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To prevent without over-protecting: children and senior citizens injured during outdoor activities
Umeå University, Faculty of Medicine, Department of Nursing. (Arcum)
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Injuries are a common public health problem. Non-fatal injuries may result in pain and disabilities. Falls are a common causes of non-fatal injuries and many of these injuries occur during some physical activity. Children and senior citizens are two groups of special interest as their body constitution makes them more vulnerable to injuries than the general population. Outdoor environments influence the risk of injury as people are generally physically active when outdoor. Despite a higher risk for injury, physical activity is a common recommendation for a healthy lifestyle. Children and senior citizens should be able to safely participate in outdoor activities and gain health benefits. There is a need to highlight the complexity of balancing injury risk and the healthy benefits of outdoor activities among these two groups.

Aim: The overall aim of this thesis was to investigate injuries among children and senior citizens sustained during outdoor activities and explore experiences and perceptions on risk and possibilities to increase safety in the outdoor environment.

Methods: The studies were performed in northern Sweden. Theparticipants were children through the age of 12 (Studies I & II) and senior citizens aged 65 and older (Studies III & IV). In Studies I and III, a crosssectional retrospective study design was used. The data were collected from an Injury Data Base (IDB) at a hospital with a catchment area of 60 kilometres in a well-defined population. Data in Study III was complemented with a study-specific questionnaire. Injury data were analysed descriptively. Study II was a field-study that included 14 days of observations, six focus-group interviews with children, and four focus-group interviews with teachers. The three data sources were taken together and analysed using qualitative content analysis. Study IV was a focus-group interview study with 31 senior citizens divided into six focus-groups. Data in Study IV was analysed with qualitative content analysis.

Results: In Study I, 795 children attended the emergency department from 2007 through 2009 and were registered in the IDB with non-minor injuries, such as fractures. The most commonly reported activities contributing to injuries were play, sport, and transport. Other factors contributing to the incident were often related to the ground surface. Contributing products were, for example, trampolines, climbing frames, bicycles, and downhill skis. In the field study (Study II), children at schoolyards were seen climbing high in trees, speeding down slides, or fighting with sticks in the woods. Different perspectives on risk and safety influenced or restricted the children’s outdoor play activities. In Study III, 300 senior citizens were registered in the IDB after injuries from pedestrian falls from January 2009 through April 2011. Women were overrepresented. Sixty percent suffered non-minor injuries. Fracture was the most common injury type. Environmental factors, especially ice, snow, and irregularities on the ground surface were the most commonly described causes to the injury incidents. As the incidents happened in public transport areas, the respondents indicated that they hold the local authorities responsible for poor sidewalk and road maintenance. However, they admitted their own responsibility in preventing similar incidents by changing their behaviour and using safety products. The senior citizens in the focus-group interview study (Study IV) described how they needed to adjust to age-related changes when outdoors, for example, by taking responsibility and using common sense. Facilitating possibilities for outdoor mobility increased with the feelings of safety within the outdoor environment and when using safety devices. To the contrary, fear of falling, shortcomings of safety devices, and dangerous elements such as ice, snow, and interactions with bicyclists constrained outdoor mobility.

Conclusion: Non-minor injuries such as fractures among children and senior citizens that are sustained during outdoor activities must be a focus of injury prevention. Different perspectives on risk and safety influence children’s outdoor play at the schoolyard and senior citizens’ outdoor mobility. There is a need for balance between teachers’ common sense knowledge and the knowledge base of injury prevention. In the same manner, there is a need for balance between healthy activities and an acceptable injury risk for participating in outdoor activities. Nurses are well suited to work with this complexity and to optimize these efforts both at schools and in other public settings.

Abstract [sv]

Bakgrund: Skador är ett vanligt folkhälsoproblem. För de som överlever en skadehändelse kan icke-dödliga skador leda till smärta och funktionshinder. Fall är en vanlig orsak till icke-dödliga skador. Många av dessa skador uppkommer vid någon sorts fysiks aktivitet. Barn och äldre personer drabbas i stor utsträckning av skador på grund av deras fysiska, psykiska och sociala sårbarhet. Omgivningen utomhus påverkar risken att skada sig eftersom människor ofta är mer aktiva där. Fysisk aktivitet är en del i en hälsosam livsstil och en allt vanligare rekommendation som ges inom hälsooch sjukvården för att minska risken för fetma och kroniska sjukdomar. Det finns hälsovinster för barn och äldre personer av att vara aktiva men också en komplexitet i att skadas utomhus. För att barn och äldre personer på ett säkert sätt ska kunna ta del av de hälsosamma fördelar fysisk aktivitet innebär behövs mer forskning. Det övergripande syftet med denna avhandling var att undersöka skador bland barn och äldre som uppkommit under utomhusaktiviteter och utforska erfarenheter och uppfattningar om risker och möjligheten att öka säkerheten utomhus.

