EMPIRICAL STUDIES
doi: 10.1111/scs.12153
Outdoor pedestrian fall-related injuries among Swedish senior citizens – injuries and preventive strategies € rnstig B.Sc., Student (Research Assistant)2, Lina Gyllencreutz RN (PhD Student)1, Johanna Bjo Ewa Rolfsman PhD (Assistant Professor)3 and Britt-Inger Saveman PhD, RNT (Professor)1 1
Department of Nursing, Ume a University, Ume a, Sweden, 2Surgical and Perioperative Sciences, Ume a University, Ume a, Sweden and Applied Educational Science, Ume a University, Ume a, Sweden
3
Scand J Caring Sci; 2015; 29; 225–233 Outdoor pedestrian fall-related injuries among Swedish senior citizens – injuries and preventive strategies Senior citizens get around, to a large extent, as pedestrians, and safe walking is desirable for senior citizens allowing them to stay mobile, independent and healthy in old age. Senior citizens are over-represented in injury statistics, and fall-related injuries are common. The aim of this study was to investigate fall-related injuries including healthcare costs among senior citizen pedestrians injured when walking in public outdoor environments and to describe their self-reported causes and suggested preventive strategies. The data were based on a combination of information from injury data and a questionnaire. Three hundred senior citizens attended one emergency department after sustaining injuries from pedestrian falls; 60% suffered nonminor injuries, mostly fractures. One-fifth of the pedestrians were hospitalised
Introduction Senior citizens are the fastest growing population group in Europe, and one in four persons will be 65 years or older by the year 2030 (1, 2). Because senior citizens are vulnerable to injuries even at low energy, falls have a major impact on them (3) and are the leading cause of injury-related death in many developed countries (4, 5). Fall-related injuries represent a major health problem and are a multidisciplinary and multiprofessional challenge that includes research in public health, nursing and other areas. Although the majority of falls among senior citizens do not result in serious injuries or death, the emotional effects can be devastating for the individual and family members because a fall can cause an Correspondence to: Lina Gyllencreutz, Department of Nursing, Ume a University, SE-901 87 Ume a, Sweden. E-mail: [email protected] © 2014 Nordic College of Caring Science
for an average of 8 days with an indirect hospital cost of 6.2 million EUR (55 million SEK). Environmental factors such as ice were the most commonly described cause of the injury incident. Forty per cent of the respondents indicated that the municipality was responsible for the cause of the injury incident. Fewer respondents mentioned their own responsibility as a preventive strategy. Thirty per cent described a combination of improvements such as better road maintenance, changes in human behaviour and use of safety products as preventive strategies. It is of great importance to highlight general safety, products and preventive strategies to minimise injury risks, so that pedestrians can safely realise the known health benefits of walking and thereby limit healthcare costs. Keywords: outdoor, elderly, safety.
environment,
fall,
prevention,
Submitted 25 February 2014, Accepted 9 May 2014
increased fear of falling, loss of confidence, immobility and lack of independence (6, 7). A vital part of all transportation among senior citizens in Europe is by foot (2, 8). Accessibility to the pedestrian environment for senior citizens has recently become a more central issue among community planners (9). Despite this, there is still a need of further assessment and improvements to ensure safe outdoor walking environments for this group (10). Safe walking is also of vital importance for senior citizens to stay mobile, independent and healthy (11). Numerous international and national health agencies also recommend walking as a basis for a healthy lifestyle and improving physical fitness for senior citizens, given conditions with minimised injury risk (12, 13). It is difficult to create a completely safe and risk-free environment, and it is probably impossible to prevent every single fall incident. However, injuries are not unpredictable incidents and injury preventive work has the potential to limit the number and the serious 225
