Injuries are recognized as a significant public health concern due to their wide-ranging physical, psychological, and social consequences. The World Report on Violence and Health published by the World Health Organization (WHO) in Geneva in 2002 conceptualizes injury as bodily harm that occurs when the human body is exposed to a sudden and excessive transfer of energy beyond the threshold of physiological tolerance. This transfer may occur through various mechanisms, including mechanical forces such as impacts or falls, thermal extremes resulting in burns or frostbite, electrical currents, chemical exposures, or ionizing and non-ionizing radiation. In addition to injuries caused by the presence of excessive energy, harm may also result from the abrupt absence of essential elements necessary for normal physiological functioning, such as oxygen deprivation leading to asphyxia or inadequate heat causing hypothermia.¹

Injuries are broadly classified into two main categories: intentional and unintentional injuries, based on the presence or absence of deliberate intent to cause harm. Unintentional injuries refer to harmful events that occur without purposeful intent and typically take place within a brief time span, often within seconds or minutes. In such situations, the resulting harm is neither anticipated nor desired by the affected individual. These injuries usually arise from sudden exposure to external physical forces or environmental hazards, including mechanical impact, thermal extremes, chemical exposure, electrical energy, or radiation. In some instances, injury may also occur when essential physiological processes are disrupted by external factors, such as obstruction of breathing, leading to drowning or suffocation.

Unintentional injuries represent a major public health concern due to their high frequency and preventable nature. Common examples include road traffic crashes, falls, burns and fire-related incidents, accidental poisoning, drowning, aspiration, and other domestic or environmental hazards. The risk of such injuries is often influenced by factors such as unsafe living conditions, inadequate environmental safety measures, occupational exposures, and reduced physical or cognitive functioning, particularly among vulnerable populations like older adults. Understanding the mechanisms and environmental determinants of unintentional injuries is essential for developing effective preventive strategies and promoting safer home and community environments.²

Injuries are of a health concern all over the world, affecting both developed and developing countries, causing 15000 deaths per day.³Unintentional injuries represent a significant cause of morbidity and mortality among older adults and are considered the fifth leading cause of death in this population, following cardiovascular diseases, stroke, cancer, and chronic pulmonary disorders. Among these injuries, falls contribute to nearly two-thirds of injury-related deaths in the geriatric age group. The incidence of falls and their associated complications increases progressively with advancing age, with particularly high vulnerability observed among individuals aged over 75 years. Older adults residing in long-term care facilities experience an even greater risk, with reported fall rates ranging from 0.6 to 3.6 falls per bed per year, and an average of approximately 1.7 falls annually.⁴

Multiple intrinsic and extrinsic factors have been identified as contributors to fall risk in the elderly. Commonly reported risk factors include reduced muscle strength, gait and balance disturbances, prolonged use of medications, and cognitive impairment. Among these, falls themselves remain a leading contributor to accidental deaths and disability in older populations.⁵ Epidemiological studies have demonstrated strong associations between falls and several clinical conditions and functional limitations, including a prior history of falls (Odds Ratio [OR] = 2.8 for any fall; OR = 3.5 for recurrent falls), gait abnormalities (OR = 2.1–2.2), use of walking aids (OR = 2.2–3.1), vertigo (OR = 1.8–2.3), and Parkinson’s disease (OR = 2.7–2.8).

In response to the substantial burden of fall-related injuries, a range of preventive strategies has been recommended and implemented to reduce risk among older adults. These include nutritional interventions such as calcium and vitamin D supplementation, structured exercise programs aimed at improving strength and balance, the use of protective devices such as hip protectors, professional assessment and modification of environmental hazards within the home or care facility, careful review and reduction of psychotropic medications where appropriate, and timely management of visual impairments, including cataract surgery.⁶ Collectively, these measuresemphasize the importance of a multifaceted approach to fall prevention and injury reduction in geriatric populations.For designing effective prevention strategies, the profile of injuries and their associated factors in the older age group needs to be explored in detail.

OBJECTIVE

To study the association between the nature of injuries and environmental factors among study participants.

INCLUSION CRITERIA:

All newly registered patients aged 60 years and above presenting with injuries to the General Outpatient Department (OPD) at Urban Health Centre (UHC) Gokalpuri during the study period, who had been residing in the Gokalpuri area for a minimum duration of six months, were considered eligible for inclusion in the study.

EXCLUSION CRITERIA:

• Patients who were critically ill and required immediate hospitalization at the time of presentation.
• Patients referred or admitted to higher health-care facilities who could not be contacted at their residence despite three separate follow-up attempts.

Study area- The study was conducted in the General Outpatient Department (OPD) of the Urban Health Centre (UHC), Gokalpuri, East Delhi, a primary health care facility that serves as an urban field practice area of the Department of Community Medicine, Maulana Azad Medical College, New Delhi.

