Falls prevention through community intervention – A Swedish example

In order to control and reduce fall-related injuries, particularly among women over the age of 55, a safety management and falls prevention campaign was structured and implemented during 2006–2007 in the small industrial town of Södertälje, Sweden. A local campaign was launched to recruit falls prevention agents, to inform key target groups in the local community, and to educate older people about fall risks. A survey showed that the campaign had a greater impact among professionals with a special relation to fall risk than among the general population. Medical records were used in the evaluation of the outcomes. The results show that between 2005 and 2007 there was a drop of fractures related to falls in the council: an overall drop of 16.7% in the population; among men 55 or older a drop of 12%, among women 55 or older a drop of 15%, among home-dwelling women 55 or older a drop of 5.7% and among women in special accommodation a drop of 44.4%. Expressed in terms of years lost to disability (YLD), the overall drop in hip fractures treated at the local hospital between 2005 and 2007 was 48%. A comparison with National medical records for the same period shows the drop for the intervention area to be much larger than that for Sweden as a whole, although the effect was not statistically significant. The study demonstrates the advantages of a broad, community-based approach to injury prevention.     

Using the RE-AIM framework to translate a research-based falls prevention intervention into a community-based program: lessons learned

Problem

Exercise-based research interventions demonstrate reduced risk and rates of falls for community dwelling older adults; however, little is known about effective mechanisms for the translation, implementation, and maintenance of these interventions in community settings.

Method

The RE-AIM framework was used to assess the translatability of an effective exercise-based research intervention in a community setting. Questions included: Reach — Would the target population attend? Effectiveness — What was the adherence and compliance to the program? Were there individual improvements in falls risk factors? Adoption: Would staff at the center adopt the program and offer it past the funding period? Implementation — What adaptations, including optimal frequency and duration, should be made to meet the community needs, still adhere to core elements and achieve similar outcomes? Maintenance — Would the program be sustained by our community partners?

Discussion

The process of translating a controlled research intervention targeting older adults at risk of falls into a community setting was challenging. Licensed professionals developed the infrastructure to safely and effectively deliver the program. The end product was highly appealing program to our target audience, resulted in improved outcomes and was successfully adopted and maintained by the community partner.

Summary

Partnerships between community and healthcare providers are key to successful implementation of falls prevention interventions. Lessons learned from this experience can be applied to the translation of future exercise-based falls prevention interventions.     

Winter storm-related injuries in Oklahoma, January 2007

Introduction

A January 2007 ice storm occurred in Oklahoma, causing power outages and hazardous travel conditions. The objective of this investigation was to describe the nature of winter storm-related injuries among Oklahoma residents, to determine populations at risk, and to inform prevention-planning personnel.

Methods

Winter storm-related injuries were a temporarily reportable condition; all acute-care hospitals and the state medical examiner logged storm-related injuries and deaths during January 12 − 30, 2007. Medical records were retrospectively abstracted.Risk of injury was described by demographic group, injury type, and mechanism.

Results

Among 6,047 persons experiencing winter storm-related injuries, 74% were injured in falls, 13% in motor-vehicle collisions (MVCs), 8% while sledding, 1% by unintentional carbon monoxide poisoning, 1% in cleanup activities, and 3% by other mechanisms. Median age of injured persons was 39 years. Persons aged ≥ 40 years were 1.4 times more likely to experience falls as the cause of injury than those aged < 40 years, and falls were twice as likely as other mechanisms to cause fractures among persons aged ≥ 40 years. Injured persons aged < 40 years were 2.2 times more likely to experience MVC-related injuries, and 19 times more likely to experience sledding-related injuries than persons aged ≥ 40 years.

Conclusions

Younger persons were more likely injured in MVCs and sledding incidents, whereas older persons were more likely to experience falls and fractures.

Impact on industry

Prevention messages for winter storm-related injuries should target winter-driving safety tips to younger adults and precautions regarding falls to older adults.     

