Clinical consequences of road traffic injuries among the elderly in Japan

Road traffic injury among elderly people and its determinant factors: a cross-sectional study

Background and aims

Injuries from Road Traffic Accidents (RTAs), particularly among vulnerable groups such as the elderly, are considered a significant public health concern. The aim of this study was to show epidemiology of RTIs among the elderly people in the Eastern Azerbaijan province of Iran.

Method

This cross-sectional study included all patients over 60 years old who admitted to the Shohada Hospital from 2006 to 2016. Data were extracted from the Hospital Information System. Injuries types were classified based on the International Classification of Diseases (ICD-10). Descriptive statistics (Mean, median and frequency) and inferential statistics (The Pearson Chi-square test) were used for data analysis through SPSS-24 software.

Results

A total of 3509 RTAs involving patients over 60 years old from 2006 to 2016. These traffic-related injuries comprised 15% of all recorded injuries (23,321 cases). The mean age of the patients was 69.91 ± 7.61 years, with a predominant male representation (2324 patients, 64.74%). The median Length of Stay (LOS) in hospital was 3 days. Injuries most commonly affected the knee and lower leg regions (27.5%). The most frequent types of accidents were those involving car passengers (40.47%) and pedestrians (36.33%). The majority of RTAs occurred during the summer season. There was a significant difference in the rate of RTAs based on variables such as sex, age, season, and LOS (p < 0.001).

Conclusion

The study highlights traffic-related injuries among the elderly, mostly affecting the knee and lower leg regions, especially during the summer season. The efforts should include enhancing safety measures for car passengers and pedestrians, particularly during the high-risk summer months. Also, it emphasizes the need for public transportation to improve safety for older people due to lower accident rates and senior-friendly features.

Are There Any Differences in Road Traffic Injury Outcomes between Older and Younger Adults? Setting the Grounds for Posttraumatic Senior Personal Injury Assessment Guidelines

Injury outcomes seem to be more severe in older than younger persons. This may make personal injury assessment (PIA) particularly difficult, mainly because of seniors’ previous health frailties. To set the grounds for seniors’ PIA guidelines, we compared an older with a younger adult population of trauma victims and, secondarily, identified differences between the groups regarding three-dimensional and medico-legal damage parameters assessment. Using a retrospective study of victims of road traffic accidents, we compared the groups (n = 239 each), assuring similar acute injury severity (ISS standardised difference = 0.01): G1 (older adults); G2 (younger adults). Logistic regression was used to estimate the odds ratio. G1 revealed higher negative consequences when considering the three-dimensional damage assessment, with more frequent and severe outcomes, being a cause of further difficulties in daily living activities, with a loss of independence and autonomy. Nevertheless, regarding the medico-legal damage parameters, permanent functional disability did not show significant differences. This study generates evidence that reveals the need to rethink the traditional methodology of PIA in older persons, giving more relevance to the real-life contexts of each person. It is essential to: obtain complete information about previous physiologic and health states, begin the medico-legal assessment as early as possible, make regular follow-ups, and perform a multidisciplinary evaluation.

Trauma outcomes in nonfatal road traffic accidents: a Portuguese medico-legal approach

The objective of this study was to compare the outcomes of nonfatal road traffic accidents by the victims’ age group and sex. We used the Portuguese medico-legal rules for personal injury assessment, in the scope of the Civil Law in that country, which includes a three-dimensional methodology. This was a retrospective study including 667 victims of road traffic accidents aged 3–94 years old. Their final medico-legal reports all used the Portuguese methodology for personal injury assessment. Outcomes were analysed by the victims’ age group (children, working-age adults, and older people) and sex. Road traffic accidents were generally serious (ISS mean 9.5), with higher severity in children and older people. The most frequent body sequelae were musculoskeletal (64.8%), which were associated with functional and situational outcomes. Temporary damage resulted in an average length of impairment of daily life of 199.6 days, 171.7 days to return to work, and an average degree of quantum doloris (noneconomic damage related to physical and psychological harm) of 3.7/7. The average permanent damage was 7.3/100 points for Permanent Functional Deficit, 0.43/3 for Permanent Professional Repercussion, 2/7 for Permanent Aesthetic Damage, 3.9/7 for Permanent Repercussion on Sexual Activity and 3.2/7 for Permanent Repercussion on Sport and Leisure Activities. Overall, 19% of people became permanently dependent (10.6% needed third-party assistance). The medico-legal methodology used, considering victims’ real-life situation, allows a comprehensive assessment. There were several significant differences among the three age groups but none between sexes. These differences and the impact of the more severe cases justify further detailed medico-legal studies in these specific situations on children, older people, and severely injured victims.

Key points:

This was a retrospective study of accident mechanisms and injury outcomes in Portugal, and considered the outcomes in the victims’ real-life situation.

Lesions from road traffic accidents were generally serious, with higher severity among children and older people.

The most frequent sequels were musculoskeletal, and associated with functional and situational outcomes.

Both temporary and permanent outcomes had repercussions for the victims.

There were significant differences between children, working-age adults and older people, but none between sexes.

