Michael F. Ballesteros

Self-Reported Falls and Fall-Related Injuries Among Persons Aged ≥ 65 Years–United States, 2006 ☆

PROBLEM In 2005, 15,802 persons aged>or=65 years died from fall injuries. How many older adults seek outpatient treatment for minor or moderate fall injuries is unknown. METHOD To estimate the percentage of older adults who fell during the preceding three months, the Centers for Disease Control and Prevention (CDC) analyzed data from two questions about falls included in the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey. RESULTS Approximately 5.8 million (15.9%) persons aged>or=65 years reported falling at least once during the preceding three months, and 1.8 million (31.3%) of those who fell sustained an injury that resulted in a doctor visit or restricted activity for at least one day. DISCUSSION This report presents the first national estimates of the number and proportion of persons reporting fall-related injuries associated with either doctor visits or restricted activity. SUMMARY The prevalence of falls reinforces the need for broader use of scientifically proven fall-prevention interventions. IMPACT ON INDUSTRY Falls and fall-related injuries represent an enormous burden to individuals, society, and to our health care system. Because the U.S. population is aging, this problem will increase unless we take preventive action by broadly implementing evidence-based fall prevention programs. Such programs could appreciably decrease the incidence and health care costs of fall injuries, as well as greatly improve the quality of life for older adults.

Gender differences in seeking care for falls in the aged Medicare population.

BACKGROUND One third of adults aged ≥65 years fall annually, and women are more likely than men to be treated for fall injuries in hospitals and emergency departments. PURPOSE The aim of this study was to examine how men and women differed in seeking medical care for falls and in the information about falls they received from healthcare providers. METHODS This study, undertaken in 2010, analyzed population-based data from the 2005 Medicare Current Beneficiary Survey (MBCS), the most recent data available in 2010 from this survey. A sample of 12,052 community-dwelling Medicare beneficiaries aged ≥65 years was used to examine male-female differences among 2794 who reported falling in the previous year, sought medical care for falls and/or discussed fall prevention with a healthcare provider. Multivariable logistic regression analyses were conducted to determine the factors associated with falling for men and women. P-values ≤0.05 were considered significant. RESULTS Nationally, an estimated seven million Medicare beneficiaries (22%) fell in the previous year. Among those who fell, significantly more women than men talked with a healthcare provider about falls and also discussed fall prevention (31.2% [95% CI=28.8%, 33.6%] vs 24.3% [95% CI=21.6%, 27.0%]). For both genders, falls were most strongly associated with two or more limitations in activities of daily living and often feeling sad or depressed. CONCLUSIONS Women were significantly more likely than men to report falls, seek medical care, and/or discuss falls and fall prevention with a healthcare provider. Providers should consider asking all older patients about previous falls, especially older male patients who are least likely to seek medical attention or discuss falls with their doctors.

A review of unintentional injuries in adolescents.

Unintentional injuries are the largest source of premature morbidity and mortality and the leading cause of death among adolescents 10-19 years of age. Fatal injury rates of males are twice those of females, and racial disparities in injury are pronounced. Transportation is the largest source of these injuries, principally as drivers and passengers, but also as cyclists and pedestrians. Other major causes involve drowning, poisonings, fires, sports and recreation, and work-related injuries. Implementing known and effective prevention strategies such as using seat belts and bicycle and motorcycle helmets, installing residential smoke alarms, reducing misuse of alcohol, strengthening graduated driver licensing laws, promoting policy change, using safety equipment in sports and leisure, and protecting adolescents at work will all contribute to reducing injuries. The frequency, severity, potential for death and disability, and costs of these injuries, together with the high success potential of prevention strategies, make injury prevention a key public health goal to improve adolescent health in the future.

Prevalence of Residential Smoke Alarms and Fire Escape Plans in the U.S.: Results from the Second Injury Control and Risk Survey (ICARIS-2)

Objectives. This study was conducted to estimate (1) the proportion of U.S. homes with installed smoke alarms and fire escape plans, and (2) the frequency of testing home smoke alarms and of practicing the fire escape plans. Methods. The authors analyzed data on smoke alarms and fire escape plans from a national cross-sectional random-digit dialed telephone survey of 9,684 households. Results. Ninety-five percent of surveyed households reported at least one installed smoke alarm and 52% had a fire escape plan. The prevalence of alarms varied by educational level, income, and the presence of a child in the home. Only 15% tested their alarms once a month and only 16% of homes with an escape plan reported practicing it every six months. Conclusion. While smoke alarm prevalence in U.S. homes is high, only half of homes have a fire escape plan. Additional emphasis is needed on testing of installed smoke alarms and on preparedness for fire escape plans.

