Downloaded from injuryprevention.bmj.com on June 27, 2014 - Published by group.bmj.com
IP Online First, published on June 10, 2014 as 10.1136/injuryprev-2014-041268 Brief report
Trends in fall-related injuries among older adults treated in emergency departments in the USA Carlos H Orces,1 Hasanat Alamgir2 1
Department of Medicine, Laredo Medical Center, Laredo, Texas, USA 2 University of Texas Health Science Center, School of Public Health, San Antonio, Texas, USA Correspondence to Dr Carlos H Orces, Laredo Medical Center, Department of Medicine, 1700 East Saunders, Laredo, TX 78041, USA; [email protected] Received 8 April 2014 Revised 17 May 2014 Accepted 26 May 2014
ABSTRACT To examine national trends in fall-related injuries among older adults treated in emergency departments (ED) and project these injuries until the year 2030. The Webbased Injury Statistics Query and Reporting System was used to generate data on fall-related injuries treated in ED. Joinpoint regression analysis was used to examine the average annual change in injury rates over time. Fallrelated injury and hospitalisation rates increased on average by 2% (95% CI 1.5% to 2.7%) and by 4% (95% CI 2.9% to 5.0%) per year, respectively. Assuming the increase in fall-related injury rates remains unchanged, the number of fall-related injuries may increase to 5.7 million by the year 2030. Fall-related injuries among older adults treated in ED increased in the USA during the study period. Moreover, a marked increase in the number of these injuries may occur over the next decades.
INTRODUCTION One-third of people over the age of 65 years who live in the community fall each year; this proportion increases to 50% by the age of 80 years.1 Although not all falls among older persons are injurious, about 5% of them result in a fracture, and 5–10% of falls result in other serious injuries.2 Approximately 30% of falls require medical attention, often resulting in emergency departments (ED) visits and subsequent hospitalisations, increasing the demand for healthcare services.3 4 In 2001, an estimated 1.64 million older adults were treated in hospital ED for unintentional nonfatal fall-related injuries in the USA. Of these, fractures accounted for 37% of women’s and 28% of men’s injuries.5 Moreover, a recent study reported that fall-related fractures among older adults treated in hospital ED increased significantly in the USA between 2001 and 2008.6 According to the Census Bureau’s projections, the number of US older adults is expected to rise significantly from 40.2 million in 2010 to 88.5 million by 2050 due in part to longer life expectancies.7 These demographic changes alone may increase considerably the number of fall-related injuries. Therefore, the objectives of this study were to examine trends in non-fatal fall-related injuries among persons aged 65 years and older treated in hospital ED and to project these injuries until the year 2030. To cite: Orces CH, Alamgir H. Inj Prev Published Online First: [please include Day Month Year] doi:10.1136/ injuryprev-2014-041268
METHODS Data source The Web-based Injury Statistics Query and Reporting System (WISQARS) was used to generate non-fatal data from the National Electronic Injury Surveillance
Orces CH, et al. Inj Article Prev 2014;0:1–3. doi:10.1136/injuryprev-2014-041268 Copyright author (or their employer) 2014.
System-All Injury Program (NEISS-AIP), which is designed to provide national estimates of all types and external causes of non-fatal injuries and poisonings treated in US hospital ED. The current study included adults aged 65 years or older treated in hospital ED for unintentional fall-related injuries between 2001 and 2012. National estimates are considered unstable and potentially unreliable if the estimated total number of injuries is less than 1200 or based on fewer than 20 NEISS-AIP cases.8
Statistical analysis The WISQARS was used to generate age-specific and age-adjusted fall-related injury rates per 100 000 persons. Trends in these injuries were examined by year, age groups (65–74, 75–84 and ≥85 years), gender and ED disposition. The joinpoint regression program software, V.4.0.1, was used to examine the statistical significance of trends in fall-related injury rates during the study period. The results are presented as the average annual percentage change in rates and corresponding 95% CI.9 This summary measure is valid even if the joinpoint model indicates that there were changes in trends during the study period. The average annual percentage change is computed as a weighted average of the annual per cent changes from the joinpoint model, with the weights equal to the length of the annual per cent change interval.10 The average annual change in injury rates by age groups was used to project fall-related injury rates until the year 2030. The predicted absolute numbers of fall-related injuries treated in ED were then obtained by multiplying the injury rates by the estimated numbers of inhabitants, the latter being obtained from the US Census Bureau population projections.11 In the figures, the observed rates are represented by symbols and the predicted trends from the joinpoint regression model are represented by lines.
