Injuries among the elderly : study of fatal and non-fatal injury events
Abstract: In view of the expected increase in the proportion of elderly in the population in most western countries, we studied injuries among the elderly (>60 years) by investigating hospital-treated injuries in inpatients and outpatients, and fatal injuries.One-year Hospital Injury Data - Even though the elderly made up only 15% of the injured in one year, they accounted for 42% of the total cost of trauma medical care, showing that injuries among the elderly place a disproportional burden on the health care system. The mean medical care cost increased significantly from the age of 60 years. Serious injuries (MAIS>3) in the elderly cost almost 2.5 times more than those in the younger group (<60 years).Study of 1,313 injury events in 1,268 elderly showed annual injury, fracture, and mortality rates per 1,000 elderly population of 57, 31, and 0.6, respectively. Almost half were injured in the home environment, and 23% in the traffic environment. Most of the severe and critical injuries (MAIS>4) occurred in the traffic environment. Injury rate, severity of injuries, fractures, and the duration of hospitalization increased with age. Almost half of the injuries were fractures; most common were wrist and hip fractures. Women had a higher injury rate, more severe injuries, and longer duration in hospitalization than men had.Study of 621 injury events in 600 elderly injured in the home environment, showed annual injury and fracture rates of 30 and 15 per 1,000 elderly home population, respectively. Injuries were grouped into fall injuries (76%) and non-fall injuries (24%). The fall injury incidence was higher in women than in men. Most falls occurred indoors. Environmental factors played a role in half of the fall injuries, and intrinsic factors in at least one fifth. Intrinsic factors in falls became increasingly important with advancing age. Non-fall injuries were mostly sustained in woodworking. Fall injuries were of a greater severity and accounted for 80% of the cost of medical care of elderly in the home environment.Study of 298 injury events in 297 elderly injured in the traffic environment, showed that pedestrian falls accounted for 52% of the injuries, and vehicle-related events for 44%. The main groups in the vehicle-related injury category were bicyclists (48%), car occupants (34%), and pedestrians (4%). Two thirds of the pedestrian falls involved slipping on ice/snow. Ice/snow-related injuries (all categories) accounted for 37% of the total cost of all injuries in the elderly in the traffic environment. Vehicle-related crashes resulted in the most severe and critical injuries and the most fatalities, and cost (total and mean) more than pedestrian falls.Fatal Injury Data from Northern Sweden - Study of 379 elderly injured in the traffic environment in a ten-year period, showed that the car occupants (43%) made up the largest category followed by pedestrians (28%), bicyclists (15%), and two-wheel-motor-vehicle riders (8%), but the risk of fatal injury per unit distance travelled was highest for pedestrians and bicyclists. Males had double the death rate as females. Most car occupants were killed in multivehicle crashes, mostly in the daylight, and at intersections. Ice/snow was the major (31%) precrash factor. One quarter of pedestrians were injured at pedestrian crossings, and half of them during darkness. One in six pedestrians was under the influence of alcohol. All pedestrians and bicyclists were injured in collisions with motor vehicles and most were injured at intersections. Pedestrians and bicyclists had more serious head injuries than chest injuries.Study of 514 car drivers (>18 years) injured in a 13-year-period, showed that fatalities per unit distance, and per licensed driver were highest for the >70-year-old and 18-19-year-old drivers. Elderly (>60 year old) and <25 year old drivers had similar fatality frequencies. The older drivers (>60 years) initiated the crash more often than younger (<60 years) ones. Fatal head injuries decreased whilst chest injuries increased with age. The older drivers were more likely to die from post-trauma complications than younger ones.In a study of role of disease in 480 fatally injured drivers (>18 years) who died within three days of the crash, a grading system was developed to assess the probability of contribution of medical intrinsic factors (MIF) to the crash. Almost one quarter of the drivers were found to have MIF. Drivers with MIF were more often at fault than those without. Medical intrinsic factors were probably an underlying cause in 1 of 17 fatal crashes in all ages, and 1 of 5 fatal crashes in the elderly; in 4% of the elderly the probability was strong.A "passive automatic" approach which does not require any action on the part of the elderly, is to be recommended when improving safety in the home and in the traffic environments. The elderly drivers can be regarded as the "miner's canary" to indicate which passive safety improvements are needed in the traffic environment. In view of the expected population trends, it is important that authorities and public health workers accept the challenge to continue and intensify the injury preventive work for the elderly.
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