Injury Prevention

Injury is classified as either unintentional or intentional. Unintentional injury occurs with no intentional human motivation (e.g., falls, traffic accidents), whereasintentional injury occurs as a result of discernible human motivation (e.g., suicide, assault). The vast majority of injury-related deaths are unintentional, but both types of deaths are preventable. In the United States, with a total of 39,311 deaths in 2001 of deaths in people age 65 years and older, those due to injury were 83.2% unintentional and 16.2% intentional (0.6% were of undetermined intention). Of unintentional injury deaths in older people, 29.6% were from falls, 18.5% from traffic-related events, 8.2% from suffocation, 2.9% from fire-related events, 1.8% from poisonings, and 1.0% from drownings. Of deaths from intentional injury, 13.7% were from suicide, 2.4% from homicide, and 0.1% from legal intervention or war.

Fall-related injuries requiring hospitalization are disproportionately high for institutionalized residents of nursing homes or other facilities when compared with those for community-dwelling older adults. Risk factors for falling may be intrinsic (characteristics of the person) or extrinsic (circumstances of the fall). Intrinsic risk factors include older age (> 80 years), female gender, sensory impairment, depressive mood, [Page 304]cognitive impairment, polypharmacy (five or more medications), neurological conditions (e.g., Parkinson's disease), gait disturbance, functional limitations, diabetes, urinary incontinence, and musculoskeletal problems (e.g., arthritis, foot problems). Extrinsic risk factors include environmental hazards inside or outside the home (e.g., poor lighting, floor obstacles, slippery terrain). The risk of falling increases with certain circumstances; for example, during the winter in regions where ice storms are more common.

To prevent falls, detection and modification of risk factors are essential tasks. To accomplish this, there are many potential interventions such as recommending exercise (e.g., Tai Chi, a form of Chinese martial arts that combines strength and balance training); instructing in home-based exercise focused on balance and strengthening; reducing or discontinuing psychotropic medications; modifying environmental hazards by installing handrails, grab bars, and night lights in homes or providing low-heeled shoes; correcting visual deficits; advising on the appropriate use of assistive devices; using bone-strengthening medications (e.g., calcium, Vitamin D, antiresorptive agents); and using hip protectors. An environmental assessment should review the home environment carefully given that most falls occur at home and many older adults spend most of their time at home. Small changes can go a long way toward preventing falls that could result in long hospital stays and declines in strength that eventually lead to disability.

Rates for motor vehicle-related injury are twice as high for older men than for older women. In the United States in 2001, deaths of older adults caused by motor vehicle traffic crashes were approximately three times higher for occupants (drivers or passengers) than for pedestrians. Age-related decreases in vision, hearing, and cognitive functions, as well as physical impairments, may affect not only older adults' driving ability but also older pedestrians' capacity to cross streets. Also, physical frailty increases susceptibility to injury in a crash. Thus, a crash that results in nonfatal injuries to a younger person might kill an older adult driver or passenger. Interventions could focus on improving the design of motor vehicles (making them easier to drive and providing better protection in the case of a crash), changing the environment to improve traffic and pedestrian safety, and changing the behavior of older drivers, passengers, and pedestrians. For example, increasing the size and illumination of instrument panels and road signs would improve their nighttime readability. Intersections with timed crossings have been shown to be safer than those that do not provide cues of the length of time left to cross. Environmental alterations, such as installing median islands on wide roadways and longer walk signals, might help older pedestrians. A screening and testing program assessing drivers' functional and cognitive abilities could help older adults to gauge their own abilities and make decisions about their driving behavior. The American Automobile Association (AAA) has developed a “Lifelong Safe Mobility” campaign that includes driver screening tools as well as other safety features.

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