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Risk factors of home injury among elderly people in Malaysia

Article  in  Asian Journal of Gerontology and Geriatrics · January 2013

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 Asian J Gerontol Geriatr 2013; 8: ?–?

Risk factors of home injury among ORIGINAL ARTICLE

elderly people in Malaysia
KH Lim1, MSc, Bsc, K Jasvindar1, MPH, MBBS, I Normala2, PHD, MB Bch,
BK Ho3, M(med) Fam Medicine, MBBS, WK Yau4, MRCP, MBBS, S Mohmad5,
MPH, MBBS, WY Lai1, MBBS, MS Sherina2, PHD, MBBS

ABSTRACT 1
Institute For Public Health, Kuala
Lumpur, Malaysia
Background. Home injuries among elderly people are a public health 2
Psychiatric Department, University Putra
concern. This study aimed to determine the frequency and risk factors Malaysia, Selangor, Malaysia
3
Kapar Health Clinic, Selangor, Malaysia
of home injuries among elderly people in Malaysia. 4
Geriatric Unit, Kuala Lumpur General
Methods. The Third National Health and Morbidity survey in 2006 Hospital, Kuala Lumpur, Malaysia
5
Family Health Unit, Ministry of Health,
was carried out from April to July 2006. The sample was proportional to Putrajaya, Malaysia
population size and selected in 2 stages. Data were collected through
face-to-face interviews using a validated questionnaire. Only injuries
occurring within the previous year were included to avoid recall bias.
The types of home injury, places where the injuries occurred, ability to
work after the injury, and hospital admission were recorded, as were
demographic variables such as sex, age, marital status, ethnicity, and
residential area.
Results. Of 4842 respondents aged ≥60 years, 279 (5.8%) had
experienced some kind of home injury within the previous year. The
most common types of injury were fall (n=205), cuts (n=43), and being
struck by objects (n=14). The most common injury locations were the
kitchen (n=81), garden (n=65), bathroom/toilet (n=45), living room
(n=26), bedroom (n=22), and stairs (n=21). Home injury rates were
significantly higher among women than men (7.4% vs. 3.9%, p<0.001).
Married elderly people were less likely to have a home injury than
divorced/widowed or single elderly people (4.9% vs. 8.0% vs. 8.0%).
Multiple logistic regression analysis revealed that women (adjusted
odds ratio [OR]=1.87, 95% confidence interval [CI]=1.37-2.55) and
respondents aged 70-74 years (adjusted OR=1.45, 95% CI=1.02-2.07)
were more likely to sustain a home injury.
Conclusion. With the increase in the elderly population, home injury
prevention programmes are urgently needed.
Correspondence to: Kuang Hock Lim, Section
of Proposal Development, Institute For Public
Key words: Accidental falls; Health services for the aged; Malaysia; Health, Jalan Bangsar, 50599, Kuala Lumpur,
Wounds and injuries Malaysia. Email: limkh@iku.moh.gov.my

INTRODUCTION home injuries among elderly people in developing

Injury among elderly people is usually associated
with high morbidity and mortality, and is thus a public
health concern.1–3 It requires longer hospitalisation
and more extensive medical attention, resulting in a
greater health care burden.4–6 Only a few studies of
and middle-income countries have been reported.7,8
According to the Second National Health
Morbidity Survey in 1996, the prevalence of home
injury in Malaysia was 2.5%, and was higher in
adults older than 80 years.9 Women, pensioners, and