Unintentional childhood injuries in the United States: key findings from the CDC childhood injury report.

On December 10, 2008, theWorld Health Organization (WHO), in collaborationwith United Nations Childrens Fund (UNICEF), launched theWorld ReportonChild InjuryPrevention (WHO/UNICEF, 2008) todrawattention to thepreventable loss of 830,000 childrenandadolescents to anunintentional injury annually throughout theworld. To coincidewith the global report, the Centers for Disease Control and Prevention (CDC) also analyzed deaths and non-fatal injuries to children and adolescents and inDecember 2008, released theCDCChildhood Injury Report: Patterns of Unintentional Injuries among 019 year olds in the United States, 2000-2006 (Borse et al., 2008). This article summarizes some of the key findings of this report. Impact of Industry: The CDC childhood injury report can inform thework of practitioners, policy-makers, elected officials, and researchers to better understand the problem and take the necessary steps to reduce the devastating burden childhood injuries place on this nation. The CDC Childhood Injury Report provides an overview of patterns of childhood unintentional injuries in the United States, related to drowning, falls, fires or burns, transportation (e.g., motor-vehicle crashes), poisoning, and suffocation, among other injuries such as overexertion, and being struck by or against an object (Borse et al., 2008). The burden of deaths and nonfatal injuries due to each cause is shown in this report by age group and sex, as well as the geographic distributionof injurydeath rates by state. Thedataused in this reportwere obtained fromtwosources. Injury deathdata from 2000 – 2005 were derived from the National Center for Health Statistics (NCHS), National Vital Statistics System (CDC, 2008). Non-fatal injury data from 2001-2006 were derived from the National Electronic Injury Surveillance System All Injury Program (U.S. Consumer Product Safety Commission, 2000). We summarize this report in three sub-headings: Leading causes of Deaths and Nonfatal Injuries, Injury Deaths, and Nonfatal Injuries. The methodology used for analysis is available at www.cdc.gov/SafeChild/ChildhoodInjuryReport.

Injuries among infants treated in emergency departments in the United States, 2001-2004.

OBJECTIVE. The objective of this study was to present a detailed examination of unintentional injuries in infants ≤12 months of age treated in emergency departments. METHODS. We conducted a retrospective analysis of data for infants ≤12 months of age from the National Electronic Surveillance System-All Injury Program for 2001–2004. Sample weights provided by the National Electronic Surveillance System-All Injury Program were used to make national estimates. RESULTS. An estimated 1314000 injured infants were treated in US emergency departments for nonfatal unintentional injuries during the 4-year period of 2001–2004, ∼1 infant every 1.5 minutes. Falls were the leading cause of nonfatal unintentional injuries for infants. Overall, the patients were more likely to be male (55.2%) than female (44.8%). Contusions/abrasions were the leading diagnosis overall (26.7%). Contusion/abrasion, laceration, hematoma, foreign-body, and puncture injuries occurred most frequently to the head or neck region. More than one third of fractures (37.2%) were to the arm or hand. Bed was the product most frequently noted as being involved in the injury event for every age except 2 and 12 months (car seat was the most frequently noted product at 2 months of age, and stairs were top ranked at 12 months). Product rank changed markedly as age increased. CONCLUSIONS. The influences of the social environment, the physical environment, and products change as infants mature in the first year of life; this was substantiated in our study by the shift in the relative importance of products involved in injuries according to month of age. The concept that aspects of safety must adapt in anticipation of developmental stage is critical.

