Trauma and injury prevention for older adults: How to protect yourself from harm

Trauma centers across the U.S. see a lot of life-threatening injuries. The most common “mechanisms of traumatic injury,” as trauma specialists call it, are car accidents and falls. According to Michelle Baker, RN, BSN, manager of trauma services at Huntington Hospital, 49% of the traumatic injuries seen at Huntington are head injuries or hip fractures caused by slips and falls, and 17% are caused by motor vehicle collisions.

But perhaps the most alarming statistic is 50% of those trauma patients are adults 65 years and older. In fact, Baker says that unintentional injury is the seventh leading cause of death for adults 65+ nationwide. And the numbers only get worse: Annually nationwide, it is reported that 36 million older adults experience falls, only 3 million go to the emergency department (ED) for falls, and 32,000 of these falls result in death.

As for driving, the statistics are equally concerning. Every day, 22 older adults die in a motor vehicle collision. Annually, seniors are involved in 1.6 million collisions, 58,000 are hospitalized, and 8,000 die after a crash.

But Baker says the good news is that 100% of traumatic injuries are preventable. That’s because trauma and injury prevention go hand in hand, which means prevention education is crucial to avoiding traumatic injuries in the first place. Baker shared some reasons why older adults in particular are at risk for traumatic injuries.

Health History
Some procedures and conditions can increase injury vulnerability from falls and motor vehicle collisions:

Cardiac history, such as high blood pressure, open-heart surgery, stents and pacemakers, can require certain medications that can affect balance and cognitive function.
Vision conditions, such as cataracts and prescription changes, can affect the ability to see hazards.

Medications
Certain medications can cause side effects that can make an otherwise innocuous injury fatal:

Blood thinners effect blood clotting, so a fall can cause life-threatening bleeds (hemorrhages) in the brain or other organs.
Blood pressure medication can cause dizziness with a sudden change in body position (e.g., getting out of bed or going from sitting to standing too quickly); dizziness can cause serious falls.
Other medications that cause confusion and sedation can increase injury vulnerability, especially if taken before driving or navigating streets or the outdoors.

Not being treated
Seniors may choose to not go to the ED after a fall for several reasons. But Baker says that it is crucial to be seen if you are 65+ and you hit your head.

Traumatic brain injury is the most frequent condition among older adults and can be fatal if not identified early.

In addition to these age-related risks, human factors put seniors at risk for traumatic injury. According to Baker, 54% of falls across all ages happen because of not paying attention while ambulating due to texting, talking on the phone and bumping into someone or something. Slippery floor surfaces are the culprit behind 25% of falls (and if the patient is an older adult, the injury is typically worse than a younger person’s) and the rest are caused by tripping over something in the home (e.g., toys, pets, unsecured carpet or area rugs). But the No. 1 factor behind falling for seniors is poor lighting when walking down stairs or on uneven surfaces.

Fortunately, despite all of these factors, seniors can prevent slips and falls and driving injuries by following the suggestions Baker lists:

Maintain musculature

Monitor vitamin D levels: Vitamin D deficiency is strongly linked to muscle weakness, which can cause heaviness in legs, difficulty standing up and climbing stairs.
Do strength and balance exercises: Exercises such as Tai chi and chair-assisted exercises like single-leg stance, standing marches and sit to stand can help keep muscles strong and can be done safely at home. Search for “older adult balance exercises” on YouTube or Google to see free demos.

Support eyes

Use distance glasses for shopping, walking or being outdoors: Bifocals or progressive lenses make objects look closer or farther than they really are, which can cause falls.
Make sure your eye prescription is up to date: Changes in vision can cause falls and vehicle collisions.
See the eye doctor regularly: Changes in eye health, such as cataracts, can hinder vision, making walking and driving unsafe.

Don’t rush

As we age, we start to slow down: Rushing, such as hurrying to catch a ride, help a pet, keep up with a younger/faster family member or friend, or be on time for an event, causes higher risk of injury.

Check footwear

Quality shoes protect feet and help with balance: Flipflops, high heels, socks and slippers can be hazardous on stairs. Stepping on sharp objects or stubbing a toe without shoes can not only cause foot injury, but cause falling.

See your doctor regularly

Report dizziness and unsteadiness: Your doctor can run tests and may recommend an assistive device, such as a cane or walker.
Review medications: Ask your doctor about taking medications at night verses day to help with daytime dizziness or drowsiness.

Eliminate hazards in the home

Floors: Remove items that can be tripped or slipped on, such as area rugs, mats, debris, items in stacks, groceries, clothes, shoes, towels, damaged flooring, etc.
Pets: Always be aware of pets to avoid tripping over them or being pushed off balance. Allocate a special place for their toys, food and bedding. Keep the floors clear of their belongings –especially before bedtime to avoid falls from tripping or slipping on pet items due to poor lighting.
Bathrooms: Add grab bars inside bathtub/shower and by toilets. Add a no-slip mat in bathtub/shower to avoid slipping on accumulated soap while bathing.
Stairs: Install railings on both sides of stairs if possible.
Kitchen: Keep often-used items within reach on the countertop or lower cabinet shelves – not on the highest cabinet shelves. Reaching up can throw off balance and cause falls.
Out-of-reach items: Never use a chair to reach high items; chairs can be unstable when used as a standing platform and do not provide handholds once you step onto them. Tall ladders are also notoriously dangerous – especially if poor balance is an issue. Ask for help to reach extremely high items.
Lighting: Make sure bedrooms and stairs are well lit. Add nightlights to rooms, hallways and stairs to light paths to areas you might visit during the night, like the bathroom or kitchen.

Drive safely

Wear a seatbelt: If a collision occurs, seatbelts prevent you from being ejected from the car, which can cause death.
Drive in the safest conditions: Daylight and dry weather are the safest conditions for driving. If you don’t feel comfortable driving for any reason (e.g., bad weather, night, alcohol use, feeling unwell, dizzy or drowsy), ride with a friend or family member, use a ride-share service, or take public transportation.
Plan route before driving: Get familiar with the route. See if there is easy and nearby parking. Provide ample time to reach destinations without rushing.
Avoid distractions in car: Turn off loud music. Avoid phone use (texting, talking, or searching for songs, locations or information). If you need to answer the phone, talk hands-free so that both hands can operate the steering wheel. Don’t eat or drink (especially alcohol, drugs and pain killers). Don’t groom (e.g., brush hair, apply makeup, shave). If you need to transport pets, put them in a cage in the back seat or secure and barricade them from the front seat. Never drive with a pet on your lap or in the front passenger seat.

Baker also suggests using the CDC’s MyMobility Plan, a handy tool that provides a calendar for doctors’ appointments, a home safety checklist to prevent falls, and transportation resources to stay mobile in the community.

Knowing how to prevent injury is crucial to aging safely and independently. Putting this information into practice can save lives. Visit the CDC website for more information about falls and driving over 65.

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