Abstracts
OBJECTIVE
To describe the scientific knowledge produced about trauma in the elderly caused by traffic accidents in healthcare area studies.
METHODS
Integrative review of studies from 2003 to 2013 searched in LILACS, SciELO, PubMed and CINHAL databases. We used combination of the descriptors injuries, wounds and accidents, in English, Portuguese and Spanish languages.
RESULTS
32 studies were selected. In the thematic analysis, three categories emerged: epidemiological data from traffic accidents involving elderly; traffic accidents with elderly pedestrians; and trauma care in the elderly. We observed increased incidence of trauma in most countries and pedestrians represented a large part of the victims. Among these, the elderly are the most vulnerable group.
CONCLUSION
Studies showed that trauma care in the elderly need protocols and professionals with training in gerontology specialized in trauma care services.
Aged; Wounds and Injuries; Accidents, Traffic; Nursing; Review
OBJETIVO
Describir el conocimiento científico producido acerca del trauma en ancianos por accidentes de tránsito en las publicaciones del área de salud.
MÉTODO
Revisión integradora a partir de publicaciones recogidas de las bases de datos LILACS, SciELO, PubMed y CINHAL, en el período de 2003 a 2013. Se utilizó la combinación de los descriptores herimientos, lesiones y accidentes, en las lenguas inglesa, portuguesa y española.
RESULTADOS
Fueron seleccionados 32 estudios. En el análisis temático emergieron tres categorías: datos epidemiológicos de los accidentes de tránsito con ancianos, los accidentes de tránsito con peatones ancianos y la atención al anciano traumatizado. Se advirtió un incremento de la incidencia de ese trauma en la mayoría de los países y los peatones representan gran parte de las víctimas. Entre ellos, las personas mayores son el grupo más vulnerable.
CONCLUSIÓN
Las publicaciones evidenciaron asimismo la atención al añoso traumatizado, sugiriendo la necesidad de existencia de protocolos y de profesionales con formación en gerontología en los servicios especializados de atención al trauma.
Anciano; Heridas y Traumatismos; Accidentes de Tránsito; Enfermería; Revisión
OBJETIVO
Descrever o conhecimento científico produzido sobre o trauma em idosos por acidentes de trânsito nas publicações da área de saúde.
MÉTODO
Revisão integrativa a partir de publicações levantadas nas bases de dados LILACS, SciELO, PubMed e CINHAL, no período de 2003 a 2013. Utilizou-se a combinação dos descritores ferimentos, lesões e acidentes, nas línguas inglesa, portuguesa e espanhola.
RESULTADOS
Foram selecionados 32 estudos. Na análise temática emergiram três categorias: dados epidemiológicos dos acidentes de trânsito com idosos, os acidentes de trânsito com idosos pedestres e o atendimento ao idoso traumatizado. Observou-se aumento da incidência desse trauma na maioria dos países e os pedestres representam grande parte das vítimas. Dentre estes, os idosos são o grupo mais vulnerável.
CONCLUSÃO
As publicações evidenciaram ainda o atendimento ao idoso traumatizado, sugerindo a necessidade de existência de protocolos e de profissionais com formação em gerontologia nos serviços especializados de atendimento ao trauma.
Idoso; Ferimentos e Lesões; Acidentes de Trânsito; Enfermagem; Revisão
Introduction
Population aging is a worldwide phenomenon that, although initially occurred in Western
European countries, that made their early demographic transition, is currently a reality
also in countries of Latin America and the Caribbean, which have initiated this process
of demographic transition for about 50 years(11 Lebrão ML. O envelhecimento no Brasil: aspectos da transição demográfica
e epidemiológica. Saúde Coletiva [Internet]. 2007 [citado 2013 out. 10];4(17):135-40.
http://www.prefeitura.sp.gov.br/cidade/secretarias/upload/saude/arquivos/pessoaidosa/EnvelhecimentoBrasil-Transicao-MLLebrao-SaudeColetiva2007.pdf
http://www.prefeitura.sp.gov.br/cidade/s...
).
Parallel to this phenomenon, trauma in the elderly have proved to be a major public
health problem, with a tendency to progressive worsening(22 Parreira JG, Farrath S, Soldá SC, Perlingeiro JAG, Assef JC. Análise
comparativa das características do trauma entre idosos com idade superior e inferior
a 80 anos. Rev Col Bras Cir [Internet]. 2013 [citado 2014 out. 5];40(4):269-74.
Disponível em: http://www.scielo.br/pdf/rcbc/v40n4/v40n4a03.pdf
http://www.scielo.br/pdf/rcbc/v40n4/v40n...
). In 2002, more than 193,000 deaths caused by traffic were
registered in the world among people who were 60 years or more. In developing countries,
the mortality rate for this cause for 100,000 inhabitants, in this population, was the
highest compared to other age groups. United Nations projections indicate that the
elderly constitute a growing percentage of the population over the next 30 years and the
vulnerability to be killed or seriously injured in traffic is an increasingly important
issue in the world(33 Peden M, Scurfield R, Sleet D, Mohan D, Hyder A, Jarawan E, et al.
Informe mundial sobre prevención de los traumatismos causados por el tránsito.
Washington: OPAS; 2004.).
In Brazil, in 2007, the Mortality information system of the Ministry of health recorded
18,946 deaths of people older than 60 years by external causes, of which 5,084 were the
result of some kind of transport accident(44 Souza ER, Minayo MCS. Inserção do tema violência contra a pessoa idosa
nas políticas públicas de atenção à saúde no Brasil. Ciênc. Saúde Coletiva [Internet]
2010 [citado 2013 set. 6];15(6):2659-2668. Disponível em:
http://www.scielo.br/pdf/csc/v15n6/a02v15n6.pdf
http://www.scielo.br/pdf/csc/v15n6/a02v1...
).
Therefore, it is believed that the knowledge about traffic accident trauma in the elderly is essential for the formulation of effective policies and programs for its prevention, enabling the reduction of the indexes in this age group and, consequently, promoting a better quality of life.
Considering the complexity of the aging process, combined with the seriousness that the traffic accidents represent for the elderly population, it was deemed important to investigate the current situation of the event in this population, in order to contribute with the actions of public management and of health professionals entered in the various health care programs in relation to responsibilities and possibilities for prevention and control of these occurrences. In this sense, the present study aimed to describe the scientific knowledge produced about trauma in the elderly caused by traffic accidents in healthcare publications.
Methods
It was used as a method the integrative review of literature search, which allows the inclusion of theoretical and empirical literature in the study, as well as studies with different methodological approaches(55 Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546-53.).
In the preparation of this review, the following steps were used: selection of the study question, establishing the criteria for the selection of the sample and literature search, definition of the information to be extracted from selected studies, assessment of studies included in the review, interpretation of results and presentation of the review(55 Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546-53.).