Study design- It is a Descriptive Cross-Sectional Study. The study was registered with the Clinical Trials Registry of India (Registration Number: CTRI /2021/10/037345).

Study Population- Patients aged 60 years and above attending the General Outpatient Department (OPD) were considered eligible for inclusion as geriatric participants in the study.

Study Period- Study was done for a period of one year.

Sampling Technique- The investigator attended the General Outpatient Department (OPD) twice weekly throughout the study period. During each visit, details and residential addresses of geriatric patients presenting with injuries since the previous visit were extracted from the OPD register. Eligible participants were subsequently approached at their residences for data collection. At the time of the home visit, the investigator provided a clear explanation of the study objectives and procedures. Participant Information Sheets were shared, and written informed consent was obtained from individuals who agreed to take part in the study. In cases where a participant was unavailable during the scheduled home visit, follow-up visits were conducted on subsequent scheduled days. A maximum of three contact attempts were made for each participant; individuals who could not be reached after three attempts were excluded from the study

Study instrument- Data were collected using a pretested, semi-structured interview schedule developed with reference to the World Health Organization (WHO) injury surveillance guidelines. The instrument was adapted to suit the local context and the specific objectives of the present study. The interview schedule was initially prepared in English, translated into Hindi for field use, and subsequently back-translated into English to ensure linguistic consistency and accuracy. The tool captured information on participant identification details, socio-demographic characteristics, injury profile, environmental factors, and relevant behavioural attributes. Prescription of OPD of UHC, prescription and discharge slip of referral hospital in referred cases, as relevant and available.

Ethical Approval- The study protocol was reviewed and approved by the Institutional Ethics Committee of Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi (Approval No.: F.1/IEC/MAMC/(70/05/2019)/No 429).Written informed consent was obtained from each participant prior to enrolment after providing adequate information regarding the purpose and procedures of the study.

STATISTICAL ANALYSIS

• Data was collected, compiled, processed and analysed by MS Excel and SPSS software version 25.0
• Proportion of new cases of injuries among all new patients attending the health centre was expressed in terms of percentages.
• Percentage distribution of various factors under study among the study population was expressed in terms of percentages.
• Association of various factors with mechanism and type of injury was tested using Chisquare test / Fischer test or Z test as applicable.
• All tests were two-tailed and p value< 0.05 was taken statistically significant.

The sociodemographic profile of the study participants is presented in Table 1. There was a male predominance in the study population, with males comprising 60% (n = 90) of participants. The majority of participants resided in urban areas (84%, n = 126), and 48.67% (n = 73) were domiciled outside Delhi. Most participants were married (70.67%, n = 106), while 26% were either divorced or widowed. Regarding educational status, 42% (n = 63) of participants had completed education up to the primary level, whereas 21.33% were graduates or had higher education. A large proportion of participants were unemployed (83.33%, n = 125) and belonged to joint families (78.67%, n = 118). According to the Modified BG Prasad socioeconomic classification, the majority of participants belonged to socioeconomic class I (41.33%), and no participants were classified under class V.

Table 1: Distribution of participants according to socio-demographic characteristics(N=150)

*Socio economic status- classification based on modified BG Prasad scale 2020.⁷

The assessment of housing characteristics depicted in table 2 revealed several environmental hazards among the households of study participants. Inadequate lighting was observed in 60% of households, while 40% had adequate lighting conditions. With respect to bathing facilities, slightly more than half of the households (52%) were found to have inadequate bathing areas, whereas 48% had adequate arrangements. Approximately one-third of participants (31.33%) reported the presence of slippery surfaces within their homes, while the majority (68.67%) did not report such hazards. Unstable furniture was relatively uncommon and was identified in only 5.33% of households, with 94.67% reporting no such risk. Similarly, projecting nails or sharp protrusions were present in 8% of households, whereas 92% of homes were free from this hazard. These findings highlight the presence of several modifiable environmental risk factors within domestic settings that may contribute to injury risk among the geriatric population.

Table2.Distributionofparticipantsaccordingto environmentalcharacteristics

The association between nature of injury and age is shown in Table 3. The distribution of nature of injuries among the study participants showed that sprain was the most common injury, accounting for 50.7% (n = 76) of cases, followed by bruises in 30% (n = 45). Fractures were observed in 14.7% (n = 22) of participants, while concussions were the least common, affecting 4.6% (n = 7) of individuals. The mean age of participants varied slightly across injury types, with the highest mean age observed among those with concussion (68.0 ± 8.39 years), followed by fractures (67.09 ± 6.75 years), bruises (65.87 ± 7.75 years), and sprains (65.11 ± 6.20 years). However, the association between nature of injury and mean age was not statistically significant (p = 0.5199), indicating that age distribution was comparable across different injury categories.

