Prevention of Unintentional Injuries Among Seniors

Workshop on Healthy Aging:
November 28-30, 2001

Trends

The proportion of Canadians 65 years of age or over will double from the current level of 12% to 23% of the population by 2041. This will significantly increase the economic and personal burden of injuries in this population group if current patterns continue.

The risk of serious injury and death due to falls increases dramatically with age among older people. For example, from 1996 to 1997, the number of hospitalizations due to falls for those between the ages of 65 and 74 was 837 per 100,000; for those 75 to 84 it was 2,443 per 100,000 and for those over 85 years of age it was 6,281 per 100,000.

Hip fractures are the most common type of fall injury among seniors and account for approximately 40% of hospital admissions for fall-related injuries for those 65 years of age or older. A recent Canadian study estimated that the number of annual hip fractures among seniors would increase annually from 23,375 in 1993 to 88,214 by 2041 due to aging of the population.

Some Key Considerations

Injuries result from an interaction of many factors. Theoretical development in the study of falls and fall-related injuries among older adults has focused on a two-tired conceptual framework based on studies of intrinsic (those internal to the individual) and extrinsic (those external to the individual) factors. Findings from these studies point to falls and fall-related injuries as resulting from a complex combination of factors reflecting physical and behavioural conditions operating alone, or in conjunction with environmental hazards. Results of studies indicate that the more internal and/or external risk factors, the greater chances that a fall will occur. Risk factors are also shown to have an additive effect, where having two risk factors imparts more than twice the risk of having each factor alone.

A considerable amount of research has been conducted into risk factors for falls. One review of epidemiological studies of falls among seniors identified over 400 variables that have been investigated. Despite this, opinions differ on the contribution of specific factors and few studies have been conducted to investigate the interactions between factors or their combined effects. Understanding the problem of falls and fall-related injuries among seniors is further hampered by a lack of investigations into factors that may be indirectly linked to falls and fall-related injuries.

To reflect the complex nature of the problem of fall-related injuries among older adults, one needs to apply a broad health determinants model, where studies of factors associated with fallrelated injuries among older adults are reviewed under biological, behavioural, environmental and socio-economic factors. While these separations are arbitrary - as most fall-related injuries result from the overlapping and compounding effects of multiple factors - they are useful to help us understand the contribution of like clusters of factors and identify target areas for risk reduction.

Biological factors, including those pertaining to the human body, are related to the natural aging process and the effects of chronic and acute health conditions. Behavioural factors include those concerning human actions, emotions or choices. Environmental factors concern physical structures or objects, and policies designed to regulate them. Socio-economic factors are those concerned with the influence and interaction of social or economic factors. In Table I, these four domains are presented, followed by an overview of key direct and indirect risk factors shown in the literature to be associated with fall-related and other injuries among older adults. Evidence is stronger for some of these factors than others, and many are found to be problematic only when found in combinations. Some factors, such as those concerned with social and economic conditions, are found in the literature to be related only indirectly to fall-related injuries.

[Previous] [Table of Contents] [Next]