Accidental injuries among the elderly within the Vienna community: Epidemiology,risk factors and preventive measures

Abstract

Unintentional injuries ('accidents’) among elderly people are a significant burden in public health because such accidents happen frequently and because the proportion of older age groups in the population will continue to rise during the coming decades. One aim of this study, which was done in Vienna, the capital of Austria, was to broaden the preventive concept, adding lifestyle and living conditions to already well-known risk factors following the health promotion approach. Furthermore, characteristics that predispose older residents to accidents should be identified in order to design preventive measures for reducing injuries in this age group.

809 interviews with people 60 years of age and over were conducted, concerning accidents, outcomes of accidents, physical fitness, drug intake, type of house or dwelling, equipment in the household incorporating safety features, psychological well-being and social relations. The information collected was used to draw cross-sectional comparisons between participants who reported having experienced at least one accident in the previous 12 months and those who did not. Furthermore, the accident incidents were classified into 2 groups: incidents without injuries and injurious accidents. The latter served as a base for the epidemiology of injuries for people 60 years of age and over within the Vienna community.

20% of all senior citizens suffer at least one unintentional injury every year, in addition to which 8% experience critical incidents (mostly falls) without injury. Most accidents occur at home or involve pedestrians in public traffic areas. Over 90% of all accidents are falls, and 20% result in fractures. The most important risk factors for accidents in the elderly are gender, increasing age, poor physical fitness and low physical activity, the type of household and household equipment, poor psychological well-being, low income and loneliness.

The findings regarding falls suggest some possible opportunities for reducing the risk of falls by improving buildings and dwellings of the elderly. A promising attempt at practical implementation of these findings is being conducted by the Vienna-based Austrian Institute for Home and Leisure Safety in cooperation with the Vienna City Council. These two organizations are implementing a long-term program that aims at mobilizing institutions and organizations involved in working with the elderly.     

The pattern and predictors of intentionally inflicted injuries on Greek adults; data from an Emergency Injury Surveillance System (EDISS)

Background Intentional injuries due to violence are both a social and a public health problem in most societies. This study assesses the patterns and some of the sociodemographic determinants of violence-related injuries among Greek adults. Methods Data recorded by the Emergency Department Injury Surveillance System (EDISS) during the two-year period 1996-1997 were used. This database relies on all age injury data collected in the emergency departments of three sentinel hospitals, covering both urban and rural population areas. Results Among 52026 recorded injuries, 1322 (3%) were violence related, excluding self-inflicted injuries, while the majority of injuries (28269) were attributed to home and leisure accidents. Weapons of any type were used only in 5% of violence-related injuries. In comparison to home and leisure injuries, the intentionally inflicted injuries occurred more frequently among men, among those 25-54 years old, and were particularly common among migrants and during late night and early morning hours. Violence-related injuries frequently occur in pubs, restaurants, cafeterias and other places of entertainment. However, 52% of violence-related injuries among women occurred at home. Intentional injuries were generally more severe than unintentional ones. Conclusions We conclude that violence is not a negligible public health problem in the Greek population, but is considerably less serious than in most other developed countries. In particular, firearms-related injuries represent a very small fraction of the generally low incidence of violence-related injuries in this Mediterranean country.     

Knowledge,attitudes and beliefs towards injury prevention: a population-based telephone survey

Public knowledge and beliefs about injury prevention are currently poorly understood. A total of 1030 residents in the State of Queensland, Australia, responded to questions about injury prevention in or around the home, on the roads, in or on the water, at work, deliberate injury and responsibility for preventing deliberate injury allowing for comparison with reported injury prevalence data. Overall, the youngest members of society were identified as being the most vulnerable to deliberate injury with young adults accounting for 59% of responses aligning with reported data. However, younger adults failed to indicate an awareness of their own vulnerability to deliberate injury in alcohol environments even though 61% of older respondents were aware of this trend. Older respondents were the least inclined to agree that they could make a difference to their own safety in or around the home but were more inclined to agree that they could make a difference to their own safety at work. The results are discussed with a view to using improved awareness of public beliefs about injury to identify barriers to the uptake of injury prevention strategies (e.g. low perceived injury risk) as well as areas where injury prevention strategies may receive public support.     

