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Fall-Induced Injuries and Deaths Among Older Adults

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Fall-Induced Injuries and Deaths Among Older Adults ORIGINAL CONTRIBUTION Fall-Induced Injuries and Deaths Among Older Adults Pekka Kannus, MD, PhD Context Although various fall-induced injuries and deaths among older adults are Jari Parkkari, MD, PhD increasing, little is known about the epidemiology of these events. Seppo Koskinen, MD, PhD Objective To determine the trends in the number and incidence of fall-induced in- juries and deaths of older adults in a well-defined white population. Seppo Niemi Design and Setting Secular trend analysis of the population of Finland, using the Mika Palvanen, MD Finnish National Hospital Discharge Register and the Official Cause-of-Death Statis- Markku Ja¨rvinen, MD, PhD tics of Finland. Ilkka Vuori, MD, PhD Participants All persons aged 50 years or older who were admitted to hospitals in Finland for primary treatment of a first fall-induced injury from the years of 1970 to ALL-INDUCED INJURIES AND 1995, and for comparison, all fall-induced deaths in the same age group from the years deaths among older adults are 1971 to 1995. a major public health problem, Main Outcome Measure The number and the age-specific and age-adjusted incidence especially in developed societ- rate (per 100 000 persons) of fall-induced injuries and deaths in each year of the study. Fies that have aging populations.1-5 As the Results For the study period, both the total and population-adjusted number (per number of older adults in these popu- 100 000 persons) of Finns aged 50 years or older with fall-induced injury increased lations continues to increase, the num- substantially. Total fall-induced injuries increased from 5622 in 1970 to 21 574 in 1995, ber of fall-related injuries and result- a 284% increase, and the rate increased from 494 to 1398 per 100 000 persons, a ing deaths is also likely to increase. 183% increase. The age-adjusted incidence also increased in both women (from 648 About one third of 65-year-old or in 1970 to 1469 in 1995, a 127% increase) and men (from 434 in 1970 to 972 in older persons living in the community 1995, a 124% increase). Moreover, the number of deaths due to falls in the overall population increased from 441 in 1971 to 793 in 1995, an 80% increase, and the rate and more than half of those living in increased from 38 in 1971 to 51 in 1995, a 34% increase. However, after age adjust- institutions fall every year, and about ment the incidence of fall-induced death did not show a clear upward trend. half of those who fall do so repeat- edly.1,2 Both the incidence of falls and Conclusions In a well-defined white population, the number of older persons with fall-induced injuries is increasing at a rate that cannot be explained simply by demo- the severity of complications increase graphic changes. Preventive measures should be adopted to control the increasing bur- with age and increased disability and den of these injuries. Fortunately, the age-adjusted incidence of the fall-induced deaths functional impairment.2,3 Not all falls shows no increasing trend over time. of older persons are injurious and life- JAMA. 1999;281:1895-1899 www.jama.com threatening, but about 5% of them re- sult in a fracture, and other serious in- deaths of older adults has been con- Discharge Register (NHDR) of Fin- juries occur in 5% to 11% of falls.1-5 ducted. Therefore, we determined the land. This statutory register contains Injury is the fifth leading cause of death secular trends in the absolute number data on age, sex, place of residence, hos- in older adults, and most of these fatal and age-specific and age-adjusted inci- pital number and department, place and injuries are related to falls.1-5 In the dence rates of fall-induced injuries and cause of injury, diagnosis, day of ad- United States, falls, occurring primar- deaths among persons aged 50 years or ily among older adults, were the sec- older in Finland, a country with approxi- Author Affiliations: Accident & Trauma Research Cen- ond leading cause of deaths due to un- mately 5 million inhabitants between the ter and the Tampere Research Center of Sports Medi- 5 years of 1970 and 1995 (deaths were in- cine, President Urho Kaleva Kekkonen Institute for intentional injuries in 1994. Health Promotion Research, Tampere, Finland (Drs Despite these facts, to our knowl- cluded beginning in 1971). Kannus, Parkkari, Palvanen, and Vuori and Mr Ni- edge, no epidemiologic study on the emi); National Public Health Institute, Helsinki, Fin- METHODS land (Dr Koskinen); and the Medical School and the secular trends of fall-induced injuries and Department of Surgery, Tampere University and Uni- Fall-Induced Injuries versity Hospital, Tampere, Finland (Dr Ja¨ rvinen). Data for the fall-induced injuries were Corresponding Author and Reprints: Pekka