Initially, the issue that has guided the study consisted of: what are the scientific knowledge produced about trauma in the elderly caused by traffic accidents, in healthcare publications?
For the selection of the publications to be included in the review, the following criteria for inclusion were adopted: primary studies, published in the period from January 2003 to August 2013, in Portuguese, English and Spanish languages, conducted with people who were 60 years old or more. Chapters of books, theses, doctoral dissertations, technical reports and studies related to other types of accidents, as well as other age groups were excluded.
Search was held in the databases Literature Latin American and Caribbean Health Sciences (LILACS), Scientific Electronic Library Online (SciELO), Medical Literature Analysis and Retrieval System Online (PubMed) and Cumulative Index to Nursing and Allied Health Literature (CINAHL), using the controlled descriptors: wounds and injuries; and accidents.
The search was conducted in August of 2013, with 616 studies in PubMed database, 366 in LILACS, 79 in CINAHL and 45 in SciELO, totaling 1,106 publications. After that, we selected the studies, considering, at first, as potentially eligible, studies whose titles and summaries reported as subject people with 60 years or more; in this step 58 publications were elected and then we proceeded to the integral reading of the selected material. After this analysis, 12 studies were excluded, five for dealing with review of the literature and seven by approaching specific lesions resulting from other types of accidents, not related to traffic accident, remaining only 46 studies. Of this total, 14 publications were repeated in the databases, and were considered only once, at the end of this process, there were 32 studies selected, being 12 in the PubMed database, 10 in LILACS, five in CINAHL and five in SciELO, which were included in the sample of this review. The selection process was developed by two publications revisers independently and is represented in Figure 1.
For the data extraction, a data collection form designed for this purpose by the authors of the study was used, containing information about authors and year of publication of the study; database and journals; place of performance and language of publication; objectives, results and conclusions of the studies.
The final synthesis was developed in a descriptive form, with regard to the objectives, results and conclusions obtained from each of the studies. Such data were grouped by similarity and organized into thematic categories. Finally, the last step corresponded to the elaboration of the document with the complete description of the steps followed.
Results
Box 1 presents a summary of studies included in the review, which formed the corpus of the study and represented the essence for the processing of the results, discussion and its conclusion on the subject of trauma from traffic accidents in the elderly.
It was found that most of the studies were published in 2010, accounting for a total of seven (22%). In the case of recurrent, we observed 19 different journals, especially the Journal Science & Public Health, which published five articles and international journals Injury Prevention and Annual proceedings of the Association for the Advancement of Automotive Medicine, which have published three studies each one.
Summary of the included studies on trauma by traffic accidents in the elderly - Teresina, PI, 2013.
From the analyzed publications, 14 (43.7%) are Brazilian studies (77 Broska Junior CA, Folchini ABD, Ruediger RR. Estudo comparativo entre o
trauma em idosos e não idosos atendidos em um Hospital Universitário de Curitiba. Rev
Col Bras Cir [Internet]. 2013 [citado 2013 ago. 30];40(4):281-6. Disponível em:
http://www.scielo.br/pdf/rcbc/v40n4/v40n4a05.pdf
http://www.scielo.br/pdf/rcbc/v40n4/v40n...
8 Rodrigues J, Ciosak SI. Elderly victims of trauma: analysis of the risk
factors. Rev Esc Enferm USP [Internet]. 2012 [cited 2013 Aug 6];46(6):1400-5.
Available from: http://www.scielo.br/pdf/reeusp/v46n6/en_17.pdf
http://www.scielo.br/pdf/reeusp/v46n6/en...
-99 Luz TCB, Malta DC, Sá NNB, Silva MMA, Lima-Costa MF. Violências e
acidentes entre adultos mais velhos em comparação aos mais jovens: evidências do
Sistema de Vigilância de Violências e Acidentes (VIVA), Brasil. Cad Saúde Pública
[Internet]. 2011 [citado 2013 ago. 6];27(11):2135-42. Disponível em:
http://www.scielo.br/pdf/csp/v27n11/07.pdf
http://www.scielo.br/pdf/csp/v27n11/07.p...
,1212 Lima MLC, Souza ER, Acioli RML, Bezerra ED. Análise dos serviços
hospitalares clínicos aos idosos vítimas de acidentes e violências. Ciênc. Saúde
Coletiva [Internet] 2010 [citado 2013 ago. 6];15(6):2687-97. Disponível em:
http://www.scielo.br/pdf/csc/v15n6/a07v15n6.pdf
http://www.scielo.br/pdf/csc/v15n6/a07v1...
13 Lima MLC, Souza ER, Lima MLLT, Barreira AK, Bezerra ED,. Acioli RML
Assistência à saúde dos idosos vítimas de acidentes e violência: uma análise da rede
de serviços SUS no Recife (PE, Brasil). Ciênc. Saúde Coletiva [Internet] 2010 [citado
2013 ago. 6];15(6):2677-86. Disponível em:
http://www.scielo.br/pdf/csc/v15n6/a06v15n6.pdf
http://www.scielo.br/pdf/csc/v15n6/a06v1...
14 Mello ALSF, Moysés SJ. Análise diagnóstica do atendimento pré-hospitalar
para acidentes e violências contra idosos em Curitiba (PR, Brasil). Ciênc Saúde
Coletiva. [Internet]. 2010 [citado 2013 ago. 6];15(6):2709-18. Disponível em:
http://www.scielo.br/pdf/csc/v15n6/a09v15n6.pdf
http://www.scielo.br/pdf/csc/v15n6/a09v1...
15 Parreira JG, Soldá SC, Perlingeiro JAG, Padovese CC, Karakhanian WZ,.
Assef JC Análise comparativa das características do trauma entre pacientes idosos e
não idosos. Rev Assoc Med Bras [Internet]. 2010 [citado 2013 ago. 6];56(5):541-6.
Disponível em: http://www.scielo.br/pdf/ramb/v56n5/v56n5a14.pdf
http://www.scielo.br/pdf/ramb/v56n5/v56n...
16 Santos ER, Souza ER, Ribeiro AP, Souza AMM, Lima RTS. Cenário do
atendimento aos agravos provocados por acidentes e violência contra idosos na rede
SUS de Manaus (AM, Brasil). Ciênc. Saúde Coletiva [Internet] 2010 [citado 2013 ago.
6];15(6):2741-52. Disponível em:
http://www.scielo.br/pdf/csc/v15n6/a12v15n6.pdf
http://www.scielo.br/pdf/csc/v15n6/a12v1...
17 Ribeiro AP, Barter EACP. Atendimento de reabilitação à pessoa idosa
vítima de acidentes e violência em distintas regiões do Brasil. Ciênc. Saúde Coletiva
[Internet] 2010 [cited 2013 ago. 6];15(6):2729-40. Disponível em:
http://www.scielo.br/pdf/csc/v15n6/a11v15n6.pdf
http://www.scielo.br/pdf/csc/v15n6/a11v1...
