To prevent without over-protecting children and senior citizens injured during outdoor activities

Sammanfattning: Background: Injuries are a common public health problem. Non-fatal injuries may result in pain and disabilities. Falls are a common causes of non-fatal injuries and many of these injuries occur during some physical activity. Children and senior citizens are two groups of special interest as their body constitution makes them more vulnerable to injuries than the general population. Outdoor environments influence the risk of injury as people are generally physically active when outdoor. Despite a higher risk for injury, physical activity is a common recommendation for a healthy lifestyle. Children and senior citizens should be able to safely participate in outdoor activities and gain health benefits. There is a need to highlight the complexity of balancing injury risk and the healthy benefits of outdoor activities among these two groups.Aim: The overall aim of this thesis was to investigate injuries among children and senior citizens sustained during outdoor activities and explore experiences and perceptions on risk and possibilities to increase safety in the outdoor environment.Methods: The studies were performed in northern Sweden. Theparticipants were children through the age of 12 (Studies I & II) and senior citizens aged 65 and older (Studies III & IV). In Studies I and III, a crosssectional retrospective study design was used. The data were collected from an Injury Data Base (IDB) at a hospital with a catchment area of 60 kilometres in a well-defined population. Data in Study III was complemented with a study-specific questionnaire. Injury data were analysed descriptively. Study II was a field-study that included 14 days of observations, six focus-group interviews with children, and four focus-group interviews with teachers. The three data sources were taken together and analysed using qualitative content analysis. Study IV was a focus-group interview study with 31 senior citizens divided into six focus-groups. Data in Study IV was analysed with qualitative content analysis.Results: In Study I, 795 children attended the emergency department from 2007 through 2009 and were registered in the IDB with non-minor injuries, such as fractures. The most commonly reported activities contributing to injuries were play, sport, and transport. Other factors contributing to the incident were often related to the ground surface. Contributing products were, for example, trampolines, climbing frames, bicycles, and downhill skis. In the field study (Study II), children at schoolyards were seen climbing high in trees, speeding down slides, or fighting with sticks in the woods. Different perspectives on risk and safety influenced or restricted the children’s outdoor play activities. In Study III, 300 senior citizens were registered in the IDB after injuries from pedestrian falls from January 2009 through April 2011. Women were overrepresented. Sixty percent suffered non-minor injuries. Fracture was the most common injury type. Environmental factors, especially ice, snow, and irregularities on the ground surface were the most commonly described causes to the injury incidents. As the incidents happened in public transport areas, the respondents indicated that they hold the local authorities responsible for poor sidewalk and road maintenance. However, they admitted their own responsibility in preventing similar incidents by changing their behaviour and using safety products. The senior citizens in the focus-group interview study (Study IV) described how they needed to adjust to age-related changes when outdoors, for example, by taking responsibility and using common sense. Facilitating possibilities for outdoor mobility increased with the feelings of safety within the outdoor environment and when using safety devices. To the contrary, fear of falling, shortcomings of safety devices, and dangerous elements such as ice, snow, and interactions with bicyclists constrained outdoor mobility.Conclusion: Non-minor injuries such as fractures among children and senior citizens that are sustained during outdoor activities must be a focus of injury prevention. Different perspectives on risk and safety influence children’s outdoor play at the schoolyard and senior citizens’ outdoor mobility. There is a need for balance between teachers’ common sense knowledge and the knowledge base of injury prevention. In the same manner, there is a need for balance between healthy activities and an acceptable injury risk for participating in outdoor activities. Nurses are well suited to work with this complexity and to optimize these efforts both at schools and in other public settings.