Nonfatal Injuries Among the Elderly Treated in Hospital Emergency Departments
Creators: name: Kocher, Keith
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2003

description: Objectives: To characterize nonfatal injuries in the elderly treated in U.S. hospital emergency departments (EDs) during 2000 and 2001, and to model which characteristics are most highly associated with hospitalization as an outcome. Methods: This was a retrospective, cross-sectional study. Data were analyzed from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AlP). NEISS-AIP is operated by the U.S. Consumer Product Safety Commission and sponsored by the Centers for Disease Control and Prevention. It provides data on roughly 500,000 injury-related ED cases each year, representing approximately 31 million injuries. These data are drawn from a nationally representative sample of 66 NEISS-AlP hospitals, which were selected as a stratified probability sample of hospitals with a minimum of six beds and a 24-hour ED in the U.S. and its territories. Data from these cases were weighted by the inverse of the probability of selection to provide national estimates. Annualized estimates were based on weighted data for 36,752 nonfatal injuries among the elderly treated in EDs during January-December 2001 and 17,605 nonfatal injuries during July-December 2000. 2001 NEISS-AlP data were utilized to arrive at injury rates while 2000 NEISS-AIP data were utilized in bivariate and multivariate logistic regression modeling. U.S. Census Bureau population estimates for 2001 were utilized in order to arrive at injury rates. A direct variance estimation procedure was used to calculate 95% confidence intervals. Nonfatal injuries were defined as bodily harm resulting from acute exposure to an external force or substance, including unintentional and violence-related causes. Cases were excluded from this analysis if 1) the person was less than 65 years old or of unknown age; 2) the principal diagnosis was for a (a) non-injury illness, (b) pain only illness, or (c) unknown; and 3) the ED visit represented a fatality. Deaths were excluded from the analysis because they are not captured completely by NEISS-AIP. Ail injuries were classified according to the mechanism of injury, disposition, diagnosis, primary body part injured, location, and intent. Results: During 2001, an estimated 935,556 males and 1,731,640 females ages ≥ 65 were treated in EDs for nonfatal injuries. This represented 5.7% of all nonfatal injuries for males and 13.3% of all nonfatal injuries for females across all ages. The overall injury rate per 100,000 persons was higher among females (8,466) than males (6,404). The injury rate also increased with each higher age bracket for both females and males until it reached a rate of 15,272 for females ages ≥ 85 and 11,547 for males ages ≥ 85. Compared to all other mechanisms, falls caused the highest rates of injuries by far across this population (4,684); however, this mechanism of injury was disproportionately represented among females (67.1%) more than males (50.5%) (P < 0.0001). Yet, males had higher percentages of other causes of nonfatal injury, including being struck by or against (11.2% vs. 7.7%, P < 0.0001), occupying a motor vehicle (9.2% vs. 6.5%, P < 0.0001), and being cut or pierced (7.2% vs. 2.7%, P < 0.0001). Most injuries among the elderly were diagnosed as fractures (25.2%) or contusions/abrasions (23.2%) while the parts of the body typically affected were the head/neck (25.8%) or arms/hands (21.7%). Many nonfatal injuries among the elderly occurred in the home (47.8%). The majority of patients were treated and then released (82.5% ), although an important number were also hospitalized (15.1 %). Those characteristics for which hospitalization as an outcome were more highly associated include: older age groups (OR= 2.00 for those ages ≥ 85, P < 0.001); males (OR= 1.25 compared to females, P < 0.001); being a motor vehicle occupant (OR= 9.12, P < 0.001); having a hemorrhage (OR= 54.22, P < 0.001), concussion (OR= 30.06, P < 0.001), or fracture (OR= 25.66, P < 0.001); and self-harm (OR= 12.22, p < 0.001). Discussion: Injuries are generally considered a problem of the young. Consequently, not as much attention has been focused on injuries in the elderly population. While it is true that injuries do not account for as many fatalities when compared to other causes of death among senior Americans (8th leading cause in 2000 when grouping intentional and unintentional injuries together for ages ≥ 65), the rate for nonfatal injuries among this population is actually quite comparable to rates among younger age groups. In fact, starting around age 65, the rates for nonfatal injuries begin to increase again after having steadily declined after the late-20s, peaking as high as 14,141 per 100,000 persons among the ≥ 85 population. This was similar to the nonfatal injury rate in the 25-29 (13,925) or 10-14 (13,252) age groups. Other important findings included the disparities between male and female injury rates and patterns, the rate of hospitalization after a nonfatal injury among the elderly (1,217) was much higher than any younger age group, and the characteristics for which hospitalization as an outcome are more highly associated. These data establish that injuries are a significant public health problem among elderly Americans.