AJPH
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

AJPH First Look, published online ahead of print Feb 28, 2007
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
AJPH.2006.091140v1
97/4/676    most recent
Right arrow Submit a response
Right arrow purchase articles
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Right arrow Get other permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Pressley, J. C.
Right arrow Articles by Jafri, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Pressley, J. C.
Right arrow Articles by Jafri, A.
Related Collections
Right arrow Aging
Right arrow Community Health
Right arrow Access to Care
Right arrow Injury/Emergency Care/Violence
Right arrow Prevention
Right arrow Screening
April 2007, Vol 97, No. 4 | American Journal of Public Health 676-678
© 2007 American Public Health Association
DOI: 10.2105/AJPH.2006.091140

RESEARCH AND PRACTICE

Improving Access to Comprehensive Injury Risk Assessment and Risk Factor Reduction in Older Adult Populations

Joyce C. Pressley, PhD, MPH, Barbara Barlow, MD, Lodze Quitel, MD and Aisha Jafri, MPH

At the time of the study, Joyce C. Pressley was with the Mailman School of Public Health, Columbia University, New York, NY, and the Injury Free Coalition, New York. Barbara Barlow was with Columbia University, Harlem Hospital, and the Injury Free Coalition, New York. Lodze Quitel was with Harlem Hospital, New York. Aisha Jafri was a summer research assistant and an MPH student at the Mailman School of Public Health, Columbia University, New York.

Correspondence: Requests for reprints should be sent to Joyce C. Pressley, PhD, MPH, Departments of Epidemiology and Health Policy and Management, Mailman School of Public Health, Columbia University, 722 W 168 St, Room 17-12, New York, NY 10032 (e-mail: jp376{at}columbia.edu).


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 References
 

Preventing injuries in older populations (aged 50–86 years) is more complex than in younger populations because of frailty, comorbidities, polypharmacy, and physical and cognitive functional limitations. To improve accessibility and delivery of comprehensive, focused injury prevention, we developed a model incorporating applicable features of our national children’s program with additional elements to address challenges of older populations. The older adult injury prevention model addresses gaps in prevention by improving access to risk factor screening, safety devices, education, counseling, medical care, and referrals.


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
METHODS
 RESULTS
 DISCUSSION
 References
 
Comprehensive children’s injury prevention programs are widely available but do not address the complexities of comorbid illnesses, physical and cognitive functioning, frailty, and polypharmacy that complicate older adult injury prevention programs.1–4 Existing older adult programs are frequently single injury mechanism programs. Although falls are the prevalent mode of injury, nonfall mechanisms contribute disproportionately to the older adult injury burden in minority communities.5,6 Although this suggests that comprehensive rather than single mechanism injury programs may be more appropriate, such models are not available and few reports have been published on injury risk factors for older adults residing in minority communities—both of which hamper prevention efforts.

Our children’s injury prevention program, based on a model with coalition involvement in reengineering of physical and social environments, contained useful features for adult and older adult injury prevention1 but did not include comprehensive risk factor identification or an injury prevention delivery mechanism suitable for addressing issues of older adult populations. A familiar and accepted delivery mechanism—the health fair—had been used successfully to increase access to a variety of preventive screenings in older populations7,8 but had not evolved sufficiently to support a focused, comprehensive prevention and intervention approach to a single, but highly complex, issue.


   METHODS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
RESULTS
 DISCUSSION
 References
 
We developed a comprehensive older adult injury prevention model by (1) adapting applicable features of the children’s program, such as community coalitions; (2) adding a screening mechanism to identify risks associated with intrinsic comorbid diseases, polypharmacy, and functional limitations; and (3) advancing the health fair concept as the delivery mechanism through which to initiate efforts to narrow gaps in access to care and injury prevention and to improve continuity of care for conditions associated with increased injury risk.

In 2005, all Harlem Hospital Center departments providing care for conditions or symptoms associated with increased injury risk and select community organizations were invited to participate in the Harlem Seniors Injury Prevention Fair geared toward issues identified through injury surveillance. Planning sessions, initially held at the departmental level, culminated in a group meeting of departmental chairs and staff. Challenges of older adult injury prevention were discussed, including gaps in access to and continuity of care for those with comorbid conditions and multiple physicians.

On-site risk assessments, screenings, referrals for comprehensive examinations, distribution of safety devices, educational counseling, and literature distribution were conducted at 17 stations, all located in a community gymnasium, staffed by physicians, health care providers, representatives from community organizations, and injury prevention staff (Table 1Go).


