Consumer product related injuries in older persons

Monash University Accident Research Centre - Report #162 - 1999

Authors: W. Watson, L. Day, J. Ozanne-Smith & J. Lough

Full report in .pdf format [5.4 MB]

Abstract:

In 1998, people aged 65 years or older constituted 12% of the Australian population. This will increase to 18 percent by the year 2021 with the most rapid population increase over the next decade among persons aged over 85 years. Unintentional injuries are a major health problem for older people in Australia and other developed countries. In older people, there is a greater likelihood that an incident will produce an injury and there is also generally a poorer prognosis following injury. While injury in the elderly is related to a combination of factors including those resulting from the aging process, the home environment and product design are important, and often modifiable, contributors.

This research was undertaken to establish the role of consumer products in injuries to older persons to underpin a proposed injury reduction program in this area by the Consumer Affairs Division of the Commonwealth Department of Treasury.

An analysis of Victorian hospital and death data was undertaken to investigate the types of consumer products involved in unintentional home and leisure injuries in the elderly. Products were ranked by frequency of association for four levels of injury severity: deaths, hospital admissions, Emergency Department presentations and General Practitioner presentations. Since falls account for a large proportion of injury in older persons, data were analysed separately for falls and other injury causes to avoid missing products that may be important in other injuries. Data from the U.S. Consumer Product Safety Commission, the U.K. Department of Trade and Industry and the Netherlands Consumer Safety Institute were also examined for comparison.

Most injuries to older persons occur in their own homes. The most frequent products associated with fall injuries at all levels of severity are concrete and other outdoor surfaces and structural features of the home including flooring and steps and stairs. Furniture items such as beds and chairs are frequently associated with fall injuries, as are loose floor coverings such as rugs, runners and mats, and footwear. Falls from height are often associated with ladders. Alcohol was also associated with 7.5 percent of falls deaths. The most frequent products associated with other fatal, non-fall injuries (apart from drugs and alcohol) were: heaters, cigarettes, baths/showers, and sofas/couches and lounges. Products frequently associated with other non-fatal, non-fall injuries include: power saws, lawn mowers, dogs, and knives. Although there is some variation in the rankings, overall the most common products associated with non-fatal injury are fairly similar in the US, the U.K., and Australia. Differences appear to reflect lifestyle variations between these countries and therefore differences in exposure to some hazards.

Injuries and the events associated with them are not the result of chance, nor are they an inevitable consequence of the aging process. It is clear from the results of this study that the issue of injury in older persons is complex and responsibility for injury prevention in this area cuts across many sectors and jurisdictions. In the case of consumer product-related injury in the elderly, most injury occurs in the home. Since responsibility for injury in the home is not exclusive to any specific discipline or sector, a multi-disciplinary, multi-sectoral approach is required for injury prevention in this setting. Where possible, a systems approach to safety in the home, in which hazards are designed out and safety features built in, is appropriate.

Executive Summary

AIMS & OBJECTIVES

The aim of this project is to research the role of consumer products in injuries among older persons to underpin a proposed injury reduction program in this area.

Specifically:

1. To undertake a review of recent Australian and international literature concerning injuries to older persons to identify the major causes of such injuries and the extent to which consumer products are involved.

2. To identify and comment on major sources of injury data in Australia and overseas that can assist in exploring the links between consumer products and injury.

3. To analyse available data to investigate:

i.    the nature of injuries and the types of consumer products that may be involved

ii.    the ranking of occurrence and severity of injury by product type.

4. To establish and comment on patterns and trends in injuries to older people as a basis for injury prevention programs.

5. To make recommendations on injury prevention measures to assist older persons, having regard for the consumer product safety responsibilities of Consumer Affairs.

METHODS

Providers of injury surveillance data in Australia and overseas were contacted to provide information. These include the National Electronic Injury Surveillance System (NEISS) managed by the US Consumer Product Safety Commission, PORS/LIS managed by the Consumer Safety Institute in Amsterdam, The Netherlands, and the Home Accident Surveillance System (HASS) and the Leisure Accident Surveillance System (LASS) managed by the Consumer Safety Unit at the British Department of Trade and Industry (DTI).

