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Erschienen in: Osteoporosis International 10/2011

01.10.2011 | Original Article

Conflicting trends in fall-related injury hospitalisations among older people: variations by injury type

verfasst von: W. L. Watson, R. Mitchell

Erschienen in: Osteoporosis International | Ausgabe 10/2011

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Abstract

Summary

Despite advances in prevention, fall-related hospitalisation rates among older people are still increasing. Rates between 1998/1999 and 2008/2009 for non-facture-related injuries increased by 6.1% while fracture injuries declined by −0.4%. Varying trends in rates of different injury types makes it difficult to provide a definitive explanation for these changes.

Introduction

Despite advances in fall prevention research and practice, the rate of fall-related hospitalisations continues to increase. However, hip fracture rates appear to be declining. An examination of trends in types of injuries that contribute to the overall fall injury rate is required to establish which injuries are driving the falls admission rate. The aim of this paper is to examine trends in fall-related injury hospital admissions by injury type in New South Wales (NSW), Australia.

Methods

A retrospective review of fall-related injury hospitalisations in NSW among individuals aged 65+ years, by injury type, was conducted from 1 July 1998 to 30 June 2009. Direct age-standardised admission rates were calculated. Negative binomial regression was used to examine the statistical significance of changes in trend over time of different hospitalised fall-related injuries.

Results

The fall-related hospitalisation rate increased by 1.7% each year (p < 0.0001; 95% confidence interval (CI), 1.3–2.1%). However, the rate of fracture declined by −0.4% (p < 0.03; 95% CI, −0.8–0.0%); whereas, the non-fracture rate increased by 6.1% (p < 0.0001; 95% CI, 5.5–6.7%) annually. Rates for severe head injuries, rib and pelvic fracture increased while those for hip and forearm fracture declined.

