Simply osteoporosis — or multifactorial genesis for the increasing incidence of fall injuries in the elderly? The need for a scientific approach to reducing injuries
Restricted accessResearch articleFirst published online September, 1990
Simply osteoporosis — or multifactorial genesis for the increasing incidence of fall injuries in the elderly? The need for a scientific approach to reducing injuries
Both the high and rising incidence of injuries in old age and a situation where accidents are looked upon as “super-human” events, impossible to prevent, call for a scientific approach to the problem.
Another strong reason for stressing the scientific approach is the complex aetiological origin of injuries in the elderly. Individual factors as well as factors overrepresented in the injured population must find a developed model as site for their importance compared to agent factors and environmental factors. If not, there will be an everlasting contradiction between the discussion on monofactorial “causes” of injuries like osteoporosis, lacking physical exercise, environmental risks, etc.
Still another reason is that the present serious situation with an increasing incidence of injuries in the elderly call for urgent preventive programmes as well as development of operation methods, rehabilitation methods and environmental changes. Unfortunately, in spite of the importance and magnitude of the number of injuries as a publich health problem, relative little scientific attention has been given to the area of injury control. In the paper it is concluded that there is a need for model development. These models should combine an epidemiological approach with a behavioural scientific method as well as a system-oriented model. Such models are available in occupational injury prevention and should as well be tested in prevention of injuries in the elderly.
Get full access to this article
View all access options for this article.
References
1.
1. International Center of Social Gerontology. Medical and Social Aspects of Accidents among the Elderly. Report of a WHO Working Group in cooperation with ICSG. International Center of Social Gerontology. Paris, 1983.
2.
2. The Prevention of Falls in later Life. A Report of the International Work Group on the Prevention of Falls by the Elderly. Gerontology Vol. 34: Special Supplement Series, No. 4. Danish Medical Bulletine. Copenhagen, 1987.
3.
3. Alffram PA.An epidemiologic study of cervical and trochanteric fractures of the femur in an urban population. Acta Orthop Scand1964: Suppl 65.
4.
4. Frandsen PA, Kruse T.Hip fractures in the county of Funen, Denmark. Implications of demographic aging and changes in incidence rates. Acta Orthop Scand1983; 54: 681–6.
5.
5. Bauer G.Epidemiology of fracture in aged persons. A preliminary investigation in fracture etiology. Clin Orthop1960; 17: 219–25.
6.
6. Jensen JS.Incidence of hip fractures. Acta Orthop Scand1980; 51: 511–3.
7.
7. Zetterberg C, Andersson GBJ.Fractures of the proximal end of the femur in Göteborg, Sweden, 1940–1979. Acta Orthop Scand1982; 53: 419–26.
8.
8. Gryffe CI, Amies A, Ashley MJ.A longitudinal study of falls in an elderly population: I. Incidence and morbidity. Age and Ageing1977; 66: 201–10.
9.
9. Lucht U.A prospective study of accidental falls and resulting injuries in the home among elderly people. Acta Socio-Med Scand1971; 2: 105–20.
10.
10. Hobson W, Pemberton J.The health of the elderly at home. London: Butterworth, 1955.
11.
11. Droller H.Falls and accidents in a random sample of elderly people living at home. In: Old age in the modern world. Report of the III Congress of the International Association of Gerontology. Edinburgh: Livingstone, 1955.
12.
12. Cwikel J.Falls among elderly living at home: Incidence and associations with medical and social factors in Israel. Jerusalem, Israel: 1988.
13.
13. Wild D, Nayak USL, Isaacs B.Prognosis of falls in old people at home. J Epidemiol Com Health1981; 35: 200–4.
14.
14. Haga H, Shibata H, Shichita K, Matsuzaki T, Hatano S.Falls in the institutionalized elderly in Japan. Arch Gerontol Geriatr1986; 5: 1–9.
15.
15. Withers BG, Baker SP.Epidemiology and prevention of injuries. Emerg Med Clin North Am.1984; 4: 701–15.
16.
16. Mellström D, Rundgren å, Johansson C, Zetterberg C.Benskörhet och frakturer hos äldre – en av nittiotalets folksjukdomar i Sverige. Forskning och praktik, 1986; 18: 63–6. (In Swedish).
17.
17. Zetterberg C, Mellström D, Rundgren å, Andersson GBJ, Frennered K, Hansson T.Hip Fractures in Elderly People – Epidemiology. Background factors. Läkartidningen1983; 80: 2043–5. (In Swedish).