Asian Journal of Gerontology & Geriatrics Vol 8 No 2 December 2013 1

Lim et al
housewives were highly associated with home injury
because of the long periods spent at home. Home
injuries among people aged ≥60 years were about
8%; falls, poisoning, and choking/suffocation were
the most common causes.10 Compounds, kitchens,
and living rooms were the most common locations
of home injuries.9,10
The health service system of Malaysia is strained
by the rapidly ageing population, who need medical
attention for multiple and chronic illnesses more
frequently than do younger people.11 Home injuries
are largely preventable, and preventive measures can
reduce the health care burden.
Based on the Third National Health Morbidity
Survey in 2006,12 this population-based survey
assessed home injuries among elderly people within
the previous year for policy makers to formulate
preventive measures.
METHODS
The Third National Health and Morbidity survey12
was carried out from April to July 2006. The sample
was proportional to population size and selected in
2 stages, based on the 2004 Labour Force Survey
sampling frame from the Department of Statistics,
Malaysia. Households were stratified by state and
urban/rural setting. The number of households
selected was based on an expected 4.4 respondents
per household. The total sample size was based
on a prevalence of 10%, a margin of error of 1.2,
and a design effect of 2. Enumeration blocks were
geographically contiguous areas consisting of 80
to 120 households and constituted the primary
sampling units, whereas households were the
secondary sampling units. All household members
aged ≥18 years were interviewed. A total of 2150
enumeration blocks (1424 in urban and 726 in
rural areas) consisting of 17 251 households were
randomly selected.
Written informed consent was given by each
participant before the interview. The study was
approved by the Medical Research Ethics Committee,
Ministry of Health, Malaysia. Data were collected in
face-to-face interviews by trained interviewers using
a validated questionnaire, which was pre-tested in 3
districts (Klang, Bangsar, and Sepang) of urban and
rural areas. Households were visited up to 3 times to
2 Asian Journal of Gerontology & Geriatrics Vol 8 No 2 December 2013
achieve an interview. Only injuries occurring within
the previous year were included to avoid recall bias.
The type of home injury, places where the injuries
occurred, ability to work after the injury, and hospital
admission were recorded, as were demographic
variables such as sex, age, marital status, ethnicity,
and residential area.
Education levels were categorised into: no formal
education, primary education (1-6 years), secondary
education (7-12 years), and tertiary education (>12
years). Residential area was determined based on
the Department of Statistics criteria. Age groups
were categorised into: 60-64 years, 65-69 years,
70-74 years, 75-79 years, and ≥80 years. Monthly
household income (in Ringgit Malaysia [RM]) was
classified into: <1000, 1000-1999, 2000-2999, 3000-
3999, 4000-4999, and ≥5000.
Any discrepancies in data were checked by
referring to the original questionnaire. Descriptive
statistics were used to estimate the prevalence,
mechanism, place, and outcome of the home injury.
Multiple regression analysis was used to determine
the effect of each variable on home injury after
controlling for potential confounders. All statistical
analyses were carried out at the 95% confidence
interval (CI).
RESULTS
34 305 respondents aged ≥18 years were
interviewed. The response rate was 96.7%. Data of
4842 respondents aged ≥60 years (mean, 68.4 years;
standard deviation, 6.74 years) were analysed. Of
whom, 53.6% were women; 68.8% were married;
86.5% had primary or no education; and 54.1%
earned <999 RM per month (Table).
279 (5.8%) of the respondents had experienced
some kind of home injury, 82 of whom were unable
to perform activities of daily living after injury, and
37 of whom were admitted to hospital. The most
common types of injury were falls (n=205), cuts
(n=43), and being struck by objects (n=14). The most
common injury locations were the kitchen (n=81),
garden (n=65), bathroom/toilet (n=45), living room
(n=26), bedroom (n=22), and stairs (n=21). Home
injury rates were significantly higher among women
than men (7.4% vs. 3.9%, p<0.001). Married elderly
people were less likely to have home injury than
 Risk factors of home injury among elderly people in Malaysia

Table
Risk factors of home injury among elderly people in Malaysia before and after controlling for confounders (n=4842)

Variable No. (%) of respondents* Crude OR p Value Adjusted OR p Value

(95% CI) (95% CI)
Total Injury No injury
Nationality
Malaysian 4784 (98.9) 277 (5.8) 4491 (94.2) 1.57 (0.38-6.49) 0.53 1.21 (0.25-5.80) 0.816
Non-Malaysian 54 (1.1) 2 (3.8) 51 (96.2) 1 - 1 -
Sex
Male 2250 (46.4) 87 (3.9) 2156 (96.1) 1 - 1 -
Female 2592 (53.6) 192 (7.4) 2390 (92.6) 1.99 (1.54-2.58) <0.001 1.87 (1.37-2.55) <0.001
Residence
Urban 2457 (50.7) 135 (5.5) 2315 (94.5) 1 - 1 -
Rural 2385 (49.3) 144 (6.1) 2231 (93.9) 1.11 (0.87-1.41) 0.41 1.08 (0.80-1.47) 0.632
Age group (years)
60-64 1646 (34.2) 84 (5.1) 1558 (94.9) 1 - 1 -
65-69 1415 (29.4) 73 (5.2) 1341 (94.8) 1.01 (0.73-1.93) 0.95 0.97 (0.68-1.37) 0.857
70-74 888 (18.5) 66 (7.5) 819 (92.5) 1.45 (1.07-2.09) 0.02 1.45 (1.02-2.07) 0.040
75-79 486 (10.1) 27 (5.6) 456 (94.4) 1.10 (0.70-1.72) 0.68 1.14 (0.70-1.86) 0.593
≥80 378 (7.8) 29 (7.8) 343 (92.2) 1.57 (1.01-2.43) 0.04 1.30 (0.79-2.15) 0.296
Ethnicity
Malay 2546 (52.6) 134 (5.3) 2407 (94.7) 0.70 (0.32-1.54) 0.38 0.99 (0.69-1.42) 0.408
Chinese 1377 (28.4) 68 (6.3 1303 (93.7) 0.66 (0.29-1.47) 0.69 1.54 (0.94-2.52) 0.400
Indian 301 (6.2) 23 (7.6) 278 (92.4) 1.04 (0.43-2.51) 0.93 0.98 (0.35-2.75) 0.970
Other indigenous 523 (10.8) 47 (9.1) 470 (90.9) 1.26 (0.55-2.87) 0.59 1.51 (0.57-3.99 0.728
Other 95 (2.0) 7 (7.4) 88 (92.6) 1 - 1 -
Education
None 1922 (40.2) 131 (6.9) 1781 (93.1) 2.80 (0.68-11.51) 0.16 1.56 (0.35-6.96) 0.560
Primary 2214 (46.3) 116 (5.3) 2092 (94.70 2.11 (0.51-8.68) 0.30 1.62 (0.38-7.02) 0.516
Secondary 563 (11.8) 25 (4.40) 537 (95.6) 1.77 (0.41-0.77) 0.44 1.47 (0.31-6.66) 0.636
Tertiary 78 (1.6) 2 (2.6) 76 (97.4) 1 - 1 -
Marital status
Single 89 (1.9) 7 (8.0) 81 (92.0) 1.69 (0.77-3.72) 0.19 1.84 (0.82-4.15) 0.140
Married 3305 (68.8) 160 (4.9) 3137 (95.1) 1 - 1 -
Divorced/widowed 1411 (29.3) 112 (8.0) 1291 (92.0) 1.70 (1.32-2.18) 0.001 1.16 (0.87-1.54) 0.316
Income (Ringgit Malaysia)
<999 2435 (54.1) 145 (6.0) 2279 (94.0) 0.84 (0.54-1.39) 0.49 0.80 (0.43-1.50) 0.493
1000-1999 972 (21.6) 53 (5.5) 919 (94.5) 0.76 (0.44-1.32) 0.33 0.84 (0.44-1.59) 0.586
2000-2999 509 (11.3) 27 (5.3) 480 (94.7) 0.74 (0.40-1.37) 0.34 0.71 (0.36-1.40) 0.322
3000-3999 214 (4.8) 12 (5.7) 200 (94.3) 0.79 (0.37-1.68) 0.54 0.76 (0.35-1.64) 0.484
4000-4999 105 (2.3) 9 (8.6) 96 (91.4) 1.23 (0.54-2.84) 0.62 1.34 (0.50-3.60) 0.555
>5000 264 (6.9) 18 (7.1) 237 (92.9) 1 - 1 -
* Total percentage may not add up to 100, owing to missing data

