|Year : 2019 | Volume
| Issue : 5 | Page : 81-84
Non-fatal home injuries among the elderly in Tamil Nadu, India
Alex Joseph1, M Bagavandas2
1 Division of Epidemiology, School of Public Health, SRM IST, Kancheepuram, Tamil Nadu, India
2 Division of Biostatistics, School of Public Health, SRM IST, Kancheepuram, Tamil Nadu, India
|Date of Submission||05-Apr-2019|
|Date of Acceptance||10-Sep-2019|
|Date of Web Publication||15-Oct-2019|
Dr. Alex Joseph
Division of Epidemiology, School of Public Health, 3rd Floor Medical Building, SRM IST, Kancheepuram - 603 203, Tamil Nadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Injuries are considered as an emerging public health problem in India. Globally every year, injuries kill more than 5 million people, and by 2020, injuries will be the third-leading cause of death and disability worldwide. The study aimed to assess the prevalence and characteristics of nonfatal home injuries among the elderly in Tamil Nadu. Methodology: A cross-sectional analytical study was conducted among 1139 elderly (60 years and above), sampled from three districts of Tamil Nadu, India. Probability proportional to size sampling technique was used for sampling; a pretested questionnaire was used to collect the data. Results: Prevalence of nonfatal home injuries among elderly within the past 1 year was 14.6% (12.5–16.7 at 95% confidence interval), (n = 1003), among those injured, 94.5% were unintentionally injured and 5.5% were of intentional nature. When classified according to the types of injuries, majority of them had fall injuries (6.7%) followed by minor domestic injuries (5.4%), animal-related injury (0.2%), burn injuries (1.1%), road traffic injury (0.4%), and suicide attempt (0.8%). Majority of the respondents were in the age group of young-old, 60–69 years of age (84%), and there was more number of males (55%) in the study. Conclusion: The study reveals that nonfatal home injuries among elderly are an emerging public health problem, unintentional injuries contribute to the majority of the injuries, fall was the single largest contributor for all injuries among elderly.
Keywords: Elderly, Falls, Intentional injury, Unintentional injury
|How to cite this article:|
Joseph A, Bagavandas M. Non-fatal home injuries among the elderly in Tamil Nadu, India. Indian J Community Med 2019;44, Suppl S1:81-4
| Introduction|| |
Injury is one of the leading causes of death and ill-health. Every year, injuries kill more than 5 million people worldwide, and by 2020, injuries will be the third-leading cause of death and disability worldwide. They contribute to a significant number of deaths, hospitalizations for short and long periods, emergency room visits, physical, social and psychological disabilities, disfigurement, pain, amputations, and agony. Injuries among elderly are also related to age-related decelerations of the functional capacity where there are no interventions available., Apart from those non modifiable causes, there are many extrinsic factors which are largely modifiable and can prevent the occurrence of injuries among the elderly.,, The term “injury” by definition means that there is a body lesion due to an external cause, either intentional or unintentional, resulting from sudden exposure to energy (mechanical, electrical, thermal, chemical, or radiant) generated by the agent–host interaction. This leads to tissue damage when it exceeds the physiological tolerance of the individual. Respectively, unintentional and intentional injuries contributed to three-fourth and one-fourth of total Disability-Adjusted Life Year (DALY).,, Lack of reliable and good quality national or regional data has thwarted the recognition of injury among the elderly as a public health concern. This aim of the work was to assess the prevalence and characteristics of nonfatal home injuries among the elderly in Tamil Nadu. Injury was defined as damage to the body produced by energy exchanges that have relatively sudden discernible effects.
| Methodology|| |
Study setting and design
A cross-sectional analytical study was conducted among 1139 elderly persons sampled from three districts of Tamil Nadu, India. Probability proportional to size sampling technique was used; the interview was conducted based on a pretested questionnaire to collect the data regarding injuries.
The study sample was calculated to be 1046 based on the following parameters: the prevalence of injury as 13%, 95% confidence interval (CI), relative precision of 16%, i.e. the margin of error 0.02, and about 10% of oversampling. A total of 1139 participants were selected from the three districts.