Kannus, See also Patient Page. MD, PhD, UKK Institute, Kaupinpuistonkatu 1, FIN- obtained from the National Hospital 33500 Tampere, Finland (e-mail: [email protected]). ©1999 American Medical Association. All rights reserved. JAMA, May 26, 1999—Vol 281, No. 20 1895 Downloaded from www.jama.com by LauraCooper, on September 11, 2006 FALL-INDUCED INJURIES AND DEATHS IN OLDER ADULTS mission and discharge, and place of fur- Fall-Induced Deaths due to injuries and their cause-of-death ther treatment. The register has been Data were obtained from the Official codes are verified further by autopsies operating since 1967 and is updated and Cause-of-DeathStatistics(OCDS)ofFin- performed in 94% to 97% of these monitored for quality by the Depart- land.13 This statutory register has been cases.13,14 The death data for this study ment of Registers and Statistics, Na- computer-based since 1971, and from were drawn from the entire population tional Research and Development Cen- the beginning, the Cause-of-Death Bu- of Finland. ter for Welfare and Health, Helsinki, reau at the Central Statistical Office of Finland. Finland(currentlyStatisticsFinland)has Age-Specific and In this study, we defined fall- updated it and has maintained quality Age-Adjusted Incidence induced injuries as having been in- control. Annual mid year population figures for curred by adults aged 50 years or older The Finnish OCDS contains data on each 5-year age group, ranging from 50 who as a consequence of a fall (ie, an age,sex,maritalstatus,placeofresidence, to more than 90 years during the years unexpected, sudden descent from an and place, cause, and time of death of from1970through1995weretakenfrom upright, sitting, or horizontal posi- the deceased. In the Finnish system of the Official Statistics of Finland.16 In each tion, the descent height being #1m) death certification, the basic reason for age group, the fall-induced injury and were hospitalized (emergency depart- thedeathisclarifiedbythephysicianwho deathincidenceswerecalculatedforboth ment visits not requiring hospitaliza- certified the death and who wrote the of- sexes and expressed as the number of tion were not included). Similar crite- ficial death certificate. In injury-related cases per 100 000 persons each year. In ria have been used in epidemiological deaths, an autopsy is required and per- calculating the age-adjusted incidences, studies of osteoporotic fractures of the formed almost without exception in 94% ageadjustmentwasperformedseparately elderly.6-8 Thus, all Finns aged 50 years to 97% of these deaths to verify that the for women and men by means of direct or older who were admitted to hospi- death was indeed injury induced.13,14 standardization using the mean popu- tals for primary treatment of a fall- The main OCDS categories for unin- lation between 1970 and 1995 as the induced injury in the years between tentional injuries are those caused by standard population. 1970 and 1995 were selected from the road traffic and water traffic collisions, NHDR. The date of the injury and falls, drownings, and poisonings.13 For RESULTS unique personal identification num- the current study, all Finns aged 50 years Fall-Induced Injuries ber system of Finnish citizens allowed or older whose deaths were due to a fall- Numbers and Incidences. The number us to focus our analysis on each sub- induced injury from 1971 through 1995 of older persons with fall-induced injury ject’s first recorded admission. The fall- were selected. increasedconsiderablybetweentheyears induced injuries were classified as In practice, the Finnish OCDS re- 1970 and 1995: from 5622 to 21 574 bone fractures, soft tissue bruises and views 100% of Finnish deaths, since each overall (a 284% increase) and from 3659 contusions, head injuries other than death certificate and the correspond- to 14 764 in women and from 1963 to fractures, joint distortions and dislo- ing decedant information in the popu- 6810 in men (FIGURE 1, A). The aver- cations, soft tissue wounds and lacera- lation register are cross-checked.13 For age annual increases for women and men tions, and other injuries. example, in 1994 only 4 death certifi- were 12.1% and 9.9%, respectively. In The Finnish NHDR is the oldest es- cates of the 47 938 deceased were not is- both sexes, the overall incidence curve tablished nationwide discharge regis- sued before the deadline and publica- also showed a clearly increasing trend, ter in the world, and the data pro- tion of the 1994 statistics.13,15 although the Finnish population of per- vided by this register are well suited to The accuracy of the data of the OCDS sonsaged50yearsorolderincreased36% epidemiologic purposes: the register has is maximized by triple-checking each (from 1.1 million to 1.5 million) during been shown to cover the acute inju- code of the death certificate issued by the this 25-year period (Figure 1, B).
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