Injuries in preschool children: the hypothetical protector effect of minor injuries and risk factors for minor and medically attended injuries

This study aimed to investigate the relationship between minor and medically attended injuries and to analyse the influence of child-related factors and family-related factors in injuries of preschool children. Individual interviews were conducted with 335 parents of 1- to 5-year-old children. Parents informed about the child and the family variables and reported the child's history of injuries in the last year. The frequencies of minor injuries and medically attended injuries were not correlated. The risk factors for both kinds of injuries include the number of siblings and the size of the family. Minor injuries were more frequent in older than in younger children. Medically attended injuries were more frequent in boys than in girls. The risk factors that influence minor and medically attended injuries are different, suggesting that the strategies to prevent and reduce injuries need to take that difference into consideration.     

Socio-economic differentials in injury risk

The aim was to highlight the role of childcare products as causes for mild brain injury (concussion) in small children (0-4 years of age) and to determine the most dangerous products. By childcare products this report means the following items: child and baby furniture, nursing tables, baby walkers, toys, baby carriages, sport equipment for children, playground equipment and security equipment for children. The data were derived from the EHLASS (European Home and Leisure Accident Surveillance System) for 1998 and 1999 and covered a restricted population of Sweden (approximately 5 per cent). According to this register 182 mild brain injuries (concussions) were recorded following a fall, an accident or a blow to the head among children (0-4 years of age) during 1998 and 158 for 1999. Of those injuries, childcare products were the cause of the accident in 84 (46 per cent) and 76 (48 per cent) cases respectively for 1998 and 1999. The number of children admitted for hospital care was 68 (57/84) and 74 (56/76) per cent respectively. The home was the most common place of the accident and play and leisure activity were the most common activities. More than 50 per cent of these accidents took place during daytime. The product type that caused most accidents was nursery furniture and, in this category, the baby walker was the most dangerous. The product type that caused the second most frequent accidents was playground equipment.     

Risk markers of severe psychological violence against women: a WorldSAFE multi-country study

This study was an attempt to determine the prevalence and significant risk factors associated with severe psychological violence in 6 WorldSAFE sites. The respondents were 3975 women aged 15–49 years and residing in selected urban areas in Chile, Egypt, the Philippines and India. Using a standard instrument translated locally, psychological violence was measured using items indicating the following domains: verbal abuse, fear and separation. A woman who had experienced severe psychological violence had admitted that she had experienced any of the above-mentioned behaviors ‘3 or more times’ in her lifetime (lifetime prevalence) or with her current partner during the past 12 months (current prevalence). The results showed a lifetime prevalence of severe psychological violence ranging from 10.5% of women in Egypt to about 50% in Chile and Trivandrum, India. Verbal abuse was most common among the different behavioral indicators. A woman's mental health status and partner alcohol use were found to be the common significant risk factors. Recommendations were made to facilitate efforts to address severe psychological violence in developing countries.     

Environmental risk factors contributing to traffic accidents in children: a case-control study

The aim of this study is to identify environmental risk factors related to road accidents in children of Tehran. This case-control study was performed in 2013. The cases were injured pedestrians aged 5–15 who were admitted to major hospitals supervised by Tehran University of Medical Sciences. The sample size for the cases was 273 and for the control group was 546. For the completeness of the clusters, 7 extra persons in case (total = 280) and 14 persons (total = 560) in control group were included. The interference of confounding variables assessed through forward conditional logistic regression. Result shows occurrence of traffic accidents was significantly associate with the width of the alleys or (<5 m: OR = 8.4, 95% CI: 3.3–21.5; 5–8 m: OR = 4.7, 95% CI: 1.8–12.2), distance from home to school((<100 m: OR = 1.7, 95% CI: 1.0–2.8), existence of parking lot (OR = 1.5, 95% CI: 1.0–2.3), traffic congestion (OR = 4.1, 95% CI: 2.6–6.4), traffic speed (OR = 2.1, 95% CI: 1.3–3.2) and existence of pedestrian bridges(OR = 4.2, 95% CI: 2.6–6.8). In the light of the important role of environmental factors in the occurrence of child traffic accidents, alleviating structural risk factors in addition to education and enforcement need more systematic efforts and planning by policymakers and urban planners to attain pedestrian safety goals.     

