How can injuries in children and older people be prevented?

Summary

The issue

Injury is a serious public health problem in Europe, with the greatest burden on the young, the older people, and those living in the most deprived circumstances. However, it is largely unappreciated as a significant public health problem. Injuries are not inevitable – they can be prevented or controlled. The causes of injury are multifaceted and inter-related, thus calling for wide-ranging policy solutions.

Findings

Legislative, environmental modification and educational approaches all have a part to play in preventing or reducing childhood injuries, and their interactive effects are encouraging.

Training and education programmes can be effective. Pedestrian skills training, which involve practical roadside experience, has proved effective. School-based traffic clubs have not been shown to be effective, but education targeted directly at parents and children have produced good evidence of behavioural change and some casualty reduction. None of the pedestrian safety programmes measured health outcomes and further evidence is needed on their effect on injury rates. Bicycle training schemes can have a positive effect in improving children’s cycling behaviour. There is little research about the effects on campaigns to prevent home accidents through parent education, but it shows that they do lead to some reduction in medically attended injuries in young children or to behavioural and environmental changes.

There is some evidence of a reduction in injuries as a result of a smoke alarm distribution programmes, and overwhelming evidence in favour of bicycle helmet programmes, particularly those employing multiple-intervention strategies. Child restraint (seat-belts etc.) educational campaigns lead to their increased use, but there is no evidence for injury outcomes. There is also evidence that window bars are effective in decreasing deaths and falls.

Some evidence suggests that supportive home visits effect behavioural or environmental changes that lead to a reduction in home hazards, and the introduction of child-resistant closures has been most effective in reducing the number of children’s deaths from poisoning. Area-wide safety programmes are effective in reducing accidents, particularly among child pedestrians and cyclists, while reduced-speed zones are effective in reducing both traffic speed and accidents.

Legislation – for instance, bicycle helmet laws – has proved the most powerful tool in the prevention of injury, and there is strong evidence that child safety seat laws increase restraint use and reduce injury rates.

Community-based approaches allow multiple interventions to be implemented over a period of time so that messages can be repeated in different forms and contexts and a culture of safety developed within a community.

A number of interventions to reduce the incidence of falls in older people are clearly effective. Those targeting multiple risk factors are effective, although it is not possible to say which of their elements most so. There is limited evidence that complex interventions aimed at specific combinations of risk factors are more effective than those applied as a “standard package”. Promoting physical activity, balance training and exercise such as Tai Chi also lower the risk of falls and fall-related injuries in selected groups of older people. Finally, there is evidence that withdrawal of certain medications reduces falls. When used on their own, cognitive or behavioural interventions have not been shown effective in reducing falls, but many effective complex interventions include behavioural components.

Several interventions have been shown to reduce injuries to older drivers, from encouraging automatic transmission use to identifying and correcting drivers’ functional problems. Other interventions are useful for reducing injuries to older pedestrians.

Policy considerations

The evidence of proven and promising strategies for the prevention of unintentional injuries in children and the older people is considerable. These include:

In children

• education and skills development
• promoting the use of safety devices
• supportive home visits
• modification of the environment
• product modification
• legislation, regulation and enforcement
• community-based studies.

In older people

• promoting physical activity and balance training
• medication withdrawal
• modifying the environment within the home
• vision assessment and modification
• cognitive/behavioural interventions
• community-based studies

In most countries, they need to be implemented in a concerted and consistent manner at national and local levels, with an emphasis on those at most risk.