-1818 Biazin DT, Rodrigues RAP. Profile of elderly patients who suffered
trauma in Londrina - Paraná. Rev Esc Enferm USP. 2009;43(3):602-8.,2222 Katz M, Okuma MAA, Santos ALG, Guglielmetti CLB, Sakaki MH, Zumiotti AV.
Epidemiologia das lesões traumáticas de alta energia em idosos. Acta Ortop Bras
[Internet]. 2008 [citado 2013 ago. 6];16(5):279-83. Disponível em:
http://www.scielo.br/pdf/aob/v16n5/v16n5a05.pdf
http://www.scielo.br/pdf/aob/v16n5/v16n5...
,3030 Mathias TAF, Mello Jorge MHP, Andrade OG. Morbimortalidade por causas
externas na população idosa residente em município da região sul do Brasil. Rev
Latino Am Enfermagem [Internet]. 2006 [citado 2013 ago. 6];14(1):17-24. Disponível
em: http://www.scielo.br/pdf/rlae/v14n1/v14n1a03.pdf
http://www.scielo.br/pdf/rlae/v14n1/v14n...
,3535 Gawryszewski VP, Mello Jorge MHP, Koizumi MS. Mortes e internações por
causas externas entre os idosos no Brasil: o desafio de integrar a saúde coletiva e a
atenção individual.. Rev Assoc Med Bras [Internet] 2004 [citado 2013 set.
6];50(1):97-103. Disponível em:
http://www.scielo.br/pdf/ramb/v50n1/a44v50n1.pdf
http://www.scielo.br/pdf/ramb/v50n1/a44v...
,3737 Souza RKT, Soares DFPP, Mathias TAF, Andrade OG, Santana RG. Idosos
vítimas de acidentes de trânsito: aspectos epidemiológicos e impacto na sua vida
cotidiana. Acta Sci Health Sci [Internet]. 2003 [citado 2013 ago. 6];25(1):19-25.
Disponível em:
http://periodicos.uem.br/ojs/index.php/ActaSciHealthSci/article/view/2247/1467
http://periodicos.uem.br/ojs/index.php/A...
). Of these, six were developed by
researchers at the Latin American Center for the Study of Violence and Jorge Careli
Health (CLAVES) from the National School of Public Health Sergio Arouca (99 Luz TCB, Malta DC, Sá NNB, Silva MMA, Lima-Costa MF. Violências e
acidentes entre adultos mais velhos em comparação aos mais jovens: evidências do
Sistema de Vigilância de Violências e Acidentes (VIVA), Brasil. Cad Saúde Pública
[Internet]. 2011 [citado 2013 ago. 6];27(11):2135-42. Disponível em:
http://www.scielo.br/pdf/csp/v27n11/07.pdf
http://www.scielo.br/pdf/csp/v27n11/07.p...
,1212 Lima MLC, Souza ER, Acioli RML, Bezerra ED. Análise dos serviços
hospitalares clínicos aos idosos vítimas de acidentes e violências. Ciênc. Saúde
Coletiva [Internet] 2010 [citado 2013 ago. 6];15(6):2687-97. Disponível em:
http://www.scielo.br/pdf/csc/v15n6/a07v15n6.pdf
http://www.scielo.br/pdf/csc/v15n6/a07v1...
13 Lima MLC, Souza ER, Lima MLLT, Barreira AK, Bezerra ED,. Acioli RML
Assistência à saúde dos idosos vítimas de acidentes e violência: uma análise da rede
de serviços SUS no Recife (PE, Brasil). Ciênc. Saúde Coletiva [Internet] 2010 [citado
2013 ago. 6];15(6):2677-86. Disponível em:
http://www.scielo.br/pdf/csc/v15n6/a06v15n6.pdf
http://www.scielo.br/pdf/csc/v15n6/a06v1...
-1414 Mello ALSF, Moysés SJ. Análise diagnóstica do atendimento pré-hospitalar
para acidentes e violências contra idosos em Curitiba (PR, Brasil). Ciênc Saúde
Coletiva. [Internet]. 2010 [citado 2013 ago. 6];15(6):2709-18. Disponível em:
http://www.scielo.br/pdf/csc/v15n6/a09v15n6.pdf
http://www.scielo.br/pdf/csc/v15n6/a09v1...
,1616 Santos ER, Souza ER, Ribeiro AP, Souza AMM, Lima RTS. Cenário do
atendimento aos agravos provocados por acidentes e violência contra idosos na rede
SUS de Manaus (AM, Brasil). Ciênc. Saúde Coletiva [Internet] 2010 [citado 2013 ago.
6];15(6):2741-52. Disponível em:
http://www.scielo.br/pdf/csc/v15n6/a12v15n6.pdf
http://www.scielo.br/pdf/csc/v15n6/a12v1...
-1717 Ribeiro AP, Barter EACP. Atendimento de reabilitação à pessoa idosa
vítima de acidentes e violência em distintas regiões do Brasil. Ciênc. Saúde Coletiva
[Internet] 2010 [cited 2013 ago. 6];15(6):2729-40. Disponível em:
http://www.scielo.br/pdf/csc/v15n6/a11v15n6.pdf
http://www.scielo.br/pdf/csc/v15n6/a11v1...
). Another country that
had a high percentage of studies were the United States, with a total of nine
publications (28.1%)(6,11,19,26-27,31-34).
As to the method adopted in the selected studies, five (15.6%) were based on the principles of triangulation method and the others are transversal observational studies (56.2%) and prospective (15.6%) and retrospective (12.6%) cohorts.
The analysis of objectives, results and conclusions of the 32 selected studies allowed the grouping into three categories: epidemiological data from traffic accidents involving elderly, traffic accidents with elderly pedestrians; and trauma care for the elderly.
Epidemiological data from traffic accidents involving elderly
Because traffic accidents constitute a public health problem worldwide, we found studies from different countries addressing this issue.
In the United States, we identified an increase in mortality and morbidity from traumatic injury among Americans aged 65 years or more, verifying that mortality from unintentional injury increased by 3% between 2000 and 2006, while the morbidity increased by 7% between 2001 and 2007. There was a noteworthy increase of 145% in the mortality rate due to motorcycle accidents and, in relation to morbidity, motorcycle accidents and bicycle increased 86% and 24%, respectively(1111 Hu G, Baker SP. Recent increases in fatal and non-fatal injury among people aged 65 years and over in the USA. Inj Prev. 2010;16(1):26-30.).
