Every day around the world, almost 16 000 people die from all types of injuries.

Injury Prevention and Home Accidents Prevention of Disability in Older Person

Prof. Dr. Selma KARABEY

• Every day around the world, almost 16 000 people die from all types of injuries.

• Injuries represent 12% of the global burden of disease, the third most important cause of overall mortality and

• the main cause of death among 1–40-year-olds

In Turkey

• In 2002, 86,000 individuals have been disabled due to accidents in the home.

• 22% of them were 60 years old and over.

• 14% are between the ages 60-69.

• 90% of older people with disabilities in home accidents have a monthly income of 50 TL or less.

In Turkey

• In 2002, 16,500 elderly people have been disabled due to accidents in the home.

• 60% of them were 60 years old and over.

• 27% of elderly people with disabilities in home accidents are widows and all were women.

In Turkey

• Prevalence of all accidents is 3.3%.

• 1.2% of the accidents are home accidents, • 1.6% are traffic accidents and • 0.5% are occupational accidents.

In Turkey

• The most prevalent accident type, namely traffic accidents are seen most in 15-34 age group and males.

• Home accidents on the other hand, are seen most in 65-and-above age group and in females.

• Occupational accidents are seen most in 15-34 age group and males.

• Injuries–resulting from • traffic collisions, • drowning, • poisoning, • falls or • burns - and violence - from assault , • self-inflicted violence or • acts of war–kill more than five million people worldwide

annually and cause harm to millions more. • They account for 9% of global mortality, and are a

threat to health in every country of the world.

• Musculoskeletal injuries are injuries occurring to the neck, spine, pelvis, and extremities;

• They include fractures, derangements, dislocations, sprains and strains, contusions, crushing injuries, open wounds, traumatic amputations.

• The most common cause of musculoskeletal injuries is falls.

• Additional major causes of musculoskeletal injuries are sports injuries,

playground accidents, motor vehicle crashes, civilian interpersonal violence, war injuries, stress injuries, over-exertion, repetitive workplace injuries.

• Each year estimated that 424 000 individuals die from falls globally of which over 80% are in low- and middle-income countries.

• Adults older than 65 suffer the greatest number of fatal falls.

• 37.3 million falls that are severe enough to require medical attention, occur each year.

A public health concernRoad deaths, disability and injury

• According to WHO data, deaths from road traffic injuries account for around 25% of all deaths from injury

• Around 85% of all global road deaths, • 96% of all children killed worldwide as a result of road

traffic injuries occur in low-income and middle-income countries.

• Over 50% of deaths are among young adults in the age range of 15–44 years .

• Among both children aged 5–14 years, and young people aged 15–29 years, road traffic injuries are the second-leading cause of death worldwide

• WHO estimates that, worldwide, between 20 million and 50 million people are injured or disabled each year in road traffic crashes.

MAIN RISK FACTORS FOR FALLS

Who is at risk for fall?

• Age is one of the key risk factors for falls. • Older people have the highest risk of death or serious

injury arising from a fall and the risk increases with age. *• Another high risk group is children. **• Across all age groups and regions, both genders are at

risk of falls. • In some countries, it has been noted that males are

more likely to die from a fall, while females suffer more non-fatal falls.

• Older women and younger children are especially prone to falls and increased injury severity.

• Worldwide, males consistently sustain higher death rates and DALYs lost

Other risk factors include:

• occupations at elevated heights or other hazardous working conditions;

• alcohol or substance use;• socioeconomic factors including poverty, overcrowded housing, sole

parenthood, young maternal age;• underlying medical conditions, such as neurological, cardiac or

other disabling conditions;• side effects of medication, physical inactivity and loss of balance,

particularly among older people;• poor mobility, cognition, and vision, particularly among those living

in an institution, such as a nursing home or chronic care facility;• unsafe environments, particularly for those with poor balance and

limited vision.

HOW TO PREVENT HOME ACCIDENTS

Prevent falls• Install lights at the top and bottom of stairways. Make

sure there is a stair rail.• Mount grab bars and use nonslip mats in bathtubs and

showers.• Provide safety gates in homes with small children.• Put nonstick backing on all area rugs.• Remove all spills from floors at once.• Pick up all clutter on stairs and floors. Clear out any

obstructions, debris or any other obstacles that create a potential falling hazard.

• Repair any damaged stair steps. Fix torn carpeting, loose boards, or uneven steps.

• Shovel snow and ice off of all walks and driveways.

Reduce potential fire damage.

• Install smoke alarms on every floor, including basements, and test the alarms once a year.

• Avoid putting flammable items on or near the stove.• Create a fire escape plan, then practice the plan with

your family at least twice a year.• Learn how to use a fire extinguisher.• Turn all pot handles in when cooking on a stove.• Stay in the kitchen at all times while cooking.• Prohibit smoking inside your home.

Minimize chances of drowning accidents.

• Supervise young children in bathtubs or when they are near water.• Enforce water and pool safety rules with your children. Make sure

they use flotation devices until they learn how to swim proficiently.• Empty all wading pools, buckets or other water receptacles when

not in use.• Learn cardiopulmonary resuscitation (CPR). According to the CDC,

victim success rates were much higher when CPR was administered while waiting for paramedics to arrive.

• Construct a four-sided, fully- enclosed and locked fence around all swimming pools.

• Clear all pool areas of toys after use to discourage small children.

Minimize potential poisonings.

