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Aging Population in Europe does it mean More Death from Fall?

Martin RusnákVeronika Bučková

Falls are prominent among the external causes of unintentional injury worldwide.

The frequency of falls increases with age and frailty level. Older people who are living in nursing homes fall more often than those who are living in community.

Approximately 28-35% of people aged of 65 and over fall each year.(WHO, 2007)

Falls in higher age

Falls occur as a result of a complex interaction of risk factors.

The main risk factors reflect the multitude of health determinants that directly or indirectly affect well-being. Those are categorized into four dimensions:

biological, behavioral, environmental and socioeconomic factors.

Age is the number one biological factor and its importance increases with population aging.

Women are more likely than men to fall and sustain fracture, resulting in twice more hospitalizations and emergency department visits than men. However, fall-related mortality disproportionately affects men. (Tromp et al., 1998)

Risk factors

This paper studies the time series by age of deadly injuries resulting from falls in Slovakia, neighboring countries and the European Union.

Using population projection it looks at prospects of the mortality from falls.

Clinical interventions, such as vitamin D supplementation, exercise or physical therapy programmes, and some comprehensive multifactorial fall assessment and management interventions can reduce falls and are safe for community-dwelling older adults.

Fall interventions at different settings, such as nursing homes, community, and hospitals have been developed and proven to be successful. The lack of dissemination of this knowledge into practice may explain the meagre progress that has been observed so far in falls prevention.(Alamgir et al., 2012)

Aim

Population data were downloaded from publicly available sources on demography by EUROSTAT;

Population forecasts were taken from the same source; Mortality data by ICD 10 for Slovakia were obtained from

the National Center for Health Information; Mortality data for Austria, Czech Republic, Hungary and

Poland were downloaded from WHO mortality database; Statistical environment {R} was used to derive forecasts; Forecasts made using linear regression with CI and

moving average with population prediction; PYLLs were computed using the LE0 for the last available

year;

Methodology

Results

Predicted populations

2013 2014 2015 2016 2017 2018 2019 2020

Slo-vakia

731851 754388 781948 812414 843666 874074 904784 936550

Czech Repub-lic

1825996 1878131 1931976 1986475 2038584 2086316 2131534 2174651

Hun-gary

1732074 1762328 1797409 1829923 1860145 1904118 1960287 2009518

Austria 1557189 1582917 1606761 1627298 1651251 1675593 1702173 1733143

Poland 5667297 5855196 6056323 6272669 6490349 6709653 6925817 7156358

5000001500000250000035000004500000550000065000007500000

Po

pu

lati

on

Prediction SMR Falls for SR

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

2016

2018

2020

0

20

40

60

80

100

120

140

SMregresiadci SMdci regresiehci SMhci regresiePPdci PPhci PPšt

andard

izova

ná ú

mrt

nosť

na 1

00 0

00 o

byv

ate

ľov

2012 2013 2014 2015 2016 2017 2018 2019 202025.3

predikcia regresiou 21.6 20.5 19.5 18.5 17.6 16.7 15.9 15.2

predikcia s využitím plávajúceho priemeru 56.4 58.1 60.3 62.7 65.1 67.4 69.7 72.0

SR SMR Falls by Age Groups

1996

2001

2006

2011

2016

0

10

20

30

40

50

60

70

80

90

65-69 roční

HM 65-69 yrsregresiaPPlci HMuci HMlci PPuci PPlci regresieuci regresie

hru

bá m

ort

ali

ta n

a 1

00 0

00

65-6

9 r

očn

ých

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

2016

2018

2020

0

20

40

60

80

100

120

140

75-79 roční

hru

bá m

ort

ali

ta n

a 1

00 0

00

75-7

9 r

očn

ých

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

2016

2018

2020

050

100150200250300350

80-84 roční

hru

bá m

ort

ali

ta n

a 1

00

000 8

0-8

4 r

očn

ých

1996

1999

2002

2005

2008

2011

2014

2017

2020

0

100

200

300

400

500

600

700

85+

hru

bá m

ort

ali

ta n

a 1

00

000 8

5+

ročn

ých

SMR Falls, 65+ of age

1996

1999

2002

2005

2008

2011

2014

2017

2020

0

20

40

60

80

100

120

140

SR 65+št

andard

izova

ná ú

mrt

nosť

na 1

00 0

00 o

byv

ate

ľov

1999

2001

2003

2005

2007

2009

2011

2013

2015

2017

2019

020406080

100120140160

Austria 65+

štandard

izova

ná ú

mrt

nosť

na 1

00 0

00 o

byv

ate

ľov

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

2016

2018

2020

0

50

100

150

200

250

300

350

CZ 65+

štandard

izova

ná ú

mrt

nosť

na 1

00 0

00 o

byv

ate

ľov

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

2016

2018

20200

50100150200250300350400450

Hungary 65+

štandard

izova

ná ú

mrt

nosť

na 1

00 0

00 o

byv

ate

ľov

Slovakia PYLL from Falls, 65+

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

age-adjusted PYLL

23.6422337519911

23.1433884998268

17.8721123006203

17.9533869660099

14.9323561025996

14.3525058573614

12.933006419162

11.0582209970856

15.9680878771388

14.2203633062401

19.9579551520402

12.0487583785955

15.9056037496915

13.7538921864325

11.911204937818

13.3795584004869

12.6147857447133

NaN

NaN

NaN

NaN

NaN

NaN

NaN

NaN

moving average

NaN

NaN

NaN

NaN

NaN

NaN

NaN

NaN

NaN

NaN

NaN

NaN

NaN

NaN

NaN

NaN

NaN

34.5199441502598

35.94877264695

37.6602730259377

39.565505922377

41.4875771988875

43.328582618625

45.0205900563657

46.9055827383371

regression

19.639

19.045

18.466

17.904

17.365

16.839

16.329

15.836

15.359

14.895

14.451

14.013

13.595

13.187

12.792

12.411

12.039

11.6792467164723

11.3310932307103

10.993693237191

10.6667033756889

10.3497915730408

10.0426366630856

9.74492801964466

9.45636520209151

3

13

23

33

43

Slovakia, PYLL

age adju

sted P

YLL per 100,000 65+

PYLL Falls 65+

19992001

20032005

20072009

20112013

20152017

2019

0102030405060708090

Austria, 65+

age.a

dju

sted P

YLL p

er

100,0

00 6

5+

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

2016

2018

2020

0

10

20

30

40

50

SR PYLL Falls 65+

age-adjusted PYLLmoving averageregression

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

2016

2018

2020

020406080

100120140160180

Czech Republic, 65+

age-a

dju

sted P

YLL p

er

100,0

00 6

5+

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

2016

2018

2020

020406080

100120140160180200

Hungary, 65+

age-a

dju

sted P

YLL p

er

100,0

00 6

5+

While linear regression provides an optimistic forecast of continuous reduction in standardised mortality the moving average using the population forecast reveals a constant increase over coming years;

The increase is more prominent in SR, HU and CZ compared to A;

There is a need to focus on preventing falls by increased provision of services for aging population to reduce the PYLL from falls.

Conclusions