Fall-related fracture trends among elderly in Sweden – exploring transitions among hospitalized cases

ProblemFall-related injuries have been a cause of worry during the end of the 20th century with increasing trends among the elderly.MethodUsing data from the Swedish National Patient Register (NPR) based on hospital admissions, this study explores the trends in fall-related fractures between 1998 and 2010.ResultsThe data shows a decreasing trend in fall-related fractures in all age- and sex-specific groups apart from men 80 years and above. While hip fracture incidence rates decreased in all age- and sex-specific groups, both central fractures and upper extremity fractures have increased in all age- and sex-specific groups apart from women 65–79 years. Lower extremity fractures have increased in the older age groups and decreased in the younger. Discussion: The differences found between the groups of fractures and by age- and sex-specific groups indicate a possible transition where more serious fractures are decreasing while less serious fractures increase among hospitalized cases.SummaryPerhaps due to a focus on hip fracture prevention, this study shows that while the incidence rate of hospitalized hip fractures has decreased, other fall-related hospitalized fractures have increased.Impact on industryPotentially, this could be indicative of a healthier younger elderly, coupled with a frailer older elderly requiring more comprehensive healthcare also for less serious injuries. Further research is needed to confirm our results.     

Fall-related injuries for three ages groups – Analysis of Swedish registry data 1999–2013

Introduction: The objective of this study was to analyze which factors (including factors pertaining to the individual, the household, and the local area) increase the risk of fall injuries for the three age groups with the highest risk for fall injuries in Sweden. Method: The study combined longitudinal data covering the period 1999–2013 from several different official registries from Statistics Sweden as well as from the Swedish health care system and fitted the models to data using mixed model regressions. Results: Three age groups had a markedly heightened risk for fall injuries: 1–3-year olds, 12–14 year olds, and the elderly (65+). The home was the most common location for fall injuries, as about 40% of all fall injuries occur in the home. Only for the elderly strong predictors for fall injuries were found, and these were: age, single household, and special housing. Conclusions: There is preventive potential in the special residences for the elderly and disabled. People living in these special residences make up a strongly selected group that needs extra safe environments. Our findings indicate that their needs are currently not meet. Practical applications: Design of special residences for the elderly and disabled should aim at reducing the consequences of falling.     

Gender aspects of work-related injuries in a Swedish municipality

The purpose of this study was to investigate gender aspects of work-related injuries in a Swedish municipality (population 41,000). All unintentional injuries treated at in- and out-patient facilities were recorded during a period of 1 year. The work-related injuries were mapped out in more detail with the help of standardized and structured surveys via telephone interviews and hospital records. The rate of work-related injuries among the gainfully employed was 33 per 1000. Males were observed to suffer more work-related injuries than females (46 compared to 12 per 1000 gainfully employed persons), and there were gender differences with regard to work-related injuries and injury event patterns. Young men showed the highest rate of injuries. Injuries caused during machine operation were the most common for both males and females, amounting to almost one quarter of all injuries. Injuries caused by falls were most common amongst females in the age groups 15–24 (25%) and 45–64 (28%). More attention should be given to gender aspects of work-related injuries and their prevention.     

Unintentional injuries treated in hospital emergency departments among persons aged 65 years and older,United States, 2006–2011

IntroductionWith the aging of the United States population, unintentional injuries among older adults, and especially falls-related injuries, are an increasing public health concern.MethodsWe analyzed emergency department (ED) data from the Nationwide Emergency Department Sample, 2006–2011. We examined unintentional injury trends by 5-year age groups, sex, mechanism, body region, discharge disposition, and primary payer. For 2011, we estimated the medical costs of unintentional injury and the distribution of primary payers, plus rates by injury mechanisms and body regions injured by 5-year age groups.ResultsFrom 2006 to 2011, the age-adjusted annual rate of unintentional injury-related ED visits among persons aged ≥ 65 years increased significantly from 7987 to 8163, per 100,000 population. In 2011, 65% of injuries were due to falls. Rates for fall-related injury ED visits increased with age and the highest rate was among those aged ≥ 100. Each year, about 85% of unintentional injury-related ED visits in this population were expected to be paid by Medicare. In 2011, the estimated lifetime medical cost of unintentional injury-related ED visits among those aged ≥ 65 years was $40 billion.ConclusionIncreasing rates of ED-treated unintentional injuries, driven mainly by falls among older adults, will challenge our health care system and increase the economic burden on our society. Prevention efforts to reduce falls and resulting injuries among adults aged ≥ 65 years have the potential to increase well-being and reduce health care spending, especially the costs covered by Medicare.Practical applicationsWith the aging of the U.S. population, unintentional injuries, and especially fall-related injuries, will present a growing challenge to our health care system as well as an increasing economic burden. To counteract this trend, we must implement effective public health strategies, such as increasing knowledge about fall risk factors and broadly disseminating evidence-based injury and fall prevention programs in both clinical and community settings.     

