Impact Study of Community Safety Resource Integration on Elderly

EASTERN ACADEMIC FORUM
Impact Study of Community Safety Resource Integration on Elderly
Injury Reduction: Empirical Study From X District in Beijing
ZHANG Qiujie, MA Yingnan, ZHU Wei
Beijing Research Center of Urban Systems Engineering, P.R.China, 100035
[email protected]
Abstract: To prevent and reduce accidental injuries of the elderly people, case study of community
safety resource integration project in X Community in Beijing is conducted by in-depth interview.
Community safety resource integration models are analyzed and a comparative analysis of accidental
injury data among the elderly before and after project implementation is performed. Results show that
by adopting community safety resource integration models in accident prevention intervention for the
elderly, the accident occurrence rate in X Community demonstrates constant decrease. The total
occurrence of accidents in the elderly in 2013 has decreased by 35.5% as compared to that of 2008, of
which occurrence of falling has dropped by 45.5% and occurrence of road accident injuries has dropped
by 23.3%. It is advisable to (1) Launch detailed implementation guidelines which better identifies the
target of the project, hence enhancing practicality of resource integration at the community level; (2)
Comprehensively coordinate community safety resources from a holistic perspective; (3) Encourage
community organizations to share safety resources by adopting more diversified and attractive
incentives.
Keywords: Elderly safety, Safety resource integration, Government purchase of services, Non-profit
organization, Voluntary service
1 Introduction
Currently China is becoming an aging society at the threshold of the first aging peak period, and injuries
among the elderly people have become a severe public issue which severely jeopardizes their safety.
Annual Report on Development of the Cause of Aging (2013) stated that by 2013 the aged population in
China has reached 202 million, accounting for 14.8% of the entire population [1]. The elderly have
become high risk and vulnerable group to accidental injuries, which cause a heavy burden on themselves,
their families and the society [2]. Prevention of accidental injuries in the elderly has become a focal point
in ensuring their safety, promoting their health and enhancing their life quality.
The elderly live in communities where such institutions and organizations as hospitals, schools,
enterprises, non-profit organizations, etc. coexist, which own safety service resources including safety
education, first aid, power supply maintenance, mental care and etc. Given this background, a study on
maximizing the availability of safety resources for the elderly injury prevention with the cooperation of
these institutions and organizations is of key significance in reducing accidental injury in the elderly
while enhancing their safety level.
2 Status of the Elderly Safety and Prevention of Injuries
2.1 Status and features of the elderly safety
Injury refers to damage to human body (normally excluding fatality) caused by sudden incidents or
accidents, including physical, chemical and biological factors. Such damage may be physical, mental or
psychological. The definition of the elderly people varies in different countries and regions, as the object
of the elderly injury in the Western countries is normally the population group aged 65 and above; while
in China this term usually refers to population over 60.
Most research findings show that falling and traffic accident are the main factors jeopardizing the
elderly safety, as a result of their physical and mental features as well as their living environment. For
679
EASTERN ACADEMIC FORUM
instance, a study conducted by Lin Peixian, et al. concludes that falling, traffic accident, burning and
scalping ranks the top in the elderly injury occurrence rate, followed by psychological trauma and sharp
injury, etc [3]. While an investigation in the elderly injuries in Jiangsu Province by Xue Chengbing, et al.
shows that the top five injury are successively falling, traffic accident, animal bite, burning and scalping
and hard object injury [4], among which falling is the most common injury in the elderly. Report from
WHO indicated the same result [5].
The particularity of the elderly results in the following characteristics of their accidental injuries: (1)
Injury occurrence rate of the elderly is far higher than that of other groups, as degeneration of body
functions and weakening eyesight, hearing and response may cause accidental injury to happen at any
time [6]; (2) Injury of identical severity tend to have a stronger impact on the elderly [7]; (3) Injuries in the
elderly show certain epidemiological characteristics, which might be explained by the common
community environment and living habits that cause injuries to occur endemically among the elderly.
Study showed that unsafe environment both inside and outside doors along with medicine taking,
disease and degeneration of body functions are main cause of falling over among the elderly [8].