Another US study with data from fatal and non-fatal accidents analyzed the shared
risks of older drivers with other users and found that, in relation to fatal
accidents, the impact was an increase in mortality rates among occupants in the
condition of passengers, who were also elderly. In non-fatal accidents, drivers with
75 years or more had a relative risk of 1.1 for collision accidents with injuries to
occupants of other vehicles compared to younger drivers(3434 Braver ER, Trempel RE. Are older drivers actually at higher risk of
involvement in collisions resulting in deaths or non-fatal injuries among their
passengers and other road users? Inj Prev [Internet]. 2004 [cited 2013 Sept
6];10(1):27-32. Available from:
http://injuryprevention.bmj.com/content/10/1/27.full.pdf+html.
http://injuryprevention.bmj.com/content/...
).
In Singapore, a study of traumatized elderly to identify patterns of injury, specific
risk factors and the needs of accident victims, found that traffic accidents were the
second leading cause of trauma in that population(2020 Yeo YYC, Lee SK, Lim CY, Quek LS, Ooi SBS. A review of elderly injuries
seen in a Singapore emergency department. Singapore Med J [Internet]. 2009 [cited
2013 Sept 6];50(3):278-83. Available from:
http://smj.sma.org.sg/5003/5003a6.pdf
http://smj.sma.org.sg/5003/5003a6.pdf...
).
Research conducted in India to assess the incidence of maxillofacial trauma intervention among elderly showed that 79.4% of the injuries resulted from traffic accidents and those aged 60 to 69 years were injured more often than older ones(2424 Gowing R, Jain MK. Injury patterns and outcomes associated with elderly trauma victims in Kingston, Ontario. Can J Surg. 2007;50(6):437-44.).
In Brazil, transportation accidents in 2000 led to mortality from external causes among people aged 60 years and older, representing 27.5% of total fatalities. This proportion was higher than that calculated for the general population, in which these causes accounted for 17.4% of deaths from external causes in the country that year(2323 Subhashraj K, Ravindran C. Maxillofacial intervention in trauma patients aged 60 years and older. Indianas J Dent Res. 2008;19(2):109-11.).
Another Brazilian study that evaluated 121 elderly people 60-74 years old and their caregivers in Londrina showed that 25.6% of the injuries suffered were caused by traffic accidents. As consequence of trauma, it occurred one to three injuries, and 9.1% of the elderly patients died(1818 Biazin DT, Rodrigues RAP. Profile of elderly patients who suffered trauma in Londrina - Paraná. Rev Esc Enferm USP. 2009;43(3):602-8.).
Considering the location of the injuries, a cross-sectional study conducted in 2006 with Swedish elderly aimed at studying the epidemiology of unintentional injuries and compare the incidence observed two decades earlier, they noted that the rate of injury and fracture per 1,000 people increased by about 40 to 50%, mainly in the older age groups, fractures being the most common extremity injuries(1010 Saveman BI, Björnstig U. Unintentional injuries among older adults in northern Sweden - a one-year population-based study. Scand J Caring Sci. 2011;25(1):185-93.).
Similarly, the characterization of injuries in elderly Canadians traumatized in accidents in a period of three years, also considering the complications, found that fractures were the most common injuries, urinary infections and aspiration pneumonia the most frequent complication(2424 Gowing R, Jain MK. Injury patterns and outcomes associated with elderly trauma victims in Kingston, Ontario. Can J Surg. 2007;50(6):437-44.).
In Mexico, a cross-sectional study with 799 elderly in the period from June 2004 to
August 2005 to identify factors associated with notification of accidental injuries,
they found that upper and lower extremities were the regions most affected by
trauma(2121 González MGR, Snyder NS. Lesiones accidentales en adultos mayores: un
reto para los sistemas de salud. Salud Pública Méx [Internet]. 2008 [citado 2013 ago.
6];50(6):463-71. Disponible en:
http://www.scielosp.org/pdf/spm/v50n6/07.pdf
http://www.scielosp.org/pdf/spm/v50n6/07...
).
In Brazil, data from traumas and injuries resulting from traffic accidents, obtained
through analysis of 13 383 deaths and 87 177 hospitalization from external causes in
people aged 60 and over in the National Health System (SUS) in 2000, showed that
fractures were the majority (45.0%), mainly located in the lower limbs (29.2%), with
emphasis on femur fractures (19.3%), followed by head injuries (14.4%), by fractures
of upper limbs (12.1%) and multiple fractures (11.9%)(3535 Gawryszewski VP, Mello Jorge MHP, Koizumi MS. Mortes e internações por
causas externas entre os idosos no Brasil: o desafio de integrar a saúde coletiva e a
atenção individual.. Rev Assoc Med Bras [Internet] 2004 [citado 2013 set.
6];50(1):97-103. Disponível em:
http://www.scielo.br/pdf/ramb/v50n1/a44v50n1.pdf
http://www.scielo.br/pdf/ramb/v50n1/a44v...
).
In the United States of America, investigation on the occurrence of injury as a
function of age, for the occupants who used seatbelts in the period 1997-2003, found
that the frontal and lateral collisions, the chest was the most frequently injured
body region in elderly occupants. It was recommended that security projects for the
elderly to include seatbelts with low limits of force, distributing the load more
evenly over the breast(3131 Augenstein J, Digges K, Bahouth G, Dalmotas D, Perdeck E, Stratton J.
Investigation of the performance of safety systems for protection of the elderly.
Annu Proc Assoc Adv Automot Med [Internet]. 2005 [cited 2013 Sept 6];49:361-9.
Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3217455/
http://www.ncbi.nlm.nih.gov/pmc/articles...
).
Likewise, the determination of injuries patterns in Australian elderly people
involved in automobile collisions in a two-year period showed that traumatized had a
higher rate of chest injuries, finding in this region of the body the most common
three injuries corresponding to 23.5% of rib fractures, 9.5% of flail chest and 5.9%
of fractures of the sternum. The overall mortality rate observed in the elderly group
was nearly twice that found in the younger group(2929 Yee WY, Cameron PA, Bailey MJ. Road traffic injuries in the elderly.
Emerg Med J [Internet]. 2006 [cited 2013 Sept 6];23(1):42-6. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564127/
http://www.ncbi.nlm.nih.gov/pmc/articles...
).
Traumatic brain injury was present in other studies. The injury rates among elderly
patients hospitalized at the Australian Institute of Health and Welfare increased 1.4
times from 1998 to 1999 and from 2004 to 2005, noting that elderly 85 years and older
were 10.8 times the rate found among who had age between 60 and 64 years(2525 Jamieson LM, Roberts-Thomson KF. Hospitalized head injuries among older
people in Australia, 1998/1999 to 2004/2005. Inj Prev [Internet]. 2007 [cited 2013
Sept 6]; 2(13):243-7. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2598353/pdf/243.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
).
In Singapore, the TBI remains a major public health problem and a condition
indicative of significant morbidity and mortality, with traffic accidents and falls
the main causes of this type of injury in that country(2828 Lee KK, Seow WT, Ng I. Demographical profiles of adult severe traumatic
brain injury patients: implications for healthcare planning. Singapore Med J
[Internet]. 2006 [cited 2013 Sept 6];47(1):31-6. Available from:
http://www.sma.org.sg/smj/4701/4701a4.pdf
http://www.sma.org.sg/smj/4701/4701a4.pd...
