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Risk factors of home injury among elderly people in Malaysia

Authors:
Kuang Hock Lim at Ministry of Health Malaysia
Kuang Hock Lim
Jasvindar Kaur
Jasvindar Kaur
Normala Ibrahim at Universiti Putra Malaysia
Normala Ibrahim
Bk Ho at Ministry of Health Malaysia
Bk Ho
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Abstract

Background. Home injuries among elderly people are a public health concern. This study aimed to determine the frequency and risk factors of home injuries among elderly people in Malaysia. Methods. The Third National Health and Morbidity Survey in 2006 was carried out from April to July 2006. The sample was proportional to population size and selected in 2 stages. Data were collected through face-to-face interviews using a validated questionnaire. Only injuries occurring within the previous year were included to avoid recall bias. The types of home injury, places where the injuries occurred, ability to work after the injury, and hospital admission were recorded, as were demographic variables such as sex, age, marital status, ethnicity, and residential area. Results. Of 4842 respondents aged ≥60 years, 279 (5.8%) had experienced some kind of home injury within the previous year. The most common types of injury were fall (n=205), cuts (n=43), and being struck by objects (n=14). The most common injury locations were the kitchen (n=81), garden (n=65), bathroom/toilet (n=45), living room (n=26), bedroom (n=22), and stairs (n=21). Home injury rates were significantly higher among women than men (7.4% vs. 3.9%, p<0.001). Married elderly people were less likely to have a home injury than divorced/widowed or single elderly people (4.9% vs. 8.0% vs. 8.0%). Multiple logistic regression analysis revealed that women (adjusted odds ratio [OR]=1.87, 95% confidence interval [CI]=1.37-2.55) and respondents aged 70-74 years (adjusted OR=1.45, 95% CI=1.02-2.07) were more likely to sustain a home injury. Conclusion. With the increase in the elderly population, home injury prevention programmers are urgently needed.
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ORIGINAL ARTICLE
Asian J Gerontol Geriatr 2013; 8: ?–?
1
Asian Journal of Gerontology & Geriatrics Vol 8 No 2 December 2013
Risk factors of home injury among
elderly people in Malaysia
KH Lim1, MSc, Bsc, K Jasvindar1, MPH, MBBS, I Normala2, PHD, MB Bch,
BK Ho3, M(med) Fam Medicine, MBBS, WK Yau4, MRCP, MBBS, S Mohmad5,
MPH, MBBS, WY Lai1, MBBS, MS Sherina2, PHD, MBBS
ABSTRACT
Background. Home injuries among elderly people are a public health
concern. This study aimed to determine the frequency and risk factors
of home injuries among elderly people in Malaysia.
Methods. The Third National Health and Morbidity survey in 2006
was carried out from April to July 2006. The sample was proportional to
population size and selected in 2 stages. Data were collected through
face-to-face interviews using a validated questionnaire. Only injuries
occurring within the previous year were included to avoid recall bias.
The types of home injury, places where the injuries occurred, ability to
work after the injury, and hospital admission were recorded, as were
demographic variables such as sex, age, marital status, ethnicity, and
residential area.
Results. Of 4842 respondents aged ≥60 years, 279 (5.8%) had
experienced some kind of home injury within the previous year. The
most common types of injury were fall (n=205), cuts (n=43), and being
struck by objects (n=14). The most common injury locations were the
kitchen (n=81), garden (n=65), bathroom/toilet (n=45), living room
(n=26), bedroom (n=22), and stairs (n=21). Home injury rates were
significantly higher among women than men (7.4% vs. 3.9%, p<0.001).
Married elderly people were less likely to have a home injury than
divorced/widowed or single elderly people (4.9% vs. 8.0% vs. 8.0%).
Multiple logistic regression analysis revealed that women (adjusted
odds ratio [OR]=1.87, 95% confidence interval [CI]=1.37-2.55) and
respondents aged 70-74 years (adjusted OR=1.45, 95% CI=1.02-2.07)
were more likely to sustain a home injury.
Conclusion. With the increase in the elderly population, home injury
prevention programmes are urgently needed.