Data analysis was conducted using the databases held at Monash University Accident Research Centre to establish the overall incidence and pattern of injury in older persons and the extent and pattern of consumer product involvement in these injuries. These databases include the Victorian Coroners Facilitation System, the Victorian Inpatient Minimum Dataset, the Victorian Emergency Minimum Dataset, and the Extended Latrobe Valley Injury Surveillance.

Injuries were examined at four levels of severity: deaths; hospital admissions; emergency department presentations (which are not admitted to hospital); and presentations to general practitioners.

To establish the sub-set of consumer product-related cases, data were extracted by first identifying the sub-set of cases aged 65 years and older, then excluding all intentional injury, the adverse effects of prescribed medication and medical and surgical complications. The data set was further refined by excluding motor vehicle traffic accidents and natural factors (such as the weather and natural features of the environment).

Falls have been well documented as the major cause of injury among older persons. The predominance of falls as a cause of injury at all levels of severity tends to mask the importance of other causes of injury and consequently the products associated with them. To facilitate the identification of these products the Victorian data has been separated into "falls" and "other causes" of injury.

A search of the national and international literature relating to fall and other injuries in older persons was conducted and the results of the study discussed in relation to the literature.

SUMMARY OF KEY FINDINGS

  • In 1993/94, almost 40,000 Victorians aged 65 years and older suffered an injury that required medical treatment in a GP’s surgery or a hospital emergency department. Of these, almost 14,500 were admitted to hospital and at least 378 died as a result of their injuries.
  • The lifetime treatment cost of injuries to persons aged 65 years and older, in Victoria, in 1993/94, was estimated at $170.45 million. Almost two-thirds of this cost is attributable to injuries in those aged 75 years and older although they account for only 40 percent of the population aged over 65 years.
  • Unlike in other age groups, females outnumber males by a ratio of 1.6 : 1 for non-hospitalised injury and 2.5 : 1 for hospitalisations. This ratio is partly a reflection of the female : male population ratio in this age-group but also due to the increased risk of injury, particularly due to falls, to females in this age-group.
  • Consumer products (within the scope of this study) were associated with just over a quarter (26 percent) of all injury deaths recorded in the Victorian Coroners data base in the 65 years and older age group (due to the exclusion of motor vehicle accident and suicide deaths that are the major causes in this group). Consumer product-related injury accounted for 89 percent of all attendances at hospital Emergency Departments recorded in the VISS database and 90 percent of GP attendances recorded in ELVIS database.
  • Most injury to older persons, at all levels of severity, occurs in the home, mainly in the living and sleeping areas.
  • Falls were the single greatest cause of injury in this age group accounting for at least 40 percent of all injury fatalities, 74 percent of all injury hospitalisations and 50 percent of all non-hospitalised cases (ED and GP injury attendances).
  • The most frequent products associated with fall injuries at all levels of severity are concrete and other outdoor surfaces and structural features of the home including flooring and steps and stairs. Furniture items such as beds and chairs are frequently associated with fall injuries as are loose floor coverings such as rugs, runners and mats, and footwear. Falls from height are often associated with ladders.
  • The most frequent products associated with other fatal, non-fall injuries (apart from drugs and alcohol) were: heaters, cigarettes, baths/showers, and sofas/couches and lounges. These were all involved in fire, burn or scald injuries (with sofas/couches and lounges being ignited). Products frequently associated with non-fatal, non-fall injuries include: power saws, lawn mowers, dogs, and knives.
  • Although there is some variation in the rankings, overall the most common products associated with non-fatal injury are fairly similar in the US, the U.K. and Australia.
  • Data from the United States CPSC suggests that sports and recreation injuries in older persons have increased significantly between 1990 and 1996. Although there has been a rise in the population of eight percent during this period, sports and recreation injuries have risen by 54 percent, suggesting increased participation rates. The highest number of injuries was related to bicycles.

