Effect Measure

Falling for your household pet

We have a small dog in our house. She came to us from Mrs. R.’s elderly mother, who had decided that a dog would be a good companion. She lived alone in the city. She also had low vision, and within weeks she had already fallen over the frisky little pup who was constantly under foot. As a public health measure, we took the pooch, although we already had a dog of our own. That was seven years ago and Rosie remains a beloved member of the family. She discovered we were easily trainable, so that part went fine (for her). Now CDC has published a report verifying that the circumstances that brought Rosie into our household were far from unusual:

In 2006, persons in approximately 43 million U.S. households owned dogs, and persons in 37.5 million households owned cats; nearly 64% of households with pets had more than one pet. With the exception of one small study, falls associated with pets have not been addressed previously in the scientific literature. This report provides the first national estimates of fall injuries associated with cats and dogs and supports anecdotal evidence that pets present a fall hazard. The findings indicate that, in 2006, cats and dogs were associated with approximately 1% of the estimated 8 million fall injuries treated in EDs [Emergency Departments] and affected persons of all ages. (CDC, Morbidity and Mortality Weekly Reports)

If you think about it, it’s not obvious how you would estimate the number of falls caused by pets. CDC used a Consumer Product Safety Commission electronic injury surveillance system attached to representative hospital emergency departments (EDs) around the country. When an injured person first presents to one of these 66 EDs, information on their most severe injury is taken from the medical records, along with the patient’s age, sex, location of injury and other case specific data. This produces a large electronic database which the researchers from CDC searched for any coded as an animal-inuced injury or had “pet,” “dog,” “cat,” “puppy,” or “kitten” mentioned in the narrative write-up portion of the record. After excluding non-relevant cases (e.g., injury caused by falling on a doghouse), they had a list of dog and cat related falls that were seen in these 66 EDs between 2001 and 2006. By knowing something about how representative the ED was, they were then able to make an estimate (a well informed guess) about how many dog/cat related falls occur yearly in the US. The result was a surprising 86,000, more or less. This number isn’t exact. But it isn’t 860,000 or 8,600 or 86. It gives us a good idea of the order of magnitude, and it isn’t small.

It’s not too surprising that most injuries were from dogs (sorry, Rosie), not cats. Injury rates increased with age for both cats and dogs, especially after age 64. But with each age category, the ratio of dogs to cats decreased with age. Again, this makes sense, as the youngest are most easily pulled or knocked over by a dog while the oldest (over 85 in this sample) are more likely to lose their balance while chasing or trying to avoid stepping on a cat. Most pet related injuries were in or very near the home, most frequently falling or tripping over a dog while walking it. For cats, the most frequent circumstance was falling while chasing a cat, usually within the home.

All of this makes sense, of course. But injury programs concerned with falls (a major public health problem) rarely, if ever, discuss pet-related causes, concentrating instead on rugs, host characteristics like balance or stair design. Dog related injury is usually confined to bites. The idea that almost 100,000 people are being seen yearly in emergency rooms from falls associated with pets is interesting, at the very least. Someone where I work has suffered two separate compound fractures, each requiring surgery, from a pet related fall or hazard. It isn’t at all rare.

Meanwhile Rosie seems unconcerned about the potential hazard she represents. I guess she figures Mrs. R. and I have voluntarily assumed the risk and she can’t be blamed. I hope she has a good lawyer.

Comments

  1. #1 C. Corax
    April 1, 2009

    I got a dog for my 85 year old mother (her idea) last summer. Having a dog has done wonders for her. At the time, she was still grieving the death of my stepfather. She is walking daily now, she’s started driving the half hour to the church she used to attend with my stepfather, her memory has improved noticeably, and she no longer is thinking about moving into assisted living in the next year or two. So maybe there are trade-offs to be considered in some cases.

    Anyway, my suggested solution to tripping falls is just to make sure the very elderly have really big, really fluffy dogs. They won’t fall far, and it’ll be a nice soft landing. :)

  2. #2 Origuy
    April 1, 2009

    Probably would be good to have an animal with a high contrast to the floor coverings. A black dog on a dark rug is an accident waiting to happen.