View this table:
[in this window]
[in a new window]

  		TABLE 1—— Select Stations and Injury Prevention Activities Conducted at the Harlem Seniors Injury Prevention Fair (N = 140): New York, 2005
 
An abbreviated version of the Comprehensive Injury Risk Assessment and Reduction for Elderly Populations survey, administered during (n=62) and following (n=27) the fair, was used to collect information for baseline injury from 4 major sources: in the community; at home; from individual, intrinsic comorbid diseases or conditions, symptoms, and functional status; and from medical care or rehabilitation.9 Example questions from one of the injury categories (poisoning) on the instrument included the following: "How many prescription medications do you currently take? Nonprescription/over-the-counter medications? Can you describe your system for knowing when to take your medications?" Other related information collected included names of prescription and nonprescription medications, conditions being treated, dose of medication, frequency of medication use, length of time taking medication, prescribing physician, and date when physician last prescribed or reviewed medications.


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
DISCUSSION
 References
 
Study Population
Among the 140 program participants, mean age was 68.3 ± 9.7 years, 80.9% were women, and 92.1% were Black. Nearly two thirds completing risk assessments reported previous injury during their lifetime; 90.5% received emergency department care, and 54.0% were hospitalized.

Most of the participants’ homes lacked 1 or more of the safety devices for falls, fire and burn prevention, environmental exposure, and poisoning (Table 2Go). Comorbid conditions and functional limitations with the potential to contribute to several injury mechanisms were prevalent among participants.


View this table:
[in this window]
[in a new window]

  		TABLE 2—— Selected Variables Reported During Injury Risk Assessments Conducted Among Community-Dwelling Older Adults Using the Comprehensive Injury Risk Assessment and Reduction for Elderly Populations Survey: New York, 2005
 
Falls
Several factors associated with increased fall risks were observed (Table 2Go). Increased fracture risk was prevalent (53.7% had negative T scores on bone mineral density [BMD] screening, 36.4% of whom had a T score≤–1, demonstrating an increased fracture risk).

Poisoning
Multiple risk factors present for unintentional medication poisoning included polypharmacy (4.5 ± 3.0 medications), lack of a pill box organizer or system for taking medication, difficulty remembering to take medications, difficulty hearing, and inability to read fine print on medication bottles with or without corrective lenses (Table 2Go).

Fire and Burns and Heat and Cold Exposure
More than one fourth of the participants had functional limitations that slowed movement and complicated stair evacuation. Smoke alarm ownership was high, but battery maintenance was 25% lower than alarm ownerships. Few owned room thermometers that would enable them to track indoor residence or outdoor temperatures (Table 2Go).


   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
References
 
We have described a community-based, comprehensive injury prevention initiative created through expansion of our children’s injury prevention model to include features that address issues associated with injuries among older adults.1 The injury prevention fair was a well-accepted delivery mechanism for initiation of prevention activities; attendees waited in lengthy lines to complete risk assessments and be rewarded with an injury prevention device. Missing data were primarily the result of an inability to meet unexpected demand at several key stations, including injury risk assessment and BMD screening.

Prevalent low BMDs, low BMD screening rates, and recent reports on calcium and pharmacological interventions support the need for intensified efforts to identify alternative methods of fracture prevention.10–12

Several aspects of the initial pilot program were identified as needing improvement. Efforts to refine the program include: (1) coordination of referrals through a centralized station at the event; (2) improved follow-up with increased access to services for high-risk participants after the event; (3) increased emphasis on fracture education, prevention, and screenings for low BMD; (4) culturally appropriate educational materials; and (5) increased risk assessment screening before and on the health fair day.

The injury prevention fair with cross-specialty physician and community agency participation was a well-accepted model for initiating assessment of highly complex issues associated with injury prevention in adults and seniors. Comprehensive injury risk assessment was essential for identifying modifiable risks at the individual level. The injury prevention fair model provided a mechanism (1) to identify risk, (2) to deliver counseling and educational materials, (3) to distribute safety devices, and (4) to improve access to and screening by health care professionals for risk factor identification and reduction.


   Acknowledgments
 
This work was supported by National Institutes of Health (grant 1P60MD000206) and by the Robert Wood Johnson Foundation.

With research assistance from Shane Tay and Aisha Jafri, portions of this work were presented at the National Leadership Summit on Health Disparities, Washington, DC, January 2006, and at the World Injury Conference, Durban, South Africa, April 2006.