DISCUSSION

Falls are the most common cause of product-related injury in this age group. The most frequent products associated with fall injuries at all levels of severity are concrete and other outdoor surfaces and structural features of the home including flooring, and steps and stairs. Furniture items such as beds and chairs are frequently associated with fall injuries as are loose floor coverings such as rugs, runners and mats, and footwear. Falls from height are often associated with ladders.

Most of the studies in the literature have focused on the role of hazardous items or products in falls among older people. There is still some debate as to the impact on falls prevention of the removal of these items or products, or the installation of safety features and products. Northridge et al (1995) found that vigorous older people with more home hazards were more likely to fall than vigorous older people with fewer hazards, supporting hypotheses put forward in the literature that environmental hazards may be more prominent in the aetiology of falls in this group, and that intrinsic factors may be more prominent among the more frail older people.

There is a substantial body of research into the use of steps and stairs, their design, and falls. It is clear that the visual capabilities of older people and the visual qualities of stair treads and other parts of the stair environment interact to influence the performance of older people on stairs. Safety features and products such as slip resistant flooring, impact absorbing floors and padded hip protectors have the potential to reduce injuries from falls.

It is clear from the evidence to date that the role of hazardous products, and of safety products, in falls prevention among older people cannot be considered in isolation from issues of age related physiological change and functional capacity. While attention to environmental hazards, safe products, and safety products is important to falls prevention, this must occur within the context of a multi-factorial strategy that includes the reduction of intrinsic falls risk factors.

The most frequent products associated with other fatal, non-fall injuries (apart from drugs and alcohol) were: heaters, cigarettes, baths/showers, and sofas/couches and lounges. These were all involved in fire, burn or scald injuries (with sofas/couches and lounges being ignited). Products frequently associated with non-fatal, non-fall injuries include: power saws, lawn mowers, dogs, and knives.

The literature relating to other causes of injury mortality and injury in older persons, apart from falls, is relatively sparse. However, many of the general interventions for such causes are relevant to this age group. For example, the installation of common safety features such as smoke detectors and hot water heaters limited to 50 degrees C are important in preventing death and severe injury in this age-group.

It is clear from the results of this study, and the foregoing discussion, that the issue of injury in older persons is complex and responsibility for injury prevention in this area cuts across many sectors and jurisdictions.

Intervention strategies fall into three main groups:

1.    Legislation/regulation (accompanied by enforcement)

2.    Environmental/design changes and

3.    Education/behaviour change

In the case of consumer product-related injury in the elderly, most injury occurs in the home. Since responsibility for injury in the home is not exclusive to any specific discipline or sector, a multi-disciplinary, multi-sectoral approach is required for injury prevention in this setting. A systems approach to safety in the home in which hazards are designed out and safety features built in is appropriate (Routley & Ashby, 1997).

Making the home environment safer for older people should be a priority for architects, designers, and public health authorities as well as for older persons and their families. Accidents among older persons are preventable if product designers take into account the requirements of the physically challenged user. With the average lifespan increasing and the concomitant increase in the older population, a major challenge will be to improve the quality of life in old age by designing products and environments with older people in mind. Guidelines to create safe and barrier-free environments for older people are urgently required to reduce the number of home accidents (Nayak, 1998).

Associated community awareness and action may result from education and incentives or as the result of legislation or regulation where appropriate and necessary. Legislation, safety education, and the development and implementation of interventions should all be founded on a sound research base.

RECOMMENDATIONS

General

1.    Action should be taken by the Consumer Affairs Division of The Treasury and other responsible authorities to reduce deaths and serious injuries associated with consumer products in older persons.

2.    A general product safety directive should be adopted and enforced in Australia/New Zealand.

3.    Where necessary, research and evaluation studies should be commissioned, to inform and monitor policy and action on product safety.

4.    The Australian government should develop legislation that requires reporting of injuries by manufacturers and/or importers to Consumer Affairs. Such an arrangement would be a component of an early warning system for Consumer Affairs for potentially dangerous products.

Standardisation

5.    As in the United States, mandation of standards should occur in Australia where voluntary standards and the marketplace are ineffective in achieving compliance and evidence warrants mandation.