Figure 1: Environmentalcharacteristicsof studyparticipants

Table 3: Association between nature of injury and age (N=150)

Figure2. Natureof injuryandage

The relationship between nature of injury and selected socioeconomic variables, including education, employment status, and socioeconomic class, is summarized in Table 4. The association between selected socioeconomic factors and the nature of injury among study participants is presented in the table. With respect to educational status, bruises were more frequently reported among participants with primary education, whereas sprains were relatively more common among those with graduate-level education. However, no statistically significant association was observed between educational status and nature of injury (p = 0.190).

Regarding employment status, the distribution of injury types did not differ significantly between employed and unemployed participants. Although sprains were slightly more common among employed individuals, and bruises and fractures were more frequently observed among unemployed participants, the association was not statistically significant (p = 0.452).

Similarly, when analyzed by socioeconomic class, bruises and fractures were more commonly observed among participants belonging to socioeconomic classes I and II, while sprains were relatively more frequent in class II and IV. However, the association between socioeconomic class and nature of injury was not statistically significant (p = 0.526).

Table 4: Association between nature of injury and socio-economic factors (N=150)

The association between environmental factors and the nature of injury among study participants is depicted in Table 5. The distribution of patients across nature of injuries on the basis of lighting status was similar with no significant difference between the two groups. The proportion of patients with fracture having inadequate bathing area (86.37%) was higher compared to the other three categories (P=0.0014). The proportion of patients with fracture having slippery area (59.10%) was higher compared to the other three categories (P=0.0051). There was no significant difference between the injury groups in terms of unstable furniture-based distribution (P=0.5671). There was no significant difference between the injury groups in terms of projecting nails-based distribution (P=0.8031).

Table 5: Association between nature of injury and environmental factors (N=150)

The aim of the present study was to assess the magnitude of cases of injuries among geriatric population attending a primary health care facility in an urban area of Delhi and to study the mechanism and types of injuries sustained by the study population and also to find out the demographic, socio economic, environmental condition of the subjects which might be associated with injuries.

Socio demographic details-A total of 150 patients were included in the study. The average age was 65.76±6.86 years with a range of 32 years (60 years and above). It was seen that there was a male preponderance in the study (90, 60%). Most of the study participants belonged to urban residential areas (126, 84%). Almost half of these participants were domiciled in non-Delhi areas (73, 48.67%). While most of these participants were married (106, 70.67%), 26% were either divorced or widow. Most of the patients were educated up to the primary level only (63, 42%) with only 21.33% patients being graduate and above. Most of the patients were unemployed (125, 83.33%) and lived in a joint family (118, 78.67%).

Study conducted by Mane BA et al, in urban area of Karnataka India observed that the mean age of the patients was 69.4 ± 7.5 years with male preponderance(52%).⁸

Similar study conducted by Ravindran MR et al in tertiary health care centre in Kerala observed that most of the patients were married (45%) and around 72% of the patients were educated.⁹Association with housing conditions-In the present study, frequency of injuries was higher in housing conditions with slippery area and inadequate bathing area. Similar findings were observed in a study conducted by Hefny FA et al and the study found out that there is a positive association between the falls and the housing conditions.¹⁰ Due to compromised state of elderly population, they are more prone to fall in poor housing conditions. No association was found between nature of injury with projecting nails and unstable furniture.

The National Electronic Injury Surveillance System (NEISS) coding manual was examined to identify codes corresponding to structural housing components that are permanently affixed to residential buildings. NEISS data from 2020 were analysed for individuals aged 65 years and older to estimate injuries linked to each identified housing component.

Across both rankings, a total of 11 housing components were found to be most frequently associated with injury-related ED visits or hospitalisations. Floors emerged as the leading contributor, accounting for an estimated 929,937 ED visits. Analysis of injury narratives highlighted common mechanisms such as falls, slips, and trips. Suggested preventive measures focused on environmental modifications to enhance balance support, facilitate recovery after a fall, minimise excessive reaching, and improve lighting and visibility within the home. Narrative analysis indicates that many of these injuries, particularly those resulting from falls, may be preventable through targeted home modifications. NEISS data provide a valuable resource for identifying household injury risks and guiding prevention efforts aimed at improving home safety for the elderly population.¹¹

Home injuries represent an important public health issue among older adults. In a cross-sectional study conducted in Samsun, Turkey, 20.6% of elderly participants reported experiencing a home injury. Injuries were significantly more common among individuals living alone compared to those living with family members (p < 0.05). A higher proportion of injuries was also observed among participants residing in housing classified as unsafe according to the Home-Screen Scale (37.0%) compared to those living in safe housing (14.7%), with the difference being statistically significant (p < 0.05). These findings highlight the role of living arrangements and housing safety in the occurrence of home injuries among the elderly.¹²