18.
18. Zetterberg C, Andersson GBJ, Nachemson A.Hip fractures in elderly people – epidemiology. Läkartidningen1983; 80: 2040–3. (In Swedish with English summary).
19.
19. Skovron M-L.Fracture of the femoral neck in the elderly: Frequency, impact and levels of prevention. 1986.
20.
20. Thomas TG, Steven RS.Social effects of fractures of the neck of the femur. Br Med J1974; 3: 456–8.
21.
21. Pogrund H, Bloom R, Menczel J.Preventing osteoporosis: current practices and problems. Geriatr1986; 4: 55–71.
22.
22. The International Symposium on Osteoporosis, Aalborg, Denmark 27/9 – 2/10, 1987. Folia rapport. FCG1988; 2: 11–22. (In Swedish).
23.
23. Aloia JF, Cohn SH et al.Prevention of involutional bone loss by exercise. Ann Intern Med1978; 89: 356–8.
24.
24. Smith EL Jr, Smith PE et al.Physical activity and calcium modalities for bone mineral increase in aged women. Med Sci Sports Exerc1981; 18: 60–4.
25.
25. MacDonald JB, MacDonald ET.Nocturnal femoral fracture and the continuing widespread use of barbiturate hypnotics. Br med J1977; 2: 483–5.
26.
26. Frankel VH.The femoral neck: An experimental study of function, fracture, mechanism, and internal fixation. Thesis. Uppsala: Almqvist & Wiksell, 1960.
27.
27. MacDonald JB.The role of drugs in falls in the elderly. Clin Geriatr Med1985; 1: 621–36.
28.
28. Prudham D, Evens JG.Factors associated with falls in the elderly: A community study. Age and Ageing1981; 10: 141–6.
29.
29. Finetti ME, Williams TF, Mayewski R.Fall risk index for elderly patients based on number of chronic disabilities. Am J Med1986; 80: 429–34.
30.
30. Wild D, Nayak USL, Isaacs B.How dangerous are falls in old people at home?Br Med J1981; 282: 266–8.
31.
31. Ballinger BR, Ramsay AC.Accidents and drug treatment in a psychiatric hospital. Br J Psychiatry1975; 126: 462–3.
32.
32. Davie JW, Blumenthal MD, Robinson-Hawkins S.A model of risk of falling for psychogeriatric patients. Arch Gen Psychiatry1981; 38: 463–7.
33.
33. Wayne AR, Griffin MR, Schaffner W, Baugh DKK, Melton LJ.Psychotropic drug use and the risk of hip fracture. N Engl J Med1987; 316: 363–9.
34.
34. Dehlin O.Samband mellan intag av lugnande läkemedel och frakturer hos äldre?Läkartidningen1985; 11: 943. (In Swedish).
35.
35. Fernie GR, Gryfe CI, Holliday PJ, Llewelly A.A relationship of postural sway in standing to the incidence of falls in geriatric subjects. Age and Ageing1982; 11: 11–6.
36.
36. Swift CG, Stevenson IH.Benzodiazepines in the elderly. In: Costa E ed. The benzodiazepines: From molecular biology to clinical practice. New York: Raven Press, 1983: 225–36.
37.
37. Campbell AJ, Somerton DT.Benzodiazepine drug effect on body sway in elderly subjects. J Clin Exp Geron1982; 4: 341–7.
38.
38. Swift CG, Swift MR, Hamley J, Svenson IH, Crokks J.Side-effect “tolerance” in elderly long-term recipients of benzodiazepine hypnotics. Age and ageing1984; 13: 335–43.
39.
39. Svanström L.Falls on stairs: An epidemiological accident study. Scand J Soc Med1974; 2: 113–20.
40.
40. Schelp L, Svanström L.Community intervention and accidents. Epidemology as a basis for evaluation of community intervention programme on accidents. Sundbyberg: Folksam1987.
41.
41. Peck WA.Falls and hip fracture in the elderly. Hospital practice. 1986: Dep of Engineering. Toronto, Canada 15; 21(12): 72A–72C, 72F–72L.
42.
42. Andersson, R, Johansson B, Lindén K, Svanström K, Svanström L.Development of a model for research on occupational accidents. J Occup Acc1971; 1: 341–52.
43.
43. Surry J.Industrial accidents research. A Human engineering approach. University of Toronto1969.
44.
44. Gordon JE.The epidemiology of accidents. Amer J Publ Health1949; 39: 504–15.