Modeling using dynamic variables – An approach for the design of loss prevention programs

Records from The National Safety Council [National Safety Council, 2007. Safety Intervention Evaluation: A Systematic Approach. <http://www.acgih.org/events/ControlBand/Thomas_SafetyIntervention.pdf> (accessed 10.01.07)] have shown that in 2004 alone, on-the-job injuries to workers constituted 35% of total recorded injuries in the United States. This generated an associated cost of about $142.2 billion. Unfortunately, the safety intervention programs enforced at work places to mitigate such losses are driven mainly by intuition and experience of involved safety personnel. This paper details implementing a computer program to furnish safety personnel with an empirical basis for designing loss prevention programs based on historical safety data. The computer tool is driven by a dynamic mathematical model which adapts itself to variations in data patterns and explains the correlation between historical incident rates and corresponding resources committed to interventions. This study empowers the industry with a tool that is capable of forming the core of optimizing valuable human resource allocation in safety program designs.     

Epidemiology and patterns of facial fractures due to road traffic accidents in Taiwan: A 15-year retrospective study

Objective: The facial region is a commonly fractured site, but the etiology varies widely by country and geographic region. To date, there are no population-based studies of facial fractures in Taiwan.

Methods: We conducted a retrospective study of patients diagnosed with facial fracture and registered in the National Health Insurance Research Database of Taiwan between 1997 and 2011. The epidemiological characteristics of this cohort were analyzed, including the etiology, fracture site, associated injuries, and sex and age distributions.

Results: A total of 6,013 cases were identified that involved facial fractures. Most patients were male (69.8%), aged 18–29 years (35.8%), and had fractures caused by road traffic accidents (RTAs; 55.2%), particularly motorcycle accidents (31.5%). Falls increased in frequency with advancing age, reaching 23.9% among the elderly (age > 65 years). The most common sites of involvement were the malar and maxillary bones (54.0%), but nasal bone fractures were more common among those younger than 18 years.

Conclusion: Most facial injuries in Taiwan occur in young males and typically result from RTAs, particularly involving motorcycles. However, with increasing age, there is an increase in the proportion of facial injuries due to falls.     

Preventing fall-from-height injuries in construction: Effectiveness of a regulatory training standard

Introduction: A regulatory training standard for construction workers using fall protection equipment became mandatory in 2015 in the province of Ontario, Canada. By the end of the transition period in 2017, 418,000 workers had been trained to the new standard. Two primary research questions were posed: (1) To what extent does the WAH training affect practices at the worksite? and (2) Has there been a change in the incidence of fall-from-height injuries coincident with the introduction of the WAH Training Standard? Materials and methods: A longitudinal survey of 633 learners was conducted in 2017 at one-, four- and seven-week post-training. A quasi-experiment estimated the incidence of lost-time injuries attributed to falls from heights in 2017 compared to 2012–2014 for a census of construction workers insured for work disability in Ontario, Canada. Results: Learners self-reported substantial increases in knowledge of and improvements in safe work practices when working at heights. The incidence rate of lost-time claim injuries attributed to falls targeted by the training declined by 19.6% (95% CI: 10.7, −27.6), compared to corresponding declines of 2.1% (95% CI: −6.3, 9.9) for other fall injuries and 7.2% (95% CI: 1.8, 12.3) for non-fall traumatic injuries. The observed decline was largest among the smallest employers (<5 full-time equivalent employees). Conclusion: The evaluation findings provide consistent support for a conclusion that the mandatory training standard was effective in reducing the incidence of injuries targeted by the training. However, the effects were modest and did not eliminate the problem. Practical application: A mandatory training standard should be considered as one approach to preventing traumatic injuries. However, other approaches higher in the hierarchy of risk controls should also be considered.     

