A cross sectional study to assess the socio-economic impact of falls in an urban community in South India

A cross sectional study to assess the socio-economic impact of falls in an urban community in South India Vani CH.1*, Nandakumar B S.2, Murthy N S.3, Suryanarayana S. P.4 DOI: https://doi.org/10.17511/ijphr.2016.i4.03 1* Vani CH, Department of Community Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India. 2 Nandakumar B S, Department of Community Medicine, M. S. Ramaiah Medical College, Bangalore, Karnataka, India. 3 Murthy N S, Department of Community Medicine, M. S. Ramaiah Medical College, Bangalore, Karnataka, India. 4 Suryanarayana S. P., Department of Community Medicine, M. S. Ramaiah Medical College, Bangalore, Karnataka, India.


Introduction
The epidemiological transition have resulted the injuries to emerge as a global public health problem not just in developed countries but also in developing countries like Asia. Injuries account to 9% of world's mortality which is 1.7 times higher when compared to combined deaths due to HIV/AIDS, tuberculosis and malaria Many studies have been conducted about risk factor for falls among elderly population both in hospitals and in the community. Few studies have also been conducted for paediatric age groups. But not many studies have been conducted to assess the impact of falls in terms of economic and social impact among all age groups. The present study is focussed to determine the prevalence of falls in an urban area, Bangalore and its social and economic impact on the individual and their family.

Materials and Methods
The present study is a part of larger study which mainly focussed on pattern of injuries and its socioeconomic impact in an urban community which has been described in detail elsewhere [6]. The present study focussed on to determine the prevalence of falls in an urban area and its social and economic impact on the individual and their family.

Socio-demographic details of falls victims:
Among 3003 people surveyed, 70 were injured while 3 people had two episodes of falls in the past one year of recall period. So total number of fall injuries in our study was 73.      (14) could not be computed since there were no values in extremes of age group.   A study was conducted using million death study data to estimate fall related mortality. Falls accounted to 25% of all deaths from unintentional injury. Its mortality rate per 1 lakh population was 14.5 (99%CI 13.7-15.4). Elderly people (>70 years) had the highest mortality rate from unintentional falls (271.2; 99% CI: 249.0-293.5) and it was higher among women. In this study they observed that fall from height was common in younger age groups while fall on same level was commonly seen among elderly people [11].

Pattern of falls injuries-
Even in our study we found that irrespective of injury severity there was no family breakups (divorce, separation, etc), loss of employment opportunity nor was there any education loss (children missing school, not able to write tests or exams etc) indicating that both at workplace and at home the injured got enough support to sustain and go through the problems following falls.
In our study a single falls injury on an average accounted to Rs 20197 (US$ 370) to the injured and their family. Only 8.1% of them were covered under health insurance or reimbursement or both while rest of them had to meet their financial needs through savings and loans indicating a huge out of pocket expenditure following falls. A study conducted among elderly to estimates the cost of fatal and non-fatal falls in USA showed that 63% of non-fatal cost was spent for hospitalisation, 21% for emergency department visits and 16% for treatment in outpatient settings.
Medical expenditure was 2-3 times higher for women compared to men [12]. Even in our study hospital charges accounted to 58.5% of total expenditure incurred. Since home was the common place of injury there is a need to develop safety precautions to avoid falls at home; example using anti-skid tiles for flooring, using mesh or barriers on windows and balconies etc. Most of the falls among children occurred while playing; hence use of protective equipments like helmets, knee caps, shoes etc would reduce the severity of falls impact.
We would also like to recommend to develop a comprehensive health care service (includes preventive, promotive, curative and rehabilitative health care service) to reduce the burden of falls in a community. Also there is a need to create awareness among general public to utilise health insurance to reduce the out of pocket expenditure.