We are deeply grateful to the Harlem Hospital Center’s Departments of Community Outreach, Ophthalmology, Audiology, Pharmacy, Radiology, Neurology, Urology, Geriatrics, Geriatric Psychiatry, Physical Therapy and Rehabilitation, Surgery, Medicine, and Social Services; New York City Fire Department; staff of the Injury Free Coalition for Kids; Friends of Harlem Hospital; and others who contributed generously.

Human Participant Protection
Institutional review board approval for this project was provided by the Harlem Hospital Center institutional review board.


   Footnotes
 
Peer Reviewed

Contributors
J. C. Pressley originated the idea for the injury prevention fair, participated in prefair planning, conducted injury risk assessments, and wrote the brief. B. Bar-low participated in prefair planning, recruitment of participating departments, and funding assurances; supervised activities on fair day; and reviewed article drafts. L. Quitel participated in prefair planning, handled prefair coordination of participating departments, conducted injury risk assessments, and commented on article drafts. A. Jafri worked tirelessly on fair preparations, conducted injury risk assessments, entered data, and reviewed and commented on the article.

Accepted for publication June 10, 2006.


   References
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 References
 
1. Pressley JC, Barlow BA, Durkin MS, Jacko SA, Dominguez DR, Johnson EL. A national program for injury prevention in children and adolescents: the Injury Free Coalition for Kids. J Urban Health. 2005;82: 389–402.[Web of Science][Medline]

2. Istre GR, McCoy MA, Osborn L, Barnard JJ, Bolton A. Deaths and injuries from house fires. N Engl J Med. 2001;344:1911–1916.[Abstract/Free Full Text]

3. Murray MD, Callahan CM. Improving medication use for older adults: an integrated research agenda. Ann Intern Med. 2003;139:425–429.[Abstract/Free Full Text]

4. Colon-Emeric CS, Pieper CF, Artz MB. Can historical and functional risk factors be used to predict fractures in community-dwelling older adults? Development and validation of a clinical tool. Osteoporos Int. 2002;13:955–961.[CrossRef][Web of Science][Medline]

5. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Web-Based Injury Statistics Query and Reporting System (WISQARS). Available at: http://www.cdc.gov/ncipc/wisqars. Accessed October 1, 2003–December 31, 2005.

6. Pressley JC, Barlow B. Cumulative disadvantage: ethnic disparities in injury-related mortality across the age span. Paper presented at: American Public Health Association Annual Meeting; November 6–10, 2004; Washington, DC.

7. Ness KK, Gurney JG, Ice GH. Screening, education, and associated behavioral responses to reduce risk for falls among people over age 65 years attending a community health fair. Phys Ther. 2003;83:631–637.[Abstract/Free Full Text]

8. Mess SE, Reese PP, Della Lana DF, Walley AY, Ives EP, Lee MC. Older, hypertensive, and hypercholesterolemic fairgoers visit more booths and differ in their health concerns at a community health fair. J Community Health. 2000;25:315–329.[CrossRef][Web of Science][Medline]

9. Pressley JC, Barlow BA. A comprehensive injury risk assessment screening tool for senior populations: preliminary findings from a minority community. In: Conference proceedings of the Eighth World Conference on Injury Prevention and Safety Promotion; April 2006; Durbin, South Africa. Abstract 737. Available at: http://www.safety2006.info/abstract.aspx. Accessed February 15, 2007.

10. Wilkins CH, Goldfeder JS. Osteoporosis screening is unjustifiably low in older African-American women. J Natl Med Assoc. 2004;96:461–467.[Medline]

11. Jackson RD, LaCroix AZ, Gass M, et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006;354:669–683.[Abstract/Free Full Text]

12. Kannus P, Uusi-Rasi K, Palvanen M, Parkkari J. Non-pharmacological means to prevent fractures among older adults. Ann Med. 2005;37:303–310.[CrossRef][Web of Science][Medline]





This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
AJPH.2006.091140v1
97/4/676    most recent
Right arrow Submit a response
Right arrow purchase articles
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Right arrow Get other permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Pressley, J. C.
Right arrow Articles by Jafri, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Pressley, J. C.
Right arrow Articles by Jafri, A.
Related Collections
Right arrow Aging
Right arrow Community Health
Right arrow Access to Care
Right arrow Injury/Emergency Care/Violence
Right arrow Prevention
Right arrow Screening

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2007 by the American Public Health Association