The National Falls Free™ Initiative, working collaboratively to affect change

Introduction

Since 2004 the National Council on Aging (NCOA) has been working in collaboration with a growing number of national, state, and local organizations through the Falls Free^© Initiative to address the growing public health issue of falls and fall-related injuries among older adults. Through collaborative leadership, evidence-based interventions, practical lifestyle adjustments, and community partnerships we are working to reduce the number of older adult falls.

Impact on industry

The many activities of the national and state coalitions have brought recognition to the issue of fall prevention, education, and training to providers and greater investment in programs and services resulting in tremendous momentum and community activism. While we have yet to realize an impact on rates of falls, this strategic investment in building the infrastructure needed to affect change is the first step toward reducing the growing number of falls among older adults.     

Occupational road trauma and permanent medical impairment

Medically impairing occupational injuries sustained in traffic in Sweden were analysed. More than half of the cases with a permanent medical impairment were caused by minor injuries. Soft tissue injuries to the neck (whiplash injuries) made up nearly half of all permanently impairing injuries, and half of these were caused by rear-end collisions. As a final result, just over one third (37%) of the total group had a permanent decreased work capacity, or needed to change jobs because of residual problems from their injuries. Professional drivers had the highest injury incidence per employed and they accounted for 28% of the total number of permanent impairment cases, and for 43% of the fatalities. Professional drivers also had a higher percentage of serious injuries and severe permanent impairments than other occupational groups. This might be associated with the low use of safety belts (16%) compared to other occupational groups, where usage was 4–5 times higher. This occupational injury problem ought to be handled in the same way as other occupational safety problems, i.e. protective equipment in a vehicle should be used and the use of safe vehicles should be encouraged.     

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.     

Two-stage biodegradation coupled with ultrafiltration for treatment of municipal landfill leachate

The municipal landfill leachate was treated in a hydrolysis–acidification reactor (HAR)/aerobic bio-contact oxidation reactor (ABOR) following a pretreatment with ultrafiltration (UF) membrane. Experiments were conducted continuously for 44 days at a constant flow rate of 20 l d⁻¹ and organic loading rates (OLRs) from 0.75 to 1.5 kgCOD m⁻³ per day. The results showed that COD of the leachate steadily decreased from 20,015 mg l⁻¹ to less than 3000 mg l⁻¹, and NH₄-N decreased from 368.6 mg l⁻¹ to 259.3 mg l⁻¹ in the UF process. The COD and NH₄-N removal efficiency of HAR was 56.7% and 27.7%, and that of ABOR was 94.6% and 86.7%, respectively. The total COD and NH₄-N removal efficiency reached 99.6% and 93.2%, respectively. UF and HAR played a critical role in raising the biodegradability of the landfill leachate, while ABOR had an important function on removing the dissolved NH₄-N in leachate.     

Improved VOC bioremediation using a fluidized bed peat bioreactor

A gas–solid fluidized bed bioreactor was successfully used to treat air contaminated with a volatile organic compound (VOC). A bioreactor containing both a fluidized and packed bed of moist peat granules removed ethanol, a representative VOC, from an air stream. The fluidized bed operation mode of the bioreactor outperformed the packed bed mode. The maximum elimination capacity (EC) of ethanol in the fluidized mode was 1520 g m⁻³ h⁻¹, with removal efficiencies ranging between 45 and 100%, at loadings up to 3400 g m⁻³ h⁻¹. Maximum EC was 530 g m⁻³ h⁻¹ in the packed bed mode. Removal efficiency in the fluidized bioreactor was best at the lowest velocity, where the bubbling bed fluidization regime predominated. As gas velocity increased, the size and amount of large bubbles (slugs) increased and removal efficiency decreased while elimination capacity increased.     