).
In Brazil, a study conducted in the southeastern region aiming to define the
characteristics of trauma in the elderly by comparing the variables between this
group and the non-elderly traumatized observed that some injuries were more common in
the elderly, such as subdural hematoma, subarachnoid hemorrhages and cerebral
contusions(1515 Parreira JG, Soldá SC, Perlingeiro JAG, Padovese CC, Karakhanian WZ,.
Assef JC Análise comparativa das características do trauma entre pacientes idosos e
não idosos. Rev Assoc Med Bras [Internet]. 2010 [citado 2013 ago. 6];56(5):541-6.
Disponível em: http://www.scielo.br/pdf/ramb/v56n5/v56n5a14.pdf
http://www.scielo.br/pdf/ramb/v56n5/v56n...
).
Regarding the vulnerability of the elderly to traffic accidents, international
studies state that increasing age and severity of injury are predictors of
complications and mortality. Increasing age reduces tolerance to shock in the
collision, and the fragility or preexisting health problem may pose a risk of death
up to 50% greater in the older group(1919 Kent R, Trowbridge M, Lopez-Valdes FJ, Ordoyo RH, Segui-Gomez M. How
many people are injured and killed as a result of aging? Frailty, fragility, and the
elderly risk-exposure tradeoff assessed via a risk saturation model. Ann Adv Automot
Med [Internet]. 2009 [cited 2013 Sept 6];53:41-50. Available from:
gov/pmc/articles/PMC3256801/pdf/file19_final.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
,2424 Gowing R, Jain MK. Injury patterns and outcomes associated with elderly
trauma victims in Kingston, Ontario. Can J Surg. 2007;50(6):437-44.,3232 Kent R, Henary B, Matsuoka F. On the fatal crash experience of older
drivers.. Annu Proc Assoc Adv Automot Med [Internet] 2005 [cited 2013 Sept
6];49:371-91. Available from:
http://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC3217450&blobtype=pdf
http://europepmc.org/backend/ptpmcrender...
).
In the studies selected, accidents involving elderly pedestrians were fairly addressed and it became imperative to describe them, so you can ask about social and environmental changes required to reduce these occurrences.
Traffic accidents with elderly pedestrians
In the USA a study that examined accidents involving pedestrians in the period 2000-2010, aiming to characterize the population and the pattern of injury, it was observed that 18.7% of the victims were elderly and of these 39% were 80 years and older, wherein the mortality rate for elderly patients was more than twice that of non-elderly patients(66 Mcelroy LM, Juern JJ, Bertleson A, Xiang Q, Szabo A, Weigelt J. A single urban center experience with adult pedestrians struck by motor vehicles. WMJ. 2013;112(3):117-22.).
In Brazil, the profile of events to external causes in the elderly differs in some
aspects from what occurs among younger, with a greater vulnerability to pedestrian
traffic accidents, calling attention to the high proportion of deaths from this cause
(48.2%)(77 Broska Junior CA, Folchini ABD, Ruediger RR. Estudo comparativo entre o
trauma em idosos e não idosos atendidos em um Hospital Universitário de Curitiba. Rev
Col Bras Cir [Internet]. 2013 [citado 2013 ago. 30];40(4):281-6. Disponível em:
http://www.scielo.br/pdf/rcbc/v40n4/v40n4a05.pdf
http://www.scielo.br/pdf/rcbc/v40n4/v40n...
,99 Luz TCB, Malta DC, Sá NNB, Silva MMA, Lima-Costa MF. Violências e
acidentes entre adultos mais velhos em comparação aos mais jovens: evidências do
Sistema de Vigilância de Violências e Acidentes (VIVA), Brasil. Cad Saúde Pública
[Internet]. 2011 [citado 2013 ago. 6];27(11):2135-42. Disponível em:
http://www.scielo.br/pdf/csp/v27n11/07.pdf
http://www.scielo.br/pdf/csp/v27n11/07.p...
,3535 Gawryszewski VP, Mello Jorge MHP, Koizumi MS. Mortes e internações por
causas externas entre os idosos no Brasil: o desafio de integrar a saúde coletiva e a
atenção individual.. Rev Assoc Med Bras [Internet] 2004 [citado 2013 set.
6];50(1):97-103. Disponível em:
http://www.scielo.br/pdf/ramb/v50n1/a44v50n1.pdf
http://www.scielo.br/pdf/ramb/v50n1/a44v...
).
Considering this issue, research conducted in Maringa associated factors as
responsible for accidents limitations of aging as the most restricted mobility, lack
of attention, visual and hearing difficulties, among other deficiencies from aging,
as well as the time of the traffic lights on the roads, which not always allow the
completion of the crossing at the scheduled time. However, a portion of the
pedestrian elderly traffic accidents were attributed to the carelessness of
drivers(3737 Souza RKT, Soares DFPP, Mathias TAF, Andrade OG, Santana RG. Idosos
vítimas de acidentes de trânsito: aspectos epidemiológicos e impacto na sua vida
cotidiana. Acta Sci Health Sci [Internet]. 2003 [citado 2013 ago. 6];25(1):19-25.
Disponível em:
http://periodicos.uem.br/ojs/index.php/ActaSciHealthSci/article/view/2247/1467
http://periodicos.uem.br/ojs/index.php/A...
).
Research conducted in Brazil to analyze morbidity and mortality from external causes
in elderly residents of a city in the south of the country found that between the age
group of 60 and 64 years pedestrian collisions had coefficient of 22.7 deaths per
100,000 for men and 5.6 deaths per 100,000 for women. However, among those aged 85
years and over this value was 3.2 deaths per 100,000 males(3030 Mathias TAF, Mello Jorge MHP, Andrade OG. Morbimortalidade por causas
externas na população idosa residente em município da região sul do Brasil. Rev
Latino Am Enfermagem [Internet]. 2006 [citado 2013 ago. 6];14(1):17-24. Disponível
em: http://www.scielo.br/pdf/rlae/v14n1/v14n1a03.pdf
http://www.scielo.br/pdf/rlae/v14n1/v14n...
).
Another national study conducted in Sao Paulo to determine the epidemiology of
injuries resulting from high-energy trauma in the elderly population and analyze the
specific characteristics linked to trauma, as well as evolvement throughout
treatment, found that the most prevalent mechanism of injury was collision, resulting
mainly in fractures of the lower limbs. The length of hospitalization was higher in
patients of younger age groups, and 90% had some type of medical complication after
orthopedic surgery, and age alone acting as a positive predictive factor for the
occurrence of complications in polytrauma(2222 Katz M, Okuma MAA, Santos ALG, Guglielmetti CLB, Sakaki MH, Zumiotti AV.
