When old folks get the shaft

I admit there are some medical articles I just read the press release for. They are almost always articles in journals I don't have easy access to and don't read regularly, but when I run across a press release I find interesting enough to read and maybe post about, it often isn't so compelling I'm going to go out and read the article. It's just mildly interesting and for my purposes the details aren't as important as the main ideas. If you guessed that I'm going to do that now, you'd be right. It's about an article in The Journal of Trauma Injury, Infection, and Critical Care from researchers at Indiana University about elevator related injuries in older adults that I only know about from a press release. I didn't read it. There, I admitted it. Anyway, where was I?

Being over 65 I'm an older adult, according to the author's definition (as reported in the press release, at least), and like everyone else I frequently take elevators. Maybe not as frequently as some. My office is on the 4th floor and I almost always take the stairs, but in taller buildings I take elevators. My rule for the parking garage (top floor is 7) is that I always walk down but I take the elevator up if I'm above the 4th floor on the way back to may car at the end of the day. It's not a health or exercise issue. I'm too impatient to wait for the elevator. Type A all the way. Enough about me. Back to the elevator and my geezer age group:

Nearly 120 billion riders enter an estimated 750,000 elevators annually in the U.S. Older adults are more likely to use elevators than stairs or escalators. While elevators are one of the safest forms of transportation, they can pose a real danger for the aging population.

According to U.S. Consumer Product Safety Commission data, approximately 44,870 (about 2,640 annually) elevator-related injuries, severe enough to require a visit to a hospital emergency department, occurred in individuals 65 years and older from 1990 to 2006. Hip fracture was the most common diagnosis for the 14 percent admitted to the hospital.

Three-fourths of these injuries involved older women. More than half of the elevator-related injuries to older adults were the result of a slip, trip or fall and about one-third were the result of the elevator door closing on the individual. Injuries related to wedging a walker in the elevator door opening was the third most frequent category. The overall injury rate from 1990 to 2006 was seven times greater in the 85 and older group than in the 65-69 age group. (Eurekalert)

So what kind of injuries are we talking about? Half are soft tissue injuries like sprains or bruises, followed by fractures and lacerations. There are even finger and toe amputations. So half of the injuries are fairly bad, about 1000 a year. Considering the gigantic number of elevator rides (120 billion rides!), it's a pretty low risk, but 1000 bad injuries is still 1000 bad injuries. The authors attribute many of them to what I'd call "host factors," bad vision or balance problems. That doesn't mean there aren't relatively cheap fixes that could help the problem. They suggest two.

One is a really big, well lit "open door" button. They say since it's not electronic or mechanical, this is a cheap easy fix that would allow people inside the elevator to quickly stop a door closing on an older person trying to get in. OK. Sounds reasonable, except I've often wondered how many of those "door close" and "door open" buttons are really connected to anything (especially the "door close" ones).

The other design fix addresses the height misalignment problem, when the elevator and the floor it is stopping at are at slightly different levels. For some reason it is usually the elevator being a bit higher in my experience, creating a slight lip you can trip on if you don't have good balance, although floors lower than the entering level would be even more of a hazard for those with bad balance (I rarely see that and I wonder why). At any rate, elevator epidemiologist author Greg Steele from Indiana University School of Medicine suggests painting a bright edge on both the room floor and the elevator floor to accentuate any level differences for those with low vision.

I don't know why these kinds of medical stories fascinate me so much. Many years ago I taught the survey course in environmental health and I did it without using any guest speakers. It was a lecture class that was 3 hours long, so every week I had to make up a 3 hour lecture (OK, it was usually two and half hours, because I gave them a nice long break halfway through, although one memorable night I just kept talking for 3 straight hours). Over the course of the academic year there were 28, 3 hour lectures. First, let me say I learned a lot doing this, You never learn something as well as you do when you have to explain it to others. Second, after spending six to twelve hours each on air pollution and radiation and food safety and other big topics -- it was a survey class so I could learn all that stuff at a reasonable but not specialist level, although it took me years of doing it before I was perfectly comfortable with all of it -- there was still a lot of lecture hours left to fill in the second semester. So I used to concoct lectures on miscellaneous topics like fires or earthquake safety. One gruesome night, I did three hours on stair safety. Students who suffered through that remember it as one of the most excruciatingly boring lectures in the history of public health education, but face it, if you are going to talk about stair safety for 3 hours you need to get into a lot of details, some of which still really interest me. Like the fact that one of the most dangerous things you can do when building stairs is to change the rise slightly on one of them (it's usually the top or bottom stair and the result of not calculating the run and rise correctly). As you climb or descend stairs your legs and feet automatically "predict" the next one from the ones that came before and if that changes, even by an inch, it is a risk factor for a fall.

There I go again. You better stop me before I begin to recite the standards for railings.