’Tis the Season of Accidents

Debra L. Glasser, M.D.

Photo by Olympia Wedding Photographer | Loewyn Behold Photography

As the first frost approaches, the wet ground grows slippery, and the culture revs up for the holiday season, the risk of a whole litany of accidental injuries increases.

I am the inveterate klutz.  It wasn’t until recently, after three significant falls in a year (two resulted in injuries), that I began to listen to my own need to prevent falls and accidents. SLOW down and use your trekking poles!  My 29-year-old son, fell again yesterday while hiking, sustaining yet another fracture.

Accidents occur at every stage of life.  Not all can be prevented, but many can.

The scope of accidental injury is huge

According to the U.S. Centers for Disease Control, each year in the US there are:

• 8 million annual physician office visits for accidents
• 5 million emergency department visits for injuries that include traumatic injuries to the body, frostbite, burns, and poisoning
• These injuries lead to 227,039 accidental deaths and are the 3^rd leading cause of death
• 44,000 of these deaths are due to falls, 44,000 to motor vehicle accidents, and 102,000 to poisoning
• Drug overdoses (described as poisoning in the literature) are the leading cause of injury deaths, most involving opioids (fentanyl and heroin)

Accidents can be deadly

Unintentional injuries are the leading cause of death for children and adults ages 1 to 45. Thereafter, diseases take top ranks. Nonetheless, by age 65, unintentional injury is the 7^th leading cause of death with falls accounting for 56% of them.

Causes of accidental deaths vary across the lifespan

In children ages 1-4, drowning is the leading cause followed by motor vehicle injuries, poisoning, and burns. Drowning stays on the top ten list through age 54.

For teens and those in their early 20s, firearms and suicide are added to the above.

By age 65, in addition to all these causes, falls top the list of deadly injuries.

Falls occur in older and younger adults

Over 14 million falls occur in older adults (>age 65) every year and affects 1 in 4 elders. Thirty-seven percent of falls result in injuries and 1 million hospitalizations, most often for head injury or hip fracture.  41,000 of those hospitalized die.  

The Centers for Disease Control tracks fall risk by state and, in Washington, we have the dubious honor of being in one of the highest fall risk categories.

As in my 29-year-old son’s case, falls in young adults are neither rare nor benign.

In a study of young adults (~age 19), within 4 months, half of the participants had fallen, with 10% of those resulting in injury. 11% were related to alcohol or drugs. Most were due to sports or walking. Fall risk goes up with the level of physical activity, the number of medications, and for males.

What is the cost of all these injuries?

In addition to death, disability, and lost time from work, school, and life, accidents cost $50 billion nationally.               

Prevention is possible and worth the effort.

Parents can protect kids. Adults can protect themselves and their elders. Some prevention is common sense. Some efforts may be complicated, take significant effort, and be an ‘ah hah’ to many.  All require attention, commitment, and behavior change.

Falls are typically caused by a combination of risk factors, some modifiable.   Improving each risk factor will reduce the chance of falling.

Resources are abundant for fall prevention in older adults. Here are a few:

• Falls-free checkup frequently asked questions from the National Council on Aging
• NCOA's Falls Free CheckUp
• Family Caregivers: Protect Your Loved Ones from Falling

Accident prevention strategies

For parents

• If you have firearms around children, lock them up, keep the ammunition locked separately, and guns never loaded.
• Every child learns to swim – sign your kids up for lessons, they are taught year-round at the Y
• Every child always wears a life jacket (PFD = personal flotation device) on watercraft and around water before they are swimmers.
• Keep all toxic substances locked and inaccessible to kids – cleaning products, solvents, medications, and alcohol.
• Buckle them up in the car with age-appropriate car seats
• Watch them like hawks around cars and teach them car safety: “Look both ways and listen before you cross the street.”

For adults and teens

• Same rules for firearms
• Wear your seatbelt and insist your passengers do
• Don’t drug or drink and drive. Bring a sober driver along or stay at home

For boaters

• Learn to swim – take adult swim lessons. Do it for your safety plus the world of wonderful water activities you could now enjoy without fear.
• Wear a personal flotation device (PFD) on a watercraft and insist others on your craft do, too.
• Some years ago, an Olympia sailor who was not wearing a PFD tragically drowned in a race. Since then, PFD use has been mandatory in sailing races.
• Falling in the 40-degree water of Puget Sound and our lakes in winter increases the risk of hypothermia and drowning from exposure in less than a minute.

For drivers

• SLOW down and drive defensively. Put down the cell phone and avoid any other driving distractions known to increase accident rates.

For chefs and cooks

• SLOW down while cooking and using knives. Remember that ‘little slip’ while rushing to prepare the holiday meal only to be interrupted by an ER visit for stitches or a painful burn.

For cyclists

• Wear helmets and colorful clothing and use lights to be seen. Follow the rules of the road. Bicycle and motorcycle accidents can be very serious and deadly.

For hikers and walkers

• SLOW down and be in tune with your body. Pay attention to fatigue.
• When I fell while hiking (a simple slow slip on a short muddy incline that resulted in a wrist fracture), I did not listen to my need for a short break and some food.

• Tune in to your balance. See your doctor to assess and intervene if you feel dizzy or unsteady. Balance issues are caused by many different things, including loss of sensation in the feet (common in diabetes), brain and/or inner ear issues, B12 deficiency, medication side effects, low blood pressure, and many more. Whatever the cause, a cane or assistive device such as a walker can help you walk more steadily and not fall.
• Trekking poles are a Godsend to young and old. They assist with balance on uneven ground, muddy slopes, inclines, and descents. Sometimes one pole is enough, other times bring them both. NO SHAME.
• Yoga and Tai Chi specifically help with balance and strength.
• Be a careful and defensive pedestrian. Be sure you are seen. Cross when the coast is clear.
• Prepare for ice – don’t go out or keep a pair of walking traction devices such as Yaktrax in your closet. It’s worth $10-30 to prevent a fall injury.
  
  • I bought mine after falling hard on an icy parking lot a few years ago. Though only worn once, I'm glad they are in my closet!
• Stay fit – exercise builds and maintains strong muscles, aids our ability to get up if we fall, keeps us responsive when we lose our balance and reduces fall risk.

For everyone included or not included above

• Check your vision and correct it while adapting to any limitations
• Use adequate light when moving around in the dark. Elders need more light to see in the dark than young people for many reasons, including cataracts.
• Attend to your feet and footwear. Foot pain is a cause of falls as is some footwear. Be careful in flip-flops and wear comfortable shoes when you are on the move.
• Attend to trip hazards in your environment – cluttered floors, area rugs and toys can result in falls at any age.
• Attend to your mental health – depression increases fall risk, and all forms of substance abuse increase the risk of injuries. Do you need addiction intervention?
• Prevention of drug overdoses is beyond the scope of this column
• See your doctor if you are afraid of or have already fallen. They may want to check for osteoporosis (which increases the risk of injury with accidents), vitamin D levels, and much more. This is a valid concern for a doctor’s visit. Your life may depend on it!

May your holiday season be sweet, unrushed and accident-free!

Debra L. Glasser, M.D. is a retired internal medicine physician in Olympia. Got a question for her? Write drdebra@theJOLTnews.com