This study was approved by the Institutional Ethical Committee of SRM School of Public Health, Kattankulathur, Tamil Nadu. The purpose of this study was explained by the investigators, and informed consent was obtained from the respondents.
Analysis of the data was performed using the IBM SPSS Statistics for Windows, Trial Version 19.0. (Armonk, NY: IBM Corp). Descriptive analysis was performed; the prevalence rates for various subgroups of the elderly were calculated.
| Results|| |
The sociodemographic characteristics of the respondents was as described in [Table 1]. Majority of the respondents were residing in the pucca house and belonged to most backward class (MBC) followed by scheduled tribes (ST). Most of the elderly were reported to be on nonvegetarian diet (64.5%), and almost one-third were purely on vegetarian diet (35.5%), about one-third of the elderly had reported to have the habit of alcohol consumption (34.2%).
[Table 2] shows that majority of the elderly perceived that their health status was good (91%) and only 5.6% of the respondents perceived that their health status was poor. Almost half of the elderly reported to have a history of cardiovascular diseases (46%) and about one-third were reported to have diabetes (31.9%), almost all the elderly had reported to have aches and pains of joints (94.1%). Perceived dimness of vision was reported to be 68% and about one-fifth of the respondents reported to have impaired hearing (22.7%). Most of the elderly had walking difficulty (62%) and decreased the sensation of the foot was present for 50.5% of the respondents. About a quarter of the respondents was reported to have dizziness (25.8%), almost one-third of the elderly were on medications (32.7%). Most of the elderly have been involved in daily physical activities (81.7%).
Among 1003 eligible elderly, prevalence of injury in the past 1 year was found to be 14.6% (12.5–16.7 at 95% CI), among those injured 94.5% was unintentional injuries and 5.5% was intentional Injury. The study found out the prevalence of fall to be the highest of all injuries (6.67%), followed by minor domestic injury (5.4%), followed by burn injuries with a prevalence of (1.1%), road traffic injuries (0.4%), and animal-related injury (0.2%) [Table 3]. Among injured elderly, fall constitutes to majority (45.8%) of all injuries, followed by minor domestic injuries (37%), burns and attempted suicides [Figure 1].
|Figure 1: Distribution of injured elderly according to the type of injury (n = 146)|
Click here to view
This study calculated prevalence rates for various subgroups among elderly, when classified according to age, the study found oldest-old age group (above 80 and above) having the highest injuries (18.5/100). Comparison based on gender found males with a slightly higher rate of injury (17.5/100) compared to females (16.4/100). ST population were found to have the highest injury rates (44.8/100), which were about more than three times higher than in SC populations. Injury rates were found to be higher among widows/widowers (22.5/100) compared to married people (14.9/100). Elderly with low education was found to have higher injury rates, and the rates fall with an increase in the educational qualifications. Farmers were found to have the highest rate of injuries (30.7/100), about twice than those who were not gainfully employed (15.5/100). Elderly living in Kutcha houses were reported to have about 1.5 times higher injury rates (24.9/100) when compared to those living in pucca houses (10.8/100). Elderly who reported to have poor lighting at the house was having about four times higher rates of injury (45.4/100) compared to those reported to have adequate lighting. The injury rates were found to be higher among the elderly who had a habit of occasional alcohol consumption (25.3/100) compared to those who did not have the habit of alcohol consumption (13.4/100).
| Discussion|| |
This study was conducted among the elderly in three districts of Tamil Nadu found an overall injury prevalence of 14.6% (12.5–16.7 at 95% CI). The injury rate was the highest in the oldest-old age group (80+) and among men compared to women similar to study by Saveman and Björnstig.
An incidence study by Gudnadottir et al. among 4469 elderly in Iceland found, falls to be the most common type of injury (7.8%); our study found the majority of the elderly with fall injuries (6.7%). Study by DeGrauw et al., in the US stated that 65% of the injuries were due to fall, which was similar to our study with 46% of injuries due to fall.
A study conducted among the elderly in China revealed that divorced and the widowed were found to have injury rates than married counterparts, which were in agreement with our study results.
