Survey of domestic accidents in the elderly
in the Province of Genoa (Northern Italy)
D. PANATTO, R. GASPARINI, A. VITALE, T. SASSO, J. LUGARINI, I. CREMONESI*, S. SENSI**, G. BADOLATI
Department of Health Science (DiSSal), University of Genoa; * Department of Health and Social Services Liguria Region Genoa;
** Unit Project Service of Emergency Management in Health (ASL Genovese) Genoa, Italy
Introduction. Accidents in the home are a major public health
issue in most industrialised countries, as they are a frequent
cause of injury and death. Moreover, since a considerable por-
tion of such accidents involve elderly people, it is important to
assess their social impact in this population. In Italy, the avail-
able data indicate that well over 3 million people per year suffer
accidents in the home, and that this number is rising. The aim
of the present study was to evaluate the number, characteristics
and causes of domestic accidents among the elderly.
Materials and methods. The study population was made up of
subjects of both sexes aged between 65 and 92 years admitted to
first aid units and emergency departments of hospitals in Genoa.
The investigation was conducted by means of an ad hoc question-
naire designed to record the circumstances of the accident, the
functional capacity of the subject involved, any risky behaviour
enacted and the safety profile of the subject’s home.
Results. The study enrolled 111 voluntary participants: 62
women and 49 men. At the time of the accident, subjects were
engaged in the following activities: housework (36.9%) “rest”
(14.5%), ablutions (10%), gardening (9%), leisure activities
(8.1%), eating and drinking (2.7%). The most common injuries
were bruises (39.6%), followed by fractures (23.4%) and cuts
(23.4%); the frequency of other, some time more severe injures
(burns, poisoning, asphyxia, crush injuries, etc.) was, fortunately,
very low. Anyway, taking into account their consequences, their
surveillance and prevention is very important. Most subjects
were deemed to be in good health and, in 76% of cases, the safety
profile of their houses proved to be satisfactory.
Discussion and conclusions. The data collected during this
survey are in line with those yielded by national and inter-
national studies. They show that the elderly are very vulner-
able to domestic accidents and that, even in the event of only
slight injury, the management of elderly victims requires a
strong organisational commitment on the part of relatives and
considerable financial resources for healthcare services. Fall-
ing proved to be the main cause of injury. Clearly, efforts to
reduce the cost of accidents in the home should aim to imple-
ment preventive intervention among elderly people, since the
elderly population is destined to grow as a result of increasing
life expectancy. In particular, preventive action should focus
on reducing the incidence of falls by eliminating risk-related
structural features in domestic settings as far as possible and
by raising public awareness of the problem through health
J PREV MED HYG 2009; 50: 53-57
Domestic accidents • Elderly • Prevention
Generally speaking, the home is the indoor environment
in which the majority of people spend most of their
time. Unlike other environments, such as the street, the
workplace etc., the home should have connotations of
safety, serenity and protection. Owing to this image of
tranquillity, the growing dangers due to technological
advances and numerous other factors in domestic set-
tings have long been underestimated .
Accidents in the home are a serious public health issue
in most industrialised countries, in that they are a major
cause of injury and death. Moreover, other consequenc-
es, such as disability, suffering and diminished produc-
tivity, have a considerable impact on society. Finally,
we should not underestimate the psychological effect of
these accidents on the general public, which hope that
the home is epitome of a safe environment .
World Health Organisation (WHO) data indicate that,
in advanced countries, domestic accidents are the lead-
ing cause of death among children from 0 to 14 years
of age . In Brussels in 2001, the European Consumer
Safety Association (ECOSA) published data on domes-
tic and leisure-time accidents in Europe in 2000. These
revealed that 225 people die in domestic or leisure-time
accidents in Europe every day. Each year, over 80,000
people die while working, or simply playing, at home;
this is twice the number of road traffic deaths in the Eu-
ropean Union and some 14 times higher than the number
of fatal accidents in the workplace. In addition to these
deaths, every year accidents in the home are responsible
for 40 million injuries requiring medical attention. In
Italy, about 30 deaths per 100,000 inhabitants are at-
tributable to domestic accidents, a figure which roughly
corresponds to the European average; Finland has the
worst record, with almost 56 deaths per 100,000 inhab-
itants, followed by France and Luxembourg, while the
United Kingdom (18 deaths) has the lowest rate .
A study conducted from 1990 to 1993 in Norway by Ko-
pjar and Wickizer  revealed an incidence of domestic
accidents of 22/1000, the highest values being recorded
among children and persons over 65 years of age.
D. PANATTO ET AL.
Hemenway et al.  carried out a study in Austria on a
stratified, randomised sample of 55,000 subjects; they
found that 2.6 per 1000 had suffered injuries caused by
falling down stairs (resulting in limitation of activity for
a least one day). In a study conducted in Hungary, Kazar
et al.  showed that the most frequent accidents are
those which happen in the home (50% of all accidents)
and that their incidence is increasing, the 1994 value
being 45 per 1000 inhabitants.