Conclusions

It appears that while fall prevention efforts in NSW are not yet affecting the overall rate of injury hospitalisation, there has been a significant decline in the rates of some fractures. Opposing trends in the rates of other fracture admissions and a significant increase in the rate of non-fracture injuries associated with falls makes a definitive explanation for these changes difficult.
Literatur
1.
Zurück zum Zitat Lord S, Sherrington C, Menz H (2007) Falls in older people: risk factors and strategies for prevention. Cambridge University Press, CambridgeCrossRef Lord S, Sherrington C, Menz H (2007) Falls in older people: risk factors and strategies for prevention. Cambridge University Press, CambridgeCrossRef
2.
Zurück zum Zitat Cummings R, Salkeld G, Thomas M, Szonyi G (2000) Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission. J Gerontol A Biol Sci Med Sci 55:M299–M305CrossRef Cummings R, Salkeld G, Thomas M, Szonyi G (2000) Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission. J Gerontol A Biol Sci Med Sci 55:M299–M305CrossRef
3.
Zurück zum Zitat Tinetti M, Powell L (1993) Fear of falling and low self-efficacy: a cause of dependence in elderly persons. J Gerontol 48(Special Issue):35–38PubMed Tinetti M, Powell L (1993) Fear of falling and low self-efficacy: a cause of dependence in elderly persons. J Gerontol 48(Special Issue):35–38PubMed
4.
Zurück zum Zitat Tinetti M, Williams C (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 337(18):1279–1284PubMedCrossRef Tinetti M, Williams C (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 337(18):1279–1284PubMedCrossRef
5.
Zurück zum Zitat Scuffham P, Chaplin S, Legood R (2003) Incidence and costs of unintentional falls in older people in the United Kingdom. J Epidemiol Community Health 57(9):740PubMedCrossRef Scuffham P, Chaplin S, Legood R (2003) Incidence and costs of unintentional falls in older people in the United Kingdom. J Epidemiol Community Health 57(9):740PubMedCrossRef
6.
Zurück zum Zitat Stevens J, Corso P, Finkelstein E, Miller T (2006) The costs of fatal and non-fatal falls among older adults. Br Med J 12(5):290 Stevens J, Corso P, Finkelstein E, Miller T (2006) The costs of fatal and non-fatal falls among older adults. Br Med J 12(5):290
7.
Zurück zum Zitat Watson W, Clapperton A, Mitchell R (2010) The burden of fall-related injury among older persons in New South Wales. Australian and New Zealand Journal of Public Health (in press) Watson W, Clapperton A, Mitchell R (2010) The burden of fall-related injury among older persons in New South Wales. Australian and New Zealand Journal of Public Health (in press)
8.
Zurück zum Zitat Bradley C, Pointer S (2008) Hospitalisations due to falls by older people, Australia 2005–06. Australian institute of health and welfare, Adelaide, 38 Bradley C, Pointer S (2008) Hospitalisations due to falls by older people, Australia 2005–06. Australian institute of health and welfare, Adelaide, 38
9.
Zurück zum Zitat Hartholt K, van der Velde N, Looman C, van Lieshout E, Panneman M, van Beeck E, Patka P, Van der Cammen T (2010) Trends in fall-related hospital admissions in older persons in The Netherlands. Arch Intern Med 170(10):905–911PubMedCrossRef Hartholt K, van der Velde N, Looman C, van Lieshout E, Panneman M, van Beeck E, Patka P, Van der Cammen T (2010) Trends in fall-related hospital admissions in older persons in The Netherlands. Arch Intern Med 170(10):905–911PubMedCrossRef
10.
Zurück zum Zitat Fisher A, O’Brien E, Davis M (2009) Trends in hip fracture epidemiology in Australia: possible impact of bisphosphonates and hormone replacement therapy. Bone 45:246–253PubMedCrossRef Fisher A, O’Brien E, Davis M (2009) Trends in hip fracture epidemiology in Australia: possible impact of bisphosphonates and hormone replacement therapy. Bone 45:246–253PubMedCrossRef
11.
Zurück zum Zitat Jaglal S, Weller I, Mamdani M, Hawker G, Kreder H, Jaakkimainen L, Adachi J (2005) Population trends in bmd testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong? J Bone Miner Res 20(6):898–905PubMedCrossRef Jaglal S, Weller I, Mamdani M, Hawker G, Kreder H, Jaakkimainen L, Adachi J (2005) Population trends in bmd testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong? J Bone Miner Res 20(6):898–905PubMedCrossRef