Key words: Accidental falls; Health services for the aged; Malaysia;
Wounds and injuries
1 Institute For Public Health, Kuala
Lumpur, Malaysia
2 Psychiatric Department, University Putra
Malaysia, Selangor, Malaysia
3 Kapar Health Clinic, Selangor, Malaysia
4 Geriatric Unit, Kuala Lumpur General
Hospital, Kuala Lumpur, Malaysia
5 Family Health Unit, Ministry of Health,
Putrajaya, Malaysia
Correspondence to: Kuang Hock Lim, Section
of Proposal Development, Institute For Public
Health, Jalan Bangsar, 50599, Kuala Lumpur,
Malaysia. Email: limkh@iku.moh.gov.my
home injuries among elderly people in developing
and middle-income countries have been reported.7,8
According to the Second National Health
Morbidity Survey in 1996, the prevalence of home
injury in Malaysia was 2.5%, and was higher in
adults older than 80 years.9 Women, pensioners, and
INTRODUCTION
Injury among elderly people is usually associated
with high morbidity and mortality, and is thus a public
health concern.1–3 It requires longer hospitalisation
and more extensive medical attention, resulting in a
greater health care burden.4–6 Only a few studies of
2 Asian Journal of Gerontology & Geriatrics Vol 8 No 2 December 2013
Lim et al
housewives were highly associated with home injury
because of the long periods spent at home. Home
injuries among people aged ≥60 years were about
8%; falls, poisoning, and choking/suffocation were
the most common causes.10 Compounds, kitchens,
and living rooms were the most common locations
of home injuries.9,10
The health service system of Malaysia is strained
by the rapidly ageing population, who need medical
attention for multiple and chronic illnesses more
frequently than do younger people.11 Home injuries
are largely preventable, and preventive measures can
reduce the health care burden.
Based on the Third National Health Morbidity
Survey in 2006,12 this population-based survey
assessed home injuries among elderly people within
the previous year for policy makers to formulate
preventive measures.
METHODS
The Third National Health and Morbidity survey12
was carried out from April to July 2006. The sample
was proportional to population size and selected in
2 stages, based on the 2004 Labour Force Survey
sampling frame from the Department of Statistics,
Malaysia. Households were stratified by state and
urban/rural setting. The number of households
selected was based on an expected 4.4 respondents
per household. The total sample size was based
on a prevalence of 10%, a margin of error of 1.2,
and a design effect of 2. Enumeration blocks were
geographically contiguous areas consisting of 80
to 120 households and constituted the primary
sampling units, whereas households were the
secondary sampling units. All household members
aged ≥18 years were interviewed. A total of 2150
enumeration blocks (1424 in urban and 726 in
rural areas) consisting of 17 251 households were
randomly selected.
Written informed consent was given by each
participant before the interview. The study was
approved by the Medical Research Ethics Committee,
Ministry of Health, Malaysia. Data were collected in
face-to-face interviews by trained interviewers using
a validated questionnaire, which was pre-tested in 3
districts (Klang, Bangsar, and Sepang) of urban and
rural areas. Households were visited up to 3 times to
achieve an interview. Only injuries occurring within
the previous year were included to avoid recall bias.
The type of home injury, places where the injuries
occurred, ability to work after the injury, and hospital
admission were recorded, as were demographic
variables such as sex, age, marital status, ethnicity,
and residential area.
Education levels were categorised into: no formal
education, primary education (1-6 years), secondary
education (7-12 years), and tertiary education (>12
years). Residential area was determined based on
the Department of Statistics criteria. Age groups
were categorised into: 60-64 years, 65-69 years,
70-74 years, 75-79 years, and ≥80 years. Monthly
household income (in Ringgit Malaysia [RM]) was
classified into: <1000, 1000-1999, 2000-2999, 3000-
3999, 4000-4999, and ≥5000.
Any discrepancies in data were checked by
referring to the original questionnaire. Descriptive
statistics were used to estimate the prevalence,
mechanism, place, and outcome of the home injury.
Multiple regression analysis was used to determine
the effect of each variable on home injury after
controlling for potential confounders. All statistical
analyses were carried out at the 95% confidence
interval (CI).
RESULTS
34 305 respondents aged ≥18 years were
interviewed. The response rate was 96.7%. Data of
4842 respondents aged ≥60 years (mean, 68.4 years;
standard deviation, 6.74 years) were analysed. Of
whom, 53.6% were women; 68.8% were married;
86.5% had primary or no education; and 54.1%
earned <999 RM per month (Table).