In the Italian ISTAT survey La vita quotidiana nel 2006
(“Daily Life in 2006”), 797,000 people (13.7/1000) re-
ported being involved in an accident in the home within
the previous three months. On this basis, it can be esti-
mated that over 3 million people per year are involved in
domestic accidents. More than 60% of all such accidents
involve women (17/1000), while among men, the fig-
ure is lower (10.1/1000). Among children and adoles-
cents (up to 14 years), more males than females suffer
accidents; in subsequent age-groups, however, more
females are involved, since they tend to spend more
time at home than males do and are more frequently in
contact with objects, tools and electrical appliances that
can cause injury (cuts, burns, etc.). The risk of injury
increases among elderly subjects, particularly those over
the age of 80 years (33.9/1000 had had an accident in
the three months prior to the survey). Children under the
age of 6 years are also at high risk. These data confirm
the association between the risk of accident and the
amount of time spent at home [8)].
In Italy, the prevention of domestic accidents was ad-
dressed by Law N. 493 of 3rd December 1999, Norme
per la tutela della salute nelle abitazioni e istituzi-
one dell’assicurazione contro gli infortuni domestici
(“Norms for the safeguard of health at home and in-
stitution of insurance against domestic injuries” (G.U.
N. 303 of 28th December 1999)). This law not only
had the merit of dignifying domestic work and institut-
ing obligatory insurance for housewives, it also dealt
with initiatives aimed at safeguarding health and safety
through the prevention of accidents in domestic settings.
In this regard, article 3 of the law obliges the National
Health Service to promote health and safety in domestic
environments and to undertake suitable action to inform
and educate the public with regard to the prevention of
risks and accidents in the home .
In Liguria, accidents in the home are particularly fre-
quent on account of the large proportion of elderly resi-
dents in the Region. The Regional Authority has there-
fore made prevention a specific objective of its Regional
Social Health Plan . From January to September
2004, domestic accidents accounted for 17,420 admis-
sions to First Aid Units (FAU)/Accident and Emergency
Departments (AED) in Liguria, 9,993 of which involved
women; in the same surveillance period in 2005, admis-
sions were 15,514 (8,911 women) .
The Region’s 2005-2007 Prevention Plan provided for
the creation of a system of domestic accident preven-
tion and of monitoring by FAUs and AEDs through the
registration of supplementary information in addition to
the data habitually recorded. In 2005, an experimental
phase (SINIACA, Sistema Informativo Nazionale sugli
Infortuni in Ambienti di Civile Abitazione (System of
National Information on Accidents in Domestic Enviro-
ments) surveillance protocol) was initiated at the AED
of Genoa’s Galliera Hospital; in 2006-2007, this experi-
mental phase was extended to include the AED of the
city’s Gaslini Children’s Hospital, in order to monitor
the situation of the paediatric population. In addition,
in 2007 the system of surveillance was extended to
FAUs and AEDs in other areas of the Region; the data
gathered were integrated with those recorded by other
information systems, such as Hospital Discharge Forms
(HDF), the regional death registry and death records
kept by the individual local health authorities .
Studies on domestic accidents are of considerable
importance in the public health sphere, since they are
the only means of acquiring the information needed in
order to implement valid prevention strategies aimed at
minimising risk factors. The aim of the present study
was to evaluate the number, characteristics and causes
of domestic accidents among the elderly and compare
the unpublished data, collected in Liguria Region from
Decembee 2002 to August 2003 with the results of sub-
sequenct SINIACA surveillance.
Materials and methods
This study forms part of a multi-regional project co-or-
dinated by the Ministry of Health and the Health Depart-
ment of the Lombardy Region. In Liguria, the regional
authority appointed the Department of Health Sciences
of the University of Genoa as its referent for the study.
The investigation used an ad hoc questionnaire prepared
by the Ministry of Health and the Health Department of
the Lombardy Region. The questionnaire consisted of
four sections: the first contained questions designed to
establish the circumstances of the accident (where, how,
when); the second aimed to determine the functional ca-
pacity of the subject at the time of the accident (Barthel
scale ); the third was designed to discover whether
the subject was engaged in any risky behaviour imme-
diately prior to the accident, and the fourth consisted
of a checklist to identify any features of the house that
might engender a risk of falling. The questionnaire was
administered by an interviewer.
