Unintentional injuries among older adults in northern Sweden--a one-year population-based study

Association of ethnicity with unintentional injury-related hospitalisation and mortality among older people residing in two regions of Aotearoa New Zealand

OBJECTIVES

To characterise unintentional injury-related hospitalisation and mortality amongst older adults (aged 50+ years) in the Lakes and Bay of Plenty District Health Boards of Aotearoa New Zealand and to examine whether hospitalisation patterns differed by ethnicity.

METHODS

This observational study analysed unintentional injury-related hospitalisations and deaths among older adults between 2014 and 2018. Routinely collected national data sets were used to calculate annualised, age-standardised injury rates. The independent variable of interest was ethnicity (Māori or non-Māori).

RESULTS

There were 11,834 unintentional injury-related hospitalisations in the study period (n = 1444 for Māori). Overall, there was no significant difference in the age-standardised hospitalisation rate between Māori and non-Māori (Standardised Rate Ratio [SRR] = 0.96 [95% CI 0.90, 1.02]). Falls were the most common mechanism of injury among Māori and non-Māori overall (50% and 71%) and relative risks of falls increased with age. Non-Māori were 57% less likely to be hospitalised for unintentional poisoning than Māori (SRR = 0.43, [0.34, 0.59]).

CONCLUSIONS

The mechanisms of injury, and variation in unintentional injury-related hospitalisation rates between Māori and non-Māori, change throughout older age, and incidence increase0073 with age. Falls cause significant injury-related hospitalisations for older Māori and responsive injury prevention and rehabilitation efforts are warranted to achieve equitable health outcomes.

Prevalence and Risk Factors for Fall among Rural Elderly: A County-Based Cross-Sectional Survey

AIM

The aim of the study was to provide evidence for the prevention and reduction of falls in the elderly living in rural areas by analyzing epidemiological data of falls among the rural older people (>65 years old) and identifying the risk and protective factors.

METHODS

This study analyzed the sociodemographic characteristics, living environment, lifestyle, chronic disease condition, mental health, activities of daily living (ADL), and detailed information of falls of 3752 rural elderly. Rank tests, chi-square tests, and binary logistic regression were used for data analysis.

RESULTS

The prevalence of falls was 30.0%, and the 75-84-years age group had the highest fall rate (18.8%). According to the binary logistic regression analysis, six variables, including roughage intake frequency, age, gender, cane use, floor tiles, and IADL, were involved in the fall patterns. Low roughage intake (OR = 2.48, 95% CI 1.24-4.97), female gender (OR = 2.12, 95% CI 1.48-3.05), the use of a cane (OR = 2.11, 95% CI 1.08-4.10), and medium IADL (OR = 2.02, 95% CI 1.89-2.32) were the top four risk factors.

CONCLUSION

The fall in the rural elderly was mainly due to the poor living and working conditions. Routine fall assessment could address several preventable risk factors to reduce the prevalence and mitigate the harm of falls.

Impact of urbanization factors on mortality due to unintentional injuries using panel data regression model and spatial-temporal analysis

Unintentional injuries pose a great risk for human health in China. Few studies have focused on unintentional injuries at national level from urbanization perspective. The panel data of mortality rate of transportation accidents (TA), fall and drowning and sinking (DS) is investigated, and urbanization development index is collected. Global Moran's I and linear regression of panel data are applied to determine the spatial distribution and spatial influencing factors of unintentional injuries. The results are the following: (1) The unintentional injury such as TA, fall, and DS shows clear non-uniformity of spatial distribution and relative immobility through time. (2) A 10,000 tons increase in SO₂ emission amount (SO₂ EA) and emission of smoke and dust (ESD) can result in 15.7 and 12.5 increases in TA death in eastern region, respectively. Meanwhile, A 10,000 tons increase in NO_x emission amount can cause 15.1 increase in TA death in western region. For every 100 billion yuan increase in GDP, the fall death can reduce by 8.4 in central region. One bed increase in number of hospital beds per 10,000 population (NHBP) is favorable for decreasing in fall death by 16.7 in eastern region. However, increase in number of workers enjoying industrial injury (NEWII) does not reduce the fall death in eastern region. (3) For every 1 ten thousand people increase in number of students in ordinary high schools (NSOHS) is conductive to reducing DS death by 7.8 in the western region. Our findings show that there exist spatial differences for urbanization influencing TA, fall, and DS death in eastern, western, and central regions. This study is expected to provide a reference for unintentional injuries control in those three regions.

