Injury Prevention in Older Adults

Abstract

Identifying risk and providing protection from injury. Because injuries are some of the most common causes of death and disability among older people, prevention of injuries in this population is an important public health goal. This article describes the public health of injuries to older adults (sec Albert, this issue) and presents interventions designed to address the leading causes of fatal and nonfatal injuries in this population. THE BURDEN OF INJURY The public health burden of injury can be measured in a variety of ways that are similar to those used to measure the burden of a disease or other condition. Commonly reported are mortality, morbidity (disability or nonfatal injury), and years of potential life lost, AS well as any disparities in the way this burden affects traditionally underserved racial/ethnic groups. MORTALITY FROM INJURY It is well known that heart disease, cancer, and stroke are the top three causes of death among adults age 6s and older. What is less well known is that injury ranks eighth on this list, representing more than 39,000 deaths in 2001. The number of injury deaths and death rates climbs with age, reaching a high of 294 deaths per 100,000 population for people age 85 years and older (see Table 1). By far the most common cause of injury death for these ages is falls. Of the 39,311 injury deaths in 2001, some 30 percent (11,623) were the result of a fall. Following falls are motor vehicle crashes (18 percent) and suicide by firearm, suffocation, and poisoning (1$ percent) (Centers for Disease Control and Prevention [CDC], 2004). The likelihood of dying from a fall is markedly different for men than for women. While more older women die, the overall fatality rate for men is almost 60 percent higher than for women, when differences in age distributions are taken into account. The underlying causes tor this difference are unclear. Men may sustain more severe injuries than women because men are more likely to fall from greater heights, such as from ladders. Or, men may have more underlying chronic conditions than women of comparable age or may be in poorer health. Motor vehicle crashes result in deaths to drivers, passengers, pedestrians, and bicyclists. There were -,544 crash deaths among older adults in 2001; the largest proportion of these deaths occurred among vehicle txxupants. When adjusted for miles driven, older drivers have higher death rates than drivers in most other age groups. Currently about 28 million older people are licensed to drive in the United States (Federal Highway Administration, 2004). The number of licensed older drivers is expected to increase with the aging population. Older adults are also at particular risk for pedestrian death caused by motor vehicles. In 2001, some 1,287 older adults were killed as pedestrians. Pedestrian death rates increase with age; the highest rates are found among people ages 80-84 (5-8 per 100,000) and those 85 years of age and older (4.8 per 100,000). Bicyclist deaths (86 in 2001) are a small proportion of all motor vehicle-related deaths (CDC, 2004). Suicide deaths have been declining among older adults, from 6,394 in 1990 to 5,393 in 2001. Death rates have shown similar declines from 20.5 per 100,000 population in 1990 to 15.4 in 2001, a 25 percent decline. However, suicide rates increase with age, with the highest death rates in the oldest age groups (14.0 per 100,000 among those ages 70-74 years, 16.8 among those 75-79 years old, 19.1 among those ages 80-84, and 18.7 among those 85 years of age and older). Among all people age 65 years and older, the suicide rate was eight times higher for men (32.5) than for women (3.9). People commit suicide in many ways. In 2001, suicide by firearm was the most common method, accounting for 3,943 deaths among older people in the U.S. and a death rate of 11.2 per 100,000. Next most frequent was suicide by suffocation, accounting for 543 deaths (death rate 1. …