Anne Reimers

Falls and fall-related injuries among the elderly: a survey of residential-care facilities in a Swedish municipality

Injurious falls among the elderly are an increasing public-health problem in Sweden. One group particularly vulnerable to falls consists of elderly people living in residential-care facilities. The purpose of this study was to investigate the extent to which falls lead to injury within a defined population of elderly people in institutionalized care. All the elderly persons living in residential-care facilities in an urban Swedish municipality during the year 1997 (n = 469 institutional places). Falls and fall-related injuries were registered over a one-year period. Data were gathered by personnel at the time of the falls, using a form specifically designed for surveillance purposes. Of the 865 falls reported during the study period, 375 were among men, with an average age of 82 years, and 490 among women, with an average age of 85 years. Men were subject to falling to a greater extent than women. The most common location was the individuals own bedroom. Injuries were incurred in approximately one in four falls, and the head was the body part most frequently injured. Only 24 falls (2.8%) resulted in a fracture, of which 18 were hip fractures. Although elderly people living in residential-care facilities fall fairly often, serious injuries, in the form of fractures, are incurred to a relatively limited extent.

Hip fractures among older people: do marital status and type of residence matter?

This study analysed the extent to which civil status and type of residence affect the risk of elderly people sustaining a hip fracture. The study population consisted of all residents, aged 65 years or older, living in Stockholm County in Sweden between the years 1993 and 1995 (about 250,000 in total). Cases of hip fractures in the Countys outpatient register (1993-1995) were linked to national registers, enabling injured people to be attributed a marital status (during year of injury), and also a size of dwelling and form of residential entitlement (in 1990). Gender-specific injury rates for three age groups were computed, as were age-standardized odds ratios (ORs) by gender for each variable of interest. As expected, hip fractures were found to rise with age among both men and women, and the risk of women sustaining such injuries was higher than that of men for all age groups. The proportion of injured men and women was higher among the unmarried than the married, and the majority of the injured were in rented accommodation (in all three age groups). The age-standardized ORs showed that the risk of hip fracture was substantially affected by civil (marital) status, but form of residential entitlement and size of dwelling did not affect the risk to any remarkable extent. The study demonstrates that being unmarried increases the risk of hip fracture among older men and women. This suggests that elderly unpartnered people may have a different daily-life pattern and may be in poorer health, both of which may be associated with a diminished social network.

Neighborhood social composition and injury risks among pre-adolescent and adolescent boys and girls. a study in Stockholm metropolitan

The study investigates the extent to which social and socioeconomic characteristics of a population within a particular living area influence injury risks among young people. The study group comprised pre-adolescent and adolescent boys and girls aged 10-19 living in the Stockholm metropolitan area in Sweden over the three-year period 2000--2002 (about 185,000 subjects each year). Area comparisons were made at parish level (96 parishes) based on three compositional indexes derived from a factor analysis of sixteen population attributes. Thereafter, each factor was transformed into an additive index and divided into three levels. Diagnosis-specific injury risks were then measured by index, considering injury causes with documented social differences (five for boys and three for girls). Injuries resulting in at least one night of hospitalization during the period 2000--2002 were considered. Three main dimensions with regard to the social fabric of the Stockholm metropolitan area were identified: socioeconomic precariousness and ethnic concentration (Factor 1), educational and financial assets (Factor 2), and concentration of well-off citizens of Nordic origin (Factor 3). Lower levels of socioeconomic precariousness and ethnic concentration showed a protective effect on boys in the cases of traffic and sports-related injuries, but an aggravating one in the cases of falls on the same level and violence-related injuries. Level of educational and financial assets did not impact on falls on the same level among boys, but increased the risk of such injuries among girls. Increased risks of traffic-related injuries among boys and of falls on the same level among both boys and girls were found in areas with lower concentrations of well-off citizens of Nordic origin. It is concluded that social and socioeconomic composition of the population in a living area impacts on injury risks of various kinds in a rather specific manner--in magnitude and in kind. The mechanisms via which contextual aspects operate during youth are likely to vary according to type (cause) of injury and gender.