Non-fatal Home Injuries among the Elderly in Tamil Nadu, India

Background:

Injuries are considered as an emerging public health problem in India. Globally every year, injuries kill more than 5 million people, and by 2020, injuries will be the third-leading cause of death and disability worldwide. The study aimed to assess the prevalence and characteristics of nonfatal home injuries among the elderly in Tamil Nadu.

Methodology:

A cross-sectional analytical study was conducted among 1139 elderly (60 years and above), sampled from three districts of Tamil Nadu, India. Probability proportional to size sampling technique was used for sampling; a pretested questionnaire was used to collect the data.

Results:

Prevalence of nonfatal home injuries among elderly within the past 1 year was 14.6% (12.5–16.7 at 95% confidence interval), (n = 1003), among those injured, 94.5% were unintentionally injured and 5.5% were of intentional nature. When classified according to the types of injuries, majority of them had fall injuries (6.7%) followed by minor domestic injuries (5.4%), animal-related injury (0.2%), burn injuries (1.1%), road traffic injury (0.4%), and suicide attempt (0.8%). Majority of the respondents were in the age group of young-old, 60–69 years of age (84%), and there was more number of males (55%) in the study.

Conclusion:

The study reveals that nonfatal home injuries among elderly are an emerging public health problem, unintentional injuries contribute to the majority of the injuries, fall was the single largest contributor for all injuries among elderly.

Epidemiology of Road Traffic Injuries among Elderly People; A Systematic Review and Meta-Analysis

Objective:

To systematically review the epidemiological patterns and interventions for prevention of road traffic injuries (RTIs) among elderly.

Methods:

Searching keywords including: accident, trauma, road injury, road traffic injuries, aging, old, elder, strategy, intervention, road traffic crash prevention and traffic accident in databases including, Google scholar, SID, IranMedex, PubMed and Scopus. English and non-Persian articles, articles presented in congresses, articles that considered elderly people to have age under than 60 years were excluded. The reporting quality of articles was assessed by two experts using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) check list.

Results:

RTIs compromised 23.6% of total injuries among elderly. The most frequent injuries were about car accidents (51.4%). Pedestrian injuries composed 48.1% of the RTIs. Head and neck (32.1%) were most injured body parts. There was a significant difference between elderly and non-elderly people in terms of RTIs associated mortality (Odd=2.57 [1.2-5.4 CI 95%]). Overall 25 main domains of intervention and 73 subordinate domains were extracted in five categories (human, road and environment, tools and cars, medical, legal and political issues).

Conclusion:

According to the notable prevalence and fatality of RTIs, lack of sufficient studies and valid evidence of the present study can provide an appropriate evidence for better interventions for RTIs prevention among elderly.

Accidental injuries among older adults: An incidence study

BACKGROUND

To date, the majority of studies assessing accidental injuries among the elderly have focused on fall injuries, while studies of other mechanisms of injuries have been lacking. Therefore, the main objective of this study was to investigate all injury-related visits among older adults to an emergency department and risk factors for injuries.

METHODS

Data were collected on all registered visits of adults, ≥67 years old, living in the capital of Iceland, to the emergency department of Landspitali, the National University Hospital, in 2011 and 2012.