  3. #3 Sue in NH
    April 1, 2009

    Revere, I assume you are not suggesting elderly people not have pets, but just be aware of the hazards. As Corax points out, the upside of companion animals may far outweigh the dangers. Being aware of the fact pup tends to lie right in the middle of the hallway, better to know if owner is going anywhere, may help prevent accidents. Also, choosing a dog that is not overly big and powerful, would be another sensible precaution.
    Overall, I cannot imagine becoming old without companion animals, both dogs and cats. They are good for the soul. Its a symbiotic relationship. We make each other happy, and can one think of something more valuable for either species?

  4. #4 revere
    April 1, 2009

    C. Corax, Sue in NH: No, I’m not at all suggesting that. My mother-in-law got little Rosie at our suggestion and for just that reason. Origuy is correct about contrast, too. Rosie is a mainly white little ShihTzu and the kitchen floor was also white and she couldn’t see her. Mrs. R. and I may not yet be classed as elderly but we are well on in years (I am in my late 60s) but we couldn’t imagine not having a dog.

    The post was about an unrecognized public health hazard. Mrs. R. is an injury epidemiologist and she is especially interested in dog bites. She was quite struck by the fact that with all her years of experience in the profession she had never thought about falls related to household pets, only bites and mauling. So when I saw the MMWR piece I thought it would be interesting to write about. That’s all.

  5. #5 Cathie M. Currie
    April 1, 2009

    It’s not that the elderly should not have pets as a way to prevent pet-induced falls, it that the pet should be fully-mature animals, not juveniles. If the ED data were coded for pet age, I am sure that most of the falls would be due to youthful pets.

    The ASPCA always has mature dogs and cats, but everyone wants puppies and kittens. So two problems can be solved at the same time — the older dogs and cats desperately need loving homes, and the elderly need docile, loving pets.

    After enduring six years of never-saw-it-coming falls, I am grateful that my crafty Cairn has finally stopped instigatiging chaos with a carefully placed body part slipped under or in front of my feet. The first couple of trips seemed like accidents, then truth began to dawn on my — he clearly enjoyed the result. MacTavish, an ASPCA yearling, is now a quieter seven year-old. Seven or older seems like a safe age for pets for the elderly.

  6. #6 Molly, NYC
    April 1, 2009

    Articles like this are the reason why I subscribe to the MMWR.

  7. #7 Gindy
    April 4, 2009

    That’s why we have dogs the size of small ponies in dark coat colors with beige carpeting. They are also great at making sure no burglars are about, hence no SWAT teams showing up.

  8. #8 Joshua Zelinsky
    April 5, 2009

    Ok, I’ve only skimmed the linked report but there seems to be an obvious correlation v. causation problem here especially in regard to the injuries with older people. Older people who can’t get out easily due to frailness or other problems might cope by getting pets. The obvious way to test that would be to see if people with pets in the upper age ranges are more likely to have falling injuries independent of their animals. I suspect this issue isn’t a major factor and certainly it doesn’t account for the increased injury rate in younger individuals, but I’d be very curious to see further studies on this subject.

  9. #9 revere
    April 5, 2009

    Joshua: This is the problem with observational studies, of course, although there is also a problem with experiments (of a different kind; the problem of counterfactuals). In this case we do know more than just the reported observations, in that in the cases cited we have a narrative of the event in the ED record. That doesn’t eliminate all possibilities, of course, but it suggests that there weren’t other obvious precipitating factors. Falls are ineed a major problem for older people independently of whether they have pets. For example, many of them fall because of throw rugs or other known causes of tripping/falling. But those reports are as open toyour objection as the pets reports. As Freud might say, sometimes tripping over an animal is just tripping over an animal.

  10. #10 BW
    April 6, 2009

    It’s not just the young’uns. Eleven year-old dogs and cats and 60+ humans sometimes do little “dances” in dark hallways and/or “one butt” kitchens!