1-09: Prevention of Injuries & Violence

Injuries remain the most important cause of loss of potential years of life before age 65. Homicide and motor vehicle accidents are a major cause of injury-related deaths among young adults, and accidental falls are the most common cause of injury-related death in older adults. Approximately one-third of all injury deaths include a diagnosis of traumatic brain injury, which has been associated with an increased risk of suicide. Although motor vehicle accident deaths per miles driven have declined in the United States, there has been an increase in motor vehicle accidents related to distracted driving (using a cell phone, texting, eating).

Men ages 16–35 are at especially high risk for serious injury and death from accidents and violence, with Black and Latino men at greatest risk. Deaths from firearms have reached epidemic levels in the United States. Having a gun in the home increases the likelihood of homicide nearly threefold and of suicide fivefold. Educating clinicians to recognize and treat depression as well as restricting access to lethal methods have been found to reduce suicide rates.

In addition, clinicians should try to educate their patients about always wearing seat belts and safety helmets, about the risks of using cellular telephones or texting while driving and of drinking and driving—or of using other intoxicants (including marijuana) or long-acting benzodiazepines and then driving—and about the risks of having guns in the home.

Clinicians have a critical role in the detection, prevention, and management of intimate partner violence (see Chapter e6). The USPSTF recommends screening women of childbearing age for intimate partner violence and providing or referring women to intervention services when needed. Inclusion of a single question in the medical history—“At any time, has a partner ever hit you, kicked you, or otherwise physically hurt you?”—can increase identification of this common problem. Assessment for abuse and offering of referrals to community resources create the potential to interrupt and prevent recurrence of domestic violence and associated trauma. Clinicians should take an active role in following up with patients whenever possible, since intimate partner violence screening with passive referrals to services may not be adequate.

Physical and psychological abuse, exploitation, and neglect of older adults are serious, underrecognized problems; they may occur in up to 10% of elders. Risk factors for elder abuse include a culture of violence in the family; a demented, debilitated, or depressed and socially isolated victim; and a perpetrator profile of mental illness, alcohol or drug abuse, or emotional and/or financial dependence on the victim. Clues to elder mistreatment include the patient’s ill-kempt appearance, recurrent urgent-care visits, missed appointments, suspicious physical findings, and implausible explanations for injuries.