RESULTS

The yearly incidence rate for injuries was 106 per 1000 adults, ≥67 years old. Of all injuries (n = 4,469), falls were the most common mechanism of injury (78 per 1000), followed by being struck or hit (12 per 1000) and being crushed, cut or pierced (8 per 1000). Other mechanisms of injury, such as acute overexertion, foreign body in natural orifice, injuries caused by thermal and chemical effect and other and unspecified mechanism were less common (8 per 1000). Fractures were the most common consequences of injuries (36 per 1000). The most frequent place of injury was in or around homes (77 per 1000), with men being more likely than women to be injured outside of the home (60 per 1000 vs. 36 per 1000).

CONCLUSION

Results indicate that falls are the main cause of accidental injuries, followed by being struck and hit injuries but other causes contributed to the rest. Falls constitute a major public health problem and fall-related injuries can have a substantial impact on the lives of older adults. As life expectancy continues to increase, fall risk is expected to increase. Since falls constitute a major impact on the lives of older adults and can lead to not only declines in physical activity and functional status, but to considerable health care costs, the health care system needs to intervene.

Risk factors for unintentional injuries among the rural elderly: a county-based cross-sectional survey

This study aimed to provide evidence for the prevention and reduction of unintentional injuries in the rural elderly by analysing epidemiological data of injuries among rural older adults (65⁺) and identifying the involved risk and protective factors. This study analysed all information, including the social demographic characteristics, chronic disease condition, lifestyle, living environment, mental health, activities of daily living and detailed information about the nature of the injuries. Chi-square tests, rank tests and a multivariate logistic regression were performed. The prevalence of unintentional injuries was 44.4%; according to the multivariate regression analysis, ten variables, including gender, floor tiles, cane use, sleeping duration, roughage intake frequency, mental health status, diabetes, arthritis and cataracts, were involved in the injury patterns. Low roughage intake (OR = 2.34, 95% CI 1.64-3.35), the use of a cane (OR = 1.78, 95% CI 1.31-2.41), a sleeping duration of five hours (OR = 1.75, 95% CI 1.27-2.42) and severe mental disorders (OR = 1.61, 95% CI 1.01-2.57) were the top 4 risk factors. In conclusion, we found that unintentional injuries among the rural elderly were closely related to chronic disease, mental health and residence environment. These findings could be beneficial for the prevention of unintentional injuries and for policy makers and health service managers.

Deaths caused by injury among people of working age (18-64) are decreasing, while those among older people (64+) are increasing

Background

Injury is an important cause of death in all age groups worldwide, and contributes to many losses of human and economic resources. Currently, we know a few data about mortality from injury, particularly among the working population. The aim of the present study was to examine death from injury over a period of 14 years (1999–2012) using the Swedish Cause of Death Registry (CDR) and the National Patient Registry, which have complete national coverage.

Method

CDR was used to identify injury-related deaths among adults (18 years or over) during the years 1999–2012. ICD-10 diagnoses from V01 to X39 were included. The significance of changes over time was analyzed by linear regression.

Results

The incidence of prehospital death decreased significantly (coefficient −0.22, r² = 0.30; p = 0.041) during the study period, while that of deaths in hospital increased significantly (coefficient 0.20, r² = 0.75; p < 0.001). Mortality/100,000 person-years in the working age group (18–64 years) decreased significantly (coefficient −0.40, r² = 0.37; p = 0.020), mainly as a result of decrease in traffic-related deaths (coefficient −0.34, r² = 0.85; p < 0.001). The incidence of deaths from injury among elderly (65 years and older) patients increased because of the increase in falls (coefficient 1.71, r² = 0.84; p < 0.001) and poisoning (coefficient 0.13, r² = 0.69; p < 0.001).

Conclusion

The epidemiology of injury in Sweden has changed during recent years in that mortality from injury has declined in the working age group and increased among those people 64 years old and over.