RESULTS An estimated 24 million adults aged 65 years or older were treated in ED for fall-related injuries between 2001 and 2012 in the USA. These injuries accounted for 63% of unintentional injuries among older adults treated in ED during the study period. Overall, women represented 69% of cases. An estimated 17 million (72%) subjects were treated and released from the ED and hospitalisations after these injuries occurred in 24% of cases. Fall-related injury rates increased with advancing age and were higher among women. In fact, compared with adults aged 65–74 years, fall-related injury rates were 4.6- and 3.8-fold higher among men and women aged 85 years or older, respectively.
Produced by BMJ Publishing Group Ltd under licence.
1
Downloaded from injuryprevention.bmj.com on June 27, 2014 - Published by group.bmj.com
Brief report The estimated number of fall-related injuries treated in ED increased from 1.6 million in 2001 to 2.4 million in 2012. After controlling for age, fall-related injury rates increased at an average annual rate of 2% (95% CI 1.5% to 2.7%). As shown in figure 1, age-adjusted fall-related injury rates among men increased annually by 2% (95% CI 1.6% to 2.9%). Similarly, the average annual change in rates in women increased by 2% (95% CI 1.5% to 2.7%). Overall, fall-related injuries among older adults treated in ED increased significantly in all age groups during the study period. However, the highest increase in rates occurred among those aged 75–84 years at an average annual rate of 2% (95% CI 1.5% to 2.9%). Over time, fall-related injury rates among those treated and discharged from the ED increased annually by 1% (95% CI 0.6% to 1.9%). Of interest, hospitalisations after fall-related injuries increased considerably at an average annual rate of 4% (95% CI 2.9% to 5.0%). As shown in figure 2, assuming that the average annual increase in fall-related injury rates remain unchanged, fall-related injuries among older adults treated in ED may increase to 3.4 million by the year 2020 and 5.7 million by the year 2030. In fact, compared with the number of fall-related injuries in the year 2012, these represent an increase in fall-related injuries by 43% and 137% in 2020 and 2030, respectively. Moreover, the projected number of fall-related injuries over the next decades may be attributed to marked upward trends in injury rates predominantly among subjects aged 85 years and older.
DISCUSSION These results indicate that fall-related injuries among older adults treated in ED considerably increased in the USA between 2001 and 2012. Although women accounted for two-thirds of these injuries, the average annual percentage increase in fallrelated injury rates was similar in both genders. Upward trends in fall-related injuries treated in ED were predominantly attributed to a marked increase in fall-related injuries among persons aged 85 years and older. Our results contrast with those from a previous study reporting a non-significant increase in fall-related injury ED admission rates among adults aged 65 years or older in the USA between 2001 and 2007.12 However, possible explanations for these contradictory findings may be related to differences in statistical analyses and periods examined. The increase
in fall-related injury rates with advancing age and among women has been previously demonstrated by other investigators.5 Gender differences in fall-related fractures treated in ED have been attributed to higher proportions of upper extremity and lower trunk fractures (lumbar spine, pelvis and hip) among women.6 Moreover, this gender disparity in fall-related injuries may be associated with higher prevalence of osteopenia and osteoporosis and lower muscle strength among women.13 14 The present findings indicate that the majority of older adults presenting to hospital ED after fall-related injuries are treated and released. However, a considerable proportion of subjects sustaining these injuries are hospitalised. Of note, the marked increase in fall-related injury hospitalisation rates nationwide among older adults is consistent with results from a recent study that demonstrated an increase by 50% in the number of hospitalisations for fall-related injuries among persons aged 65 years or older in the USA between 2001 and 2008.3 Moreover, the proportion of hospitalisations for fall-related fractures among older adults increased in the USA from 43% in 2001 to 48% in 2008.6 Upward trends in the number of hospitalisations for fallrelated injuries among older adults also have been previously reported in the Netherlands and Finland.2 15 On the contrary, a recent study demonstrated that age-adjusted injury hospitalisation rates among elderly Finns have decreased since the late 1990s.16 Similarly, a previous study of fall-related injury hospitalisations in the USA reported that injury rates levelled off in men between 1997 and 2005. Among women, a non-significant decrease in rates was seen from 1998 onward, which may be attributed to downward trends in hip fracture hospitalisations in the USA since 1996.4 17 The increase in fall-related injury ED rates among older in the USA may not be explained by only demographic changes of the population. Possible explanations for the present findings may be attributed to increased prevalence of self-reported disability over time among older Americans in basic activities of daily living, instrumental activities of daily living and mobility.18 Disability of the lower extremities has been associated with increased risk for fall-related hip fracture in white women.19 Several limitations of this study need to be discussed while interpreting the present findings. First, the number of fallrelated ED visits among older adults may be underestimated
Figure 1 Age-adjusted fall-related injury rates among older adults treated in the emergency department.
