# Presentation: 687370

## National Trend Data on Hospitalization of the Elderly for Injuries, 1979-2001

- Margaret Jean Hall, Ph.D.
- Lois Fingerhut, M.A.
- Melissa Heinen, M.P.H.

## Study Objectives – to analyze trend data on elderly injury hospitalizations and to identify ways to decrease  injuries in the future.

## Data from the National Hospital Discharge Survey- Based on a sample of non-federal short-stay hospitals- Abstracted from the medical records of a sample of inpatients- Data for 1979-2001 for about 450 hospitals and 300,000 discharges per year- Weighted to produce national estimates

## Injury defined byInternational Classification of Disease Codes (ICD-9-CM) 

- 800-909.2, 909.4, 909.9,
- 910-994.9, 995.5-995.59,
- 995.80-995.85
-  Definition developed by the State and Territorial Injury Prevention Directors’ Association (STIPDA)

## Trends in injury hospitalization by age

- 65 and over

- < 15

- 15-44

- 45-64

- Elderly injury hospitalization rates were higher and did not
- decrease as much as rates for younger patients.

- 1979

- 2001

## Injury hospital patients under and over age 65

- The proportion of injury hospital patients who are elderly has
- been increasing.

- %

## Elderly injury hospitalization	

-                                     **1979**		   **2001  **
-  #  of discharges       593,000	717,000
-  Rate per 10,000
-     population  		235.9		    202.8
- % of total elderly
- hospitalizations	   	   7%		       6%

## Type of injury resulting in elderly hospitalization

- Fractures

- Internal injuries

- Poisoning

- Other injuries

- Most of the elderly injury hospitalizations were for fractures.
- The share of injury hospitalizations for fractures increased
- over time.

## Injury hospital discharge rates by sex for those 65 and over 

- females

- males

- 1979

- 2001

- Elderly females had higher injury hospital discharge rates than elderly males.

## Fracture hospitalization rates by sex for the elderly 

- females

- males

- Elderly females have higher fracture hospitalization rates than males.  Both male and
- female fracture hospitalization rates for the elderly remained stable over time.

- 1979

- 2001

## Hip fracture hospital discharge rate for females 65 and over 

- 85 and over

- 75-84

- 65-74

- Females 85 and over had the highest discharge rate for hip fractures and this
- rate increased over time.

- 1979

- 2001

## Elderly injury patients with and without external cause codes

- With at least one external cause code

- No external cause
- code

- External cause coding increasing but still missing for more than
- a third of the elderly injury patients.

- 90%

- 73%

- 51%

- 35%

**Percent**

## Hospitalized elderly injury patients with no external cause codes, 2001

- Had no room on abstract form for E-code

- Had room for
- E-codes on
- abstract form

- 55%

- 45%

## External cause of injury data for elderly injury hospitalizations, 2001

- Falls

- Poisoning

- Motor vehicle traffic

- No external cause

- Other external causes

- Falls were cause of almost half of elderly injury hospitalizations.

- 49%

- 2%

- 3%

- 11%

- 35%

## External cause of injury data for fracture hospitalizations for the elderly, 2001

- Falls
- 55%

- Motor vehicle traffic 2%

- No external cause
- 35%

- Other external causes
-                8%

- Falls were cause of more than half of elderly fracture hospitalizations.

## Reasons why elderly are at higher risk of injury hospitalization

- Longer lives may bring more frailty or cognitive impairment
- Illness or medications can cause dizziness
- or unsteadiness
- Slower response times, including while driving, can increase accident risk
- Safety hazards often exist in homes
- When elderly are in an accident there is a greater likelihood of being seriously hurt

## What can be done?

- Complete health assessment and  coordinated medical care, including vision checks,  on a regular basis
- Medication monitoring including dosage, side effects and drug interactions
- Screening for osteoporosis in middle age to halt or even reverse bone damage
- Weight-training and other exercise programs, such as tai chi,  to keep older adults stronger and improve their gait
- Improve the appearance and comfort of hip pads to prevent injury from falls,  and identify ways to increase  compliance with their use

## What can be done?

- Increase home safety by improving lighting, installing  handrails on steps and in bathtubs, and eliminating other  dangerous situations
- Transportation
- 	 Conduct safe driver programs geared to the elderly
- 	Teach physicians and family members how to assess  	 whether an elderly  person should continue to 	drive
- 	Offer alternative forms of transportation for the elderly  	who don’t drive

## Source of additional injury data: Trends in Injury Hospitalizations: United States, 1979-2001published byThe National Center for Health Statistics, CDChttp://www.cdc.gov/nchs/injury.htm