Developing a glossary of terms for burden of injury studies

Objectives. To compile and publish a dictionary of terminology containing a set of terms representing concepts found in burden of injury studies. Methods. A systematic outline of the glossary was designed on the basis of the literature. The glossary was filled with concepts and terms brought up by experts in the field of burden of injury research. Decisions were made by experts from several European countries in the field of burden of injury research. Definitions are based on the international literature, existing glossaries, medical dictionaries and expert opinion. In group sessions, the experts decided on preferred terms/definitions, admitted terms/definitions, and refused terms/definitions. Results. The glossary consists of three parts: concepts in health economics, concepts in health status measurement and valuation, and concepts related to health care practice. The glossary contains about 140 terms and is publicly available via the Internet. Conclusions. The glossary fulfils a clear need for uniform terminology. New terms will be considered and assessed by a group of experts. In order to make the glossary more user-friendly, interactive software should be developed.     

Preventing falls in the elderly living in a deprived area: Evaluation of a community intervention

Statement of the Problem While greatly easing the shopping process for parents, transportation of children in shopping carts also represents a hazard for injuries. Effective accident prevention measures would therefore be desirable. Methods 137 shopping cart-related accidents, the 138 victims of which presented to an Austrian Pediatric Surgical Casualty Department over a period of nine years, were reviewed retrospectively by analysis of the patient charts and of 79 questionnaires returned, correctly filled in, by the family. Results The yearly number varied between 10 and 21 without a falling trend. While 43% of the children were 2 years of age or younger, 18% were older than 4. Three-quarters of the latter had been placed inside the trolley although the maximum permitted weight is 15 kg. Falls out of the trolley comprised two-thirds of all accidents, with the child standing up as the leading cause; these were mostly falls from the basket, followed in almost 20% of cases by toppling over of the entire shopping cart. The youngest children – almost all regularly placed in the integrated seat – were at a special risk for this kind of accident, which frequently occurred in the car park. Lessons learned from the accidents were limited almost exclusively to behavioral changes implemented by the parents. Current European Standards have obviously not taken the main accident mechanisms into account, even though these have repeatedly been described in the literature. Conclusion We believe that technical improvements in the present shopping cart design are desirable to reduce the risk of accidents. Our main suggestions include: solid child seats with integrated footrests, obligatory installation and use of safety belts, and construction of trolleys with a lower center of gravity and a broader wheel base.     

Child injury prevention in Vietnam: achievements and challenges

As with other South Asian countries, injury is becoming a leading cause of death and morbidity among children in Vietnam. In response to the increasing burden of child injury, government and non-government agencies in Vietnam have combined efforts during the last decade to develop and implement various child injury prevention strategies and programmes. This article provides, through a review of relevant documents and interviews with major stakeholders, an overview of these efforts and highlights major challenges to child injury prevention in the country. The findings point to notable achievements in terms of increasing awareness of injury facing children at all levels in the community and developing a sound injury prevention policy framework in a relatively short period of time. However, much needs to be done to implement necessary environmental and legislative changes, strengthen child injury surveillance and injury prevention research; and to improve access to health services. The insight into the experience of Vietnam could benefit other low- and middle-income countries with a high burden of child injury.     