divorced/widowed or single elderly people (4.9% vs. that women (adjusted odds ratio [OR]=1.87, 95%
8.0% vs. 8.0%) [Table]. CI=1.37-2.55) and respondents aged 70-74 years
(adjusted OR=1.45, 95% CI=1.02-2.07) were more
Multiple logistic regression analysis revealed likely to sustain a home injury (Table). Other

Asian Journal of Gerontology & Geriatrics Vol 8 No 2 December 2013 3

Lim et al
variables that were significant in the univariate
analysis did not reach significance after controlling
for social and demographic variables.
DISCUSSION
In the current study, 5.8% of the elderly population
had some kind of home injury within the previous
year, which is comparatively lower than in other
studies.13-16 This could be due to the fact that
the current study was conducted in community
households, and not in a hospital setting or nursing
homes. In addition, this study did not include
mortality cases secondary to home injuries or other
types of injuries, such as motor vehicle accidents,
which are common in other countries.16
The most common cause of injury was falls,
which corresponds with the findings of a study in
Verona, Italy, in which falls accounted for 75% of
injuries among elderly people aged 65 to 99 years
admitted to geriatric departments of public and
private hospitals.13 Of 460 trauma admissions to a
hospital in Ontario, Canada over 3 years (2000-2003),
125 (27.2%) were for elderly people aged ≥65 years.
The main reasons for admission were falls (64%)
and motor vehicle accidents (27%).16 Among 720
patients aged ≥65 years presenting with trauma to
an emergency department in Singapore, 67.9% were
home injuries, 85.3% of which were caused by falls,
74.1% of which occurred at home.17 The frequency of
home injuries was higher among men until the age
of 50 years, but was higher among women for the
older age groups.18 This can be explained by different
activities performed by different sexes and ages of
people. Younger men (aged 31-40 years) are more
interested in repair and do-it-yourself activities,
whereas women are more involved in domestic work
activities.18 In addition, life expectancy is higher for
women.18 Home injuries occurred more commonly
among women and in the kitchen, as women are
more likely to be involved with kitchen activities
such as cooking and cleaning.13,18,19 Women tend to
incur more home injuries because of the nature of
their work within the home.17
The increase in home injuries in elderly people
aged >65 years, particularly those >70 years, can be
due to diminished reflexes and chronic diseases.16
Independent risk factors for subsequent falls
among respondents aged ≥85 years were a history
4 Asian Journal of Gerontology & Geriatrics Vol 8 No 2 December 2013
of recurrent falling, poor vision, use of antipsychotic
drugs, and feelings of anxiety, nervousness, or fear.20
As the life expectancy of Malaysians increases,
the rate of home injuries among elderly people
is expected to increase. Most home injuries can
be prevented. Elderly people should be taught to
practice safety measures at home. Improvement
in home furnishings, especially in accident-prone
areas such as the kitchen and bathroom/toilet is
necessary.1,14 As fall was the major cause of home
injury, fall prevention measures should include
regular medical check-ups for visual acuity, activities
of daily living, physical health, and cognitive and
memory functioning, and home inspection to ensure
adequate lighting, railings and support bars in toilets/
bathrooms, and proper arrangement of furniture to
avoid tripping and falls.21,22
ACKNOWLEDGEMENT
We thank the Director-General of Health, Malaysia
for his permission to publish this paper.
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