2
Orces CH, et al. Inj Prev 2014;0:1–3. doi:10.1136/injuryprev-2014-041268
Downloaded from injuryprevention.bmj.com on June 27, 2014 - Published by group.bmj.com
Brief report Figure 2 Fall-related injury rate projections among older adults.
because it includes only those persons who were treated in hospital ED. Second, the WISQARS does not provide information about the principal diagnosis or primary body part affected after fall-related injuries treated in ED. Third, regional variation in fall-related injuries treated in ED by state cannot be determined. In conclusion, fall-related injuries among older adults treated in ED and hospitalisation for these injuries significantly increased in the USA during the study period. Moreover, a marked rise in the number of fall-related injuries is expected to occur over the next decades unless effective fall prevention programmes are implemented predominantly among the oldest old.
REFERENCES 1 2 3 4
5 6
What is already known on the subject
7
▸ Fall-related injuries are major public health problem affecting older adults. ▸ Fall-related fractures treated in the emergency department (ED) increased in the USA between 2001 and 2008.
8
9 10 11
What this study adds
12 13
▸ Fall-related injuries treated in the ED significantly increased among older adults in the USA between 2001 and 2012. ▸ Fall-related injury hospitalisation rates markedly increased on average by 4% per year. ▸ The estimated number of fall-related injuries may increase to 5.7 million by the year 2030.
14
15
16
Contributors CHO contributed with the design, analysis, interpretation of results and writing of the manuscript. HA contributed with the interpretation of results and writing of the manuscript.
17 18
Competing interests None. Ethics approval Center for Disease Control. Provenance and peer review Not commissioned; externally peer reviewed.
Orces CH, et al. Inj Prev 2014;0:1–3. doi:10.1136/injuryprev-2014-041268
19
Tinetti ME, Williams CS. Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 1997;337:1279–4. Kannus P, Pakkari J, Koskinen S, et al. Fall-induced injuries and deaths among older adults. JAMA 1999;281:1895–9. Hartholt KA, Stevens JA, Polinder S, et al. Increase in fall-related hospitalizations in the United States, 2001–2008. J Trauma 2011;71:255–8. Orces CH. Trends in hospitalization for fall-related injury among older adults in the United States, 1988–2005. Ageing Res 2010;1:1–4. http://www. pagepress.org/journals/index.php/ar/article/view/ar.2010.e1/1538 (accessed Oct 2013). Stevens JA, Sogolow ED. Gender differences for non-fatal unintentional fall related injuries among older adults. Inj Prev 2005;11:115–19. Orces CH. Emergency department visits for fall-related fractures among older adults in the USA: A retrospective cross-sectional analysis of the national electronic injury surveillance system all injury program, 2001–2008. BMJ Open 2013;3. pii: e001722. Dramatic changes in U.S. Aging highlighted in new census. NIH report http://www. nia.nih.gov/newsroom/2006/03/dramatic-changes-us-aging-highlighted-new-censusnih-report (accessed May 2013). Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS). National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. http://www.cdc.gov/ncipc/wisqars (accessed May 2013). http://surveillance.cancer.gov/joinpoint/ (accessed Oct 2013). Clegg LX, Hankey BF, Tiwari R, et al. Estimating average annual per cent change in trend analysis. Stat Med 2009;28:3670–82. http://wonder.cdc.gov/WONDER/help/PopulationProjections.HTML (accessed Nov 2013). Hu G, Baker SP. Recent increases in fatal and non-fatal injury among people aged 65 years and over in the USA. Inj Prev 2010;16:26–30. Looker AC, Melton LJ III, Harris TB, et al. Prevalence and trends in low femur bone density among older US adults: NHANES 2005–2006 compared with NHANES III. J Bone Miner Res 2010;25:64–71. Frontera WR, Hughes VA, Lutz KJ, et al. A cross-sectional study of muscle strength and mass in 45- to 78-yr-old men and women. J Appl Physiol 1991;71:644–50. Hartholt KA, van der Velde N, Looman CW, et al. Trends in fall-related hospital admissions in older persons in the Netherlands. Arch Intern Med 2010;170:905–11. Korhonen N, Niemi S, Palvanen M, et al. Declining age-adjusted incidence of fall-induced injuries among elderly Finns. Age Ageing 2012;41:75–9. Stevens JA, Rudd RA. The impact of decreasing U.S. hip fracture rates on future hip fracture estimates. Osteoporos Int 2013;24:2725–8. Seeman TE, Merkin SS, Crimmins EM, et al. Disability trends among older Americans: National Health and Nutrition Examination Surveys, 1988–1994 and 1999–2004. Am J Public Health 2010;100:100–7. Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 1995;332:767–73.
3
Downloaded from injuryprevention.bmj.com on June 27, 2014 - Published by group.bmj.com
Trends in fall-related injuries among older adults treated in emergency departments in the USA Carlos H Orces and Hasanat Alamgir Inj Prev published online June 10, 2014
doi: 10.1136/injuryprev-2014-041268
Updated information and services can be found at: http://injuryprevention.bmj.com/content/early/2014/06/10/injuryprev-2014-041268.full.html
These include:
References P
IP Online First, published on June 10, 2014 as 10.1136/injuryprev-2014-041268 Brief report
Trends in fall-related injuries among older adults treated in emergency departments in the USA Carlos H Orces,1 Hasanat Alamgir2 1
Department of Medicine, Laredo Medical Center, Laredo, Texas, USA 2 University of Texas Health Science Center, School of Public Health, San Antonio, Texas, USA Correspondence to Dr Carlos H Orces, Laredo Medical Center, Department of Medicine, 1700 East Saunders, Laredo, TX 78041, USA; [email protected] Received 8 April 2014 Revised 17 May 2014 Accepted 26 May 2014
ABSTRACT To examine national trends in fall-related injuries among older adults treated in emergency departments (ED) and project these injuries until the year 2030. The Webbased Injury Statistics Query and Reporting System was used to generate data on fall-related injuries treated in ED. Joinpoint regression analysis was used to examine the average annual change in injury rates over time. Fallrelated injury and hospitalisation rates increased on average by 2% (95% CI 1.5% to 2.7%) and by 4% (95% CI 2.9% to 5.0%) per year, respectively. Assuming the increase in fall-related injury rates remains unchanged, the number of fall-related injuries may increase to 5.7 million by the year 2030. Fall-related injuries among older adults treated in ED increased in the USA during the study period. Moreover, a marked increase in the number of these injuries may occur over the next decades.
