The costs of fatal and non-fatal falls among older adults.

OBJECTIVE: To estimate the incidence and direct medical costs for fatal and non-fatal fall injuries among US adults aged >or=65 years in 2000, for three treatment settings stratified by age, sex, body region, and type of injury. METHODS: Incidence data came from the 2000 National Vital Statistics System, 2001 National Electronic Injury Surveillance System-All Injury Program, 2000 Health Care Utilization Program National Inpatient Sample, and 1999 Medical Expenditure Panel Survey. Costs for fatal falls came from Incidence and economic burden of injuries in the United States; costs for non-fatal falls were based on claims from the 1998 and 1999 Medicare fee-for-service 5% Standard Analytical Files. A case crossover approach was used to compare the monthly costs before and after the fall. RESULTS: In 2000, there were almost 10 300 fatal and 2.6 million medically treated non-fatal fall related injuries. Direct medical costs totaled 0.2 billion dollars for fatal and 19 billion dollars for non-fatal injuries. Of the non-fatal injury costs, 63% (12 billion dollars ) were for hospitalizations, 21% (4 billion dollars) were for emergency department visits, and 16% (3 billion dollars) were for treatment in outpatient settings. Medical expenditures for women, who comprised 58% of the older adult population, were 2-3 times higher than for men for all medical treatment settings. Fractures accounted for just 35% of non-fatal injuries but 61% of costs. CONCLUSIONS: Fall related injuries among older adults, especially among older women, are associated with substantial economic costs. Implementing effective intervention strategies could appreciably decrease the incidence and healthcare costs of these injuries.

Motor vehicle and fall related deaths among older Americans 1990-98: sex, race, and ethnic disparities.

OBJECTIVES: To examine differences in motor vehicle and fall related death rates among older adults by sex, race, and ethnicity. METHODS: Annual mortality tapes for 1990-98 provided demographic data including race and ethnicity, date, and cause of death. Trend analyses were conducted using Poisson regression. RESULTS: From 1990-98, overall motor vehicle related death rates remained stable while death rates from unintentional falls increased. Motor vehicle and fall related death rates were higher among men. Motor vehicle related death rates were higher among people of color while fall related death rates were higher among whites. Among whites, fall death rates increased significantly during the study period, with an annual relative increase of 3.6% for men and 3.2% for women. CONCLUSIONS: The risk of death from motor vehicle and fall related injuries among older adults differed by sex, race and ethnicity, results obscured by simple age and sex specific death rates. This study found important patterns and disparities in these death rates by race and ethnicity useful for identifying high risk groups and guiding prevention strategies.

An evaluation of the accuracy and efficiency of a school screening model that uses a questionnaire.

The role of the school nurse is changing to meet the increasing needs for health promotion and health education. However, the evolution is being hampered by the inefficient work practices involved in undertaking some of the more traditional tasks such as school screening. A survey questionnaire model of screening was developed and trialed with a sample of students and parents and then compared with the results of the more traditional one to one screening programme. The questionnaire survey model was evaluated for accuracy and efficiency against the traditional screening model. The questionnaire method exhibited a relatively low error rate and required one third of the time to complete when compared with the traditional screening programme. The implications of these findings as well as the advantages and limitations of each model are examined in the discussion.

Alcohol as a risk factor for fall injury events among elderly persons living in the community.

OBJECTIVE: To determine if alcohol use is a risk factor for fall injury events among community-dwelling older persons. DESIGN: Case-control study. SETTING: South Miami Beach, Florida. PARTICIPANTS: 320 persons 65 or older who sought treatment at six area hospitals for injuries resulting from falls; 609 controls, matched for sex and age, selected randomly from Health Care Financing Administration (Medicare) files. MAIN INDEPENDENT VARIABLES: Self-reported current alcohol use. RESULTS: No association was found between fall injury events and average weekly alcohol use. CONCLUSIONS: Further efforts at reducing injuries to older persons from falls should concentrate on other modifiable risk factors, including adequate treatment of underlying medical conditions, reducing inappropriate psychotropic medication use, and installing safety devices in the home.

[Prevalence of smoking among women in reproductive age in Puerto Rico]. / Prevalencia del hábito de fumar en mujeres de edad fértil de Puerto Rico.

The prevalence of smoking in Puerto Rican women was estimated on the basis of data from 3,157 women 15 to 49 years of age who had been surveyed in the 1982 Evaluation of Fertility and Family Planning in Puerto Rico. The weighted prevalence was 15.5%, with a 95% confidence interval of 13.8 to 17.1. The prevalence varied by age group, education, marital status, place of residence at age 15, and consumption of alcohol. The prevalence of smoking increased in successive birth cohorts while the mean age at initiation of the habit tended to decline. The data suggest that in Puerto Rico smoking is on the rise among younger women.