Neighborhood social characteristics and fall injuries in children: an area-based study in Stockholm County

Summary.Objectives:To study the potential influence of the composition of the population in Stockholm County on the occurrence of paediatric fall injuries.Methods:Odds ratios are compiled considering socio-demographic composition (socioeconomic circumstances, socioeconomic status, and social integration), fall injury mechanisms, age groups and injury severity levels.Results:Compositional characteristics impact on fall injuries in various ways depending on type of exposure, age of victim, fall circumstance, and severity level. For younger children, effects are observed above all in the case of socioeconomic circumstances and for older children, in that of social integration. Also, both protective and aggravating effects are observed. Further, all falls aggregated and for both young and old children, social integration is associated with excess odds of admissions for long-bone fractures.Conclusion:The effect of neighbourhood social composition on fall-related injury in childhood is not straightforward. Better understanding of the underlying mechanisms may aid the determination of targets, and also enhance strategies for prevention and for the allocation of health-care resources.Zusammenfassung.Soziale Charakteristika der Quartiere und Sturzverletzungen bei Kindern. Gebiets-basierte Studie im Landkreis Stockholm.Ziele:Der potentielle Einfluss der Zusammensetzung der Bevö lkerung auf die Häufigkeit von Verletzungen durch Stürze im Landkreis Stockholm soll untersucht werden.Methoden:Odds-ratios wurden berechnet unter Berücksichtigung der soziodemografischen Zusammensetzung (sozioökonomische Verhältnisse, sozioökonomischer Status, soziale Integration), der Mechanismen der Sturzverletzung, Altersgruppen und Schweregrad der Verletzung.Resultate:Die kompositen Eigenschaften beeinflussen Sturzverletzungen in verschiedener Weise, je nach Typ der Verletzung, Alter der Betroffenen, Umstände des Sturzes und Schweregrad. Bei kleinen Kindern wurde vor allem ein Zusammenhang mit den sozioökonomischen Verhältnissen beobachtet und für ältere Kinder ein solcher mit der sozialen Integration. Des Weiteren wurde für alle Stürze, sowohl aggregiert wie für kleinere und grössere Kinder festgestellt, dass die soziale Integration in Zusammenhang steht mit einer erhöhten Wahrscheinlichkeit des Spitaleintritts aufgrund einer Röhrenknochenfraktur.Schlussfolgerungen:Die Auswirkungen der sozialen Determinanten eines Quartiers auf sturzbedingte Verletzungen in der Kindheit sind nicht eindeutig zuzuordnen. Ein besseres Verständnis der zugrundeliegenden Mechanismen könnte dazu beitragen, präzisere Zielvorgaben zu definieren und die Strategien für die Prävention und die Ressourcenzuteilung zu verbessern.Résumé.Caractéristiques sociales des quartiers et traumatismes par chute chez les enfants: une étude géographique dans le comté de StockholmObjéctifs:Etudier l’influence potentielle de la composition de la population du comté de Stockholm sur l’incidence de traumatisms par chute chez les enfants.Méthodes:Les Odds ratios sont calculés selon trois indicateurs sociodémographiques (contextesocio-économique, statut socio-économique, intégration sociale), selon le mécanisme de la chute, selon la gravité de la blessure et selon l’âge des enfants.Résultats:Selon l’exposition, l’âge de la victime, le mécanisme de la chute et la gravité de la blessure, les caractéristiques de la population ont un impact différent sur les traumatismes. Chez les plus jeunes, c’est avant tout le contexte socioéconomique qui joue un rôle alors que chez les enfants plus âgés, c’est l’intégration sociale. On observe donc aussi bien des effets protecteurs qu’aggravateurs de ces caractéristiques. D’autre part, pour les chutes dans leur ensemble et pour les enfants de tous les groupes d’âge, l’intégration sociale est associée avec un excès d’Odds pour les admissions pour fractures des os longs.Conclusions:L’effet de la composition sociale du voisinage sur les traumatismes par chute chez les enfants est complexe. Une meilleure compréhension des mécanismes sous-jacents pourrait contribuer à identifier des objectifs précis et à améliorer les stratégies de prévention et d’allocation des ressources.