279 (5.8%) of the respondents had experienced
some kind of home injury, 82 of whom were unable
to perform activities of daily living after injury, and
37 of whom were admitted to hospital. The most
common types of injury were falls (n=205), cuts
(n=43), and being struck by objects (n=14). The most
common injury locations were the kitchen (n=81),
garden (n=65), bathroom/toilet (n=45), living room
(n=26), bedroom (n=22), and stairs (n=21). Home
injury rates were significantly higher among women
than men (7.4% vs. 3.9%, p<0.001). Married elderly
people were less likely to have home injury than
3
Asian Journal of Gerontology & Geriatrics Vol 8 No 2 December 2013
Risk factors of home injury among elderly people in Malaysia
divorced/widowed or single elderly people (4.9% vs.
8.0% vs. 8.0%) [Table].
Multiple logistic regression analysis revealed
that women (adjusted odds ratio [OR]=1.87, 95%
CI=1.37-2.55) and respondents aged 70-74 years
(adjusted OR=1.45, 95% CI=1.02-2.07) were more
likely to sustain a home injury (Table). Other
Variable No. (%) of respondents* Crude OR
(95% CI)
p Value Adjusted OR
(95% CI)
p Value
Total Injury No injury
Nationality
Malaysian 4784 (98.9) 277 (5.8) 4491 (94.2) 1.57 (0.38-6.49) 0.53 1.21 (0.25-5.80) 0.816
Non-Malaysian 54 (1.1) 2 (3.8) 51 (96.2) 1 - 1 -
Sex
Male 2250 (46.4) 87 (3.9) 2156 (96.1) 1 - 1 -
Female 2592 (53.6) 192 (7.4) 2390 (92.6) 1.99 (1.54-2.58) <0.001 1.87 (1.37-2.55) <0.001
Residence
Urban 2457 (50.7) 135 (5.5) 2315 (94.5) 1 - 1 -
Rural 2385 (49.3) 144 (6.1) 2231 (93.9) 1.11 (0.87-1.41) 0.41 1.08 (0.80-1.47) 0.632
Age group (years)
60-64 1646 (34.2) 84 (5.1) 1558 (94.9) 1 - 1 -
65-69 1415 (29.4) 73 (5.2) 1341 (94.8) 1.01 (0.73-1.93) 0.95 0.97 (0.68-1.37) 0.857
70-74 888 (18.5) 66 (7.5) 819 (92.5) 1.45 (1.07-2.09) 0.02 1.45 (1.02-2.07) 0.040
75-79 486 (10.1) 27 (5.6) 456 (94.4) 1.10 (0.70-1.72) 0.68 1.14 (0.70-1.86) 0.593
≥80 378 (7.8) 29 (7.8) 343 (92.2) 1.57 (1.01-2.43) 0.04 1.30 (0.79-2.15) 0.296
Ethnicity
Malay 2546 (52.6) 134 (5.3) 2407 (94.7) 0.70 (0.32-1.54) 0.38 0.99 (0.69-1.42) 0.408
Chinese 1377 (28.4) 68 (6.3 1303 (93.7) 0.66 (0.29-1.47) 0.69 1.54 (0.94-2.52) 0.400
Indian 301 (6.2) 23 (7.6) 278 (92.4) 1.04 (0.43-2.51) 0.93 0.98 (0.35-2.75) 0.970
Other indigenous 523 (10.8) 47 (9.1) 470 (90.9) 1.26 (0.55-2.87) 0.59 1.51 (0.57-3.99 0.728
Other 95 (2.0) 7 (7.4) 88 (92.6) 1 - 1 -
Education
None 1922 (40.2) 131 (6.9) 1781 (93.1) 2.80 (0.68-11.51) 0.16 1.56 (0.35-6.96) 0.560
Primary 2214 (46.3) 116 (5.3) 2092 (94.70 2.11 (0.51-8.68) 0.30 1.62 (0.38-7.02) 0.516
Secondary 563 (11.8) 25 (4.40) 537 (95.6) 1.77 (0.41-0.77) 0.44 1.47 (0.31-6.66) 0.636
Tertiary 78 (1.6) 2 (2.6) 76 (97.4) 1 - 1 -
Marital status
Single 89 (1.9) 7 (8.0) 81 (92.0) 1.69 (0.77-3.72) 0.19 1.84 (0.82-4.15) 0.140
Married 3305 (68.8) 160 (4.9) 3137 (95.1) 1 - 1 -
Divorced/widowed 1411 (29.3) 112 (8.0) 1291 (92.0) 1.70 (1.32-2.18) 0.001 1.16 (0.87-1.54) 0.316
Income (Ringgit Malaysia)
<999 2435 (54.1) 145 (6.0) 2279 (94.0) 0.84 (0.54-1.39) 0.49 0.80 (0.43-1.50) 0.493
1000-1999 972 (21.6) 53 (5.5) 919 (94.5) 0.76 (0.44-1.32) 0.33 0.84 (0.44-1.59) 0.586
2000-2999 509 (11.3) 27 (5.3) 480 (94.7) 0.74 (0.40-1.37) 0.34 0.71 (0.36-1.40) 0.322
3000-3999 214 (4.8) 12 (5.7) 200 (94.3) 0.79 (0.37-1.68) 0.54 0.76 (0.35-1.64) 0.484
4000-4999 105 (2.3) 9 (8.6) 96 (91.4) 1.23 (0.54-2.84) 0.62 1.34 (0.50-3.60) 0.555
>5000 264 (6.9) 18 (7.1) 237 (92.9) 1 - 1 -
Table