12.
Zurück zum Zitat Melton L, Kearns A, Atkinson E, Bolander M, Achenbach S, Huddleston J, Therneau T, Leibson C (2009) Secular trends in hip fracture incidence and recurrence. Osteoporos Int 20(5):687–694PubMedCrossRef Melton L, Kearns A, Atkinson E, Bolander M, Achenbach S, Huddleston J, Therneau T, Leibson C (2009) Secular trends in hip fracture incidence and recurrence. Osteoporos Int 20(5):687–694PubMedCrossRef
13.
Zurück zum Zitat Nymark T, Lauritsen J, Ovesen O, Röck N, Jeune B (2006) Decreasing incidence of hip fracture in the Funen County, Denmark. Acta Orthop 77(1):109–113PubMedCrossRef Nymark T, Lauritsen J, Ovesen O, Röck N, Jeune B (2006) Decreasing incidence of hip fracture in the Funen County, Denmark. Acta Orthop 77(1):109–113PubMedCrossRef
14.
Zurück zum Zitat Rogmark C, Sernbo I, Johnell O, Nilsson J (1999) Incidence of hip fractures in Malmö, Sweden, 1992–1995 a trend-break. Acta Orthop 70(1):19–22CrossRef Rogmark C, Sernbo I, Johnell O, Nilsson J (1999) Incidence of hip fractures in Malmö, Sweden, 1992–1995 a trend-break. Acta Orthop 70(1):19–22CrossRef
15.
Zurück zum Zitat Langley J, Samaranayaka A, Davie G, Campbell A (2010) Age, cohort and period effects on hip fracture incidence: analysis and predictions from New Zealand data 1974–2007. Osteoporos Int. doi:10.1007/s00198-010-1205-6 PubMed Langley J, Samaranayaka A, Davie G, Campbell A (2010) Age, cohort and period effects on hip fracture incidence: analysis and predictions from New Zealand data 1974–2007. Osteoporos Int. doi:10.​1007/​s00198-010-1205-6 PubMed
16.
Zurück zum Zitat Dimai H, Svedbom A, Fahrleitner-Pammer A, Pieber T, Resch H, Zwettler E, Chandran M, Borgström F (2010) Epidemiology of hip fractures in Austria: evidence for a change in the secular trend. Osteoporosis International (ePub):1–8 (in press) Dimai H, Svedbom A, Fahrleitner-Pammer A, Pieber T, Resch H, Zwettler E, Chandran M, Borgström F (2010) Epidemiology of hip fractures in Austria: evidence for a change in the secular trend. Osteoporosis International (ePub):1–8 (in press)
17.
Zurück zum Zitat Leslie WD, O’Donnell S, Jean S, Lagace C, Walsh P, Bancej C, Morin S, Hanley DA, Papaioannou A, Osteoporosis Surveillance Expert Working Group (2009) Trends in hip fracture rates in Canada. J Am Med Assoc 302(8):883–889CrossRef Leslie WD, O’Donnell S, Jean S, Lagace C, Walsh P, Bancej C, Morin S, Hanley DA, Papaioannou A, Osteoporosis Surveillance Expert Working Group (2009) Trends in hip fracture rates in Canada. J Am Med Assoc 302(8):883–889CrossRef
19.
Zurück zum Zitat Boufous S, Finch C, Lord S (2004) Incidence of hip fracture in New South Wales: are our efforts having an effect? Med J Aust 180:623–626PubMed Boufous S, Finch C, Lord S (2004) Incidence of hip fracture in New South Wales: are our efforts having an effect? Med J Aust 180:623–626PubMed
20.
Zurück zum Zitat National Centre for Classification in Health (2006) International statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD-10-AM), 5th edn. National Centre for Classification in Health, Sydney National Centre for Classification in Health (2006) International statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD-10-AM), 5th edn. National Centre for Classification in Health, Sydney
21.
Zurück zum Zitat Centre for Epidemiology and Research (2006) Health Outcomes and Information Statistical Toolkit (HOIST). NSW Department of Health, Sydney Centre for Epidemiology and Research (2006) Health Outcomes and Information Statistical Toolkit (HOIST). NSW Department of Health, Sydney
22.
Zurück zum Zitat Population Health Division (2008) The health of the people of New South Wales—report of the Chief Health Officer. NSW Department of Health, Sydney Population Health Division (2008) The health of the people of New South Wales—report of the Chief Health Officer. NSW Department of Health, Sydney
23.
Zurück zum Zitat Dobson A, Kuulasmaa K, Eberle E, Scherer J (1991) Confidence intervals for weighted sums of poisson parameters. Stat Med 10(3):457–462PubMedCrossRef Dobson A, Kuulasmaa K, Eberle E, Scherer J (1991) Confidence intervals for weighted sums of poisson parameters. Stat Med 10(3):457–462PubMedCrossRef