INTRODUCTION One-third of people over the age of 65 years who live in the community fall each year; this proportion increases to 50% by the age of 80 years.1 Although not all falls among older persons are injurious, about 5% of them result in a fracture, and 5–10% of falls result in other serious injuries.2 Approximately 30% of falls require medical attention, often resulting in emergency departments (ED) visits and subsequent hospitalisations, increasing the demand for healthcare services.3 4 In 2001, an estimated 1.64 million older adults were treated in hospital ED for unintentional nonfatal fall-related injuries in the USA. Of these, fractures accounted for 37% of women’s and 28% of men’s injuries.5 Moreover, a recent study reported that fall-related fractures among older adults treated in hospital ED increased significantly in the USA between 2001 and 2008.6 According to the Census Bureau’s projections, the number of US older adults is expected to rise significantly from 40.2 million in 2010 to 88.5 million by 2050 due in part to longer life expectancies.7 These demographic changes alone may increase considerably the number of fall-related injuries. Therefore, the objectives of this study were to examine trends in non-fatal fall-related injuries among persons aged 65 years and older treated in hospital ED and to project these injuries until the year 2030. To cite: Orces CH, Alamgir H. Inj Prev Published Online First: [please include Day Month Year] doi:10.1136/ injuryprev-2014-041268
METHODS Data source The Web-based Injury Statistics Query and Reporting System (WISQARS) was used to generate non-fatal data from the National Electronic Injury Surveillance
Orces CH, et al. Inj Article Prev 2014;0:1–3. doi:10.1136/injuryprev-2014-041268 Copyright author (or their employer) 2014.
System-All Injury Program (NEISS-AIP), which is designed to provide national estimates of all types and external causes of non-fatal injuries and poisonings treated in US hospital ED. The current study included adults aged 65 years or older treated in hospital ED for unintentional fall-related injuries between 2001 and 2012. National estimates are considered unstable and potentially unreliable if the estimated total number of injuries is less than 1200 or based on fewer than 20 NEISS-AIP cases.8
Statistical analysis The WISQARS was used to generate age-specific and age-adjusted fall-related injury rates per 100 000 persons. Trends in these injuries were examined by year, age groups (65–74, 75–84 and ≥85 years), gender and ED disposition. The joinpoint regression program software, V.4.0.1, was used to examine the statistical significance of trends in fall-related injury rates during the study period. The results are presented as the average annual percentage change in rates and corresponding 95% CI.9 This summary measure is valid even if the joinpoint model indicates that there were changes in trends during the study period. The average annual percentage change is computed as a weighted average of the annual per cent changes from the joinpoint model, with the weights equal to the length of the annual per cent change interval.10 The average annual change in injury rates by age groups was used to project fall-related injury rates until the year 2030. The predicted absolute numbers of fall-related injuries treated in ED were then obtained by multiplying the injury rates by the estimated numbers of inhabitants, the latter being obtained from the US Census Bureau population projections.11 In the figures, the observed rates are represented by symbols and the predicted trends from the joinpoint regression model are represented by lines.
RESULTS An estimated 24 million adults aged 65 years or older were treated in ED for fall-related injuries between 2001 and 2012 in the USA. These injuries accounted for 63% of unintentional injuries among older adults treated in ED during the study period. Overall, women represented 69% of cases. An estimated 17 million (72%) subjects were treated and released from the ED and hospitalisations after these injuries occurred in 24% of cases. Fall-related injury rates increased with advancing age and were higher among women. In fact, compared with adults aged 65–74 years, fall-related injury rates were 4.6- and 3.8-fold higher among men and women aged 85 years or older, respectively.
Produced by BMJ Publishing Group Ltd under licence.
1
Downloaded from injuryprevention.bmj.com on June 27, 2014 - Published by group.bmj.com
Brief report The estimated number of fall-related injuries treated in ED increased from 1.6 million in 2001 to 2.4 million in 2012. After controlling for age, fall-related injury rates increased at an average annual rate of 2% (95% CI 1.5% to 2.7%). As shown in figure 1, age-adjusted fall-related injury rates among men increased annually by 2% (95% CI 1.6% to 2.9%). Similarly, the average annual change in rates in women increased by 2% (95% CI 1.5% to 2.7%). Overall, fall-related injuries among older adults treated in ED increased significantly in all age groups during the study period. However, the highest increase in rates occurred among those aged 75–84 years at an average annual rate of 2% (95% CI 1.5% to 2.9%). Over time, fall-related injury rates among those treated and discharged from the ED increased annually by 1% (95% CI 0.6% to 1.9%). Of interest, hospitalisations after fall-related injuries increased considerably at an average annual rate of 4% (95% CI 2.9% to 5.0%). As shown in figure 2, assuming that the average annual increase in fall-related injury rates remain unchanged, fall-related injuries among older adults treated in ED may increase to 3.4 million by the year 2020 and 5.7 million by the year 2030. In fact, compared with the number of fall-related injuries in the year 2012, these represent an increase in fall-related injuries by 43% and 137% in 2020 and 2030, respectively. Moreover, the projected number of fall-related injuries over the next decades may be attributed to marked upward trends in injury rates predominantly among subjects aged 85 years and older.