Risk factors of home injury among elderly people in Malaysia before and after controlling for confounders (n=4842)
* Total percentage may not add up to 100, owing to missing data
4 Asian Journal of Gerontology & Geriatrics Vol 8 No 2 December 2013
Lim et al
variables that were significant in the univariate
analysis did not reach significance after controlling
for social and demographic variables.
DISCUSSION
In the current study, 5.8% of the elderly population
had some kind of home injury within the previous
year, which is comparatively lower than in other
studies.13-16 This could be due to the fact that
the current study was conducted in community
households, and not in a hospital setting or nursing
homes. In addition, this study did not include
mortality cases secondary to home injuries or other
types of injuries, such as motor vehicle accidents,
which are common in other countries.16
The most common cause of injury was falls,
which corresponds with the findings of a study in
Verona, Italy, in which falls accounted for 75% of
injuries among elderly people aged 65 to 99 years
admitted to geriatric departments of public and
private hospitals.13 Of 460 trauma admissions to a
hospital in Ontario, Canada over 3 years (2000-2003),
125 (27.2%) were for elderly people aged ≥65 years.
The main reasons for admission were falls (64%)
and motor vehicle accidents (27%).16 Among 720
patients aged ≥65 years presenting with trauma to
an emergency department in Singapore, 67.9% were
home injuries, 85.3% of which were caused by falls,
74.1% of which occurred at home.17 The frequency of
home injuries was higher among men until the age
of 50 years, but was higher among women for the
older age groups.18 This can be explained by different
activities performed by different sexes and ages of
people. Younger men (aged 31-40 years) are more
interested in repair and do-it-yourself activities,
whereas women are more involved in domestic work
activities.18 In addition, life expectancy is higher for
women.18 Home injuries occurred more commonly
among women and in the kitchen, as women are
more likely to be involved with kitchen activities
such as cooking and cleaning.13,18,19 Women tend to
incur more home injuries because of the nature of
their work within the home.17
The increase in home injuries in elderly people
aged >65 years, particularly those >70 years, can be
due to diminished reflexes and chronic diseases.16
Independent risk factors for subsequent falls
among respondents aged ≥85 years were a history
of recurrent falling, poor vision, use of antipsychotic
drugs, and feelings of anxiety, nervousness, or fear.20
As the life expectancy of Malaysians increases,
the rate of home injuries among elderly people
is expected to increase. Most home injuries can
be prevented. Elderly people should be taught to
practice safety measures at home. Improvement
in home furnishings, especially in accident-prone
areas such as the kitchen and bathroom/toilet is
necessary.1,14 As fall was the major cause of home
injury, fall prevention measures should include
regular medical check-ups for visual acuity, activities
of daily living, physical health, and cognitive and
memory functioning, and home inspection to ensure
adequate lighting, railings and support bars in toilets/
bathrooms, and proper arrangement of furniture to
avoid tripping and falls.21,22
ACKNOWLEDGEMENT
We thank the Director-General of Health, Malaysia
for his permission to publish this paper.
