Alarming rise in fall-induced severe head injuries among elderly people

Introduction 

A head injury is a common and serious consequence of falling among older adults and a great majority of elderly people's nonfatal and fatal head injuries are induced by falls.1, 3, 5 Previously, we reported that the number of elderly Finns who were admitted to hospitals due to a fall-induced severe head injury clearly rose during 1970–1999.4 We have now followed up the highest risk group, the population 80 years of age or older, for 5 more years (till the end of 2004) to see whether the alarming development has continued in the new millennium. In addition, to properly predict the expected number of elderly patients requiring treatment in the coming decades, we assessed whether the average individual risk (that is, the age-adjusted or age-specific incidence) of a fall-induced severe head injury is also rising.

Subjects and methods 

The data of the fall-induced severe head injuries originated from the Finnish National Hospital Discharge Register. This statutory, computer-based register is the oldest nationwide discharge register in the world (in operation since 1967), and provides reportedly accurate and reliable data for severe injuries of the Finnish population of five million people.5, 8, 12 The annual midyear populations were taken from the Official Statistics of Finland, the statutory, computer-based population register of the country.11

Throughout the study years, a fall-induced severe head injury of a person 80 years of age or older was defined as a head injury that occurred as a consequence of a fall from standing height of 1m or less and that resulted in hospitalisation of the victim.4 Injuries caused by vehicular crashes or other high energy traumas were excluded.

In calculating the age-adjusted injury incidences, the midyear population figures were used for each study year and the age adjustment was done by means of direct standardisation using mean population of persons aged 80 years or older between 1970 and 2004 as the standard population. The age-specific incidences were calculated in 5-year age groups (80–84, 85–89, and ≥90 years).

Results 

The number of Finns aged 80 years or older with a fall-induced severe head injury increased considerably between the years 1970 and 2004, from 60 (women) and 25 (men) in 1970 to 745 (women), and 350 (men) in 2004 (Fig. 1A). The relative increases were 1142 and 1300%, respectively. Across the study period, the age-adjusted incidence of injury also showed a clear increase from 1970 to 2004: from 168 to 506 in women (201% increase), and from 172 to 609 in men (254% increase) (Fig. 1B). A similar finding was observed in age-specific incidences. In women, the mean injury incidence rates (per 100,000 persons) in the period 1970 through 1974 were 176, 194, and 263 in the age groups of 80–84, 85–89, and 90 years or older, respectively, versus 397, 608, and 735 in the period 2000 through 2004. In men, these incidence rates in the period 1970 through 1974 were 164, 143, and 281, versus 465, 617, and 976 in the period 2000 through 2004.

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Figure 1. Number (A) and age-adjusted incidence (per 100,000 persons) (B) of fall-induced severe head injuries in Finland in people 80 years of age or older between 1970 and 2004. The number of people in this age group was 50,943 in 1970 and 199,369 in 2004.

If the age-adjusted incidence of injury continues to rise at the same rate as in 1970–2004 and the size of the 80 year old or older population of Finland increases as predicted (approximately 2.2-fold increase during the coming 25 years),10 the number of fall-induced severe head injuries in this population will be about 3.4-fold higher in the year 2030 (about 3700 injuries) than it was in 2004 (1095 injuries). During the same time period, the average life expectancy in Finland will increase from the current 82 years in women and 75 years in men to 85 and 80 years, respectively.10

Discussion 

Our findings show that both the number and age-adjusted or age-specific incidence of fall-induced severe head injuries in Finns 80 years of age or older have increased steeply from 1970 to 2004 and have not declined in the most recent years. These injuries represent an alarming epidemic and the predicted ageing of populations will soon exacerbate the burden on our health care systems.1, 3, 4, 5, 10

The exact reasons for the increase in the age-adjusted or age-specific incidence of fall-induced severe head injuries among elderly people are unknown. An increase in the average risk of falling might partly explain the phenomenon. On the other hand, today elderly persons, or a part of them, may fall more seriously than their predecessors: when an increasing number of less-healthy and functionally less-capable elderly persons are, among others, now surviving to old ages (e.g. due to more effective health care and life-expanding treatments and medication), the problems of severe falls may also rise.1, 3, 4, 5, 7, 9

Because the number of fall-induced severe head injuries among Finns aged 80 years or older shows a rise with a rate that cannot be explained merely by demographic changes, effective preventive measures are needed. Randomised interventions aiming at reducing the number of falls of elderly persons by modifying the predisposing and situational risk factors for falls have shown promising results.2 Especially, strength and balance training has effectively reduced the risk of falling.13 In diminution of fall severity, protection of the head with a helmet in very high-risk elderly individuals (such as multiple fallers with previous head injuries) might be a reasonable and feasible option.6