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Public Health and Aging: Nonfatal Injuries Among Older Adults Treated
in Hospital Emergency Departments—United States, 2001
1 table omitted
Because injuries generally are considered a problem of the young, injuries
among older adults (i.e., persons aged ≥65 years) have received little
attention. However, injuries are the eighth leading cause of death among older
adults in the United States.1 In 2001, approximately 2.7 million
older adults were treated for nonfatal injuries in hospital emergency departments
(EDs); the majority of these injuries were the result of falls.1 To
characterize nonfatal injuries among older adults, CDC analyzed data from
the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP).
This report summarizes the results of that analysis, which indicate differences
in type and mechanism of injury by sex, suggesting that prevention programs
should be designed and tailored differently for men and women.
NEISS-AIP is operated by the U.S. Consumer Product Safety Commission
and collects data about initial visits for all types and causes of injuries
treated in U.S. EDs, drawing from a nationally representative sample of 66
hospitals selected as a stratified probability sample of hospitals in the
United States. Data from these cases are weighted by the inverse of the probability
of selection to produce national estimates.2 For this report, annualized
estimates were calculated on the basis of weighted data for 36,752 nonfatal
injuries among older adults treated in EDs during January-December 2001. U.S.
Census Bureau population estimates for 2001 were used to calculate injury
rates.3 A direct variance estimation procedure was used to calculate
95% confidence intervals and to account for the complex sample design.2 All nonfatal injuries were classified according to the mechanism of
injury (e.g., fall, struck by/against, or motor vehicle crash), diagnosis,
primary body part injured, disposition, location of injury, and intent. The
diagnosis and intent of the injury were classified according to the most severe
injury.4 Injuries of unknown intent were grouped with those classified
During 2001, an estimated 935,556 men and 1,731,640 women aged ≥65
years were treated in EDs for nonfatal injuries. The overall injury rate per
100,000 persons was higher among women (8,466 per 100,000 persons) than among
men (6,404). Injury rates increased with age, to 15,272 for women aged ≥85
years and 11,547 for men aged ≥85 years. Nearly all injuries (99%) were
classified as unintentional/unknown intent.
Overall, falls resulted in the highest rates of injury (4,684 per 100,000
persons) and were the most common mechanism of injury, accounting for 62%
of all nonfatal injury ED visits in this population. The injury rate from
falls was higher among women (5,659) than men (3,319). However, the injury
rates for women were lower with certain other types of injuries, such as being
struck by/against (588 versus 617), occupying a motor vehicle (525 versus
540), and being cut or pierced (243 versus 488).
The greatest number of nonfatal injuries among older adults were diagnosed
as fractures (26%), followed by contusions/abrasions (23%), lacerations (17%),
strains/sprains (13%), and internal injuries (5%). Diagnoses varied by sex.
Fractures of all parts of the body were more common among women than men (30%
versus 19%), and lacerations were more common among men than women (22% versus
14%). The parts of the body affected most were the head/neck (25%) and arms/hands
(22%). The majority (82%) of older adults were treated and released; 16% were
hospitalized. The ratio of patients treated/released to those hospitalized
was lower among women (4.7:1) than men (5.9:1), suggesting women were more
often hospitalized after a nonfatal injury. The most common (47%) location
for nonfatal injuries was the home.
KE Kocher, MD, Dept of Emergency Medicine, Univ of Michigan, Ann Arbor.
AM Dellinger, PhD, Div of Unintentional Injury Prevention, National Center
for Injury Prevention and Control, CDC.
CDC Editorial Note:
Falls remain the leading cause of both nonfatal and fatal injury among
older adults aged ≥65 years in the United States.1 The findings
in this report, which indicate that falls were the most common reason for
injury-related ED visits among persons aged ≥65 years, are consistent with
previous studies indicating that approximately 40% of older adults living
in community settings (e.g., in private residences or minimally assisted environments)
fall each year.5
In this study, 82% of persons aged ≥65 years were treated and released
following injury, compared with 95% of persons aged <65 years. Older adults
were more than three times more likely (1,217 per 100,000 persons) to be hospitalized
than persons aged <65 years (353).1
The findings in this report are subject to at least five limitations.
First, NEISS-AIP provides national estimates and does not allow for estimates
by region, state, or local jurisdiction. Second, injury outcomes are specific
to ED visits and do not include subsequent outcomes. Third, NEISS-AIP data
reflect only those injuries that were severe enough to require treatment in
an ED. Fourth, in cases with multiple injuries, only data regarding the most
severe injury are recorded. Finally, data for intent are classified on the
basis of information contained in the medical record. Injuries for which intent
cannot be determined conclusively from the ED record are grouped with unintentional
The findings in this report can form the basis for targeting prevention
efforts to different populations of older adults. For example, exercise can
reduce the risk for fall among older adults by 15%.6 Because women
are more likely to sustain fall-related injuries, exercise can be an especially
important preventive measure for this population. Data from NEISS-AIP can
continue to be a source for monitoring trends, evaluating interventions, and
characterizing nonfatal injuries among persons aged ≥65 years.
This report is based on contributions by the U.S. Consumer Product Safety
Commission. K Gotsch, P Holmgreen, JL Annest, PhD, Office of Statistics and
Programming, National Center for Injury Prevention and Control, CDC.
References: 6 available
Public Health and Aging: Nonfatal Injuries Among Older Adults Treated in Hospital Emergency Departments—United States, 2001. JAMA. 2003;290(20):2657–2658. doi:10.1001/jama.290.20.2657
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