TRAUMA BY TRAFFIC ACCIDENT IN ELDERLY PEOPLE: RISK FACTORS AND CONSEQUENCES

ABSTRACT Objective: to analyze cases of trauma caused by traffic accidents in elderly individuals assisted at a reference municipal emergency hospital in 2010 and 2011. Method: longitudinal retrospective study was developed at an emergency hospital and a Traffic Accidents Repression Station, with 524 elderly individuals. All variables were submitted for descriptive analysis. Risk of involvement in accidents, occurrence of injury and death were determined using relative risk. Results: a statistically significant association was found in accidents with injuries when motorcycles were the vehicle that ran over the individual. Associations were also found between men and the occurrence of accidents, injury and death, mainly among younger elderly individuals. Most of the 524 elderly individuals who suffered an accident were men, married and had elementary school level education. Of these, 78.6% presented with injuries, with the majority of them being pedestrians. Conclusion: among younger elderly individuals, the possibility of death as a result of the injury was 3.4 times higher in 2010.

Role of Hip Abductor Muscle Composition and Torque in Protective Stepping for Lateral Balance Recovery in Older Adults

OBJECTIVES

To examine differences in hip abductor strength and composition between older adults who primarily use medial step versus cross-step recovery strategies to lateral balance perturbations.

DESIGN

Cross-sectional.

SETTING

University research laboratory.

PARTICIPANTS

Community-dwelling older adults (N=40) divided into medial steppers (n=14) and cross-steppers (n=26) based on the first step of balance recovery after a lateral balance perturbation.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Computed tomography scans to quantify lean tissue and intramuscular adipose tissue (IMAT) areas in the hip abductor, hip abductor isokinetic torque, and first step length.

RESULTS

Medial steppers took medial steps in 71.1% of trials versus 4.6% of trials with cross-steps. The cross-steppers when compared with medial steppers, had lower hip abductor IMAT (24.7±0.7% vs 29.9±2.8%; P<.05), greater abductor torque (63.3±3.6Nm vs 48.4±4.1Nm; P<.01), and greater normalized first step length (.75±.03 vs .43±.08; P<.001). There was no difference in hip abductor lean tissue between the groups (P>.05).

CONCLUSIONS

Our findings suggest that older adults who initially use a medial step to recover lateral balance have lower hip abductor torque and may be less able to execute a biomechanically more stable cross-step. This may be related to increased IMAT levels. Assessments and interventions for enhancing balance and decreasing fall risk should take the role of the hip abductor into account.

[Trauma in the elderly caused by traffic accident: integrative review]

OBJECTIVE

To describe the scientific knowledge produced about trauma in the elderly caused by traffic accidents in healthcare area studies. METHODS :Integrative review of studies from 2003 to 2013 searched in LILACS, SciELO, PubMed and CINHAL databases. We used combination of the descriptors injuries, wounds and accidents, in English, Portuguese and Spanish languages.

RESULTS

32 studies were selected. In the thematic analysis, three categories emerged: epidemiological data from traffic accidents involving elderly; traffic accidents with elderly pedestrians; and trauma care in the elderly. We observed increased incidence of trauma in most countries and pedestrians represented a large part of the victims. Among these, the elderly are the most vulnerable group.

CONCLUSION

Studies showed that trauma care in the elderly need protocols and professionals with training in gerontology specialized in trauma care services.

Trauma recidivism at an emergency department of a Swedish medical center

Background

To inform targeted prevention, we studied patterns of trauma recidivism and whether a first injury predicts the risk for a recurrent injury.

Methods

In a population-based study of 98,502 adult injury events 1999–2012, at the emergency department of Umeå University Hospital, Sweden, we compared non-recidivists with recidivists in terms of patients’ sex, age, type of injury and severity of the injury.