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Article
  • Jan 2020
Background A fall can be defined as a sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, or the ground, other than because of sudden onset of paralysis, epileptic seizure, or overwhelming external force. (1) Older adults often fall, causing a substantial burden on patients and the healthcare system at the same time. Falls and fall-related injuries are a common and major problem among older adults. It is the leading cause of severe injuries, as hip fractures in older population. (2) Also, the post-fall anxiety syndrome, fear of falling, is another consequence of falls, this in turn lead to deconditioning, weakness and gait problems and may actually increase risk of falls. (3) Globally, falls are a major public health problem. The most prevalent fall-related injuries among older adults are fractures of the hip, spine, upper arm, forearm, and bones of the pelvis, hand, and ankle. Of these, the most serious injury is hip fracture, a leading cause of morbidity and excess mortality among older adults. Older adults are hospitalized for fall-related injuries five times more often than they are for injuries from other causes, and women are nearly three times more likely than men to be hospitalized for a fall-related injury. (4) It is a serious public health issue, with a substantial impact on health and healthcare costs. Elderly people attending geriatric outpatient clinics are a distinctive group that has different characteristics from those of the ordinary population or those in other institutions. Consequently, it is favorable to establish the profile of falls among the geriatric outpatient clinical population to establish care strategies for this group. (5) METHODS Study Design: Cross-sectional study was conducted in Ain-Shams University Hospital at outpatient clinics. The study included 120 older adults ≥ 60 yrs. old (males and females) who attended outpatient clinics. All the patients were able to walk independently and their condition was stable. Patients who had acute illness or overt dementia were excluded. METHODS: All participants were assessed regarding their demographic characteristics including age, gender, marital status, educational level and body mass index (BMI). Also, baseline data of participants were assessed as the presence of comorbidity or number of them (≥3 or< 3) and types of medications used or Abstract Background: Older people are more susc eptible for fall. Fall is one of the most common geriatric syndromes that affects the quality of life of the elderly persons. It is the leading cause of severe injuries, as hip fractures in older population. Such injuries can result in "disability, chronic pain, loss of independence, poor quality of life, and in severe cases, death. Falls result from mix of biological, medical, behavioral or environmental risk factors.
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... However, Malaysia must confront the reality of the increasing older population in the coming years (Lim et al., 2019). Furthermore, each week sees alarming incidents of older adults being abandoned by their families and ending up in old folks' homes (Lim et al., 2014). ...
The Preliminary Results on the Push Factors for the Elderly to Move to Retirement Villages in Malaysia
Article
  • Jun 2022
Many countries are witnessing a rise in the ageing population, which has become a global phenomenon that all nations must address. As the population of greying people is expected to increase in Malaysia, the demand for senior citizen accommodation is predicted to have experienced a major rise by 2030. However, although studies related to retirement villages (RV) are highly important to understand how to provide a better ambience for the elderly, research on the development of retirement villages in Malaysia is yet to gather pace fully. Thus, this paper aims to explore the potential of the retirement village in Malaysia by focusing on the push factors for the elderly to move to retirement villages in the local Malaysian context. The outcome of this paper presents the initial findings derived from a literature review and pilot survey. Eight potential push factors were identified after questions were posed to potential respondents through a pilot survey questionnaire. The research revealed that the main potential reason why the elderly relocate to retirement villages was related to social factors, with the elderly preferring better access to healthcare and support due to their unique requirements. The findings of this study are relevant to Chapter 11, as underlined in the Sustainable Development Goals (SDGs), which call on all governments to offer access to a secure, green environment for everyone, especially the elderly. Theoretically, this research provides the first findings on the elements that encourage the elderly to relocate to an RV when they retire in Malaysia.
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... According to the analysis "Risk factors of home injury among older peoples in Malaysia", among 4842 informants having lived over 60 years, a total of 279 (5.8%) had suffered a home injury of some sort during the year before. The most frequent types of injuries were falls (n=205), object-oriented (n=14) and, cuts (n=43) [7]. Most research on fall detection utilizes accelerometers, sometimes gyroscope-based detection system has also been used. ...