Injuries in different socio-economic groups in Finland

Introduction. Suicides are a hidden and unrecognized epidemic in the Indian region, affecting predominantly younger age groups. Information on causative risk factors and mechanisms is not available in the country, which is crucial for designing intervention programmes.

Objectives. To identify and quantify risk factors for completed suicides in the city of Bangalore.

Methods. A case–control study was conducted with the families of 269 completed suicides and 269 living controls within the broader population of the city using psychological autopsy methods.

Results. The study has shown that several factors in the areas of family, marriage, education, occupation, general health, mental health and absence of protective factors contribute significantly for suicides. The cumulative and repetitive interaction of several factors in a complex manner results in suicides. The significant factors were presence of previous suicidal attempt in self (odds ratio (OR) = 42.62), interpersonal conflicts and marital disharmony with spouse (OR = 27.98), alcoholism in self (OR = 23.38), presence of a mental illness (OR = 11.07), sudden economic bankruptcy (OR = 7.1), domestic violence (OR = 6.82) and unemployment (OR = 6.15). Individuals completing suicides did not have a positive outlook towards life, problem-solving approaches and coping skills.

Conclusion. The observed findings are at variance with suicidal causation in the West in some areas operating in a different sociocultural and economic environment. The intervention strategies should include prioritized macro and micro level efforts aimed at individual, family and society.     

Epidemiology of yoga-related injuries in Canada from 1991 to 2010: a case series study

The aim is to describe the epidemiology of yoga injuries presenting to select Canadian emergency departments (EDs). Those who presented with a yoga injury to a Canadian ED participating in the Canadian Hospitals Injury Reporting and Prevention Program and had completed a data collection form between 1991 and 2010 were included. Demographic and injury characteristics were tabulated and injury profiles of children were compared to adults. Sixty-six individuals (48 female, 18 male) who sustained 67 injuries were included. The median age was 19 (intraquartile range: 13, 32) and 73% of individuals were injured after 2005 (p = 0.0003). Sprain was the most common injury (23/67, 34%) and the most common body region injured was the lower extremity (27/67, 42%). Significantly more children were injured while being instructed than adults (p = 0.003) but more adults required treatment (p = 0.023). Although yoga-related injuries presenting to an ED are not common, the number of injuries are increasing.     

Seasonal variations in injury rates in children: evidence from a 10-year study in the Veneto Region,Italy

The objective of this study was to investigate the long term trend of pediatric injuries in Veneto Region (North-East of Italy) over 10 years, evaluating if seasonality in injury hospitalisations exists. Regional data on hospital admissions during the period 2000–2009 were analysed. Injury was defined as any condition identified by the International Classification of Diseases, 9th edition, Clinical Modification (ICD-9-CM) codes 800–999, excluding late effects from injury (ICD-9-CM codes 905–909), and complications of surgical and medical care, not classified elsewhere (ICD-9-CM code 995-999) in the first diagnostic field. Cyclic trends in seasonality of injuries were tested with Nam test. Thirty-five thousand seven hundred and fifty-one hospitalisations due to an injury have been recorded. Significant seasonal variation in hospitalisations for injuries was observed, with a summer to winter ratio ranging from 1.8 for minor injuries to 2.0 for severe injuries (p <0.001). The observed pattern of increased admission in the summer months should guide resource planning and implementation of preventive strategies.     

Childhood and adolescent injuries in elementary schools in north-western Uganda: extent,risk and associated factors

Childhood injuries remain understudied in Uganda. The objective of this study was to determine the extent, nature and determinants of school-related childhood injury risk in north-western Uganda. A cohort of 1000 grade fives from 13 elementary schools was followed-up for one term. Survival and multi-level modelling techniques compared the risk rates across gender, schools and locations. Childhood injuries are common in north-western Uganda. Most of them occur during travel, breaks, practical classes and gardening, while walking, playing, learning and digging. Most injuries result from collisions with objects, sports and falls. Two-thirds of children receive first aid and hospital care. Times to injury were 72.1 and 192.9 person days (p = 0.0000). Gender differences in time to event were significant (p = 0.0091). Girls had better survival rates: cumulative prevalence of childhood injury was 36.1%; with significant gender differences (p = 0.007). Injury rate was 12.3/1000 person days, with a hazard ratio of 1.4. Compared to girls, boys had a 37% higher injury rate (p = 0.004). Rates varied among schools. Associated factors include sex and school. Rural–urban location and school differences do influence childhood injury risk. Childhood injuries are common: the risk is high, gender- and school-specific. Determinants include gender and school. Location and school contexts influence injury risk.     