In accordance with the regional programme, the study
population was made up of subjects of both sexes aged
between 65 and 92 years who attended the FAU and
AED of Villa Scassi Hospital and San Martino Hospital
in Genoa and the FAU of the 4th Local Health Facility
In order to enrol an appropriate number of subjects, the
above-mentioned facilities were asked to provide lists
of patients admitted as a result of a domestic accidents
during the period established by the study. Care was
SURVEY OF DOMESTIC ACCIDENTS IN THE ELDERLY IN THE PROVINCE OF GENOA
taken to ensure that privacy laws were respected. From
these lists, a random sample of 15% of the total number
of cases was drawn up. Subsequently, the subjects in-
volved, or their relatives, were contacted by telephone
and invited to participate in the study. Once informed
consent had been obtained, arrangements were made
with the elderly person as to when and how the inter-
view-inspection could be carried out by the appointed
ASSESSMENT OF THE SUBJECT’S FUNCTIONAL CAPACITY
The Barthel index  was used to evaluate the func-
tional capacity of the elderly person at the time of the
accident. On the Barthel scale (0-100), scores from 100
to 91 indicate very good functional capacity; from 90 to
75 good; from 74 to 50 fair/sufficient; and < 49 poor/
very poor functional capacity.
The data gathered were processed by means of a pro-
gramme specifically designed for the study (SE-V-A
3/2004) run on the hardware of the Department of
Health Sciences of the University of Genoa.
Only 14.2% of the subjects contacted by telephone
consented to take part in the study. The main reasons
for refusal were: diffidence towards strangers who ask
to come into their homes, even though the operators
identified themselves as members of a workgroup co-
ordinated by the Ministry of Health and the regional
authority; reluctance on the part of those who feel that
their house is humble and unfit to receive a visit from
operators charged with collecting information on the
sanitary conditions of the premises; lack of trust in the
National Health Service (NHS), and therefore unwill-
ingness to co-operate.
A total of 786 subjects were contacted by telephone; of
these, 111 (14.12%) participated in the study: 62 women
(55.85%) and 49 men (44.15%). Most of the respond-
ents interviewed were able to answer the questions per-
sonally; only 4 (3.6%) needed to be helped by relatives
or other assistants, owing to their advanced age.
Most of the interviewees were at home alone when the
accident happened (51: 45.9%); of these, 43 (84.3%)
were reached by relatives or friends within an hour
of the accident, while the remaining eight went to the
emergency facility on their own. Thirty-eight subjects
stated that they lived alone, and only one was equipped
with an emergency alarm device.
Most of the accidents happened in the kitchen (36:
32.4%); 33 happened in the living room/dining room/
bedroom area, 14 in the bathroom, 22 in areas adjacent to
Fig. 1. Activity in progress at the time of the accident.
Fig. 2. Main causes of accidents.
D. PANATTO ET AL.
the house (garden, orchard, external steps, garage, cellar,
etc.), and 6 in other rooms (store-room, corridor, etc.).
With regard to the subject’s activity at the moment of
the accident, the item most frequently cited was “house-
work” (41: 36.9%), followed by “rest” (16: 14.5%),
“ablutions” (11: 10%), “gardening” (10: 9%), “leisure
activity” (9: 8.1%), and “eating and drinking” (3: 2.7%);
21 subjects indicated other activities (Fig. 1).
With regard to how the accident happened, 55 subjects
(49.5%) stated that they had tripped or slipped, 27 that
they had fallen from a height, 9 that they had cut them-
selves, and 10 that they had bumped into objects; the
other items in the questionnaire (crushing, stings, tripping
over animals, poisoning, etc.) were negligible (Fig. 2).
The most frequent injuries sustained were bruises (44:
39.6%), followed by fractures (26: 23.4%) and cuts (26:
23.4%); the frequency of other, some time more severe
injures (burns, poisoning, asphyxia, crush injuries, etc.)
was, fortunately, very low (Fig. 3). The most common
sites of injury were the limbs (arms 30 [27%], legs 24
[21.6%]), followed by the head (23: 20.7%) and the
chest/back (18: 16.2%); other sites (eye, nose, ear, teeth,
etc.) were much less frequent.
The study also investigated any potentially risky be-
haviour on the part of the subject at the time of the ac-
cident. Few respondents reported that the accident had
resulted from improper behaviour, though eight of the
nine subjects who had suffered cuts admitted to having
used sharp instruments improperly. Of the 55 subjects
who had tripped or slipped, 5 reported that mats had
been inappropriately positioned, 10 attributed their falls
to inadequate lighting and 5 stated that they had left the
floor wet after having a shower.
The functional capacity of the subjects at the time of the
accident was assessed as being very good in 68.5% of
cases (76), good in 14.4% (16), fair/sufficient in 8.1%
(9) and poor in 9% (Fig. 4).
The fourth section of the questionnaire concerned the
conditions of safety in the house, particularly with re-
gard to identifying possible risks of falling. In 76.6% of
the houses (85), the conditions were found to be good.
Discussion and conclusions
In spite of the fact that accidents in the home have been
steadily increasing for years, too little attention is paid to
this issue in Italy. In contrast to the downward trends seen
in accidents in the workplace and on the roads, the statistics
reveal that accidents in the home are increasingly frequent
and involve more than 3 million people per year .