2.2 Prevention of injuries in the elderly
Study on the elderly injury identifies prevention of such injury and reduction of its impact as the
fundamental objective, which also constitutes a major move in enhancing community safety and
responding to public health challenges. Relevant intervention plans in the elderly injury prevention have
been adopted both in China and overseas.
From an international perspective, it is generally believed that professional elderly health education is
the key factor in preventing injuries in the elderly. The UN Expert Meeting on Injury Prevention in May,
1993 proposed that community health education and health education for the elderly shall reduce their
injury risks. Assessment of health education shows an obvious drop in injury occurrence rate in the
elderly in Jing’an District, Shanghai after receiving professional education and intervention [9].
Aged nursing services are also important intervention to reduce elderly injury occurrence. The elderly
require specific care and services based on their particular physiological, pathological and psychological
features. Improved aged nursing services and standardized nursing activities will contribute to slowing
down pathological aging, reducing the impact of side-effects of drugs and implementing diet and health
plans in a more rational manner, which shall reduce risks and remove hazards, therefore preventing or
reducing accidental injuries in the elderly.
A third significant intervention measure lies in safety environment. As injuries in the elderly mostly
occur at home or in the community, home safety facilities and improved community safe environment
prove to be highly important in the prevention of accidental injuries. Assessment and evaluation of
falling risk factors at home has been conducted by Xia Qinghua et al., proving a decrease in falling
occurrence rate from 30.1% before intervention to 15.3% after intervention [10]. Various studies in other
countries also show that improved pedestrian road safety and protective facilities shall prevent falling
and road accident injuries in the elderly.
However, research in the elderly injury prevention from a community safety resource integration
perspective has been absent from existing literature. Therefore this paper aims at filling this gap by
studying the role of community safety resource integration in preventing injuries in the elderly.
Community safety resource integration models are analyzed and a comparative analysis of accidental
injury data among the elderly before and after project implementation is performed.
3 Research Methods
Adopting an analytic case study approach with X Community in Beijing as an example, this paper tracks
and analyses the entire process of the elderly injury prevention by implementing community safety
resource integration from 2008 to 2013, collecting data of the elderly injuries before and after for
comparative study. In-depth interview and data analysis are main methods in case data collection, which
680
EASTERN ACADEMIC FORUM
is highly detailed through multiple rounds of tracking and interviews of the studied case.
4 Safety Resource Integration Models in X Community
4.1 Background of safety resource integration in X Community
With the disintegration of unit system in China, large numbers of people and communities originally
belonging to units are now separated, hence no longer entitled to various safety service resources which
used to be provided by units. On the other hand, communities are not yet ready to provide these safety
service resources, failing to satisfy residents’ needs for safety. The absence of basic safety services such
as road, gas and power supply maintenance and repair, has triggered severe risks for community
residents, especially aged ones, resulting in frequent accidental injuries, including falling, road accidents,
electric shock, gas poisoning, etc.. In 2008, the number of the elderly above 60 years old in X
Community amounts to 11,072. According to injury monitoring data of the community health services
center in 2008, the most common type of injury in the elderly in the community is falling (123 cases),
accounting for 57% of total injuries, followed by car accidents (30 cases), accounting for 14% of total
injuries. Other common types of injuries include sharp injuries, stunt injuries, burning & scalping and
animal bites. Besides, common safety hazards mentioned by the elderly in the community during
interviews include: (1) Electricity leak caused by damaged wires; (2) Gas leak caused by aging or
damage of gas pipes; (3) Falling caused by poorly maintained roads in the community; (4) Deception
and financial loss as most the elderly lack necessary safety information; (5) Psychological problem of
the elderly living alone.
Located in the core urban area of Beijing, X Community is home to over 2,000 governmental organs and
state-owned enterprises, 3 institutes of higher education, 11 primary and secondary schools, 10
kindergartens and 1 community school. With its specific geographical and resource advantages, X
Community aims to provide its elderly residents with safety services and resources through various
community safety resource integration models.