24.
Zurück zum Zitat Armitage P, Berry G, Matthews J (2002) Statistical methods in medical research. Fourth edition. Blackwell Science, CornwellCrossRef Armitage P, Berry G, Matthews J (2002) Statistical methods in medical research. Fourth edition. Blackwell Science, CornwellCrossRef
25.
Zurück zum Zitat SAS Institute (2003) SAS: statistical software, version 9.1. SAS Institute, Cary SAS Institute (2003) SAS: statistical software, version 9.1. SAS Institute, Cary
26.
Zurück zum Zitat Orces CH (2009) Trends in hospitalization for fall-related injury among older adults in the United States, 1988–2005. Ageing Res 1:e1CrossRef Orces CH (2009) Trends in hospitalization for fall-related injury among older adults in the United States, 1988–2005. Ageing Res 1:e1CrossRef
27.
Zurück zum Zitat Centre for Health Advancement and Centre for Epidemiology and Research (2010) New South Wales falls prevention baseline survey: 2009 report. NSW Department of Health, Sydney Centre for Health Advancement and Centre for Epidemiology and Research (2010) New South Wales falls prevention baseline survey: 2009 report. NSW Department of Health, Sydney
28.
Zurück zum Zitat NSW Department of Health, Public Health Division (2000) New South Wales older people’s health survey 1999. NSW Department of Health, Sydney NSW Department of Health, Public Health Division (2000) New South Wales older people’s health survey 1999. NSW Department of Health, Sydney
29.
Zurück zum Zitat Kannus P, Niemi S, Parkkari J, Palvanen M, Heinonen A, Seivanen H, Jarvinen T, Khan K, Jarvinen M (2002) Why is the age-standardized incidence of low-trauma fractures rising in many elderly populations? Bone 17:1363–1367 Kannus P, Niemi S, Parkkari J, Palvanen M, Heinonen A, Seivanen H, Jarvinen T, Khan K, Jarvinen M (2002) Why is the age-standardized incidence of low-trauma fractures rising in many elderly populations? Bone 17:1363–1367
30.
Zurück zum Zitat Jamieson LM, Roberts-Thomson KF (2007) Hospitalized head injuries among older people in Australia, 1998/1999 to 2004/2005. Inj Prev 13:243–247PubMedCrossRef Jamieson LM, Roberts-Thomson KF (2007) Hospitalized head injuries among older people in Australia, 1998/1999 to 2004/2005. Inj Prev 13:243–247PubMedCrossRef
31.
Zurück zum Zitat Koskinen S, Alaranta H (2008) Traumatic brain injury in finland 1991–2005: a nationwide register study of hospitalized and fatal TBI. Brain Inj 22(3):205–214PubMedCrossRef Koskinen S, Alaranta H (2008) Traumatic brain injury in finland 1991–2005: a nationwide register study of hospitalized and fatal TBI. Brain Inj 22(3):205–214PubMedCrossRef
32.
Zurück zum Zitat Langlois J, Rutland-Brown W, Wald M (2006) The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil 21(5):375PubMedCrossRef Langlois J, Rutland-Brown W, Wald M (2006) The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil 21(5):375PubMedCrossRef
33.
Zurück zum Zitat Kannus P, Niemi S, Parkkari J, Palvanen M, Sievanen H (2007) Alarming rise in fall-induced severe head injuries among elderly people. Injury 38:31–83CrossRef Kannus P, Niemi S, Parkkari J, Palvanen M, Sievanen H (2007) Alarming rise in fall-induced severe head injuries among elderly people. Injury 38:31–83CrossRef
34.
Zurück zum Zitat NSW Health Quality and Safety Branch (2008) Policy directive: closed head injury in adults - initial management. NSW Health, Sydney NSW Health Quality and Safety Branch (2008) Policy directive: closed head injury in adults - initial management. NSW Health, Sydney
35.
Zurück zum Zitat Hindmarsh D, Hayen A, Finch C, Close J (2009) Relative survival after hospitalisation for hip fracture in older people in New South Wales, Australia. Osteoporos Int 20(2):221–229PubMedCrossRef Hindmarsh D, Hayen A, Finch C, Close J (2009) Relative survival after hospitalisation for hip fracture in older people in New South Wales, Australia. Osteoporos Int 20(2):221–229PubMedCrossRef
36.
Zurück zum Zitat Kelsey J, Samelson E (2009) Variation in risk factors for fractures at different sites. Curr Osteoporos Rep 7(4):127–133PubMedCrossRef Kelsey J, Samelson E (2009) Variation in risk factors for fractures at different sites. Curr Osteoporos Rep 7(4):127–133PubMedCrossRef