Results

Thirty-six percent of all patients suffered recurrent injuries, which were associated with a higher proportion of inpatient care and more hospital days. Young men and elderly women were at the highest risk for trauma recidivism. At 20 to 24 years, men had a 2.4 (CI 95 % 2.3–2.5) higher risk than women, a 90 years old woman had almost a 10-fold higher risk for another moderate/severe injury than a 20 years old one. A fracture were associated with a hazard ratio of 1.28 (CI 95 % 1.15–1.42) among men younger than 65 years and 1.31 (CI 95 % 1.12–1.54) for men older than 65 years for a subsequent moderate/severe injury. For women younger than 65 years a fracture was associated with a hazard ratio of 1.44 (CI 95 % 1.28–1.62) for a subsequent moderate/severe injury. A sprain carries a higher risk for a new moderate/severe injury for both men and women and in both age groups; the hazard ratio was 1.13 (CI 95 % 1.00–1.26) for men younger than 65 years, 1.42 (CI 95 % 1.01–1.99) for men older than 65 years, 1.19 (CI 95 % 1.05–1.35) for women younger than 65 years and 1.26 (CI 95 % 1.02–1.56) for women older than 65 years. A higher degree of injury severity was associated with a higher risk for a new moderate/severe injury.

Conclusion

Trauma recidivism is common and represents a large proportion of all injured. Age and sex are associated with the risk for new injury. Injury types and severity, also have implications for future injury.

Injury and medical expenditure in emergency department visits of older veterans

AIM

The purpose of the present study was to investigate the injury types and medical utilization profiles of veterans in emergency department visits by using big data from the National Health Insurance program in Taiwan.

METHOD

We used the outpatient prescriptions and treatment records between 1997 and 2010 of veterans aged ≥65 years in the National Health Insurance Research Database. The International Classification of Diseases, Ninth Revision, Clinical Modification codes 800-999 (i.e. injuries) were selected, and the emergency medical treatment and the medical institutions' basic profile were recorded.

RESULTS

A total of 287 113 veterans were selected for this study. The average age was 77.4 years, and most participants were men (71.2%). The total medical expenses were US$46.0 million (an average of US$160.00 per person). Contusions/abrasions, open wounds, and fractures comprised 29.2%, 26.6% and 16.3% of the injuries, respectively. In addition, contusions/abrasions, open wounds, and fractures comprised 23.8%, 21.5% and 19.8%, respectively, of the total medical expenses. The highest charges for a single injury episode were for spinal cord and nerve injuries (an average of US$349.00 per person). Regarding sex differences, women mainly experienced fractures and contusions/abrasions, whereas men experienced open wounds.

CONCLUSIONS

The injury rate of veterans was reported higher than the non-veterans. Preventive methods are proposed to decrease the occurrences of injury, number of emergency visits and medical expenses. Geriatr Gerontol Int 2016; 16: 1254-1262.

Health-related quality of life in relation to mobility and fall risk in 85-year-old people: a population study in Sweden

Optimal mobility is fundamental for healthy ageing and quality of life. This study is part of a cross-sectional population-based study of 85-year-old people residing in Linköping municipality, Sweden. The purpose was to describe 85-year-old peoples' health-related quality of life (HRQoL) in relation to mobility and fall risk while adjusting for gender and body mass index. Data collection included a postal questionnaire, a home visit and a reception visit. HRQoL was assessed with EQ-5D-3L, mobility with the Timed Up and Go test (TUG) and fall risk with the Downton Fall Risk Index (DFRI). All those who completed the DFRI, TUG and EQ-5D-3L were included in the present study (N = 327). Lower HRQoL was associated with longer time taken to complete TUG and higher fall risk in both genders but not with body mass index. Women had higher risk of falling, took a longer time to complete TUG and reported less physical activity compared with men. Health-care professionals should address mobility capacity and fall risk in order to maintain quality of life in elderly people. This is of utmost importance, especially for elderly women because impaired mobility, high risk of falling and occurrence of pain are common among women, and related to lower HRQoL.

Epidemiologic patterns of injuries treated at the emergency department of a Swedish medical center

Background

The injury spectrum published in the literature has mainly been presented for a certain age group, as elderly or for a certain type of injury, as fracture and often restricted to in-hospital care cases. Our objective was to give an overview of the major types of injuries for all age groups and trends in the adult population.

Methods

We analyzed 68,159 adult injury events, which occurred between 1999 and 2008 and was treated at the Emergency Department of Umea University Hospital. All these injuries are registered in a database. The injuries were analyzed depending on frequency, type of injury, and activity at the time of injury. Incidence rates were calculated using population data from Statistics Sweden.