Pillion riders' cloth related injuries and helmet wearing patterns: a study of Lahore,Pakistan

This study aims at investigating the burden and pattern of clothing related pillion riders' injuries and their helmet wearing pattern in Lahore, Pakistan. Data were collected for nine months (July 2013 to March 2014), reporting 13,248 motorcycle related injuries, out of which 8751 (66%) cases were related to the clothing related pillion riders' injuries. Out of these injuries 10.30% were severe injuries which can be prevented or reduced by proper safety measure, e.g. wearing helmet. It was also found that most of the fatalities were not wearing helmet. Injuries due to wearing of loose fitting clothes and absence of helmet are not uncommon in Pakistan and other underdeveloped parts of the world. Such accidents may be reduced by creating awareness and safety sense in the riders, where use of safe dress and helmet should be encouraged in order to avoid such fatal damages.     

Balance and agility training does not always decrease lower limb injury risks: a cluster-randomised controlled trial

The objective of this study was to examine the effects on lower limb injury rates of adding structured balance and agility exercises to the 80-day basic training programme of army recruits. A blocked (stratified), cluster-randomised controlled trial was employed, with one intervention group (IG) and one control group (CG), in which 732 male and 47 female army recruits from the Australian Army Recruit Training Centre participated through to analysis. The IG performed specified balance and agility exercises in addition to normal physical training. The incidence of lower limb injury during basic training was used to measure effect. Analysis, which adhered to recommendations for this type of trial, used a weighted paired t-test based on the empirical logistic transform of the crude event rates. The intervention had no statistically significant effect on lower limb injury incidence (RR = 1.25, 95% CI 0.97–1.53, 90% CI 1.04–1.47), on knee and ankle injury incidence (RR = 1.08, 95% CI 0.83–1.38), and on knee and ankle ligament injury incidence (RR = 0.98, 95% CI 0.64–1.47). We conclude that the intervention, implemented in this fashion, is possibly harmful, with our best estimate of effect being a 25% increase in lower limb injury incidence rates. This type of structured balance and agility training added to normal military recruit physical training did not significantly reduce lower limb, knee and ankle, or knee and ankle ligament injury rates. Caution needs to be used when adding elements to training programmes with the aim of reducing injury, as fatigue associated with the addition may actually raise injury risk.     

An epidemiological study of injury in mines: implications for safety promotion

This paper is intended to raise risk management as a topic for discussion among product safety professionals and discuss one particular key element of understanding risk. Risk management is an essential part of good product safety management, whether at the policy level or the implementation stage, and is relevant to all those involved in the development and use of standards, including regulators and suppliers. The risk management process involves measuring the risks at the initial stage, by looking at consequence (possible injury) and likelihood (of that injury occurring) which then gives us the ‘inherent risk.’ We then seek ways to treat the risks. A second assessment of the risks is subsequently done to establish the extent to which the treatment will address the problem (‘assessed risk’). In product safety, this means how dangerous is the product as it is and how effective will a measure be in reducing the risk. Communication is vital in this process. When standards are developed and policy adopted, the factors that are taken into consideration need to be properly documented. The rationales for decisions, i.e., what the hazard is and how it is treated by the product specification, should be recorded within the standard itself. In the absence of recorded reasons, assumptions are made and these may well be incorrect. This paper discusses this topic in some detail and provides illustrative examples.