37.
Zurück zum Zitat Abrahamsen B, Vestergaard P (2010) Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997–2006. Osteoporos Int 21(3):373–380PubMedCrossRef Abrahamsen B, Vestergaard P (2010) Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997–2006. Osteoporos Int 21(3):373–380PubMedCrossRef
38.
Zurück zum Zitat Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Järvinen M (2006) Nationwide decline in incidence of hip fracture. J Bone Miner Res 21(12):1836–1838PubMedCrossRef Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Järvinen M (2006) Nationwide decline in incidence of hip fracture. J Bone Miner Res 21(12):1836–1838PubMedCrossRef
39.
Zurück zum Zitat Kannus P, Niemi S, Palvanen M, Sievänen H, Parkkari J, Järvinen M (2008) Rising incidence of low-trauma fractures of the calcaneus and foot among Finnish older adults. J Gerontol A Biol Sci Med Sci 63(6):642PubMed Kannus P, Niemi S, Palvanen M, Sievänen H, Parkkari J, Järvinen M (2008) Rising incidence of low-trauma fractures of the calcaneus and foot among Finnish older adults. J Gerontol A Biol Sci Med Sci 63(6):642PubMed
40.
Zurück zum Zitat Kannus P, Palvanen M, Niemi S, Sievänen H, Parkkari J (2009) Rate of proximal humeral fractures in older Finnish women between 1970 and 2007. Bone 44(4):656–659PubMedCrossRef Kannus P, Palvanen M, Niemi S, Sievänen H, Parkkari J (2009) Rate of proximal humeral fractures in older Finnish women between 1970 and 2007. Bone 44(4):656–659PubMedCrossRef
41.
Zurück zum Zitat Kannus P, Palvanen M, Niemi S, Parkkari J, Järvinen M (2008) Stabilizing incidence of low-trauma ankle fractures in elderly Finnish people in 1970–2006 and prediction for the future. Bone 43:340–342PubMedCrossRef Kannus P, Palvanen M, Niemi S, Parkkari J, Järvinen M (2008) Stabilizing incidence of low-trauma ankle fractures in elderly Finnish people in 1970–2006 and prediction for the future. Bone 43:340–342PubMedCrossRef
42.
Zurück zum Zitat Boufous S, Finch C, Lord S, Close J (2005) The increasing burden of pelvic fractures in older people, New South Wales, Australia. Injury 36:1323–1329PubMedCrossRef Boufous S, Finch C, Lord S, Close J (2005) The increasing burden of pelvic fractures in older people, New South Wales, Australia. Injury 36:1323–1329PubMedCrossRef
43.
Zurück zum Zitat Boufous S, Finch C, Lord S, Close J, Gothelf T, Walsh W (2006) The epidemiology of hospitalised wrist fractures in older people, New South Wales, Australia. Bone 39(5):1144–1148PubMedCrossRef Boufous S, Finch C, Lord S, Close J, Gothelf T, Walsh W (2006) The epidemiology of hospitalised wrist fractures in older people, New South Wales, Australia. Bone 39(5):1144–1148PubMedCrossRef
44.
Zurück zum Zitat Downton J, Andrews K (1990) Postural disturbance and psychological symptoms amongst elderly people living at home. Int J Geriatr Psychiatry 5(2):93–98CrossRef Downton J, Andrews K (1990) Postural disturbance and psychological symptoms amongst elderly people living at home. Int J Geriatr Psychiatry 5(2):93–98CrossRef
45.
Zurück zum Zitat Chung M, McKee K, Austin C, Barkby H, Hayley Brown H, Cash S, Ellingford J, Hanger L, Pais T (2009) Posttraumatic stress disorder in older people after a fall. Int J Geriatr Psychiatry 24(9):955–964PubMedCrossRef Chung M, McKee K, Austin C, Barkby H, Hayley Brown H, Cash S, Ellingford J, Hanger L, Pais T (2009) Posttraumatic stress disorder in older people after a fall. Int J Geriatr Psychiatry 24(9):955–964PubMedCrossRef
46.
Zurück zum Zitat Boufous S, Finch C (2005) Estimating the incidence of hospitalized injurious falls: impact of varying case definitions. Injury Prevention 11:334–336 Boufous S, Finch C (2005) Estimating the incidence of hospitalized injurious falls: impact of varying case definitions. Injury Prevention 11:334–336
Metadaten
Titel
Conflicting trends in fall-related injury hospitalisations among older people: variations by injury type
verfasst von
W. L. Watson
R. Mitchell
Publikationsdatum
01.10.2011
Verlag
Springer-Verlag
Erschienen in
Osteoporosis International / Ausgabe 10/2011
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-010-1511-z

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