Results

Injury event incidence varied between 614 (2004) and 669 (2007) per 10,000 persons. The most common injury was a fracture, although contusions and wounds were also frequent. Fractures were responsible for almost three quarters of hospital days related to injury. The risk for fractures increased with age, as did contusions and concussions, whereas sprains decreased with age. Fracture incidence increased among the 50- to 59-year age group for both women and men. Fall-related injuries increased significantly for middle-aged adults. Sports-related and work injuries decreased, while injuries occurring during leisure time increased the most.

Conclusion

A fracture is the most frequent type of injury for adults and accounts for the largest proportion of the trauma care burden. Contusions are also common and responsible for a significant proportion of the in-hospital days. Injuries caused by a fall increased among middle-age adults imply a need for an extension of fall prevention programs.

Community-dwelling older people with an injurious fall are likely to sustain new injurious falls within 5 years--a prospective long-term follow-up study

BACKGROUND

Fall-related injuries in older people are a leading cause of morbidity and mortality. Self-reported fall events in the last year is often used to estimate fall risk in older people. However, it remains to be investigated if the fall frequency and the consequences of the falls have an impact on the risk for subsequent injurious falls in the long term. The objective of this study was to investigate if a history of one single non-injurious fall, at least two non-injurious falls, or at least one injurious fall within 12 months increases the risk of sustaining future injurious falls.

METHODS

Community-dwelling individuals 75-93 years of age (n = 230) were initially followed prospectively with monthly calendars reporting falls over a period of 12 months. The participants were classified into four groups based on the number and type of falls (0, 1, ≥2 non-injurious falls, and ≥1 injurious fall severe enough to cause a visit to a hospital emergency department). The participants were then followed for several years (mean time 5.0 years ±1.1) regarding injurious falls requiring a visit to the emergency department. The Andersen-Gill method of Cox regression for multiple events was used to estimate the risk of injurious falls.

RESULTS

During the long-term follow-up period, thirty per cent of the participants suffered from at least one injurious fall. Those with a self-reported history of at least one injurious fall during the initial 12 months follow-up period showed a significantly higher risk for sustaining subsequent injurious falls in the long term (hazard ratio 2.78; 95% CI, 1.40-5.50) compared to those with no falls. No other group showed an increased risk.

CONCLUSIONS

In community-dwelling people over 75 years of age, a history of at least one self-reported injurious fall severe enough to cause a visit to the emergency department within a period of 12 months implies an increased risk of sustaining future injurious falls. Our results support the recommendations to offer a multifactorial fall-risk assessment coupled with adequate interventions to community-dwelling people over 75 years who present to the ED due to an injurious fall.

Violências e acidentes entre adultos mais velhos em comparação aos mais jovens: evidências do Sistema de Vigilância de Violências e Acidentes (VIVA), Brasil

Dados do Sistema de Vigilância de Violências e Acidentes (VIVA) de 2009 foram utilizados para examinar características sociodemográficas, desfechos e tipos de acidentes e violências que levaram a atendimento em 74 serviços sentinela situados em 23 capitais brasileiras e no Distrito Federal. A análise incluiu 25.201 indivíduos com idade > 20 anos (10,1% com > 60 anos), dos quais 89,3% foram vítimas de acidentes e 11,9% de violências. A hospitalização foi o desfecho de 11,1% dos casos. Em comparação à população geral, observou-se ainda um excesso de homens e da cor da pele não branca entre vítimas de acidentes e, sobretudo, de violência. O perfil desses eventos entre os mais velhos diferiu dos mais jovens (20-59 anos), com destaque para a menor contribuição do álcool, o predomínio de ocorrências no domicílio, a maior importância relativa das quedas e a maior vulnerabilidade a atropelamentos e a agressões por familiares. Políticas para a prevenção de acidentes e violências devem levar em conta as especificidades desses eventos na população mais velha.