Seasonal variation in fall-related emergency department visits by location of fall – United States, 2015

Introduction: In the United States, fall-related emergency department (ED) visits among older adults (age 65 and older) have increased over the past decade. Studies document seasonal variation in fall injuries in other countries, while research in the United States is inconclusive. The objectives of this study were to examine seasonal variation in older adult fall-related ED visits and explore if seasonal variation differs by the location of the fall (indoors vs. outdoors), age group, and sex of the faller. Methods: Fall-related ED visit data from the National Electronic Injury Surveillance System-All Injury Program were analyzed by season of the ED visit, location of the fall, and demographics for adults aged 65 years and older. Results: Total fall-related ED visits were higher during winter compared with other seasons. This seasonal variation was found only for falls occurring outdoors. Among outdoor falls, the variation was found among males and adults aged 65 to 74 years. The percentages of visits for weather-related outdoor falls were also higher among males and the 65–74 year age group. Conclusions: In 2015, there was a seasonal variation in fall-related ED visits in the United States. Weather-related slips and trips in winter may partially account for the seasonal variation. Practical Implications: These results can inform healthcare providers about the importance of screening all older adults for fall risk and help to identify specific patients at increased risk during winter. They may encourage community-based organizations serving older adults to increase fall prevention messaging during winter.     

CDC's research portfolio in older adult fall prevention: a review of progress, 1985-2005, and future research directions

PROBLEM: Falls are a leading cause of mortality and morbidity among adults age 65 and older. Population models predict steep increases in the 65 and older population bands in the next 10-15 years and in turn, public health is bracing for increased fall rates and the strain they place on health care systems and society. To assess progress in fall prevention, the Centers for Disease Control and Prevention conducted a research portfolio review to examine the quality, relevance, outcomes and successes of the CDC fall prevention program and its impact on public health. METHODS: A peer review panel was charged with reviewing 20 years of funded research and conducting a SWOT (strengths, weaknesses, opportunities, and threats) analysis for extramural and intramural research activities. Information was collected from grantees (via a survey instrument), staff were interviewed, and progress reports and products were reviewed and analyzed. RESULTS: CDC has invested over $24,900,000 in fall-related research and programs over 20 years. The portfolio has had positive impacts on research, policies and programs, increasing the public health injury prevention workforce, and delivering effective fall prevention programs. DISCUSSION: Public health agencies, practitioners, and policy makers recognize that while there are some evidence-based older adult fall prevention interventions available, many remain unused or are infeasible to implement. Specific recommendations across the public health model, include: additional research in gathering robust epidemiologic data on trends and patterns of fall-related injuries at all levels; researching risk factors by setting or sub-population; developing and testing innovative interventions; and engaging in translation and dissemination research on best practices to increase uptake and adoption of fall prevention strategies. CDC has responded to a number of suggestions from the portfolio review including: funding translation research of a proven Tai Chi fall intervention; beginning to address gaps in gender, ethnic, and racial differences in falls; and collaborating with partner organizations who share in CDC's mission to improve public health by preventing falls and reducing fall-related injuries. IMPACT ON INDUSTRY: Industry has an opportunity to develop more accessible and usable devices to reduce injury from falls (for example, hip protectors and force reducing flooring). By implementing effective, evidence-based interventions to prevent falls and reduce injuries from falls, significant decreases in health care costs can be expected.     

Nonfatal bathroom injuries among persons aged ≥15 years--United States, 2008

Problem

Information about where nonfatal unintentional injuries occur is limited, but bathrooms commonly are believed to be a hazardous location.

Methods

Data from a nationally representative sample of hospital emergency departments (ED) was used to quantify and characterize nonfatal unintentional bathroom injuries among people aged ≥ 15 years.

Results

In 2008, an estimated 234,094 nonfatal bathroom injuries were treated in EDs. Most injuries (81.1%) were caused by falls and 37.3% of injuries occurred when bathing, showering, or getting out of the tub or shower. Both injury and hospitalization rates increased with age.

Summary

These results suggest that bathrooms tend to be most hazardous for persons in the oldest age groups.

Impact on Industry

Bathroom injuries among all household members might be reduced by increasing awareness about potentially hazardous activities in the bathroom combined with simple environmental changes such as adding grab bars inside and outside the tub or shower.     

Implementing the evidence for preventing falls among community-dwelling older people: a systematic review

Problem and objective

The translation of the evidence-base for preventing falls among community-dwelling older people into practice has been limited. This study systematically reviewed and synthesised the effectiveness of methods to implement falls prevention programmes with this population.

Methods

Articles published between 1980 and May 2010 that evaluated the effects of an implementation strategy. No design restrictions were imposed. A narrative synthesis was undertaken.

Results

15 studies were identified. Interventions that involved the active training of healthcare professionals improved implementation. The evidence around changing the way people who fall are managed within primary care practices, and, layperson, peer or community delivered models was mixed.

Impact on industry

Translating the evidence-base into practice involves changing the attitudes and behaviours of older people, healthcare professionals and organisations. However, there is a need for further evaluation on how this can be best achieved.     

Preferred modes of travel among older adults: What factors affect the choice to walk instead of drive?