DISCUSSION These results indicate that fall-related injuries among older adults treated in ED considerably increased in the USA between 2001 and 2012. Although women accounted for two-thirds of these injuries, the average annual percentage increase in fallrelated injury rates was similar in both genders. Upward trends in fall-related injuries treated in ED were predominantly attributed to a marked increase in fall-related injuries among persons aged 85 years and older. Our results contrast with those from a previous study reporting a non-significant increase in fall-related injury ED admission rates among adults aged 65 years or older in the USA between 2001 and 2007.12 However, possible explanations for these contradictory findings may be related to differences in statistical analyses and periods examined. The increase
in fall-related injury rates with advancing age and among women has been previously demonstrated by other investigators.5 Gender differences in fall-related fractures treated in ED have been attributed to higher proportions of upper extremity and lower trunk fractures (lumbar spine, pelvis and hip) among women.6 Moreover, this gender disparity in fall-related injuries may be associated with higher prevalence of osteopenia and osteoporosis and lower muscle strength among women.13 14 The present findings indicate that the majority of older adults presenting to hospital ED after fall-related injuries are treated and released. However, a considerable proportion of subjects sustaining these injuries are hospitalised. Of note, the marked increase in fall-related injury hospitalisation rates nationwide among older adults is consistent with results from a recent study that demonstrated an increase by 50% in the number of hospitalisations for fall-related injuries among persons aged 65 years or older in the USA between 2001 and 2008.3 Moreover, the proportion of hospitalisations for fall-related fractures among older adults increased in the USA from 43% in 2001 to 48% in 2008.6 Upward trends in the number of hospitalisations for fallrelated injuries among older adults also have been previously reported in the Netherlands and Finland.2 15 On the contrary, a recent study demonstrated that age-adjusted injury hospitalisation rates among elderly Finns have decreased since the late 1990s.16 Similarly, a previous study of fall-related injury hospitalisations in the USA reported that injury rates levelled off in men between 1997 and 2005. Among women, a non-significant decrease in rates was seen from 1998 onward, which may be attributed to downward trends in hip fracture hospitalisations in the USA since 1996.4 17 The increase in fall-related injury ED rates among older in the USA may not be explained by only demographic changes of the population. Possible explanations for the present findings may be attributed to increased prevalence of self-reported disability over time among older Americans in basic activities of daily living, instrumental activities of daily living and mobility.18 Disability of the lower extremities has been associated with increased risk for fall-related hip fracture in white women.19 Several limitations of this study need to be discussed while interpreting the present findings. First, the number of fallrelated ED visits among older adults may be underestimated
Figure 1 Age-adjusted fall-related injury rates among older adults treated in the emergency department.
2
Orces CH, et al. Inj Prev 2014;0:1–3. doi:10.1136/injuryprev-2014-041268
Downloaded from injuryprevention.bmj.com on June 27, 2014 - Published by group.bmj.com
Brief report Figure 2 Fall-related injury rate projections among older adults.
because it includes only those persons who were treated in hospital ED. Second, the WISQARS does not provide information about the principal diagnosis or primary body part affected after fall-related injuries treated in ED. Third, regional variation in fall-related injuries treated in ED by state cannot be determined. In conclusion, fall-related injuries among older adults treated in ED and hospitalisation for these injuries significantly increased in the USA during the study period. Moreover, a marked rise in the number of fall-related injuries is expected to occur over the next decades unless effective fall prevention programmes are implemented predominantly among the oldest old.
REFERENCES 1 2 3 4
5 6
What is already known on the subject
7
▸ Fall-related injuries are major public health problem affecting older adults. ▸ Fall-related fractures treated in the emergency department (ED) increased in the USA between 2001 and 2008.