Internet of things based fall detection and heart rate monitoring system for senior citizens
Article
Full-text available
Falls cause the maximum number of injuries, deaths, and hospitalizations due to injury for senior citizens worldwide. So, fall detection is essential in the health care of senior citizens. Present methods lack either accuracy or comfortability. The design of fall detection and heart rate monitoring system for senior citizens has been presented in this paper. The hardware interface includes wearable monitoring devices based on a tri-axial accelerometer and Bluetooth module that makes a wireless connection by software interface (mobile application) to the caregiver. Global positioning system (GPS) can also track the location of the elder. For detecting falls accurately, an effective fall detection algorithm is developed and used. The performance parameters of the fall detection system are accuracy (97.6%), sensitivity (92.8%), and specificity (100%). A pulse sensor is used for monitoring the heart rate of the elder. The device is put on the hips to increase comfortability. Whenever the elder's fall is detected, the device can send information on fall data and heart rate with location to the respective caregiver successfully. So, this device can minimize the injury and health cost of a fallen person as a victim can get help within a short time.
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... According to (Hamid, 2015), fall might occur among the bedridden person especially elderly which is about 30% of those over 65 years and 40% of those over 80 years. From the total number of falls happen, bedroom can be considered as one of the most common falling location (Lim et al., 2013). This is why an automated bedridden monitoring system is vital to recognize the awakening events of bedridden and further alert the caregivers to instantly give assistance to prevent falls. ...
The evaluation of depth image features for awakening event detection
Article
Full-text available
  • Mar 2018
Falls among bedridden would increase in number if they are left unsupervised by the caregivers. Fall might occur among the bedridden person especially elderly which is about 30% of those over 65 years and 40% of those over 80 years. From the total number of falls happen, bedroom can be considered as one of the most common falling location The aim of this study is to evaluate the features from the Kinect-like depth image representing the bedridden in detecting the awakening event as the event that falls might occur. The images from 20 subjects performing six sleeping activities including the awakening events were obtained before image segmentation based on horizontal line profile was computed to these images in localizing the bedridden as region of interest. After that, the biggest blob selection was executed in selecting the blob of bedridden person body. Finally, blob analysis was formulated to the resultant image before boxplot and machine learning approach called decision tree were used to analyze the output features of blob analysis. Based on the results from the boxplot analysis, it seems that centroid-x is the most dominant feature to recognize awakening event successfully as the boxplot represent the centroid-x of awakening event were not overlap with other sleeping activities. The result from machine learning approach is also seem in good agreement with boxplot analysis whereby the modelled decision tree with solely using centroid-x achieve the accuracy of 100%. The second largest accuracy is the perimeter followed by major axis length and area.
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Recognizing the Activity Daily Living (ADL) for Subject Independent
Article
  • Sep 2019
Recently, Human Activity Recognition (HAR) has gained meaningful information for a human being. A wearable sensor like an accelerometer, small and simple to perform, has opened the room for scientists to explore an initial understanding of ubiquitous computing. The wearable sensor has begun to receive attention among researchers in some respects to conduct their studies in a wide area of recognition of human activity. Recent ADL discusses not only simple activities but also cater to the broad categories of complex activities. However, when involving enormous numbers of a subject, the accuracy of recognition tends to reduce. Although a different subject performed the same activity, the acceleration signal acquired considerably differs. This is due to the distinct pattern of action for each subject based on various factors such as subject age, gender, emotion and personality. Thus, by enhancing the accuracy of recognition of ADL, this article proposes the framework for addressing the subject independent matter. The signal acquired from an accelerometer sensor will undergo a segmentation process to extract important features. Some of the characteristics may be meaningless in some instances to determine the class. Therefore, proposing a variety of features to select the most relevant features that can lead to accuracy above 90%. Also, this article outlined a brief empirical evaluation of previous related work. Using several machine learning algorithms, this preliminary work will be examined and analyzed.
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Evaluation of home injuries in elderly people (HIEP) in Verona area (North-East Italy)
Article
Full-text available
Background Home injuries in elderly represent an important cause of tempo-rary or permanent physical inability, psychological consequences and high socio-economic costs.