• Place carbon monoxide detectors on low levels of every floor to prevent carbon monoxide poisoning.

• Ventilate all rooms when using cleaners and chemicals.• Keep all medications, chemicals and cleaners out of

reach of children.• Dispose properly of all medications that have expired.• Remove all peeling and lead-based paints from your

home.• Ensure that all gas appliances are installed and serviced

by professionals.

Vitamin D Supplementation

• A recent study, published in the Journal of the American Geriatrics Society (2005), reveals that older people in residential care can reduce their incidence of falls if they take a vitamin D supplement for two years.

• The Australian researchers examined the effect of vitamin D supplementation in 625 residents of 149 residential care facilities for a period of two years.

• The participants were randomly assigned to receive vitamin D supplements (ergocalciferol) or inactive ‘placebo’ for two years.

• All subjects received 600 mg of elemental calcium daily as calcium carbonate.

• The researchers found that that vitamin D use cut the risk of falls 27% to 37 % compared with placebo.

• The study thus highlights the potential benefits of vitamin D supplementation in a population of elderly people in residential care.

Interventions/best practice of falls prevention

• Multifaceted programs, including exercise, vision correction, medication review and adjustment, and environmental modification, appear to be effective in randomized control trials.

• Individually prescribed programs of muscle strengthening and balance retraining, and also Tai Chi (which combines strength and balance training) may be effective as sole interventions for preventing falls (Gillespie, Gillespie, Robertson, et al., 2002).

• Effective fall prevention programmes aim to reduce the number of people who fall, the rate of falls and the severity of injury should a fall occur.

• For older individuals, fall prevention programmes can include a number of components to identify and modify risk, such as:

• screening within living environments for risks for falls;• clinical interventions to identify risk factors, such as

medication review and modification, treatment of low blood pressure, Vitamin D and calcium supplementation, treatment of correctable visual impairment;

• home assessment and environmental modification for those with known risk factors or a history of falling;

• prescription of appropriate assistive devices to address physical and sensory impairments;

• muscle strengthening and balance retraining prescribed by a trained health professional;

• community-based group programmes which may incorporate fall prevention education and Tai Chi-type exercises or dynamic balance and strength training;

• use of hip protectors for those at risk of a hip fracture due to a fall.

Hip Protector

• For children, effective interventions include multifaceted community programmes; engineering modifications of nursery furniture, playground equipment, and other products; and legislation for the use of window guards.

• Other promising prevention strategies include: use of guard rails/gates, home visitation programmes, mass public education campaigns, and training of individuals and communities in appropriate acute pediatric medical care should a fall occur.

• Among the behavioural strategies that have been shown to increase the likelihood that a person will sustain a new behaviour are the following:

• Securing social support from family and friends. • Promoting the participant’s self-efficacy and perceived competence. • Providing older persons with active choices that are tailored to their personal needs and preferences. • Encouraging older persons to commit to an intervention by developing health contracts and/or goal statements that include realistic and measurable plans of action with specified health goals.

• Concerns for safety are identified as a barrier to changing behaviour by many older adults. • Educating participants about actual risks of interventions

can help to alleviate many of these concerns.• Providing regular and accurate performance feedback can assist older adults in developing realistic expectations about their own progress.

• By building on the three pillars of falls prevention, the model proposes specific strategies for:

1. building awareness of the importance of falls prevention and treatment; 2. improving the assessment of individual, environmental, and societal factors that increase the likelihood of falls; and 3. for facilitating the design and implementation of culturally-appropriate, evidence-based interventions that will significantly reduce the number of falls among older persons.

• http://kaza.gazi.edu.tr/posts/view/title/hakkimizda-77691

• Gazi University Accident Research and Prevention Institute was founded in 1983.

References and Web Sources

• The Burden of Musculoskeletal Diseases in the United States, Musculoskeletal Injuries

• http://www.boneandjointburden.org/• Simple Steps to Fall Prevention,Take simple precautions to protect

yourself from fall-related injuries, Melanie Lasoff Levs• http://www.arthritistoday.org/what-you-can-do/protecting-joints/preve

nting-falls/fall-prevention.php• How to Prevent Home Accidents, • http://www.wikihow.com/Prevent-Home-Accidents• WHO Global Report on Falls Prevention in Older Age,2007• http://www.who.int/ageing/publications/Falls_prevention7March.pdf• CHRONIC DISEASES AND RISK FACTORS SURVEY

IN TURKEY,2013

References and Web Sources

• WHO, Falls,Fact sheet N°344,October 2012• http://www.who.int/mediacentre/factsheets/fs344/en/• Birinci Türkiye Yaşlılık Raporu, Prof. Dr. İsmail TUFAN,2006• http://www.itgevakif.com/pdfs/I.T%C3%BCrkiyeYa%C5%9Fl%C4%B1l%C4

%B1kRaporu_itufan_sicher.pdf

• World report on road traffic injury prevention, Margie Peden, Richard Scurfield, David Sleet, Dinesh Mohan,Adnan A. Hyder, Eva Jarawan and Colin Mathers, World Health Organization Geneva, 2004

• FALLS IN OLDER PEOPLE NATIONAL / REGIONAL REVIEW INDIA,Dr. B. Krishnaswamy, Professor and Head, Dr. Gnanasambandam Usha, Assistant Professor

• Home Safety Brochure, Phoenix Children’s Hospital• www.phoenixchildrenshospital.com