injuries in older persons
The importance of studying injuries in older persons
Demographically, South Africa has one of the oldest populations in Africa, housing the second largest number of older persons (after Nigeria) on the continent. Despite the demographic impact of the AIDS epidemic, the number and proportion of older persons is projected to continue growing for the next two decades, and the growth rate of the older population is projected to be considerably higher than that of the rest of the population.1
Compared to non-communicable diseases, injuries are not a major cause of death in the country’s older population. However, of the estimated 145 000 deaths that occurred in persons 60+ in the year 2000 in South Africa, over 4 000 were from injuries. Moreover, in the same year, death rates from homicide and road traffic accidents in South Africa’s older population were considerably higher than those of older persons in the global population.
Data source: the National Injury Mortality Surveillance System
In South Africa, shortcomings exist in the national registration system of deaths due to external causes. The National Injury Mortality Surveillance System (NIMSS) was established in 1999 to address these shortcomings by providing ongoing and systematic information about the incidence and causes of non-natural deaths from selected sentinel mortuaries. Through a data collection form processed by the Medical Research Council, 21 items of information are recorded for every deceased that enters the forensic medico-legal system at participating mortuaries.2
Data for deceased persons 60 years or older, for the years 2001 and 2002, were examined and are presented below.
Nature and extent of fatal injuries
The combined NIMSS data from 2001 and 2002 show that road traffic accidents accounted for about a third of injury deaths in both older men and women. A quarter of male injury deaths and a fifth of female injury deaths were attributed to homicide. Suicide in older men were almost double the proportion of that in older women, whereas deaths from fires in older women were almost three times the proportion of that in older men (Figure 1).
Figure 1: Apparent manner of fatal injury deaths in males and females ≥60
Source: NIMSS 2001 and 20022
Homicide and road traffic injuries
Death rates in South Africa in the year 2000 due to homicide in the male population 60 years or older were 64,4 per 100 000. This is much higher than the global rate of 13,3 per 100 000. The homicide rate in South African older women (18,1) was also much higher than the global older female rate (4,7).3
Fatal road traffic injuries in South African older men (67,1) and women (28,9) also showed considerably higher rates compared to the global male (49,0) and female (10,0) rates.3
Pervasive levels of violence against older persons
Pervasive levels of violence in South Africa are reflected in the older persons’ homicide data. Studies in the international literature primarily focus on abuse and neglect of older persons by relatives or others known to them, either in the home setting or in residential or institutional care, whereas studies about violence and crime against older persons - either by relatives or strangers - are less frequently found.
While suicides globally are a more prominent cause of death than homicide, homicides in South African older persons are considerably more prominent than suicide.
The particularly high homicide rates in older men and women emphasise the importance of conducting research in South Africa on physical violence against older persons. Risk and protective factors for older persons need to be researched to aid in preventing and reducing South Africa’s high levels of injury mortality.
References
- 1. Joubert JD, Bradshaw D, Dorrington R, Moultrie T. Population ageing in South Africa in the era of AIDS. Paper presented at the 18th World Congress of the International Association of Gerontology, Rio de Janeiro, Brazil, 26 - 30 June 2005.
- Matzopoulos R. (Ed.). A profile of fatal injuries in South Africa. Third annual report of the National Injury Mortality Surveillance System (NIMSS). Cape Town: Crime, Violenc and Injury Lead Programme, Medical Research Council; 2002. Available from URL: http://www.sahealthinfo.org/violence/ [Accessed 31/08/04].
- Joubert JD, Bradshaw D, Laubscher R, Marais S. Violent and other fatal injuries among older South Africans. Poster presented at the 7th Global Conference of the International Federation of Ageing, 4 - 7 September 2004, Singapore.
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