Injuries and ageing: interdisciplinary topics, whole-society solutions
Authors: Maziar Moradi-Lakeh
Journal: The Lancet Healthy Longevity (2022)

In The Lancet Healthy Longevity, Samar Al-Hajj and colleagues investigate injury burden in people aged 50 years or older in the Eastern Mediterranean region, and highlight increased rates of disability-adjusted life years due to injuries in this region compared with global rates; differences in rates between the countries in the region are also shown.1Al-Hajj S Farran S Sibai AM et al.Injury burden in individuals aged 50 years or older in the Eastern Mediterranean region, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019.Lancet Healthy Longev. 2022; 3: e253-e262Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), from which data are derived in the study by Al-Hajj and colleagues, provides estimates for the burden of diseases and injuries, and for the burden attributable to different risk factors by cause, age, sex, location, and time, but does not provide estimates based on birth cohort. The cohort effect is important in assessment of health in older adults, because health in this population depends on lifestyle and different exposure to risk factors throughout the life course. Those birth cohorts that experience war or other types of conflicts have sustained effects for several years or even the whole life course. Such effects include both the direct physical or mental consequences of conflicts, such as lifelong bodily injuries or chronic anxiety disorders, and indirect health complications mediated by the factors related to conflicts, such as displacement, mass migration, land occupation, and disruption of social services. Other studies have demonstrated significant independent influences of age, birth cohort, and period effects on unintentional injuries, such as death from motorcycle injuries in traffic accidents,2Langley J Samaranayaka A Begg DJ Age, period and cohort effects on the incidence of motorcyclist casualties in traffic crashes.Inj Prev. 2013; 19: 153-157Crossref PubMed Scopus (5) Google Scholar, 3Puac-Polanco V Keyes KM Li G Mortality from motorcycle crashes: the baby-boomer cohort effect.Inj Epidemiol. 2016; 3: 19Crossref PubMed Scopus (10) Google Scholar as well as on risk factors of injuries, such as occupational risks and decreased bone density; programmes against these risk factors should usually start before elderly to prevent poor outcomes efficiently in older age.4National Institute for Health and Care ExcellenceOsteoporosis: assessing the risk of fragility fracture.https://www.nice.org.uk/guidance/CG146Date: Feb 7, 2017Date accessed: March 3, 2022Google Scholar This means that when we describe injuries in older people for several consecutive years, we also need to consider their birth cohorts; people of the same age group but from different birth cohorts might be affected differently by injuries, especially when there is a long time difference between the first and the last birth cohorts included. In the Eastern Mediterranean region, a commission of Social Determinants of Health, initiated by the WHO regional office, published the Build back fairer report, which includes a conceptual framework, different recommendations, and suggested actions for improving the social determinants of health and for reducing health inequities; healthy ageing as a life condition, and conflict and consequences thereof as structural drivers have been recognised by the commissioners as important fields for interventions in the region.5WHORegional Office for the Eastern Mediterranean. Build back fairer: achieving health equity in the Eastern Mediterranean Region: report of the commission on social determinants of health in the Eastern Mediterranean Region.https://apps.who.int/iris/handle/10665/348185Date: 2021Date accessed: February 14, 2022Google Scholar Conflicts, both within and between the countries, are more common in the Eastern Mediterranean region than in other places in the world. Since the beginning of the 21st century, all countries in this region have in some way been affected by war, armed conflict, or terrorism.5WHORegional Office for the Eastern Mediterranean. Build back fairer: achieving health equity in the Eastern Mediterranean Region: report of the commission on social determinants of health in the Eastern Mediterranean Region.https://apps.who.int/iris/handle/10665/348185Date: 2021Date accessed: February 14, 2022Google Scholar Obviously, peace has a crucial role in reducing the burden of intentional injuries and its consequences in all age groups,6GBD 2015 Eastern Mediterranean Region Intentional Injuries CollaboratorsIntentional injuries in the Eastern Mediterranean Region, 1990–2015: findings from the Global Burden of Disease 2015 study.Int J Public Health. 2018; 63: 39-46Crossref PubMed Scopus (16) Google Scholar and should be actively followed as a main objective; at the same time, other interventions, including the humanitarian and emergency assistance to affected populations, are also important to reduce the devastating effects of conflicts and terroristic attacks.5WHORegional Office for the Eastern Mediterranean. Build back fairer: achieving health equity in the Eastern Mediterranean Region: report of the commission on social determinants of health in the Eastern Mediterranean Region.https://apps.who.int/iris/handle/10665/348185Date: 2021Date accessed: February 14, 2022Google Scholar As the authors mentioned, it is important to reshape current health-care systems in the region to improve provision of, and increase access to, care for the ageing population; however, we should avoid medicalising interdisciplinary subjects such as ageing or injuries. To identify and address the root causes of issues related to ageing and injuries, society as a whole and the whole government (ie, all government sectors) should be engaged and committed.5WHORegional Office for the Eastern Mediterranean. Build back fairer: achieving health equity in the Eastern Mediterranean Region: report of the commission on social determinants of health in the Eastern Mediterranean Region.https://apps.who.int/iris/handle/10665/348185Date: 2021Date accessed: February 14, 2022Google Scholar For example, high-quality data on injuries are historically rare in most countries in the region. Different components of essential injury data are collected by different sectors (such as police, fire department, pre-hospital emergency systems, and hospitals), and are not linked and accessible for injury experts. Linkage and sharing of data usually requires a strong commitment and coordination at higher levels of decision-making. Such engagement and commitment are also required for improving universal health coverage and access to care after injuries in older adults, especially when new rules and regulations, and shifts in budget are required.7Rajan D Ayazi MH Moradi-Lakeh M et al.People's voice and civil society participation as a core element of universal health coverage reforms: review of experiences in Iran.Int J Health Policy Manag. 2021; (published online Sept 6.)https://doi.org/10.34172/ijhpm.2021.123Crossref PubMed Google Scholar, 8Hosseini Jebeli SS Rezapour A Rosenberg M Moradi-Lakeh M Measuring universal health coverage to ensure continuing care for older people: a scoping review with specific implications for the Iranian context.East Mediterr Health J. 2021; 27: 806-817Crossref PubMed Scopus (1) Google Scholar I am one of the collaborators of the GBD study. Injury burden in individuals aged 50 years or older in the Eastern Mediterranean region, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019Injuries still pose a real threat to people aged 50 years or older living in the Eastern Mediterranean region, mainly due to transport and violence-related injuries. Dedicated efforts should be implemented to devise injury prevention strategies that are appropriate for older adults and cost-effective injury programmes tailored to the needs and resources of local health-care systems, and to curtail injury-associated risk and promote healthy ageing. Full-Text PDF Open Access