Every day around the world, almost 16 000 people die from all types of injuries.

1. Injury Prevention and Home Accidents Prevention of Disability in Older PersonProf. Dr. Selma KARABEY

2. Every day around the world, almost 16 000 people die from all types of injuries. • Injuries represent 12% of the global burden of disease, the third mostimportant cause of overall mortality and • the main cause of death among 1–40-year-olds

3. InTurkey • In 2002, 86,000 individuals have been disabled due to accidents in the home. • 22% of them were 60yearsold and over. • 14% are between the ages 60-69. • 90%of older people with disabilities in home accidents have a monthlyincome of 50 TL orless.

4. InTurkey • In 2002, 16,500 elderlypeoplehave been disabled due to accidents in the home. • 60% of them were 60 yearsoldand over. • 27% of elderly people with disabilities in home accidentsare widows and all werewomen.

5. InTurkey • Prevalence of all accidents is 3.3%. • 1.2% of the accidents are home accidents, • 1.6% are trafficaccidents and • 0.5% are occupational accidents.

6. InTurkey • The most prevalent accident type, namely traffic accidents are seenmost in 15-34 age group and males. • Home accidents on the other hand, are seen most in 65-and-aboveage group and in females. • Occupational accidents are seen most in 15-34 age group and males.

8. Injuries–resulting from • traffic collisions, • drowning, • poisoning, • falls or • burns - and violence - from assault , • self-inflicted violence or • acts of war–kill more than five million people worldwide annually and cause harm to millions more. • They account for 9% of global mortality, and are a threat to health in every country of the world.

10. Musculoskeletal injuries are injuries occurringto the neck, spine, pelvis, and extremities; • Theyinclude fractures, derangements, dislocations, sprains and strains, contusions, crushing injuries, open wounds, traumatic amputations.

11. Themost common cause of musculoskeletal injuries isfalls. • Additional major causes of musculoskeletalinjuries are sports injuries, playgroundaccidents, motor vehicle crashes, civilianinterpersonal violence, war injuries, stress injuries, over-exertion, repetitive workplace injuries.

12. Each year estimated that424 000 individuals die from falls globally of which over 80% are in low- and middle-income countries. • Adults older than 65 suffer the greatest number of fatal falls. • 37.3 million falls that are severe enough to require medical attention, occur each year.

13. A public health concernRoad deaths, disability and injury • According to WHO data, deaths from road traffic injuries account for around 25% of all deaths from injury • Around 85% of all global road deaths, • 96% of all children killed worldwide as a result of road traffic injuries occur in low-income and middle-income countries.

14. Over 50% of deaths are among young adults in the age range of 15–44 years . • Among both children aged 5–14 years, and young people aged 15–29 years, road traffic injuries are the second-leading cause of death worldwide • WHO estimates that, worldwide, between 20 million and 50 million people are injured or disabled each year in road traffic crashes.

17. MAIN RISK FACTORS FOR FALLS

18. Who is at risk for fall? • Age is one of the key risk factors for falls. • Older people have the highest risk of death or serious injury arising from a fall and the risk increases with age. * • Another high risk group is children. ** • Across all age groups and regions, both genders are at risk of falls. • In some countries, it has been noted that males are more likely to die from a fall, while females suffer more non-fatal falls.

19. Older women and younger children are especially prone to falls and increased injury severity. • Worldwide, males consistently sustain higher death rates and DALYs lost

20. Other risk factors include: • occupations at elevated heights or other hazardous working conditions; • alcohol or substance use; • socioeconomic factors including poverty, overcrowded housing, sole parenthood, young maternal age; • underlying medical conditions, such as neurological, cardiac or other disabling conditions; • side effects of medication, physical inactivity and loss of balance, particularly among older people; • poor mobility, cognition, and vision, particularly among those living in an institution, such as a nursing home or chronic care facility; • unsafe environments, particularly for those with poor balance and limited vision.

22. How to Prevent Home Accidents

23. Prevent falls • Install lights at the top and bottom of stairways. Make sure there is a stair rail. • Mount grab bars and use nonslip mats in bathtubs and showers. • Provide safety gates in homes with small children. • Put nonstick backing on all area rugs. • Remove all spills from floors at once. • Pick up all clutter on stairs and floors. Clear out any obstructions, debris or any other obstacles that create a potential falling hazard. • Repair any damaged stair steps. Fix torn carpeting, loose boards, or uneven steps. • Shovel snow and ice off of all walks and driveways.

24. Reduce potential fire damage. • Install smoke alarms on every floor, including basements, and test the alarms once a year. • Avoid putting flammable items on or near the stove. • Create a fire escape plan, then practice the plan with your family at least twice a year. • Learn how to use a fire extinguisher. • Turn all pot handles in when cooking on a stove. • Stay in the kitchen at all times while cooking. • Prohibit smoking inside your home.

25. Minimize chances of drowning accidents. • Supervise young children in bathtubs or when they are near water. • Enforce water and pool safety rules with your children. Make sure they use flotation devices until they learn how to swim proficiently. • Empty all wading pools, buckets or other water receptacles when not in use. • Learn cardiopulmonary resuscitation (CPR). According to the CDC, victim success rates were much higher when CPR was administered while waiting for paramedics to arrive. • Construct a four-sided, fully- enclosed and locked fence around all swimming pools. • Clear all pool areas of toys after use to discourage small children.

