, age, height, body weight, body mass index (BMI), injury severity score (ISS), season, number of injury sites, details of injury and treatment option.

RESULTS

One hundred thirty-two patients were included in this study. 101 patients were injured from stepladder falls, and 31 patients were injured from ladder falls. The number of females sustaining injuries due to a stepladder fall was significantly higher than those due to a ladder fall. The most frequent type of injury after fall from stepladder was fracture (48.9%), whereas the most frequent type of injury after fall from ladder was contusion/sprain (56.4%). The most frequently injured body part from stepladder fall was lower extremity (32.6%). In contrast, the most frequently injured body part due to a ladder fall was spine (27.3%).

CONCLUSION

The current study found that the number of females sustaining injuries due to a stepladder fall was significantly higher than those due to a ladder fall. Furthermore, the most frequent body parts that needed surgery following a ladder fall injury were spine and upper extremity, whereas the most frequent body parts that needed surgery following a stepladder fall injury was lower extremity. Our study indicated that stepladder falls cause severe injuries and physical disability and can be a huge financial burden.

Accidental adult deaths involving ladders: A forensic perspective

A retrospective study was undertaken of autopsy cases at the Forensic Science South Australia state mortuary over a 20-year period from January 1999 to December 2018 for all cases aged ≥18 years where a ladder was mentioned in the death scene description and/or police reports. Twelve cases were identified, all of whom were male, with an average age of 56 years (range 21–83 years). The most frequent cause of death was a fall from a ladder ( n = 8; 66%), followed by electrocution ( n = 4; 33%). The falls were associated with deaths from blunt injuries, impalement and laceration. The age range of those who fell was 47–83 years (average 66 years). The three of the four deaths associated with electrocutions involved contact with power lines or live electrical wires; the remaining case involved a sharp metal ladder base cutting through a live power lead. The age range of those who were electrocuted was 21–43 years (average 35 years) – significantly younger than those who had died from falls ( p < 0.05). The increase in mean age of the population with increasing popularity of home maintenance activities may result in more cases of lethal falls involving ladders presenting for forensic assessment.

Healthcare costs and productivity costs of hand and wrist injuries by external cause: A population-based study in working-age adults in the period 2008-2012

BACKGROUND

Hand and wrist injuries are very common at the Emergency Departments (ED), and among the most costly injury types in the working population. The purpose of this study was to explore the causes of non-trivial hand and wrist injuries (i.e., hand fractures, wrist fractures and complex soft-tissue injuries) in working-age adults in order to identify target areas for prevention.

METHODS

Data were extracted from the Dutch Injury Surveillance System, from the National Hospital Discharge Registry and from a patient follow-up survey in working-age adults (aged 20-64 years) in the period 2008-2012. An incidence-based cost model was used to estimate healthcare costs, and an absenteeism model for estimating the productivity costs. Total costs were calculated by external cause, subdivided in their main categories (home, sports, work, traffic and violence) and their most important subclasses.

RESULTS

Total costs of these injuries in The Netherlands were US $410 million per year, of which 75% (US $307 million) productivity costs. Males represented 66% (US $271 million) of the total costs. Within the male group, the group 35-49 years had the highest contribution to total costs (US $112 million), as well as the highest costs per case (US $10,675). Work-related injuries showed the highest costs per case (US $11,797), however, only 25% of the total costs were work-related. The top five causes in terms of total costs were: accidents at home (falls 23%, contact with an object 17%), traffic (cycling 9%) and work (industrial work 4%, and construction work 4%).

CONCLUSION

Hand and wrist injuries are a major cause of healthcare and productivity costs in working-age adults. To reduce the costs to society, prevention initiatives should be targeted at major contributing causes, that are mainly related to activities at home (falls, contact with an object) and accidents at the road (cycling).

Consumer products and fall-related injuries in seniors

OBJECTIVE

To conduct an environmental scan to identify the scope of literature on consumer products and injuries in seniors and to fill in some of the information gaps by exploring the relationship between assistive devices (AD) and fall-related injuries.

METHODS

The environmental scan included primary literature identified in Medline and EMBASE databases and grey literature was identified in Google and consumer product safety sites in the US, Canada, the UK, and Australia.Weighted logistic regression was then used to examine the relationship between socio-demographic factors, frailty indicators, and AD use at the time of the fall, and the type of health services utilized and psychological consequences of the fall based on data from the 2008-2009 Canadian Community Health Survey on Healthy Aging.

RESULTS

The majority of the articles on consumer products and injuries reported secondary database sources and did not directly link the consumer product's influence on a given injury. We found AD use at the time of a fall was associated with hospitalization, worry about re-injury, and limiting one's activities due to this worry, even after adjustment for socio-demographic variables. When frailty variables were included in the model, however, AD use was no longer statistically significant.

CONCLUSION

This study provides preliminary information on the relationship between AD use and fall-related outcomes. However, the current data are not sufficient to draw specific conclusions. More detailed questions regarding AD use for the entire population and additional questions regarding the contribution of the AD to the injury will help to provide a richer understanding of this relationship.