Epidemiologia das lesões traumáticas de alta energia em idosos. Acta Ortop Bras
[Internet]. 2008 [citado 2013 ago. 6];16(5):279-83. Disponível em:
http://www.scielo.br/pdf/aob/v16n5/v16n5a05.pdf
http://www.scielo.br/pdf/aob/v16n5/v16n5...
).
Trauma care for the elderly
The increasing number of elderly in the population and a more active life they have developed, including conducting professional activities, have provided increased exposure and hence enabled the increased occurrence of trauma by traffic accident in this group(9.12 22).
National and international studies claim that the occurrence of common aging factors
such as frailty, comorbidities, polypharmacy, functional, physical and cognitive
limitations make traumatic injuries more complicated to prevent among the elderly.
For this reason, the evaluation protocols of trauma among people over the age of 60
must be considered with special attention, since the injuries can be hidden,
increasing the risk of fatal outcome(77 Broska Junior CA, Folchini ABD, Ruediger RR. Estudo comparativo entre o
trauma em idosos e não idosos atendidos em um Hospital Universitário de Curitiba. Rev
Col Bras Cir [Internet]. 2013 [citado 2013 ago. 30];40(4):281-6. Disponível em:
http://www.scielo.br/pdf/rcbc/v40n4/v40n4a05.pdf
http://www.scielo.br/pdf/rcbc/v40n4/v40n...
,2121 González MGR, Snyder NS. Lesiones accidentales en adultos mayores: un
reto para los sistemas de salud. Salud Pública Méx [Internet]. 2008 [citado 2013 ago.
6];50(6):463-71. Disponible en:
http://www.scielosp.org/pdf/spm/v50n6/07.pdf
http://www.scielosp.org/pdf/spm/v50n6/07...
-2222 Katz M, Okuma MAA, Santos ALG, Guglielmetti CLB, Sakaki MH, Zumiotti AV.
Epidemiologia das lesões traumáticas de alta energia em idosos. Acta Ortop Bras
[Internet]. 2008 [citado 2013 ago. 6];16(5):279-83. Disponível em:
http://www.scielo.br/pdf/aob/v16n5/v16n5a05.pdf
http://www.scielo.br/pdf/aob/v16n5/v16n5...
,2626 Pressley JC, Barlow B, Quitel L, Jafri A. Improving access to
comprehensive injury risk assessment and risk factor reduction in older adult
populations. Am J Public Health [Internet]. 2007 [cited 2013 Sept 6];97(4):676-8.
Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829339/pdf/0970676.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
-2727 Scheetz LJ, Zhang J, Kolassa JE. Using crash scene variables to predict
the need for trauma center care in older persons. Res Nurs Health [Internet]. 2007
[cited 2013 Sept 6];30(4):399-412. Available from:
http://onlinelibrary.wiley.com/doi/10.1002/nur.20203/pdf
http://onlinelibrary.wiley.com/doi/10.10...
,3333 Scheetz LJ. Relationship of age, injury severity, injury type, comorbid
conditions, level of care, and survival among older motor vehicle trauma patients.
Rev Nurs Health [Internet]. 2005 [cited 2013 Sept 6];28(3):198-209. Available from:
http://onlinelibrary.wiley.com/doi/10.1002/nur.20075/pdf.
http://onlinelibrary.wiley.com/doi/10.10...
,3636 Liberman M, Mulder DS, Sampalis JS. Increasing volume of patients at
level I trauma centres: is there a need for triage modification in elderly patients
with injuries of low severity? Can J Surg[Internet] . 2003 [cited 2013 Sept
6];46(6):446-52. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3211761/.
http://www.ncbi.nlm.nih.gov/pmc/articles...
).
In Canada, a study investigated the records of trauma in a period of seven years and
analyzed the nature of the injuries and the need for modification of screening
protocols recommended in specialized geriatric assessment and suitability of these
documents for conducting appropriate referral to proper centers(3636 Liberman M, Mulder DS, Sampalis JS. Increasing volume of patients at
level I trauma centres: is there a need for triage modification in elderly patients
with injuries of low severity? Can J Surg[Internet] . 2003 [cited 2013 Sept
6];46(6):446-52. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3211761/.
http://www.ncbi.nlm.nih.gov/pmc/articles...
).
In this sense, national studies have reported the occurrence of problems in the early
diagnosis of injuries in the traumatized elderly and considering indispensable the
presence of professionals with backgrounds in gerontology teams in trauma care,
recommending urgent training of professionals specialized services for the
identification, performance, referral and proper monitoring of these cases(1212 Lima MLC, Souza ER, Acioli RML, Bezerra ED. Análise dos serviços
hospitalares clínicos aos idosos vítimas de acidentes e violências. Ciênc. Saúde
Coletiva [Internet] 2010 [citado 2013 ago. 6];15(6):2687-97. Disponível em:
http://www.scielo.br/pdf/csc/v15n6/a07v15n6.pdf
http://www.scielo.br/pdf/csc/v15n6/a07v1...
,1414 Mello ALSF, Moysés SJ. Análise diagnóstica do atendimento pré-hospitalar
para acidentes e violências contra idosos em Curitiba (PR, Brasil). Ciênc Saúde
Coletiva. [Internet]. 2010 [citado 2013 ago. 6];15(6):2709-18. Disponível em:
http://www.scielo.br/pdf/csc/v15n6/a09v15n6.pdf
http://www.scielo.br/pdf/csc/v15n6/a09v1...
-1515 Parreira JG, Soldá SC, Perlingeiro JAG, Padovese CC, Karakhanian WZ,.
Assef JC Análise comparativa das características do trauma entre pacientes idosos e
não idosos. Rev Assoc Med Bras [Internet]. 2010 [citado 2013 ago. 6];56(5):541-6.
Disponível em: http://www.scielo.br/pdf/ramb/v56n5/v56n5a14.pdf
http://www.scielo.br/pdf/ramb/v56n5/v56n...
).
In 2009, a diagnostic analysis in clinical hospital services and emergency for
traumatized in five Brazilian capitals was conducted, elderly care with reference to
some public policies such as the National Policy for Reduction of Morbidity and
Mortality from Accidents and Violence, National Policy of Emergency Care, Ordinance
No. 2048-GM/MS20, the Elderly Statute and the National Health Policy for the Elderly.
The results showed that none of the capitals studied met all requirements recommended
by policy, showing deficiencies in structure and organization to keep a companion,
failures in referring to referral services in specific clinical protocols, in case
report forms, in support of the elderly on the job training and the definition of
flow for this population(1212 Lima MLC, Souza ER, Acioli RML, Bezerra ED. Análise dos serviços
hospitalares clínicos aos idosos vítimas de acidentes e violências. Ciênc. Saúde
Coletiva [Internet] 2010 [citado 2013 ago. 6];15(6):2687-97. Disponível em:
http://www.scielo.br/pdf/csc/v15n6/a07v15n6.pdf
http://www.scielo.br/pdf/csc/v15n6/a07v1...