Metoder: Studierna genomfördes i norra Sverige. Deltagarna var barn upp till 12 år (Studie I & II) och personer i åldern 65 år och äldre (Studie III & IV). Studierna I och III är retrospektiva tvärsnittsstudier. Uppgifterna har samlats in genom en skadedatabas (IDB) på ett sjukhus med en väldefinierad population och ett upptagningsområde av en radie på 60 kilometer. Data i studie III kompletterades med en studiespecifik enkät utformad utifrån Haddons matrix. Skadedata har främst analyserats deskriptivt. Studie II var en fältstudie bestående av 14 dagars observationer, sex fokus-gruppintervjuer med barn, och fyra fokus-gruppintervjuer med lärare. De tre datakällorna lades ihop i analysen och analyserades med kvalitativ innehållsanalys. Studie IV var en fokus-gruppstudie med intervjuer av 31 äldre personer indelade i sex grupper. Data i studie IV analyserades med kvalitativ innehållsanalys.

Resultat: I studie I registrerades 795 skadehändelser av barn i utomhusmiljö med icke-lindriga skador, såsom frakturer, under 2007-2009.De vanligaste rapporterade aktiviteterna som bidrog till skador var relaterade till lek, sport och transport. Markunderlaget var en bidragande orsak till skadehändelsen, tillsammans med produkter som studsmattor, klätterställningar, cyklar och slalom/snowboard utrusning. I fältstudien (Studie II) har barn på skolgården setts klättra högt i klätterställningar, åka med hög fart nedför backar eller slåss med pinnar i skogen. Olika uppfattningar om risk och säkerhet på skolgården påverkar barnens möjlighet till utomhusaktiviteter under skoltid. I studie III, registrerades 300 skadehändelser av äldre personer efter att de fallit och skadats som fotgängare under januari 2009 till april 2011. Kvinnor var överrepresenterade i skadematerialet. Sextio procent drabbades av ickelindriga skador. Frakturer var den vanligaste skadetypen. Faktorer i omgivningen som is och snö var den vanligast beskrivna orsaken till skadehändelsen, samt att det var dåligt sandat på skadeplats. Då skadehändelserna inträffade i offentliga områden angav de skadade fotgängarna att kommunen var ansvarig för det dåliga underhållet av trottoarer och gator/vägar. Men de erkände också sitt eget ansvar för att förhindra att liknande skadehändelser skulle upprepas, det vill säga genom att ändra sitt beteende och använda säkerhetsprodukter. De pensionärer som deltog i fokus-grupp intervjuerna (Studie IV) beskrev hur de anpassade sig till åldersrelaterade förändringar för att kunna vara aktiva utomhus, bland annat genom att ta ansvar och använda sunt förnuft. Att känna sig trygg i närmiljön och att använda säkerhetsprodukter ökade möjligheten till utomhusaktiviteter. Däremot ansågs fallrädsla, brister i säkerhetsprodukter och farliga omgivningar som snö, is och samspelet med cyklister på gång och cykelbanor förhindra utomhusaktiviteter.

Slutsats: Icke-lindriga skador som frakturer bland barn och äldre personer och som uppkommer under utomhusaktiviteter kan vara, och måste vara, i fokus för skadeförebyggande arbete. Olika perspektiv på risker och säkerhet kan påverka barns utelek på skolgården och äldre personers mobilitet. Det finns ett behov av en balans mellan lärarnas sunda förnuft och den kunskapsbas som finns inom skadeprevention. På samma sätt finns det ett behov av en balans mellan hälsosamma fysiska aktiviteter och en acceptabel skaderisk. Sjuksköterskor är en lämplig grupp professionella som kan arbeta med denna komplexitet och försöka optimera insatser för att barn och äldre personer på ett säkert sätt ska kunna delta i utomhusaktiviteter på skolor och i andra offentliga områden.

Place, publisher, year, edition, pages
Umeå: Umeå University , 2015. , 60 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1725
National Category
Nursing
Identifiers
URN: urn:nbn:se:umu:diva-102906ISBN: 978-91-7601-286-4 (print)OAI: oai:DiVA.org:umu-102906DiVA: diva2:811082
Public defence
2015-06-04, Vårdvetarhusets aula, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-05-13 Created: 2015-05-10 Last updated: 2017-02-14Bibliographically approved
List of papers
1. Non-minor injuries among children sustained in an outdoor environment: a retrospective register study
Open this publication in new window or tab >>Non-minor injuries among children sustained in an outdoor environment: a retrospective register study
2015 (English)In: International Journal of Injury Control and Safety Promotion, ISSN 1745-7300, E-ISSN 1745-7319, Vol. 22, no 1, 3-10 p.Article in journal (Refereed) Published
Abstract [en]

The aim was to investigate non-minor injuries sustained during outdoor activities among 0-12 year old children and to explore self-reported circumstances surrounding these incidents. During 2007-2009, the Umea University Hospital injury database (IDB) registered 795 children with moderate (n = 778) and serious (n = 17) injuries, such as fractures. The IDB includes data from a questionnaire completed in the emergency department by the injured child or a parent. The open-ended questions catch the injured child's description of what circumstances precede the injury incident. The most commonly reported activities contributing to injuries were play, sport, and transport. Surface impacts were also reported as contributing factors along with products such as trampolines, bicycles, and downhill skis. By achieving a deeper knowledge about the activities and circumstances that precede non-minor injury incidents, creating safer outdoor environments may be feasible.