Introduction

There are many factors that influence older adults' travel choices. This paper explores the associations between mode of travel choice for a short trip and older adults' personal characteristics.

Methods

This study included 406 drivers over the age of 64 who were enrolled in a large integrated health plan in the United States between 1991 and 2001. Bivariate analyses and generalized linear modeling were used to examine associations between choosing to walk or drive and respondents' self-reported general health, physical and functional abilities, and confidence in walking and driving.

Results

Having more confidence in their ability to walk versus drive increased an older adult's likelihood of walking to make a short trip by about 20% (PR = 1.22; 95% CI: 1.06-1.40), and walking for exercise increased the likelihood by about 50% (PR = 1.53; 95% CI = 1.22-1.91). Reporting fair or poor health decreased the likelihood of walking, as did cutting down on the amount of driving due to a physical problem.

Discussion

Factors affecting a person's decision to walk for exercise may not be the same as those that influence their decision to walk as a mode of travel. It is important to understand the barriers to walking for exercise and walking for travel to develop strategies to help older adults meet both their exercise and mobility needs. Impact on Industry: Increasing walking over driving among older adults may require programs that increase confidence in walking and encourage walking for exercise.     

The injury problem among older adults: mortality, morbidity and costs

The Journal of Safety Research has partnered with the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, USA, to briefly report on some of the latest findings in the research community. This report is the seventh in a series of CDC articles.     

Falls among older adults--risk factors and prevention strategies

The Journal of Safety Research has partnered with the Injury Center at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, USA, to briefly report on some of the latest findings in the research community. This report is the third in a series of CDC articles. Look for other such articles in future issue of the Journal of Safety Research.     

Projections of hospitalised fall-related injury in NSW, Australia: impacts on the hospital and aged care sectors

Projections of the number, rate and cost of fall-related hospitalised injuries for individuals aged 65 years and older in New South Wales (NSW), Australia were estimated to 2051 for two scenarios: (1) demographic change only using 2008 admission rates; and (2) modelled change using negative binominal regression taking into account current trends in admission rates. Based on demographic change alone, the number and cost of fall injury hospitalisations among older people is expected to increase almost three-fold by 2051. Transfers to permanent residential aged care will also increase 3.2 fold. However, if the fall-related hospitalisation rate sustains its current trend, these increases are projected to be more than ten-fold by 2051. Even with demographic change alone, there will be a significant impact on the resources required to care for older people suffering a fall injury hospitalisation over the next forty years in NSW. The impact on the hospital and aged care sectors will be considerable unless significant improvements occur in the prevention and treatment of fall-related injury in older people.     

Individual difference factors in risky driving among older adults

INTRODUCTION: Motor-vehicle crashes kill roughly 4,500 American adults over the age of 75 annually. Among younger adults, one behavioral factor consistently linked to risky driving is personality, but this predictor has been overshadowed by research on cognitive, perceptual, and motor processes among older drivers. METHOD: In this study, a sample of 101 licensed drivers, all age 75 and over, were recruited to complete self-report measures on personality, temperament, and driving history. Participants also completed a virtual environment (VE) course designed to assess risk-taking driving behavior. State records of motor-vehicle crashes were collected. RESULTS: Results suggest both a sensation-seeking personality and an undercontrolled temperament are related to risky driving among older adults. Sensation-seeking was particularly related to history of violations and tickets, while temperamental control was more broadly related to a number of risky driving measures. Methodological and crash prevention issues are discussed.     

Translation of falls prevention knowledge into action in hospitals: what should be translated and how should it be done?

Introduction

Falls prevention evidence has changed and evolved over time with positive and negative studies revealing that a “one-size fits all” approach is not the solution. Care must be taken to critically appraise the evidence and the potential applicability of that evidence to the specific hospital setting.

Method

A narrative account of the evolution of research evidence in this field is first presented. How this evidence should be applied in clinical practice is challenging, with a lack of translational evidence for the hospital setting we draw on broader theory of translating knowledge to action.

Conclusions

The journey should begin with formation of a management and engagement committee. A review of existing practices and the difference between existing practice and evidence-based practice should be undertaken to identify the “evidence-practice gap.” Engagement with staff is recommended to inform a plan for practice change. Plans for resourcing, targeting, and evaluating these strategies should also be undertaken.

Impact on Industry

This paper will assist hospitals to identify and implement evidence based falls prevention strategies leading to an improvement in patient safety.     

Occupational accidents with ladders in Spain: Risk factors

Introduction

Occupational accidents suffered by workers in Spain when using ladders were analyzed over a six year period from 2003-2008, during which the total of notified ladder-related accidents amounted to 21,725. Method: Different accident-related factors were identified for the purpose of developing a pattern of those factors that had the greatest influence on the seriousness and the fatality of such accidents. Thus, a series of variables were examined such as age and length of service of the injured worker, firm size, the work sector, the injury suffered, and the part of the body that was injured. Since falls is the most frequent and most serious of ladder related occupational accidents, a special analysis of falls was performed. Results: The findings showed that the seriousness of ladder-related accidents increased with the age of the injured worker. Likewise, accidents at places other than the usual workplace were more serious and registered higher fatalities than those that occurred at the usual place of work. Conclusions: The analysis of falls from ladders established that accidents in smaller-sized firms were of greater seriousness and involved more fatalities than those in larger-sized firms. The investigation also underlined the need for stricter compliance with preliminary safety assessments when working with ladders.     