226
L. Gyllencreutz et al.
consequences of injuries, unnecessary pain, poorer health and the high burden on medical services and high costs for society. Humans are important contributors to injuries, depending on individual characteristics such as gender, age, physical resiliency and risk-taking behaviour. Also, the characteristics of the physical and social environments directly influence the risk of injuries (14). A significant amount of research within the field of injury prevention considers indoor falls (15), and research conducted on senior citizens falling outdoors is sparse by comparison. A number of studies do not distinguish between indoor and outdoor falls, even though they differ in terms of risk factors (16). Outdoor falls are associated with an active lifestyle (17) and more often influenced by characteristics of the outdoor environment such as environmental hazards, surface irregularities and seasonal variations (18, 19) compared with indoor falls that are more often associated with physical difficulties and poor health (20, 21). As many as 60% of Swedish citizens 45 years and older who had fallen reported their most recent fall as an outdoor fall (18, 20). Pedestrian falls are reported to be more common among senior citizens than other age groups (22). Even though seniors only account for approximately 10% of all pedestrian activities across all ages, they account for about 50% of all pedestrian deaths and a large proportion of the serious injuries (23). Previous research on injuries among senior citizens sustained during outdoor activities has generally focused on injuries caused by motor vehicle collisions (24). However, pedestrian fall-related injuries cause about five times as many nonfatal injuries as those caused by being hit by a motor vehicle. Additionally, fall-related injuries cause more hospital bed days and healthcare costs. Further, fall-related injuries receive far less attention and resources from society and in research (19, 25). Thus, a better understanding of how senior citizens are injured as pedestrians in an outdoor environment and how the environment influences outdoor falls is requested (18) as well as healthcare costs for this category of injury incidents. This study provides self-reported data from senior citizens who have been injured when falling as pedestrians as they have firsthand knowledge of the circumstances surrounding their injury incident. Further, preventive strategies suggested by the injured may clarify the most appropriate strategies in how the injury incident could have been prevented.
Aim The aim of this study was to investigate injuries among senior citizen pedestrians who fell in a public outdoor environment including healthcare costs. Further, the aim was to describe their self-reported causes of the incident and suggested preventive strategies.
Materials and methods This study is based on register data derived from the injury registration database (IDB) at Ume a University Hospital and a study-specific complementary questionnaire distributed to all persons aged 65 or older who had fallen as a pedestrian in a public area in the city of Ume a municipality from January 2009 to April 2011. The site of the incident was public roads, sidewalks and pedestrian and cycle paths where the municipality is responsible for the conditions and the surface maintenance. Pedestrian–motor vehicle collisions are excluded. Any injured person in need of medical treatment can be included in the IDB. The inclusion is optional, and external missing cases are continuously checked and result in
doi: 10.1111/scs.12153
Outdoor pedestrian fall-related injuries among Swedish senior citizens – injuries and preventive strategies € rnstig B.Sc., Student (Research Assistant)2, Lina Gyllencreutz RN (PhD Student)1, Johanna Bjo Ewa Rolfsman PhD (Assistant Professor)3 and Britt-Inger Saveman PhD, RNT (Professor)1 1
Department of Nursing, Ume a University, Ume a, Sweden, 2Surgical and Perioperative Sciences, Ume a University, Ume a, Sweden and Applied Educational Science, Ume a University, Ume a, Sweden
3
Scand J Caring Sci; 2015; 29; 225–233 Outdoor pedestrian fall-related injuries among Swedish senior citizens – injuries and preventive strategies Senior citizens get around, to a large extent, as pedestrians, and safe walking is desirable for senior citizens allowing them to stay mobile, independent and healthy in old age. Senior citizens are over-represented in injury statistics, and fall-related injuries are common. The aim of this study was to investigate fall-related injuries including healthcare costs among senior citizen pedestrians injured when walking in public outdoor environments and to describe their self-reported causes and suggested preventive strategies. The data were based on a combination of information from injury data and a questionnaire. Three hundred senior citizens attended one emergency department after sustaining injuries from pedestrian falls; 60% suffered nonminor injuries, mostly fractures. One-fifth of the pedestrians were hospitalised
Introduction Senior citizens are the fastest growing population group in Europe, and one in four persons will be 65 years or older by the year 2030 (1, 2). Because senior citizens are vulnerable to injuries even at low energy, falls have a major impact on them (3) and are the leading cause of injury-related death in many developed countries (4, 5). Fall-related injuries represent a major health problem and are a multidisciplinary and multiprofessional challenge that includes research in public health, nursing and other areas. Although the majority of falls among senior citizens do not result in serious injuries or death, the emotional effects can be devastating for the individual and family members because a fall can cause an Correspondence to: Lina Gyllencreutz, Department of Nursing, Ume a University, SE-901 87 Ume a, Sweden. E-mail: [email protected] © 2014 Nordic College of Caring Science
for an average of 8 days with an indirect hospital cost of 6.2 million EUR (55 million SEK). Environmental factors such as ice were the most commonly described cause of the injury incident. Forty per cent of the respondents indicated that the municipality was responsible for the cause of the injury incident. Fewer respondents mentioned their own responsibility as a preventive strategy. Thirty per cent described a combination of improvements such as better road maintenance, changes in human behaviour and use of safety products as preventive strategies. It is of great importance to highlight general safety, products and preventive strategies to minimise injury risks, so that pedestrians can safely realise the known health benefits of walking and thereby limit healthcare costs. Keywords: outdoor, elderly, safety.