Keyword
outdoor, children, prevention, injury, play
National Category
Health Sciences Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-80540 (URN)10.1080/17457300.2013.833945 (DOI)000351835400002 ()
Available from: 2013-09-20 Created: 2013-09-20 Last updated: 2017-12-06Bibliographically approved
2. Approve or disapprove risky outdoor play among school children: a field study
Open this publication in new window or tab >>Approve or disapprove risky outdoor play among school children: a field study
(English)Manuscript (preprint) (Other academic)
Keyword
child, school, play, risk, injury prevention, health promotion
National Category
Medical and Health Sciences
Research subject
omvårdnadsforskning med samhällsvetenskaplig inriktning
Identifiers
urn:nbn:se:umu:diva-102911 (URN)
Available from: 2015-05-10 Created: 2015-05-10 Last updated: 2015-05-11Bibliographically approved
3. Outdoor pedestrian fall-related injuries among Swedish senior citizens: injuries and preventive strategies
Open this publication in new window or tab >>Outdoor pedestrian fall-related injuries among Swedish senior citizens: injuries and preventive strategies
2015 (Swedish)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 2, 225-233 p.Article in journal (Refereed) Published
Abstract [en]

Senior citizens get around, to a large extent, as pedestrians, and safe walking is desirable for senior citizens allowing them to stay mobile, independent and healthy in old age. Senior citizens are over-represented in injury statistics, and fall-related injuries are common. The aim of this study was to investigate fall-related injuries including healthcare costs among senior citizen pedestrians injured when walking in public outdoor environments and to describe their self-reported causes and suggested preventive strategies. The data were based on a combination of information from injury data and a questionnaire. Three hundred senior citizens attended one emergency department after sustaining injuries from pedestrian falls; 60% suffered nonminor injuries, mostly fractures. One-fifth of the pedestrians were hospitalised for an average of 8 days with an indirect hospital cost of 6.2 million EUR (55 million SEK). Environmental factors such as ice were the most commonly described cause of the injury incident. Forty per cent of the respondents indicated that the municipality was responsible for the cause of the injury incident. Fewer respondents mentioned their own responsibility as a preventive strategy. Thirty per cent described a combination of improvements such as better road maintenance, changes in human behaviour and use of safety products as preventive strategies. It is of great importance to highlight general safety, products and preventive strategies to minimise injury risks, so that pedestrians can safely realise the known health benefits of walking and thereby limit healthcare costs.

Keyword
elderly, outdoor, environment, fall, prevention, safety
National Category
Nursing
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-92582 (URN)10.1111/scs.12153 (DOI)000354260700004 ()24913321 (PubMedID)
Available from: 2014-08-29 Created: 2014-08-29 Last updated: 2017-05-12Bibliographically approved
4. Everyday outdoor mobility in old age: focus group interviews with active senior citizens
Open this publication in new window or tab >>Everyday outdoor mobility in old age: focus group interviews with active senior citizens
2015 (English)In: Healthy Aging Research, ISSN 2261-7434, Vol. 4, 32Article in journal (Refereed) Published
Abstract [en]

Background: Senior citizens are over-represented in injury statistics, and fall-related injuries are globally recognized as a major threat to their health and wellbeing. Outdoor falls are likely to occur among those who are active and healthy when walking or cycling. The objective of this study was to explore active senior citizens’ experiences and perceptions of how their safety could be increased and their risk reduced in outdoor environments.

Methods: Six focus-group interviews with 31 healthy and active senior citizens were conducted in northern Sweden. Data were analyzed via a qualitative content analysis method.

Results: Participants adjusted to age-related changes in order to stay safe during outdoor mobility. Outdoor activities were facilitated by having confidence of safety within the environment, and by using safety devices. Fear of, for example, falling and dangerous environments, such as uneven surfaces, as well as the shortcomings of safety devices, were constraining elements for outdoor activity.

Conclusions: It is of great importance to raise awareness of healthy aging and to illuminate directions for environmental changes. Asking old people about their experiences allows the researcher to identify with their perspective, and may give a more comprehensive understanding of the most appropriate recommendations for health and safety improvements.

Keyword
outdoor, fall, healthy aging, old age, mobility, injury prevention
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-102912 (URN)10.12715/har.2015.4.32 (DOI)000373688900001 ()
External cooperation:
Available from: 2015-05-10 Created: 2015-05-10 Last updated: 2016-09-05Bibliographically approved

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