Ulf Björnstig

Unintentional injuries among elderly people: Incidence, causes, severity, and costs

People aged 60 years or older (1,313 injured) treated for unintentional injuries at the emergency department of the Regional Hospital in Umeå, Sweden, over a period of one year were included in the material. The injury, fracture, and mortality rates per 1,000 persons aged 60 years or over were 57, 31, and 0.6, respectively. The causes of injuries were falls (70%), vehicle accidents (10%), and other (20%). Injury incidence, severity of injuries, proportion of injuries that were fractures, femur neck fracture frequency, duration of hospitalization, and mean costs of medical care increased with age of patients. Women had a higher injury rate, more severe injuries, longer duration in hospital, and higher cost of medical care than men. The cost of medical care of this group of elderly, making up 15% of all injured in the primary admission area, was SEK* 14 million; this being almost half the cost for all injured. Since the elderly population, especially the very old, is expected to increase in the future, prevention of falls (taking up 80% of total treatment costs) and vehicle accidents (causing the most critical injuries) is of utmost importance.

Ladder injuries: Mechanisms, injuries and consequences

Hospital-based data from northern Sweden indicates that there were 114 ladder accidents during 1 year and, of these, one third happened during working hours. The majority of injured were men (81%), and the average age was 42 years. Thirty percent of the accidents during working hours took place outdoors while the corresponding figure was 77% during leisure time. The most common accident was a fall from a free, straight tilting ladder (73%), or a stepladder (20%). It was common for the tilting ladders to slide on the ground (41%) and for the stepladders to fall sideways (48%). The extremities were most commonly injured (60%), and 37% of all injuries were fractures. Those 50 years old and over received the most serious injuries. One third of the injured still had persisting symptoms more than 1 year after the accident. Twenty-seven percent of the injured needed hospitalization for an average of 8 days, and two thirds of the patients entitled to sickness benefit received this benefit for an average of 57 days. On average, the total care and sickness benefits amounted to SEK* (Swedish Crowns) 12,300 (

Injuries caused by animals

2,000) per case, of which half was sickness benefit.

Injuries to the elderly in the traffic environment

Injuries caused by animals and treated at the University Hospital of Umeå were analysed. Dogs caused nearly one-half of the injuries, while horses caused one-third of the injuries and the highest number of fractures. The cost of treatment and sickness benefit was fairly evenly distributed between horse-, cattle-, and dog-related injuries. The average cost per injured person was, however, highest in those injured in cattle accidents and moose-car collisions. The impact of animal-related injuries on the health care and social security systems was similar to occupational accidents and car accidents in several respects.

Trauma in the Elderly: The Impact on the Health Care System

Two hundred ninety-seven persons, all aged 60 or over (180 women, 117 men), injured in the traffic environment, and treated at the Regional Hospital in Umeå, over a one-year period, were analysed. Injuries were grouped into three main categories: falls (52%), vehicle-associated events (44%), and other injury events (4%). In women, falls were a more common cause of injury than vehicle events, whilst in men there was a tendency for a converse relationship. Two-thirds of the falls involved slipping on ice and snow. Ice- and snow- related injuries (all categories) accounted for 37% of the total cost of all injuries in the elderly in the traffic environment. The main groups in the vehicle-associated injury category were cyclists (48%), car occupants (34%), other occupants (14%), and pedestrians (4%). Vehicle-associated injuries became more common with advancing age, resulted in the most severe and critical [Maximum Abbreviated Injury Scale (MAIS) greater than or equal to 4] injuries and the most fatalities, and cost (total and mean) more than falls. In conclusion, from the injury cost point of view, it is most important to prevent vehicle-associated injuries. However, when total frequencies are considered, falls deserve to be given just as much priority in injury prevention programs as vehicle-associated injuries, to make the traffic environment safer for this growing population.

Fatalities caused by nonvenomous animals: A ten-year summary from Sweden

The impact of injuries in the elderly on the acute health care system was assessed in terms of the cost of injuries. The cost of injuries in the elderly (greater than or equal to 60 years) was compared with that in the younger group (less than 60 years) in a health district in northern Sweden. Even though the elderly made up only one sixth of the total injured during a one year period, they accounted for 42% of the total cost of the medical care of injuries. The mean medical care cost increased significantly from the age of 60 years; the cost was four times higher in the older group than in the younger group. Severe injuries in the elderly cost almost 2.5 times more than those in the younger group. In conclusion, since the elderly place a heavy burden on the health care system, they urgently need to be given priority in injury research and injury intervention programmes.

Persistent medical problems and permanent impairment: Injuries associated with work, vehicles, and sports

All 58 deaths caused by nonvenomous animals in Sweden 1975-1984 were scrutinized. In 38 cases horses were involved, in 16 cattle and in one case each a moose, a lion, a dog and a ram. In the horse-related fatalities, the most common cause of accident was that the horse bolted or reared, causing the rider to fall off the horse or the cart or sulky. Falls were thus associated with 22 horse-related deaths. In cattle-related accidents, all fatalities where the cause of accident was known occurred due to aggressive behaviour of the animal. In horse-related accidents, head injuries dominated, while in cattle-related accidents head and chest injuries were equally common. It is suggested that wearing a proper helmet is the most important safety measure in horse-related activities. In cattle-related activities, the herding of untethered bulls together with cows is particularly dangerous and should be avoided.

School injuries. epidemiology and clinical features of 307 cases registered at hospital during one school year

Among injuries treated in one year at the University Hospital in Umeå, Sweden, work- and sports-related accidents caused 16% each and vehicle-related accidents caused 12% of all injuries treated. Most fatalities and severe injuries were associated with vehicles. The proportion of victims with permanent medical impairment was highest among vehicle- and work-related injuries-6%. The proportion of persons who reported some form of persistent medical problem five years after the accident was similar in the three groups--between 21% and 24%. Among those injured in work- and vehicle-related accidents, one percent had been retired early or were on long-term sick leave. In all three groups, between 1% and 3% had changed jobs because of the injury, and between 3% and 6% had changed their leisure time activities to a large degree. Twelve percent of the work-related injuries and 8% of the vehicle-related injuries, but only 3% of the sports-related injuries, were claimed under some sort of insurance scheme. Pain was the most common persistent medical problem. Pain, together with serious brain and spinal injuries, is rather poorly defined in the impairment classification presently used by Swedish insurers to determine degree of permanent medical impairment. Improved and clarified criteria would be of great value.

Pedal Cycling Fatalities in Northern Sweden

Injuries at school were studied for one school year in 57 primary and three secondary schools (13,733 students, aged 7-19 years) at Umeå in northern Sweden. The injury rate was 22/1000 student years. There was a wide variation in injury rate between different schools. The boy/girl ratio was 1.1/1. Physical education was the dominating activity at the time of injury for the older students and play in the school yard for the younger. The majority of the students had a minor injury, but 17% had a fracture. The injured students did not seem to have more somatic, psychological or social problems than students in general. Fewer competitive sports and ball games and more adult supervision and organized activities during breaks are suggestions to reduce injuries at school. A hospital-based injury registration system is well fitted for serving as a base for analysing school injuries.