environment,
fall,
prevention,
Submitted 25 February 2014, Accepted 9 May 2014
increased fear of falling, loss of confidence, immobility and lack of independence (6, 7). A vital part of all transportation among senior citizens in Europe is by foot (2, 8). Accessibility to the pedestrian environment for senior citizens has recently become a more central issue among community planners (9). Despite this, there is still a need of further assessment and improvements to ensure safe outdoor walking environments for this group (10). Safe walking is also of vital importance for senior citizens to stay mobile, independent and healthy (11). Numerous international and national health agencies also recommend walking as a basis for a healthy lifestyle and improving physical fitness for senior citizens, given conditions with minimised injury risk (12, 13). It is difficult to create a completely safe and risk-free environment, and it is probably impossible to prevent every single fall incident. However, injuries are not unpredictable incidents and injury preventive work has the potential to limit the number and the serious 225
226
L. Gyllencreutz et al.
consequences of injuries, unnecessary pain, poorer health and the high burden on medical services and high costs for society. Humans are important contributors to injuries, depending on individual characteristics such as gender, age, physical resiliency and risk-taking behaviour. Also, the characteristics of the physical and social environments directly influence the risk of injuries (14). A significant amount of research within the field of injury prevention considers indoor falls (15), and research conducted on senior citizens falling outdoors is sparse by comparison. A number of studies do not distinguish between indoor and outdoor falls, even though they differ in terms of risk factors (16). Outdoor falls are associated with an active lifestyle (17) and more often influenced by characteristics of the outdoor environment such as environmental hazards, surface irregularities and seasonal variations (18, 19) compared with indoor falls that are more often associated with physical difficulties and poor health (20, 21). As many as 60% of Swedish citizens 45 years and older who had fallen reported their most recent fall as an outdoor fall (18, 20). Pedestrian falls are reported to be more common among senior citizens than other age groups (22). Even though seniors only account for approximately 10% of all pedestrian activities across all ages, they account for about 50% of all pedestrian deaths and a large proportion of the serious injuries (23). Previous research on injuries among senior citizens sustained during outdoor activities has generally focused on injuries caused by motor vehicle collisions (24). However, pedestrian fall-related injuries cause about five times as many nonfatal injuries as those caused by being hit by a motor vehicle. Additionally, fall-related injuries cause more hospital bed days and healthcare costs. Further, fall-related injuries receive far less attention and resources from society and in research (19, 25). Thus, a better understanding of how senior citizens are injured as pedestrians in an outdoor environment and how the environment influences outdoor falls is requested (18) as well as healthcare costs for this category of injury incidents. This study provides self-reported data from senior citizens who have been injured when falling as pedestrians as they have firsthand knowledge of the circumstances surrounding their injury incident. Further, preventive strategies suggested by the injured may clarify the most appropriate strategies in how the injury incident could have been prevented.
Aim The aim of this study was to investigate injuries among senior citizen pedestrians who fell in a public outdoor environment including healthcare costs. Further, the aim was to describe their self-reported causes of the incident and suggested preventive strategies.
Materials and methods This study is based on register data derived from the injury registration database (IDB) at Ume a University Hospital and a study-specific complementary questionnaire distributed to all persons aged 65 or older who had fallen as a pedestrian in a public area in the city of Ume a municipality from January 2009 to April 2011. The site of the incident was public roads, sidewalks and pedestrian and cycle paths where the municipality is responsible for the conditions and the surface maintenance. Pedestrian–motor vehicle collisions are excluded. Any injured person in need of medical treatment can be included in the IDB. The inclusion is optional, and external missing cases are continuously checked and result in