Validating an evidence-based, self-rated fall risk questionnaire (FRQ) for older adults

Background

Falls are a common, serious, and often unrecognized problem facing older adults. The objective of this study was to provide an initial clinical and statistical validation for a public health strategy of fall risk self-assessment by older adults using a Fall Risk Questionnaire (FRQ).

Methods

Adults age 65 + (n = 40) were recruited at a Los Angeles Veterans Affairs (VA) medical facility and at a local assisted living facility. Participants completed the FRQ self-assessment and results were compared to a “gold standard” of a clinical evaluation of risks using the American/British Geriatrics Society guidelines to assess independent predictors of falls: history of previous falls, fear of falling, gait/balance, muscle weakness, incontinence, sensation and proprioception, depression, vision, and medications. For the comparison, we used an iterative statistical approach, weighing items based on relative risk.

Results

There was strong agreement between the FRQ and clinical evaluation (kappa = .875, p < .0001). Individual item kappa values ranged from .305-.832. After dropping one FRQ item (vision risk) because of inadequate agreement with the clinical evaluation (kappa = .139, p = .321), the final FRQ had good concurrent validity.

Conclusions

The FRQ goes beyond existing screening tools in that it is based on both evidence and clinical acceptability and has been initially validated with clinical examination data. A larger validation with longitudinal follow-up should determine the actual strength of the FRQ in predicting future falls.     

Dogs and cats as environmental fall hazards

Problem

Falls are the leading cause of non-fatal injuries in the United States. This study assessed the prevalence of fall injuries associated with cats and dogs in the United States and describes the types of injuries sustained, the location, activity, and circumstances under which they occurred.

Methods

Data were from a nationally representative sample of emergency department visits from January 1, 2001 to December 31, 2006, available through the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP).

Results

Based on 7,456 cases, an estimated 86,629 fall injuries each year were associated with cats and dogs, for an injury rate of 29.7. There were 7.5 times as many injuries involving dogs as cats and females were 2.1 times more likely to be injured than males. Injury rates were highest among people aged ≥ 75, but pets were a fall hazard for all ages. Fractures and contusions or abrasions were the most common injuries; the highest rates were for injuries to the extremities. About 66.4% of falls associated with cats and 31.3 % of falls associated with dogs were caused by falling or tripping over the pet. An additional 21.2% of falls related to dogs were caused by being pushed or pulled.

Summary

Although pets were associated with fall injuries, this risk can be reduced by increasing public awareness about situations that can lead to falls, such as dog-walking and chasing pets, and by calling attention to the importance of obedience training for dogs to minimize hazardous behaviors such as pulling and pushing.

Impact on industry

Fall injuries represent a burden to individuals, our society and our health care system. Increasing public awareness and implementing basic prevention strategies can help people of all ages enjoy their pets, reduce their chances of experiencing pet-related falls, and lessen the impact of fall injuries on our health care system.     

Falls from buildings and other fixed structures in New Zealand

Epidemiologic studies of falls from buildings and other fixed structures have historically focused on the urban environment. In this study, national injury mortality and hospitalisation data, supplemented by Coroner's investigation reports, were used to describe the epidemiology of such falls across an entire nation, New Zealand. The overall death rate was 0.30 per 100,000 persons per year. Ninety-three percent of cases were older than 14 years of age. Sixty-nine percent of falls were from buildings, with 31% from other structures. Sixty-seven percent of fatal falls were from a height of 10 meters or less. The incidence rate of hospitalisations was 21.4, with the highest rates among those aged 0–9. Fifty-five percent of non-fatal falls were from buildings, with 45% from other structures. National measures to prevent falls from structures should extend to a wide variety of structures and environments. Data presented on the age distributions of falls from different types of structures and structural components (windows, etc.) provide indicators for fall prevention.     

Ecology of player-to-player contact in boys' youth soccer play

INTRODUCTION: Youth soccer (football) injuries occur for a wide range of reasons, but the most frequent cause of injury is via player-to-player contact. This study was designed to study the ecology of collisions between players during youth soccer play. METHOD: Six teams of 11- and 12-year-old male players were followed over the course of a full season. Games were videotaped and reviewed to address three primary questions: how frequently do player-to-player collisions occur; when and where on the field do those collisions occur; and what is the rate of falls and injuries as a result of player-to-player contact. RESULTS: A total of 1,279 player-to-player collisions was observed, or an average of 65.59 collisions per game. Nearly half of the observed collisions resulted in one or both players falling to the ground, and about one-tenth resulted in the referee calling a foul, but very few of the collisions (less than 1%) resulted in an injury. Collisions occurred relatively consistently throughout the games, no matter what the score was. They occurred most frequently in the midfield area, when the ball was on or near the ground, and when players were attempting to retrieve a loose, uncontrolled ball. CONCLUSIONS: Results are discussed with respect to implications for injury prevention.