Sistema de indicadores de morbilidad y mortalidad por accidentes de tráfico: una revisión sistemática

Objetivo Elaborar un sistema de indicadores de morbilidad y mortalidad por accidentes de tráfico, con el fin de mejorar los procesos de recopilación y registro de la información de seguridad vial en el país.Materiales y Métodos Revisión sistemática cualitativa de artículos científicos publicados en revistas indexadas en las principales bases de datos (Scopus, PubMed, Lilacs, SciELO, Google Scholar), sobre accidentes de tráfico desde el año 1995 hasta el año 2015. La información recolectada pasó por 4 fases de revisión.Resultados Se seleccionaron 84 indicadores, agrupados en nueve dimensiones: accidentalidad, morbilidad, mortalidad, temporalidad, geoespacial, sociodemográfica, parque vehicular, impacto en salud pública, tipos y causas.Conclusiones Una gestión eficaz sobre seguridad vial exige que cada país cuente con un sistema de indicadores efectivo e institucionalizado que permita recolectar, analizar y gestionar la información de forma rápida y oportuna, enmarcada en el campo de la investigación científica, para difundir a la comunidad y organismos responsables de la seguridad vial, con miras a la adopción de medidas preventivas y correctivas. Por lo que, se recomienda a los organismos competentes de seguridad vial del país incorporar el sistema de indicadores elaborado en la presente investigación, lo cual permitirá contar con un sistema de registro da datos confiables.

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.

Effect of Rhythmic Auditory Cueing on Aging Gait: A Systematic Review and Meta-Analysis

Rhythmic auditory cueing has been widely used in gait rehabilitation over the past decade. The entrainment effect has been suggested to introduce neurophysiological changes, alleviate auditory-motor coupling and reduce cognitive-motor interferences. However, a consensus as to its influence over aging gait is still warranted. A systematic review and meta-analysis was carried out to analyze the effects of rhythmic auditory cueing on spatiotemporal gait parameters among healthy young and elderly participants. This systematic identification of published literature was performed according to PRISMA guidelines, from inception until May 2017, on online databases: Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE, and PROQUEST. Studies were critically appraised using PEDro scale. Of 2789 records, 34 studies, involving 854 (499 young/355 elderly) participants met our inclusion criteria. The meta-analysis revealed enhancements in spatiotemporal parameters of gait i.e. gait velocity (Hedge's g: 0.85), stride length (0.61), and cadence (1.1), amongst both age groups. This review, for the first time, evaluates the effects of auditory entrainment on aging gait and discusses its implications under higher and lower information processing constraints. Clinical implications are discussed with respect to applications of auditory entrainment in rehabilitation settings.

Factors associated with the occurrence of injuries requiring hospital transfer among older and working-age pedestrians in Kurume, Japan

Background

Pedestrian injuries among older people tend to occur near their residence. However, knowledge regarding whether distance travelled from home to the injury site or road environmental/socioeconomic factors affect injury severity remains limited.

Methods

A cross-sectional study was performed using injury registry data from the Kurume City Fire Department, Japan. Distance travelled from home was determined with geographic information system (GIS) software. Data were analyzed for potential association with injury occurrence and severity, with stratification by age. Signal detection analysis using 10 variables was applied to identify factors associated with the occurrence of severe pedestrian injuries.

Results

Among the 545 adult pedestrian injuries reviewed, the factors associated with the occurrence of severe pedestrian injuries for older people and working-age people were evaluated, focusing on the effect of the network distance travelled from home to injury site. Network distance travelled from home to injury site was not associated with the occurrence of severe pedestrian injuries among older people. By applying signal detection analysis, for older people, higher socioeconomic status, wider road width per lane, and higher aging rate in the residential area were significant factors, and for working-age pedestrians, longer network distance travelled between injury place and their residential area and a higher aging rate in the residential area were significantly associated.

Conclusions

To reduce severe pedestrian injuries among older people, improvement of road infrastructure in areas with wider roads, higher socioeconomic status and higher aging rates is required.

The Burden of Road Traffic Injuries in Yazd Province - Iran

OBJECTIVES

To estimate the Disabled-adjusted Life Years (DALYs) of Road Traffic Accidents in patients referred to hospitals in Yazd Province, central Iran.

METHODS

This cross-sectional study was conducted in Yazd province during 2010. To calculate the Years of Life Lost (YLL) due to premature death and to calculate the incidence of non-fatal injuries and Years Lost due to Disability (YLD), the data were collected from Yazd death registration system and hospital records. The causes of death and nature of non-fatal injuries were classified using International Classification of Diseases (ICD-10). We estimated Disability Adjusted Life Years (DALYs) on the guidelines of the Global Burden of Disease Study (discount rate: 0.03, age weight: 0.04, constant age weight correction factor: 0.165). Age and sex composition was taken from the National Statistical Center for the year 2010.

RESULTS

During 2009, 483 deaths were caused by traffic accidents in Yazd Province, 382 (79.09%) of which were males, and 101 (20.91%) were females. The mortality rates for males and females were 70.98 and 20.15 in 100,000, respectively. The years of life lost due to premature deaths were 15.84/1000 in men and 4.75/1,000 in women. Total YLLs caused by traffic accidents were 10,908 years. The injuries caused by traffic accidents were calculated as 15.21 and 3.73/1,000 in males and females, respectively. The total YLDs was calculated 1.51/1,000. The total burden of Road Traffic Injuries in Yazd province was 12478 years (DALYs), 87.41% of which was due to premature death, and 12.59% was related to disability. Also, 78.32% was lost in males. The age specific peak of burden was in 15-29 year.

CONCLUSION

This study showed that traffic accidents in Yazd impose a high burden. It seems that it is one of the health sector priorities. It is recommended to revise laws on use of motorcycles, especially on helmet use for motorcyclists, enforce strict laws in residential areas, and review social determinant affecting the incidence of such accidents.