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Epidemiology of domestic injuries. A survey in an emergency department in North-East Italy
Article
Full-text available
  • Sep 2009
Home injuries (HI) represent a social and public health problem worldwide. In Italy, there are 1,300,000-1,700,000 admissions to Emergency Department (ED) for HI and 130,000 hospitalizations every year, but the data are incomplete and fragmentary. A study of the phenomenon was carried out in Emergency Department (ED) of Civil Hospital of Verona to evaluate prevalence, characteristics and possible preventive actions. In 2007, 3120 admission for HI have been registered at the Eä of the Civil Hospital of Verona. The distribution was calculated in relation to sex, age, month, code of urgency, outcomes, type and location of trauma. Children in pre-school age, men between 30 and 40 years and women over 60 years are the population groups most at risk, with a fairly homogeneous incidence distribution. Both sexes have similar distributions up to 41-50 years followed by an increase in females and a decrease in males at higher age. The traumas are generally slight (49.8% white code and 42.1% green code) and the hospitalizations represent 5.8% of all recorded HI. The most frequent injuries are wounds/abrasions (28.7%), contusions/crushing (27.7%) and fractures/distortions/ dislocations. The most affected body parts are hands and wrists (25.9%). Head trauma is significantly more frequent in children and elderly people, fracture in elderly people, and burn in adult women and male children. Every year about 30% of the admissions to emergency departments are caused by HI. Even though 92% of the times the events aren't serious, the sanitary cost is consistent due to the elevate number of admissions. It is therefore important to do prevention through sanitary education and adequate building legislation.
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A review of elderly injuries seen in a Singapore emergency department
Article
Full-text available
  • Apr 2009
The elderly population in Singapore is steadily increasing, thus increasing the stress on healthcare provision and financing. Elderly injuries result in significant mortality and morbidity. This study aimed to identify the injury patterns, specific risk factors involved and needs of the elderly so that the current emergency model of care for the injured elderly can be improved and injury prevention strategies devised. We conducted a retrospective study of all elderly aged 65 years and older seen for trauma in an emergency department over six months. Data captured in the real-time computer system was studied with regard to patient profile, mechanism of injury and patient disposition. 720 patients aged 65 years and older were seen for trauma in the first six months of 2005, accounting for 10.4 percent of the total attendance for that age group. Home injuries (67.9 percent) were the most common, followed by road-related injuries (21.2 percent). 85.3 percent of the injuries were due to falls. 49.9 percent of the patients were admitted to hospital. We also examined the underlying causes of the injuries and the common injuries sustained. Injuries in the elderly is a significant problem. Most of the injuries occur at home and falling is the commonest cause. Many of the injuries are potentially preventable. Several possible injury prevention strategies and improvements to the current emergency model of care of the injured elderly are discussed. The establishment of a national elderly injury surveillance database is advocated.
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Fall risk among a very old home-dwelling population
Article
Full-text available
The aim of this prospective study was to examine risk factors of falling in a very old home-dwelling population. A prospective study of home-dwelling elderly people. Baseline data were collected by home-nursing staff through postal questionnaires and clinical tests. Data on falls were recorded in telephone interviews every other month during a follow-up of 11 months constituting 494 person years (PY). Negative binomial modeling was used to assess fall risk. General community. A population sample of home-dwelling subjects aged 85 years or older (n = 555). Main outcome measures. Fall rate and risk factors of falls. Altogether 512 falls occurred in 273 (49%) subjects, incidence rate 1.03/PY. According to a multivariate model, history of recurrent falling, trouble with vision when moving, use of antipsychotic drug, and feelings of anxiety, nervousness, or fear were independent risk factors for subsequent falls. Appropriate care of poor vision and feelings of anxiety, nervousness, or fear, and avoidance of use of antipsychotic drugs might be useful in the prevention of falls among the most elderly home-dwellers.
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Accident profile of older people in Antalya City Center, Turkey
Article
Full-text available
Accidents are major health problems leading to deaths and injuries among older people. The present study was performed to investigate the characteristics of the accidents experienced within the last 1 year in people aged 60 years and older living in Antalya City Center. The study was planned as a cross-sectional research. A total of 840 individuals selected from the study population with cluster-sampling method were used in questionnaires. A number of 163 (19.4%) individuals had at least one accident in the last year. A total of 178 accidents were reported within the last 1-year; 124 (69.7%) falls, 22 (12.4%) traffic accidents and 12 (6.7%) dropping of objects to head. The accidents occurred mostly at home (40.4%), at avenue-street etc. (31.5%), and in garden (8.4%). The result of logistic regression analysis revealed that accident frequency was positively related with female gender (odds=1.79, P<0.05), disability of lower extremities (odds=1.63, P<0.05) and hearing impairment (odds=2.01, P<0.05) whereas it was negatively related with living in detached house (odds=0.41, P<0.05). It was found that accidents caused health (82.0%) and financial (38.2%) problems in elderly and also the disabilities in daily activities (66.3%). Average numbers of days with disability in daily activities were 21.1 in 1 year per accident and 5.7 in 1 year per individual. Occurrence of health problems and disability in daily activities were more frequent among women compared to men (P<0.05). Methods like environmental measures or educational programs to prevent accidents and accident-related injuries must be focused on defined risk groups and places where the accidents occur more frequently. Future researches about the effectiveness of prevention in elderly on accident frequency, mortality and morbidity are needed to deal with this current problem.
