Sarah is 72 years old and lives by herself. She is very independent and likes to keep busy. She spends a lot of time playing cards and chatting with the ladies down at the community hall. The stairs leading up to the hall are a bit rickety and don’t have a banister. Today, Sara has brought cinnamon buns and raspberries from her garden to share with the group. As she rushes up the rickety stairs of the hall carrying the box full of treats, she stumbles on an uneven step. She loses her balance and falls to the ground. She has a broken hip and arm, and is in hospital for weeks. When Sara first returns home, she needs nearly constant care. She finds it difficult to get around and do all the things she is used to doing. Sara is also afraid of falling again and stops going out as much. Her health gets worse and within the year she must go into a nursing home. And we think this could not be prevented?
The truth is, an injury is no accident. Most injuries can be predicted and prevented. Yet injuries continue to be the number one cause of death and disability among Canadians under the age of 40. This year in Canada, more people in this age group will die of an injury than from AIDS, cancer, and heart disease combined.
Stephen and Sara’s stories describe two of the most common types of injuries in Canada. Together with suicide, motor vehicle collisions (MVCs) and falls account for over 70 per cent of deaths related to an injury. Every year, over 3,500 Canadians die by suicide, about 3,000 die in MVCs, and nearly 2,700 die because of a fall. These deaths are a fraction of the large number of people who have spent time in hospital in recent years because of an injury. More than 250,000 Canadians are hospitalized annually because of an injury. Over two-thirds of these are a result of a self-inflicted injury, an MVC, or a fall.
All of us are at risk of injury. However, the degree of risk and impact of an injury can vary greatly by age, sex, region, income group, and type of injury. Men have higher rates of injury than women. Young people are at higher risk of injury from motor vehicle collisions. Older adults are at higher risk of injury from falls. First Nations people have higher rates of injury overall than other groups. In general, lower income groups tend to have a higher risk of a fatal injury than higher income groups.
The costs of injuries are shocking – both in human and economic terms. Direct economic costs of major unintentional injuries in Canada are estimated to be more than $4.2 billion each year. The indirect costs are estimated to exceed $4.5 billion. This says nothing about the impact these injuries have on an injured person’s family, workplace, and other responsibilities.
Where does all this leave us? We know injuries are predictable and preventable. We know how much pain and suffering they cause. We know how much they cost us. But what are we doing to prevent them?
Unfortunately, Stephen’s story is all too common. In 1999, in the four western provinces of Canada, there were 191,790 motor vehicle collisions reported. These resulted in 1,060 deaths and over 73,000 non-fatal injuries. And that is just in one year.
Stories like Stephen’s are common in all parts of Canada. MVC injuries and deaths commonly include young men, alcohol, speed, no seatbelts, and distractions while driving. Of all age and sex groups, young men aged 20 to 24 years have the highest rates of MVC deaths, emergency department visits, and hospitalization. What may be more tragic and frustrating is that most MVCs can be avoided. There are proven ways to prevent the number of collisions and the seriousness of resulting injuries.
Speeding is the leading cause of severe injuries and death due to collisions. Enforcing roadway speed limits is critical to reducing speeds and injuries. Wearing a seatbelt in a collision reduces the chance of being killed by 55 per cent.
Graduated Drivers’ Licensing (GDL) programs are another strategy designed to help new, inexperienced drivers. The idea is to create better drivers and reduce injuries through a three-phase apprenticeship program. A number of regions across North America including Alberta and British Columbia have GDL programs. A recent review found that these programs help reduce crash rates of young, new drivers, a high-risk group for collisions.
Other strategies for preventing injuries include using special car seats for children, requiring helmets for motorcyclists, and reducing drunk driving. There are the common sense driving practices -- slowing down, obeying traffic signals, and following the rules of the road. It is also important to avoid distractions such as talking on cell phones or eating while driving.
Positive effects from programs to reduce the number and seriousness of collisions have already been seen. In the Capital Health Region (Edmonton area) of Alberta, prevention efforts have helped reduce MVC deaths. In 1985, the MVC death rate was 14.9 per 100,000 for males and 8.1 for females. In 1999, the rate decreased to 5.7 deaths per 100,000 males and 3.5 for females. Although we still have a long way to go, these programs have saved hundreds of lives and prevented thousands of injuries. As well, billions of dollars have been saved on health care, property damage, and costs to society.
Like collisions, falls are a major health concern, especially for older adults. Data suggest that Sara’s fall is far from being unusual. Among people aged 65 and older, falls are the leading cause of death from an injury, hospitalization and visits to Emergency. More older adults are hospitalized because of a fall than for all other types of injury combined, including MVCs, unintended poisonings, and assaults. In 1999, Albertans aged 65 and older made over 14,000 visits to Emergency due to a fall. As well, over 5,000 Albertans (aged 65+) spent time in hospital, and 52 died because of a fall. Women experienced 67 per cent of the fall-related Emergency visits and 68 per cent of the hospitalizations.
The cost of falls among older adults is huge. It is estimated that in Canada, over $980 million is spent treating falls among older adults every year. Older adults injured in a fall are much more likely to use health care services in the following year, compared to those who have not fallen. Falls and the associated fear of falling affect older adults’ health, quality of life, mobility, and independence. Falls also account for 40 per cent of admissions to nursing homes, and a 10 per cent increase in the use of home care services.
Yet falling is often considered a ‘normal’ part of aging. There is nothing normal about these falls among older adults or their results. Falls are usually preventable. There are ways to reduce or remove the risk of falling. These in turn can reduce the number and seriousness of falls.
As with Sara, falls are usually not the result of a single cause. Any approach to fall prevention must be thorough. Healthy aging strategies, reducing risks, and creating safe environments are all necessary and possible. Improving physical activity, strength, balance, and flexibility among older adults helps to prevent falls and lessen the seriousness of an injury related to a fall. Other personal risk factors for falls include not paying attention, drinking, and taking many prescription medications. Risk factors in the environment, such as uneven surfaces, poor lighting, a lack of banisters, and other slip and trip factors must also be addressed.
The success of fall prevention efforts can be seen in the data. In the Capital Health region of Alberta, these efforts have contributed to a decline in deaths from falls. In 1994, the overall death rate from falls was 5.7 per 100,000. By 1999, the rate decreased to 3.1 per 100,000. Remember that the number of deaths resulting from a fall is a fraction of the number of hospitalizations and visits to Emergency. There remains much to be done in fall prevention.
Injuries are a major health concern resulting in huge costs to the health care system and society. However, injury prevention requires more than simply asking people to be careful. It requires effort by political representatives and those working in the injury prevention and control areas. Urban planners, builders, engineers, police, and citizens are also involved. We must work together to create a safe environment for everyone.