).
Study conducted in Curitiba, focusing on the general conditions of infrastructure,
planning and support for mobile and fixed pre-hospital care to victimized elderly
care caused by accidents and violence, concluded that this service is still nascent
treatment with the actions developed in the 14 services investigated in that city .
The authors observed no specific plan or definition of flows for elderly care that is
in this situation, missing preventive protocols approach, also occurring deficiency
in reported cases(1414 Mello ALSF, Moysés SJ. Análise diagnóstica do atendimento pré-hospitalar
para acidentes e violências contra idosos em Curitiba (PR, Brasil). Ciênc Saúde
Coletiva. [Internet]. 2010 [citado 2013 ago. 6];15(6):2709-18. Disponível em:
http://www.scielo.br/pdf/csc/v15n6/a09v15n6.pdf
http://www.scielo.br/pdf/csc/v15n6/a09v1...
).
In Recife, another diagnostic analysis based on the guidelines of National Policy for
Reduction of Morbidity and Mortality from Accidents and Violence and the National
Health Policy for the Elderly showed that these guidelines are only partially
covered, and poor compliance in relation to various aspects such as protocols
clinical, notifying, support for elderly, caregivers and victimizers, and job
training(1313 Lima MLC, Souza ER, Lima MLLT, Barreira AK, Bezerra ED,. Acioli RML
Assistência à saúde dos idosos vítimas de acidentes e violência: uma análise da rede
de serviços SUS no Recife (PE, Brasil). Ciênc. Saúde Coletiva [Internet] 2010 [citado
2013 ago. 6];15(6):2677-86. Disponível em:
http://www.scielo.br/pdf/csc/v15n6/a06v15n6.pdf
http://www.scielo.br/pdf/csc/v15n6/a06v1...
).
In this regard, the elderly care of accident victim and violence in Manaus revealed
scarcity of hospital beds and intensive care units for treatment of the elderly. They
also made evident the need for training of health professionals and medical
specialists to monitor these elderly patients hospitalized for trauma(1616 Santos ER, Souza ER, Ribeiro AP, Souza AMM, Lima RTS. Cenário do
atendimento aos agravos provocados por acidentes e violência contra idosos na rede
SUS de Manaus (AM, Brasil). Ciênc. Saúde Coletiva [Internet] 2010 [citado 2013 ago.
6];15(6):2741-52. Disponível em:
http://www.scielo.br/pdf/csc/v15n6/a12v15n6.pdf
http://www.scielo.br/pdf/csc/v15n6/a12v1...
).
Regarding rehabilitation care to the elderly, victims of accidents and violence, a
research conducted in five Brazilian cities, based on the National Policy for
Reduction of Morbidity and Mortality from Accidents and Violence in the Elderly
Statute and National Health Politics for the Elderly, pointed out that this care
shows weaknesses in the implementation of public policies considered. Few units have
the resources to respond to the specific needs of the elderly victims of these
issues(1717 Ribeiro AP, Barter EACP. Atendimento de reabilitação à pessoa idosa
vítima de acidentes e violência em distintas regiões do Brasil. Ciênc. Saúde Coletiva
[Internet] 2010 [cited 2013 ago. 6];15(6):2729-40. Disponível em:
http://www.scielo.br/pdf/csc/v15n6/a11v15n6.pdf
http://www.scielo.br/pdf/csc/v15n6/a11v1...
).
Discussion
The selected studies on trauma caused by traffic accident in the elderly were, mostly, studies conducted in Brazil. It is believed that the importance given to this topic by CLAVES contributed to this fact, from the selected Brazilian studies, six were conducted for this study group and discuss accidents and violence with the elderly based on established policies in the country, demonstrating the concern of these researchers with the problem of violence and accidents in this age group in Brazil. As for the number of north-American publications, the Committee on Trauma, created in 1922 by the American College of Surgeons, has recognized this event as aggravation and proceeded to propose prevention and control, in search of improved care.
Regarding study design, the majority of studies were observational, mostly
cross-sectional, exclusively using information from databases of trauma, which
demonstrates the importance of adequate registry data on trauma for epidemiological
analysis of these events. However, it is emphasized that the difficulty of
cross-sectional studies is to establish causal relationships. Perhaps, for this reason,
there is a lack of studies identifying risk factors that can prevent trauma in the
elderly(88 Rodrigues J, Ciosak SI. Elderly victims of trauma: analysis of the risk
factors. Rev Esc Enferm USP [Internet]. 2012 [cited 2013 Aug 6];46(6):1400-5.
Available from: http://www.scielo.br/pdf/reeusp/v46n6/en_17.pdf
http://www.scielo.br/pdf/reeusp/v46n6/en...
).
Based on the main results and conclusions of the studies showed, there were similar issues related to trauma by traffic accident involving elderly people in different countries, including the increased incidence, the location of the most prevalent injuries, the severity of pedestrian traffic accidents with increased mortality and complications.
Regarding the increase in the incidence of injuries resulting from traffic accidents in
the elderly population, it is observed that even in a developed country such as the
United States, there was an increase in traffic accidents, especially those involving
motorcycles, showing a similar reality found in Brazil. Based on the above, the need for
investigation of causes is confirmed, so that there may be planning and implementation
of stricter measures to control and prevent these issues in different countries. It
appears, therefore, that accidents with elderly are important events because of the
greater vulnerability of this segment of the population, which can result in injuries of
varying severity(3030 Mathias TAF, Mello Jorge MHP, Andrade OG. Morbimortalidade por causas
externas na população idosa residente em município da região sul do Brasil. Rev
Latino Am Enfermagem [Internet]. 2006 [citado 2013 ago. 6];14(1):17-24. Disponível
em: http://www.scielo.br/pdf/rlae/v14n1/v14n1a03.pdf
http://www.scielo.br/pdf/rlae/v14n1/v14n...
).
Considering the most prevalent types of injury among the elderly victims in traffic, the injuries of the extremities were highlighted. Thus, it emphasizes the importance of these injuries, although they alone cannot be life threatening for the injured, on the other hand, they are responsible for most of the immobilizations and, consequently, the loss of functional independence of these people, even if this is temporary.
Other types of injuries frequently cited in publications were the traumas of the thorax and cranioencephalic, which were significant for being related to higher mortality, as well as by increasing the retention of older people in intensive care units. Through the discussions, it is noticed that the elderly, although they are not the group most victimized by traffic accidents represent the most serious, both for the physiological changes that occur during aging and by the seriousness of the injuries caused by these events. Due to all it has been mentioned, it is necessary to investigate causal factors and possible prevention measures for this population.