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Population-based cohort study of injuries
Article
A population-based cohort study was done to estimate the incidence of different types of injuries and to evaluate certain risk factors in an urban slum; 4333 slum dwellers in Madras city in India were randomly selected by cluster sampling, of whom 1.7 per cent were lost during the 12 months of follow up. The cumulative injury incidence for 12 months for all injuries was 127 per 1000 persons (95 per cent confidence interval 117-137); for males 137 per 1000 and for females 118 per 1000. Incidence of unintentional injury was 121 per 1000 persons. The incidence for road traffic injury was 16 per 1000 persons, for household injuries 57 per 1000 persons and for injury at place of work 19 per 1000 persons. The relative risk of males to females for traffic injuries was 3.04 and for household injuries was 0.39. The relative risk of traffic injuries among adult males who reported daily alcohol consumption was 2.26. The incidence of injury is high in an urban slum and it is a priority health problem. This study has identified groups of people who are at high risk for injuries and who may need specific protective measures.
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Mortality and Morbidity Related to Injuries from Falls in British Columbia
Article
  • Sep 1999
Falls are a major health problem for persons aged 65 years and over. This study examined differences in patterns of fall-related injuries and deaths between age groups, sexes, and among Health Regions of BC. For those under the age of 65 years, fall-related injuries are highest among males, whereas for those 65 and over, falls among females exceed those among males by 2:1. For persons aged 65 and over, 84% of hospital days for unintentional injuries involve falls, with transportation and "other" unintentional injuries contributing 16%. While older women are hospitalized more often for fall-related injuries, more older men die from fall-related injuries. Hospitalization rates due to injuries from falls are highest in the Northern Regions of BC. Policy implications of the findings are discussed.
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Cost-Outcome Analysis in Injury Prevention and Control: Eighty-Four Recent Estimates for the United States
Article
The objectives of this study were to review cost-outcome analyses in injury prevention and control and estimate associated benefit-cost ratios and cost per quality-adjusted life-year. Medline and Internet search, bibliographic review, and federal agency contacts identified published and unpublished studies from 1987 to 1998 for the United States. Studies of low quality and analyses of occupational, air, rail, and water transport safety programs were excluded. Selected results were recomputed to increase discount rate, benefit category, and benefit estimate comparability and to update injury incidence rates. More than half of the 84 injury prevention measures reviewed yielded net societal cost savings. Twelve measures had costs that exceeded benefits. Of 33 road safety measures analyzed, 19 yielded net cost savings. Of 34 violence prevention approaches studied, 19 yielded net cost savings, whereas 8 had costs that exceeded benefits. Interventions with the highest benefit-cost ratios included juvenile delinquent therapy programs, fire-safe cigarettes, federal road and traffic safety program funding, lane markers painted on roads, post-mounted reflectors on hazardous curves, safety belts in front seats, safety belt laws with primary enforcement, child safety seats, child bicycle helmets, enforcement of laws against serving alcohol to the intoxicated, substance abuse treatment, brief medical interventions with heavy drinkers, and a comprehensive safe communities program in a low-income neighborhood. Studies of cost-saving measures do not exist for several injury types. Injury prevention often can reduce medical costs and save lives. Wider implementation of proven measures is warranted.
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Injuries among older adults: The challenge of optimizing safety and minimizing unintended consequences
Article
  • Jan 2003
To describe the problem of falls, motor vehicle related injuries, and suicide among older adults, and issues related to their prevention. Summary and synthesis of selected literature. About 39 000 adults aged 65 and older die each year in the United States from injuries; worldwide this annual toll is about 946 000 persons. The top three causes of injury related death in this age group in the United State are falls, those related to motor vehicle crashes, and suicide. Effective strategies exist for preventing fall related injuries and deaths. Preventing injuries and deaths from motor vehicles and suicide may be more difficult because of the nature of these problems. As the number and percentage of older adults continues to rise in the United States and globally, new approaches to preventing injuries will be critical. Interventions will need to operate at multiple levels-directed at the individual, at interpersonal relationships, and at the community level.
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