Injury data collection

6.    The Consumer Affairs Division of the Commonwealth Department of Treasury should consider the establishment of an Injury/Potential Injury Incident File and an In-depth Investigations File similar to those operated by the US CPSC (see section on Injury Surveillance, Chapter 3).

7.    The National Coronial Information System, currently under development, should identify products and their involvement in deaths. The Consumer Safety Division could provide strategic and financial support for the development and implementation of a consumer product-related injury module for this system.

8.    Methods should be developed to improve the capture of older persons fall cases and relevant details in the National Coronial Information System.

9.    A strategy, which takes into account developments in emergency department injury surveillance, is required to increase the level of detail routinely available in the hospital admissions data, so that the involvement of specific products can be identified.

10.    Options for future directions in emergency department injury surveillance should include the collection of product-related injury data in sufficient detail and sufficient numbers to provide useful in-depth analyses and reliable secular trend data. It should contain sufficient cases by state to allow comparisons to identify best practice and effective interventions. There is potential for state support for options which would involve adequate numbers of cases to be collected to meet state needs.

11.    Linkage of emergency department injury surveillance and hospital admission datasets should be undertaken to provide reasonably comprehensive information on moderate and severe injury cases (admissions). In addition, measures should be taken to improve the quality of, and level of detail in, case narratives provided through emergency department surveillance.

Research and evaluation

12.    Household surveys should be undertaken to collect additional information with regard to the exposure of older persons to products of interest (those associated with injury and protective equipment). Products of interest should be selected on the basis of severity, frequency, and cost of injury consequences. It is recommended that the surveys be undertaken collaboratively with other sectors or state departments interested in further exposure issues.

13.    Follow-up case studies should be undertaken to determine whether injuries to older persons associated with consumer products involve a range of factors which should be further investigated. These could be undertaken collaboratively, examining several products at the same time, or over a longer period of time, to ensure useful case numbers. Areas of particular interest identified in this report include: the nature of involvement in injury of beds, chairs, mobility aids and other specific items of furniture, lawn mowers, power tools, ladders, garden tools, and kitchen knives.

14.    In depth investigations should be undertaken in conjunction with coronial inquiries for all deaths involving consumer products. There should be consistent and systematic follow-up, investigating products involved in deaths.

15.    Interventions should be evaluated. The effects of the introduction of new standards, and mandation of existing standards, should be evaluated against injury data.

16.    Current studies evaluating the effectiveness of hip protectors in preventing fractures as a result of falls should be monitored. Research to date indicates this is a promising intervention. Further research and development is needed, not only in evaluation, but also to address issues such as design and cost to make the product more comfortable and affordable.

17.    A literature review is required to determine the extent of the evidence regarding prevention of falls on steps and stairs, and to make recommendations for implementation and/or further research as appropriate.

18.    Further research is needed on floor surfaces with regard to falls prevention (slip resistance) and impact absorption to prevent the serious consequences of falls.

19.    Although not specifically identified in this study, footwear significantly influences the potential for slips and trips leading to falls. Further research on footwear design and its interaction with common surfaces and conditions is required to optimise grip and support.

Dissemination of information

20.    The findings of this report should be published in formats accessible to government, industry, and other relevant professionals as journal articles and in Victorian Injury Surveillance System publications.

21.    Point of sale information about the correct use of products and the associated hazards should be developed and provided for consumers (eg correct footwear to prevent falls).

22.    National guidelines should be developed for safe home design for older persons based on the current Australian Standard Guidelines for Safe Home Design (AS4226-1994 for new homes and renovations, and taking into account other relevant standards. This could be undertaken in conjunction with the National Injury Prevention Advisory Council (NIPAC) and the Commonwealth Department of Health and Aged Care.

23.    Guidelines for the prevention of DIY and home maintenance injuries for older persons should be developed. This could include safety advice, information on how to go about particular tasks and how to get assistance when needed. ArchiCentre (Victoria), for example, has a Home Renovation Advisory Centre and many local councils have home maintenance assistance schemes.

This project was funded by Consumer Affairs Division, Commonwealth Dept of Treasury