A study conducted in Manaus, with the elderly population who were victims of accident
and violence, found that little has been done in the field of prevention, noting that
the registry of data and notification appeared as the weakest points in the three levels
of care(1616 Santos ER, Souza ER, Ribeiro AP, Souza AMM, Lima RTS. Cenário do
atendimento aos agravos provocados por acidentes e violência contra idosos na rede
SUS de Manaus (AM, Brasil). Ciênc. Saúde Coletiva [Internet] 2010 [citado 2013 ago.
6];15(6):2741-52. Disponível em:
http://www.scielo.br/pdf/csc/v15n6/a12v15n6.pdf
http://www.scielo.br/pdf/csc/v15n6/a12v1...
).
The epidemiological data obtained demonstrated the importance of traffic accidents for the elderly, allowing us to infer the severity of such events pose to reaching a healthy old age, noting the existence of similar aspects in different countries, such as increased mortality from this cause among the elderly, especially among the oldest ones, reaching, in some countries, similar number of occurrences found among young people.
There have also been other aggravating factors, such as the elderly living with
permanent disabilities after the accident and the difficulty of preventing such
occurrences, due to the multifactorial nature of the event. The elderly, due to
accident, can suffer an impairment in their quality of life with the possibility of
worsening, as a result of other changes due to aging, since the impact of the accident
in everyday life tends to reduce integration into society. Also, because of the
vulnerability, the chances of economic costs in this phase of life are even greater, as
determined by the probability of a longer hospital stay, with greater chance of
complications(3737 Souza RKT, Soares DFPP, Mathias TAF, Andrade OG, Santana RG. Idosos
vítimas de acidentes de trânsito: aspectos epidemiológicos e impacto na sua vida
cotidiana. Acta Sci Health Sci [Internet]. 2003 [citado 2013 ago. 6];25(1):19-25.
Disponível em:
http://periodicos.uem.br/ojs/index.php/ActaSciHealthSci/article/view/2247/1467
http://periodicos.uem.br/ojs/index.php/A...
).
The vulnerability of the elderly to the traffic accident is undeniable, and in the
condition of pedestrian, the vulnerability is accentuated by the greater exposure of the
victim at the time of the collision. However, the protective measures in this direction
are timid and limited(3737 Souza RKT, Soares DFPP, Mathias TAF, Andrade OG, Santana RG. Idosos
vítimas de acidentes de trânsito: aspectos epidemiológicos e impacto na sua vida
cotidiana. Acta Sci Health Sci [Internet]. 2003 [citado 2013 ago. 6];25(1):19-25.
Disponível em:
http://periodicos.uem.br/ojs/index.php/ActaSciHealthSci/article/view/2247/1467
http://periodicos.uem.br/ojs/index.php/A...
), and yet no
country requires that the front of the vehicle are designed to minimize injury to
pedestrians(33 Peden M, Scurfield R, Sleet D, Mohan D, Hyder A, Jarawan E, et al.
Informe mundial sobre prevención de los traumatismos causados por el tránsito.
Washington: OPAS; 2004.).
The studies have also discussed issues related to the care of these patients, which presents specificities. In this sense, Brazilian studies of situational analysis for diagnostic attention to accidents and violence services, based on the established policies in the country, found that the services do not fully meet the recommended measures.
Study that addressed the inclusion of the topic violence against elderly in Brazilian
public policies on health care claim that the early years of this century have been
presented as a period of creation, coordination, integration and consolidation of plans,
safety nets and guarantees of the rights of elderly, a population that grows rapidly and
requires monitoring to ensure a long and healthy life(44 Souza ER, Minayo MCS. Inserção do tema violência contra a pessoa idosa
nas políticas públicas de atenção à saúde no Brasil. Ciênc. Saúde Coletiva [Internet]
2010 [citado 2013 set. 6];15(6):2659-2668. Disponível em:
http://www.scielo.br/pdf/csc/v15n6/a02v15n6.pdf
http://www.scielo.br/pdf/csc/v15n6/a02v1...
).
In this sense, the importance of effective participation in nursing care for the elderly is emphasized - both in primary care, by promoting healthy behaviors and safe environments to establish mechanisms that encourage the disclosure of educational information about biopsychosocial aspects of aging - as well as in pre-hospital and in-hospital care to elderly victims of accidents and violence, monitoring these events and participating in the interdisciplinary and inter-sectorial victim care with trained professionals in the fields of geriatrics and gerontology and provision of services.
It is believed that the aspects listed on this type of care showed the severity of the problem, especially considering that this population is already experiencing, on a daily basis, other losses associated with aging. Therefore, the planning and implementation of actions aimed at valuing the elderly are urgently needed, considering the population growth of this age group, as well as their importance to the economy.
Conclusion
Epidemiological data of traffic accidents involving the elderly showed an increased incidence of trauma for this reason, in most countries studied in the past ten years. These studies showed that most victims of traffic accidents are pedestrians and the elderly, mainly the oldest portion of this age group are more vulnerable.
Currently, the traffic in cities is more risky, hence elderly pedestrians become more vulnerable due to the limitations of aging, but also due to lack of attention from drivers and inadequate urban planning, among other factors. Therefore, it is urgent to invest in efforts to prevent and reduce deaths and injuries from accidents in this population, creating appropriate strategies to minimize such occurrences.
It is urgent to build urban spaces, which are friendlier for elderly, as well as investment in the culture of solidarity, thinking of a society for all. Safe mobility is a fundamental right, and to ensure that, some measures need to be discussed, such as: appropriate traffic lights, especially in the busiest Avenues or streets; protected bus stops where access in and out of collective transportation are provided; accessible and readable information, considering the limited vision of aging; closer monitoring of traffic in relation to speed limits; and the adoption of educational and punitive measures aimed at combating these accidents and to protect vulnerable street users.
In the general context, the results drew attention to the possibilities for prevention, considering that traffic accidents can be avoided with the use of simple measures, representing a challenge for nurses in health promotion through guidance and self-care programs for seniors and their families.
The publications analyzed discussed the elderly trauma care, highlighting the need for adaptation of protocols and the presence of professionals with specialized training in gerontology in trauma care services. Studies of diagnostic analysis conducted in Brazil have shown that elderly trauma care has shortcomings, not being followed the precepts recommended by the public policies established in the country. Therefore, training of human resources for this service is essential, highlighting the preparation of nurses to care for this population, as they are able to evaluate the risks to the injured elderly treated in emergency in the country and their consequent monitoring services.
Thus, there is a need to involve society in general, including commitment of managers and professionals, educational institutions and professional associations in the health field, as well as security and communication agencies so that, the elderly is seen in their specific features and weaknesses, being recognized as vulnerable to traffic accidents, especially in the condition of the pedestrian.
-
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*
Extracted from the thesis "Trauma por acidente de trânsito no idoso: fatores de risco e consequências", Nursing School of Ribeirão Preto, University of São Paulo, 2013.
Publication Dates
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Publication in this collection
Jan-Feb 2015
History
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Received
10 Jan 2014 -
Accepted
03 Nov 2014