8
9 10 11
What this study adds
12 13
▸ Fall-related injuries treated in the ED significantly increased among older adults in the USA between 2001 and 2012. ▸ Fall-related injury hospitalisation rates markedly increased on average by 4% per year. ▸ The estimated number of fall-related injuries may increase to 5.7 million by the year 2030.
14
15
16
Contributors CHO contributed with the design, analysis, interpretation of results and writing of the manuscript. HA contributed with the interpretation of results and writing of the manuscript.
17 18
Competing interests None. Ethics approval Center for Disease Control. Provenance and peer review Not commissioned; externally peer reviewed.
Orces CH, et al. Inj Prev 2014;0:1–3. doi:10.1136/injuryprev-2014-041268
19
Tinetti ME, Williams CS. Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 1997;337:1279–4. Kannus P, Pakkari J, Koskinen S, et al. Fall-induced injuries and deaths among older adults. JAMA 1999;281:1895–9. Hartholt KA, Stevens JA, Polinder S, et al. Increase in fall-related hospitalizations in the United States, 2001–2008. J Trauma 2011;71:255–8. Orces CH. Trends in hospitalization for fall-related injury among older adults in the United States, 1988–2005. Ageing Res 2010;1:1–4. http://www. pagepress.org/journals/index.php/ar/article/view/ar.2010.e1/1538 (accessed Oct 2013). Stevens JA, Sogolow ED. Gender differences for non-fatal unintentional fall related injuries among older adults. Inj Prev 2005;11:115–19. Orces CH. Emergency department visits for fall-related fractures among older adults in the USA: A retrospective cross-sectional analysis of the national electronic injury surveillance system all injury program, 2001–2008. BMJ Open 2013;3. pii: e001722. Dramatic changes in U.S. Aging highlighted in new census. NIH report http://www. nia.nih.gov/newsroom/2006/03/dramatic-changes-us-aging-highlighted-new-censusnih-report (accessed May 2013). Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS). National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. http://www.cdc.gov/ncipc/wisqars (accessed May 2013). http://surveillance.cancer.gov/joinpoint/ (accessed Oct 2013). Clegg LX, Hankey BF, Tiwari R, et al. Estimating average annual per cent change in trend analysis. Stat Med 2009;28:3670–82. http://wonder.cdc.gov/WONDER/help/PopulationProjections.HTML (accessed Nov 2013). Hu G, Baker SP. Recent increases in fatal and non-fatal injury among people aged 65 years and over in the USA. Inj Prev 2010;16:26–30. Looker AC, Melton LJ III, Harris TB, et al. Prevalence and trends in low femur bone density among older US adults: NHANES 2005–2006 compared with NHANES III. J Bone Miner Res 2010;25:64–71. Frontera WR, Hughes VA, Lutz KJ, et al. A cross-sectional study of muscle strength and mass in 45- to 78-yr-old men and women. J Appl Physiol 1991;71:644–50. Hartholt KA, van der Velde N, Looman CW, et al. Trends in fall-related hospital admissions in older persons in the Netherlands. Arch Intern Med 2010;170:905–11. Korhonen N, Niemi S, Palvanen M, et al. Declining age-adjusted incidence of fall-induced injuries among elderly Finns. Age Ageing 2012;41:75–9. Stevens JA, Rudd RA. The impact of decreasing U.S. hip fracture rates on future hip fracture estimates. Osteoporos Int 2013;24:2725–8. Seeman TE, Merkin SS, Crimmins EM, et al. Disability trends among older Americans: National Health and Nutrition Examination Surveys, 1988–1994 and 1999–2004. Am J Public Health 2010;100:100–7. Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 1995;332:767–73.
3
Downloaded from injuryprevention.bmj.com on June 27, 2014 - Published by group.bmj.com
Trends in fall-related injuries among older adults treated in emergency departments in the USA Carlos H Orces and Hasanat Alamgir Inj Prev published online June 10, 2014
doi: 10.1136/injuryprev-2014-041268
Updated information and services can be found at: http://injuryprevention.bmj.com/content/early/2014/06/10/injuryprev-2014-041268.full.html
These include:
References P