Ecological level analysis of the relationship between smoking and residential-fire mortality

Objectives: To examine the association between tobacco smoking and residential-fire mortality and to investigate whether this association is explained by the confounding effects of selected socioeconomic factors (ie, educational attainment and median household income). Design: An ecological analysis relating state-level residential-fire mortality to state-level percentages of adults who smoke was conducted. Negative binomial rate regression was used to model this relationship, simultaneously controlling for the selected socioeconomic factors. Results: After educational attainment and median household income had been controlled for, smoking percentages among adults correlated significantly with state-level, population-based residential-fire mortality (estimated relative rate for a 1% decrease in smoking = 0.93; 95% CI 0.89 to 0.97). Conclusions: Mortality from residential fires is high in states with high smoking rates. This relationship cannot be explained solely by the socioeconomic factors examined in this study.

An Older Adult Falls Research Agenda from a Public Health Perspective

This article reviews fall prevention research using the Centers for Disease Control public health model and suggests several critical research questions at each step. Research topics include surveillance and data systems, fall risk factors, development, evaluation and implementation of fall interventions, translation of interventions into programs, and promotion, dissemination, and widespread adoption of fall prevention programs. These broad topics provide a framework for research that can guide future advances in older adult fall prevention.

Helmet use among motorcyclists in Cambodia: a survey of use, knowledge, attitudes, and practices.

Objective: Road traffic injuries (RTIs) are a leading cause of disability and fatality globally. Motorcycle-related injuries, mainly head injuries, and related deaths and disabilities are a significant contributor to the burden of disease in low- and middle-income countries (LMICs). Helmets have been proven to be an effective way to reduce the risk of head injury. As motorcycle use continually increases in Cambodia, head injuries and related deaths and disabilities are expected to rise. This article aims to assess the current status of helmet use in Cambodia, as well as the knowledge, attitudes, and practices among motorcyclists, in order to assist with better planning and implementation of injury prevention strategies. Methods: Two separate methodologies were employed for this study. Helmet observations were conducted in Phnom Penh, Kandal, Kampong Speu, Siem Reap, and Kampong Cham to assess the current status of helmet use during the day and at night. Roadside knowledge, attitudes, and practice (KAP) interviews were also conducted in Phnom Penh, Kandal, and Kampong Speu to determine the prevailing beliefs around helmet use in Cambodia. Results: Based on observations, the proportion of helmet wearing across all study sites was 25 percent at night and 43 percent during the day among all motorcyclists. The observed proportion was up to 10 times higher among drivers compared to passengers. The top 3 reasons for always wearing a helmet were lifesaving potential, legal duty, and police fines. Almost 60 percent of respondents said that their use or nonuse of a helmet depended on where they were driving. Helmet quality, price, style, and color were important factors influencing the decision to purchase a helmet. Conclusions: A paradox appears to exist in Cambodia; though awareness of the benefits of wearing a helmet is high, actual helmet use remains low in the country. Daytime usage is higher than nighttime, and these proportions are significantly higher among drivers compared to passengers. There is a continuing need to improve the proportion of all-day helmet wearing, especially at night and among motorcycle passengers in Cambodia.

Injury and frequency of use of playground equipment in public schools and parks in Brisbane, Australia

Objective: The purpose of this study was to determine the frequency of use of play equipment in public schools and parks in Brisbane, Australia, and to estimate an annual rate of injury per use of equipment, overall and for particular types of equipment. Methods: Injury data on all children injured from playground equipment and seeking medical attention at the emergency department of either of the two children’s hospitals in the City of Brisbane were obtained for the years 1996 and 1997. Children were observed at play on five different pieces of play equipment in a random sample of 16 parks and 16 schools in the City of Brisbane. Children injured in the 16 parks and schools were counted, and rates of injury and use were calculated. Results: The ranked order for equipment use in the 16 schools was climbing equipment (3762 uses), horizontal ladders (2309 uses), and slides (856 uses). Each horizontal ladder was used 2.6 times more often than each piece of climbing equipment. Each horizontal ladder was used 7.8 times more than each piece of climbing equipment in the sample of public parks. Slides were used 4.6 times more than climbing equipment in parks and 1.2 times more in public schools. The annual injury rate for the 16 schools and 16 parks under observation was 0.59/100 000 and 0.26/100 000 uses of equipment, respectively. Conclusions: This study shows that annual number of injuries per standardized number of uses could be used to determine the relative risk of particular pieces of playground equipment. The low overall rate of injuries/100 000 uses of equipment in this study suggests that the benefit of further reduction of injury in this community may be marginal and outweigh the economic costs in addition to reducing challenging play opportunities.