Non-occupational injuries caused by transport packaging: Residential and retail hazards

BackgroundBackground: Pallets are key components of domestic supply chains, and yet present unique hazards when used by homeowners and retailers for unintended uses. No previous works have investigated non-occupational injuries that occur due to unintentional contact with pallets. This study sought to describe the incidence and epidemiology of non-occupational pallet-related injuries as seen in United States emergency departments (EDs). Method: The National Electronic Injury Surveillance System database was used to derive national, weighted estimates of pallet-related injuries by age, sex, injured body part, and location where injury occurred. Data for the years 2014 to 2018 were analyzed with all relevant narratives reviewed. Results: From 2014 to 2018, there were an estimated 30,493 persons who visited an ED for a pallet-related injury. The yearly incidence of pallet injuries rose during this period. The 35–44 age group (n = 5,481) was most likely to be injured, but about 3,000 children and youth under 18 years of age were injured and more than 4,000 persons 65 years of age or older suffered injuries. The elderly were especially likely to suffer injuries from slip, trip and fall incidents. The lower extremities were the most commonly injured body parts. An estimated 3,964 persons, accounting for approximately 14% of all pallet-related injuries, were treated for injuries incurred while at a retail establishment. African Americans, Hispanics, and the elderly appeared to be disproportionately more likely to have pallet-related injuries in retail locations. Conclusions: Non-occupational pallet-related injuries affect a wide range of patients and cause a variety of injuries, with the elderly being especially vulnerable to tripping incidents. Retailer prevention strategies should focus on the misuse of pallets for merchandising purposes. Industry should maintain control of pallets so they are not used for unintended purposes. Practical applications: Retailers should limit the use of pallets for floor-level merchandising purposes and remove pallets from customer-facing locations where unintentional contact could occur. Owners of pallets should maintain them in a controlled supply chain so that they don’t leak out into the hands of homeowners. Policy-makers should educate the public about the dangers of used pallets.     

The Merseyside Accident Information Model (MAIM) can reveal components of accidents that lead to attendance at fracture clinics and cause disability: a new approach to accident prevention

The objectives of this study were to identify components of accidents that cause the most disability and to discover the principal sources of injuries treated in the fracture clinics. Patients attending fracture clinics of the Royal Liverpool University Hospital were interviewed using a portable computer-based questionnaire, the Merseyside Accident Information Model (MAIM). Patients were followed up by telephone interview or letter to enquire about disability continuing after discharge. Disability was measured by the pre-accident to post-discharge changes in scores for 11 normal functions. Of the 1326 patients interviewed, 900 (68%) were successfully followed up and 37% reported disability after discharge. First events ‘tripping’, ‘slipping’ and ‘other underfoot events’ accounted for 433 patients (194 reporting disability), and ‘collapsed/fainted — no other event' for 66 patients (27 reporting disability). Activities at the time of accident most frequently associated with disability involved moving about on foot. Among first event objects, ground surfaces and underfoot hazards were reported in 35%. Sources of injuries included underfoot accidents (48%), sport (13%), and transport accidents (12%.). Underfoot accidents contributed to 58% of patients reporting disability, sport 6% and transport accidents 11%. Underfoot accidents together with ‘collapsed/fainted — no other event’ accounted for 79% of female patients reporting disability and 50% of men. Such data could be used for cost-effective targeting of preventative measures, and to study the effectiveness of accident prevention initiatives.     

Fatal occupational injuries in Jordan during the period 1980 through 1993

All fatal occupational injuries compensated by the Social Security Corporation (SSC) in Jordan during the period 1980–1993 were studied. Variables considered in the analysis included gender, age, nationality, occupation, salary, cause of injury, body part injured and cause of death. The overall fatality rate, of the 705 cases reviewed, was 25.5/100,000/year. The majority (98%) of fatalities were males. The risk of fatal injuries increased with age. Workers over 55 years, had the highest annual fatality rate (37.8). Immigrant workers had a higher fatality rate (32.26) than Jordanians (23.95). Unskilled workers constituted 58.3% of decedents and professionals had the highest fatality rate (52.9). Transportation sector had the highest fatality rate (122.4) followed by construction (50.6). Over the study period, fatality rates tended to decrease significantly in manufacturing, construction and trade economic sectors while no such trend was established by transportation, agriculture and services sectors. The leading causes of fatal injuries were motor-vehicle related accidents (63.0%) and fall of persons (11.1%). Head was the body part most injured and was involved in 46.6% of all deaths. Haemorrhage was the main reported cause of death (24.5%). It is concluded that intervention measures targeting specific occupations (transportation and construction) and causes of fatalities such as motor-vehicle incidents are needed.