A cross-sectional study by Kurume, in Japan, found older people who are working to have a high occurrence of injuries; the study found similar results with agricultural workers having higher injuries (30.7/100).
Studies have found alcohol consumption associated with a higher risk for injury, our study found higher injury rates among occasional alcohol users.,
The study found higher rates of injuries among the elderly in low-socioeconomic status, which was in line with other global studies were the disparities in socioeconomic status for injuries were well established.,
| Conclusion|| |
The study identified that oldest-old and males having higher injuries and falls as the major cause for injury among the elderly population. The study might have recall bias, information regarding injuries were collected based on self reporting. The study shows the tip of the iceberg since trivial and injuries with fatal outcome was not included. Further research is needed to identify the full spectrum of injuries of various severity and outcome and identify the risk factors for injuries among the elderly.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N
Engl J Med 1988;319:1701-7.
Nevitt MC, Cummings SR, Kidd S, Black D. Risk factors for recurrent nonsyncopal falls. A prospective study. JAMA 1989;261:2663-8.
Ray WA, Fought RL, Decker MD. Psychoactive drugs and the risk of injurious motor vehicle crashes in elderly drivers. Am J Epidemiol 1992;136:873-83.
Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk M, et al.
Amultifactorial intervention to reduce the risk of falling among elderly people living in the community. N
Engl J Med 1994;331:821-7.
van Nieuwenhuizen RC, van Dijk N, van Breda FG, Scheffer AC, Korevaar JC, van der Cammen TJ, et al.
Assessing the prevalence of modifiable risk factors in older patients visiting an ED due to a fall using the CAREFALL triage instrument. Am J Emerg Med 2010;28:994-1001.
Gururaj G. Injuries in India: A National Perspective. Background Papers: Burden of Disease in India Equitable Development-Healthy Future. New Delhi: National Commission on Macroeconomics and Health, Ministry of Health & Family Welfare, Government of India; 2005. p. 325-47.
Tiesman HM, Peek-Asa C, Whitten P, Sprince NL, Stromquist A, Zwerling C. Depressive symptoms as a risk factor for unintentional injury: A cohort study in a rural county. Inj Prev 2006;12:172-7.
Sjögren H, Björnstig U. Unintentional injuries among elderly people: Incidence, causes, severity, and costs. Accid Anal Prev 1989;21:233-42.
Robertson LS. Injury Epidemiology. 2nd
ed. New York: Oxford University Press; 1998. p. 265.
Saveman BI, Björnstig U. Unintentional injuries among older adults in Northern Sweden – A one-year population-based study. Scand J Caring Sci 2011;25:185-93.
Gudnadottir M, Thorsteinsdottir TK, Mogensen B, Aspelund T, Thordardottir EB. Accidental injuries among older adults: An incidence study. Int Emerg Nurs 2018;40:12-7.
DeGrauw X, Annest JL, Stevens JA, Xu L, Coronado V. Unintentional injuries treated in hospital emergency departments among persons aged 65 years and older, United States, 2006-2011. J Safety Res 2016;56:105-9.
Hu G, Rao K, Baker SP. Non-fatal injuries among Chinese aged 65 years and older: Findings from the fourth national health services survey. Inj Prev 2010;16:230-4.
Nagata T, Abe T, Takamori A, Kimura Y, Hagihara A. Factors associated with the occurrence of injuries requiring hospital transfer among older and working-age pedestrians in Kurume, Japan. BMC Public Health 2017;17:537.
Balsa AI, Homer JF, Fleming MF, French MT. Alcohol consumption and health among elders. Gerontologist 2008;48:622-36.
Hingson R, Howland J. Alcohol and non-traffic unintended injuries. Addiction 1993;88:877-83.
Ameratunga S, Hijar M, Norton R. Road-traffic injuries: Confronting disparities to address a global-health problem. Lancet 2006;367:1533-40.
Ballesteros MF, Schieber RA, Gilchrist J, Holmgreen P, Annest JL. Differential ranking of causes of fatal versus non-fatal injuries among US children. Inj Prev 2003;9:173-6.
[Table 1], [Table 2], [Table 3]