Permanent supportive housing (PSH) has contributed to reductions in chronic homelessness in the United States; however, its capacity to address age-related risks such as falls remains uncertain. This study assessed the prevalence and determinants of falls among 237 PSH tenants aged 45-80 years in Los Angeles between January and August 2017. Survey data were used to evaluate demographics, health status, homelessness history, and fall events, with multivariable logistic regression identifying factors associated with falls. Over half of participants reported at least one fall in the previous year, and more than 40% experienced recurrent falls. Functional impairment, frailty, and chronic pain were independently associated with increased fall risk. Among a subsample of 66 tenants, falls most frequently occurred within the home, particularly in bathrooms, and more than one-third sustained serious injuries. These findings highlight the need for targeted fall prevention strategies within PSH settings and further investigation into individual and environmental risk factors.¹³

This population-based case-control study conducted in South Miami Beach, Florida, evaluated whether home environmental hazards increased the risk of fall-related injuries among community-dwelling adults aged 65 years and older. A total of 270 older adults treated for fall injuries were compared with 691 age- and sex-matched controls. Although environmental hazards were commonly present in nearly all homes, most were not significantly associated with an increased risk of fall-related injury after adjusting for confounding factors. An increasing number of tripping or total household hazards did not correspond to a higher fall risk. These findings suggest that broadly targeting all environmental hazards may have limited effectiveness in fall prevention, while specific interventions such as grab bar installation may require further investigation.¹⁴

This two-year prospective population-based study conducted in rural municipalities of northern Finland examined risk factors for recurrent falls among 1,016 community-dwelling adults aged 70 years and older. Recurrent falls occurred in 6% of men and 14% of women. Female sex, urinary urgency, fear of falling, dizziness, impaired postural pulse response, and a history of falls were independently associated with recurrent falling. When prior falls were excluded from the model, urinary incontinence and recent changes in housing conditions emerged as significant predictors. These findings suggest that women and elderly individuals with urinary symptoms, balance-related complaints, or recent housing changes should be prioritized for fall prevention interventions.¹⁵

Serious fall-related injuries are a common and potentially preventable cause of morbidity among older adults living in the community. In a representative cohort of 1,103 individuals aged 72 years and older followed for a median of 31 months, nearly half experienced at least one fall, and approximately one in eight sustained a serious fall-related injury. Cognitive impairment, multiple chronic conditions, balance and gait deficits, and low body mass index were independently associated with an increased risk of serious injury. Among those who fell, female sex further increased the likelihood of sustaining a serious injury. These findings highlight a distinct subgroup of older fallers at elevated risk and underscore the importance of targeted fall-injury prevention strategies.¹⁶

Limitations- The data was collected by means of history by elderly participants and hence there’s a possibility of recall bias. Also, Misreporting and over reporting might increase with age and varies greatly with the disease. As different participants had access to various health care setups and services, this might have led to biased reporting of medical conditions to the health care facility selected for enrolling subject. Current study was done in urban area so cannot be fully extrapolated for rural area

The present study, titled “A Cross-sectional study for Association of Nature of Injuries with Environmental Factors among the Geriatric Population Attending a Primary Health Care Facility of an Urban Resettlement Colony in Delhi,” was conducted at the Urban Health Centre (UHC), Gokalpuri, located in North East Delhi. The study population predominantly comprised older adults, with a greater representation of males. Most participants were residents of urban areas, and a substantial proportion were migrants from outside Delhi. The majority were married, while a smaller proportion were widowed or divorced. Educational attainment was generally low, with most participants having completed only primary education, and a smaller proportion having attained higher education. Unemployment was common among the study participants, and most lived in joint family settings. Environmental assessment revealed that inadequate lighting and bathing facilities were common in participants’ households. Slippery surfaces were frequently reported, while unstable furniture and projecting nails were also present in some homes. Fractures were more commonly observed among participants residing in households with inadequate bathing areas and slippery surfaces compared to other injury types. These findings emphasize the importance of improving household environmental conditions to reduce the risk of injuries among the geriatric population.

DATA AVAILABILITY STATEMENT- The data used to support the conclusions of this study can be obtained from the corresponding author upon reasonable request. Public sharing of the data is restricted due to ethical considerations and the presence of confidential participant information.

Funding statement – The Author(s) have received no funding for the research.

Conflict of Interest- There were no conflicts of interest.

Ethical Approval- Study was conducted after due approval from the Institutional Ethics Committee on 1/11/2019 (F.1/IEC/MAMC/(70/05/2019)/No 429).

Author Contributions- Author 1 conceptualized the study, conducted data collection, performed statistical analysis, and drafted the initial manuscript.
Author 2 and Author 3 provided overall supervision, contributed to study design, and critically reviewed the manuscript for intellectual content.

Author 4 and Author 5 assisted in data interpretation and manuscript editing.

All authors read and approved the final manuscript.

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