26. Minimize potential poisonings. • Place carbon monoxide detectors on low levels of every floor to prevent carbon monoxide poisoning. • Ventilate all rooms when using cleaners and chemicals. • Keep all medications, chemicals and cleaners out of reach of children. • Dispose properly of all medications that have expired. • Remove all peeling and lead-based paints from your home. • Ensure that all gas appliances are installed and serviced by professionals.

27. Vitamin D Supplementation • A recent study, published in the Journal of the American GeriatricsSociety (2005), reveals that older people in residential care can reduce theirincidence of falls if they take a vitamin D supplement for two years.

28. The Australian researchers examined the effect of vitamin D supplementation in 625 residents of 149 residential care facilities for a period of two years. • The participants were randomly assigned to receive vitamin Dsupplements (ergocalciferol) or inactive ‘placebo’ for two years. • All subjectsreceived 600 mg of elemental calcium daily as calcium carbonate. • The researchersfound that that vitamin D use cut the risk of falls 27% to 37 % compared withplacebo. • The study thus highlights the potential benefits of vitamin Dsupplementation in a population of elderly people in residential care.

29. Interventions/best practice of falls prevention • Multifaceted programs, including exercise, vision correction, medicationreview and adjustment, and environmental modification, appear to be effective inrandomized control trials. • Individually prescribed programs of musclestrengthening and balance retraining, and also Tai Chi (which combines strengthand balance training) may be effective as sole interventions for preventing falls(Gillespie, Gillespie, Robertson, et al., 2002).

30. Effective fall prevention programmes aim to reduce the number of people who fall, the rate of falls and the severity of injury should a fall occur. • For older individuals, fall prevention programmes can include a number of components to identify and modify risk, such as: • screening within living environments for risks for falls; • clinical interventions to identify risk factors, such as medication review and modification, treatment of low blood pressure, Vitamin D and calcium supplementation, treatment of correctable visual impairment;

31. home assessment and environmental modification for those with known risk factors or a history of falling; • prescription of appropriate assistive devices to address physical and sensory impairments; • muscle strengthening and balance retraining prescribed by a trained health professional; • community-based group programmes which may incorporate fall prevention education and Tai Chi-type exercises or dynamic balance and strength training; • use of hip protectors for those at risk of a hip fracture due to a fall.

32. HipProtector

33. For children, effective interventions include multifaceted community programmes; engineering modifications of nursery furniture, playground equipment, and other products; and legislation for the use of window guards. • Other promising prevention strategies include: use of guard rails/gates, home visitation programmes, mass public education campaigns, and training of individuals and communities in appropriate acute pediatric medical care should a fall occur.

42. Among the behavioural strategiesthat have been shown to increase thelikelihood that a person will sustain a newbehaviour are the following: • Securing social support from familyand friends. • Promoting the participant’s self-efficacyand perceived competence. • Providing older persons with activechoices that are tailored to their personalneeds and preferences. • Encouraging older persons to committo an intervention by developing healthcontracts and/or goal statements thatinclude realistic and measurable plansof action with specified health goals.

43. • Concerns for safety are identified as abarrier to changing behaviour by manyolder adults. • Educating participantsabout actual risks of interventions canhelp to alleviate many of these concerns. • Providing regular and accurate performancefeedback can assist older adultsin developing realistic expectationsabout their own progress.

44. Bybuilding on the three pillars of falls prevention,the model proposes specific strategiesfor: 1. building awareness of the importance offalls prevention and treatment; 2. improving the assessment of individual,environmental, and societal factors thatincrease the likelihood of falls; and 3. for facilitating the design and implementationof culturally-appropriate,evidence-based interventions that willsignificantly reduce the number of fallsamong older persons.

46. http://kaza.gazi.edu.tr/posts/view/title/hakkimizda-77691 • Gazi University Accident Research and Prevention Institute was founded in 1983.

47. References and Web Sources • The Burden of Musculoskeletal Diseases in the United States, Musculoskeletal Injuries • http://www.boneandjointburden.org/ • Simple Steps to Fall Prevention,Take simple precautions to protect yourself from fall-related injuries, Melanie Lasoff Levs • http://www.arthritistoday.org/what-you-can-do/protecting-joints/preventing-falls/fall-prevention.php • How to Prevent Home Accidents, • http://www.wikihow.com/Prevent-Home-Accidents • WHO Global Reporton Falls Prevention in Older Age,2007 • http://www.who.int/ageing/publications/Falls_prevention7March.pdf • CHRONIC DISEASESANDRISK FACTORS SURVEY IN TURKEY,2013

48. References and Web Sources • WHO, Falls,Fact sheet N°344,October 2012 • http://www.who.int/mediacentre/factsheets/fs344/en/ • Birinci Türkiye Yaşlılık Raporu, Prof. Dr. İsmail TUFAN,2006 • http://www.itgevakif.com/pdfs/I.T%C3%BCrkiyeYa%C5%9Fl%C4%B1l%C4%B1kRaporu_itufan_sicher.pdf • World report on road traffic injury prevention, Margie Peden, Richard Scurfield, David Sleet, Dinesh Mohan,Adnan A. Hyder, Eva Jarawan and Colin Mathers, World Health Organization Geneva, 2004 • FALLS IN OLDER PEOPLE NATIONAL / REGIONAL REVIEW INDIA,Dr. B. Krishnaswamy, Professor and Head, Dr. Gnanasambandam Usha, Assistant Professor • Home Safety Brochure, Phoenix Children’s Hospital • www.phoenixchildrenshospital.com