The data collected during this investigation are in line
with those yielded by national and international stud-
ies [4-7, 12].
Fig. 3. Injuries sustained in domestic accidents.
Fig. 4. Functional capacity of the subject at the time of the ac-
cident (Barthel scale).
SURVEY OF DOMESTIC ACCIDENTS IN THE ELDERLY IN THE PROVINCE OF GENOA
It is well known that domestic accidents mostly involve
people who spend a lot of time at home: women, children
and the elderly. Elderly people in particular are highly
vulnerable to accidents. Indeed, our study revealed that,
even in the event of only slight injury, the management of
elderly victims requires a strong organisational commit-
ment on the part of relatives and considerable financial
resources for healthcare services. These data are compa-
rable with those of SINIACA surveillance.
We recorded a slightly higher number of injuries among
women. This is probably due to the fact that they spend
more time at home than men do, that they are more
often engaged in housework, and that they are more
frequently in contact with objects, tools and electrical
appliances that may cause injury.
Falls were the most common type of accident, followed
by cuts and knocks. In elderly subjects, falling is prob-
ably related to postural instability, functional status,
impaired eyesight and pathological factors such as
cardiovascular and neurological diseases and arthrosis.
In any case, whatever the cause may be, falls can have
serious physical and psychological consequences in the
elderly and may accelerate the individual’s physical
and mental decline, leading to a precocious reduction
in self-sufficiency. The collected data agree with those
assessed by SINIACA surveillance.
With regard to the types of injury sustained, the most fre-
quent were superficial injuries or bruises, particularly to
the limbs. In most cases, the injury was slight and did not
necessitate hospitalisation. Attendance at emergency facil-
ities in cases in which treatment by the general practitioner
would be sufficient raises healthcare costs and highlights
the need to implement health education programmes to
increase public awareness of the citizen’s role in contain-
ing regional healthcare expenditure.
In order to assess the variables correlated with the risk
of domestic accidents, we measured the functional ca-
pacity of our subjects and evaluated the potential risks
present in their homes. In only 9% of cases did the
functional capacity of the participants prove to be insuf-
ficient, and the safety profile of the houses examined
was generally deemed to be good. These findings are
confirmed by the fact that few respondents attributed
their accidents to structural deficiencies of their homes
or to health-related risky behaviour (e.g. falling out of
bed following a sudden attack of illness).
Accidents in the home have a considerable impact both
from the social and healthcare standpoint and in econom-
ic terms. Moreover, a large percentage of such accidents
involve elderly persons. It is therefore very important to
evaluate the economic impact of domestic accidents in
the elderly. In Italy, the SINIACA study carried out a
preliminary analysis of the costs linked to accidents in
the home and found that the unit cost of hospitalisation
increases with the age of the subject; indeed, the cost of
hospitalising a patient aged between 70 and 74 years is
5 times higher than that of hospitalising a child under
the age of 1 year. These higher costs are related to the
different reaction of the organism to treatment. The most
striking finding, however, is that patients over the age of
70 years account for 69% of total costs .
Clearly then, efforts to reduce the cost of accidents in
the home should aim to implement preventive interven-
tion among elderly people, since the elderly population
is destined to grow as a result of increasing life expect-
ancy. In particular, preventive action should focus on re-
ducing the incidence of falls by eliminating risk-related
structural features in domestic settings as far as possible
and by raising public awareness of the problem through
health education campaigns.
Inter- and intra-disciplinary programs and policies should
be drawn up in order to identify risks and to seek to reduce
them through safer housing design. In this regard, public
health agencies have an important role to play, in that
they should alert politicians, planners, specialists and the
general population to the current risks. In order to achieve
this objective, the results yielded by active epidemiologi-
cal surveillance systems need to be made accessible and
should be utilised to design prevention programmes and
to work out an effective response to this problem.
■ Acknowledgement: This research has been carried out with a
financing of Liguria Region (Local Degree N. 2778 of the 20th
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 Hemenway D. Solinck S J, Koeck C, Kitir J. The incidence of
stairway injuries in Austria. Acc Anal Prev 1994;26:675-9.
 Kazar G, Gaal P, Kosa J, Barzo M. Significance of home
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salute nelle abitazioni e istituzione dell’assicurazione contro gli
infortuni domestici. (G.U. n. 303 del 28 dicembre 1999).
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■ Received on January 5, 2009. Accepted on February 20, 2009.
■ Correspondence: Donatella Panatto, Department of Health Sci-
ence (DiSSAL), University of Genoa, via A. Pastore 1, 16145
Genoa, Italy - Tel. +39 010 353 8109 - Fax +39 010 353 8545
- E-mail: firstname.lastname@example.org