4.2 Models of Community safety resource integration
In providing injury prevention intervention, X Community fully leverages on the market mechanism and
social resources to facilitate community institutions and organizations to share their safety services and
resources, which results in diversified providers of community safety services and variety of provision
models. Common community safety resource integration models include the following:
(1) Promoting community safety resource integration through government purchase of services. In the
form of government purchase of services, X Community has signed service agreements with 31 service
providers, who shall provide residents over 60 with various safety services, such as home appliance
repair, replacement of gas pipes and valves, home electric circuit check-up and repair, etc., with all
expenses covered by the government.
(2) Promoting community safety resource integration through contracting and outsourcing. X
Community has signed a contract with a local old age home to build a daycare center for the elderly
covering an area of 335 square meters with 12 beds. This daycare center, with its multiple functions
including daycare, safety education and psychological comfort, is freely available for elderly residents
in the community. By offering lectures on safety issues and organizing discussion and talk groups, it
arouses safety awareness and provides psychological comfort for the elderly.
(3) Engaging non-profit organizations in community safety resource integration. Non-profit
organizations play a significant role alongside with the government and the market and are increasingly
becoming an important social organ supporting stable development of the society and reaching where
government and market fail. With numerous Grade III Class A (top grade) hospitals located in X
Community, the government actively engages these hospitals and leverages on their technical expertise,
inviting medical professionals to lecture on safety issues for elderly residents in the community and to
provide them with free medical check-up as well as specific treatment for those prone to falling injuries,
681
EASTERN ACADEMIC FORUM
i.e. the elderly with eye or leg problems.
(4) Promoting community safety resource integration through voluntary services by community
volunteers. Voluntary community public service is an important form of public service socialization,
reflecting the transfer of public service pattern from the government to social members as well as the
enrichment of ways to satisfy community residents’ needs for public services. Numerous community
volunteer groups in X Community provide voluntary safety services for elderly residents in the
community. Volunteers form one-to-one pairs with their aged neighbors and visit them on a regular basis,
which proves an effective comfort and encouragement. On snowy days, volunteers help their aged
neighbors to clear ice and snow from their doorstep so as to prevent falling injuries in the elderly.
(5) Facilitating community safety resource integration with voucher system. Vouchers refer to
marketable stamps or cards distributed by the government to help certain groups purchase specific items
or services. Community residents entitled to vouchers use them to purchase specific items or services in
public service providers approved by the government, and the government trades these vouchers
received by profit organizations with cash. Hence the government enables consumers to choose their
preferred safety services through vouchers. X Community offers old-age vouchers to eligible the elderly,
who, with these vouchers, enjoy various safety services provided by approved service providers,
including domestic services and rehabilitation care.
(6) Accelerating community safety resource integration by establishing an interagency institution, which
integrates fire extinguishing, public security, transportation and the elderly service agencies to
collaborate in building a safe environment for the elderly. Most of senior residents in X Community live
in hutongs (old lanes) and old residential compounds, where, due to poor infrastructure, many residents
install ground stakes, ground locks or barriers without approval, which constitute a considerable falling
risk for residents, especially aged ones. X Community has mobilized urban administration,
transportation and public security agencies to remove barriers and ground locks installed on sidewalks
for the visually-challenged, in old residential compounds, hutongs and enclosed complexes without
approval or authorization. Road hazard survey and renovation projects have been launched in old
residential compounds with larger number of aged residents, with problems such as water accumulation
in rainy season and uneven road surface promptly solved.
5 Effects and Existing Problems in Community Resource Integration
5.1 Effects of project
Injury prevention intervention for the elderly through community safety service resource integration has
met with initial success in the elderly injury prevention and community safety organization in X
Community. Firstly, occurrence rate of injuries among the elderly in X Community sees constant
decrease. According to the injury monitoring results of community health service center, the year 2013
saw 138 cases of the elderly injuries, 76 less than the 214 cases in 2008, or a 0.69% decrease in injury
occurrence rate. In 2013, there were 67 cases of falling among the elderly, 56 less than the 123 cases in
2008, or a 0.50% decrease in falling injury occurrence rate. In 2013, there were 23 cases of car accidents
involving the elderly, 7 less than the 30 cases in 2008, or a 0.06% decrease in car accident injury
occurrence rate. Other injury rate has decreased from 61 in 2008 to 48 in 2013, with a 0.12% reduction
(Table 1). Decrease in injury occurrence rate, though of various extents, is seen in the three key venues,
namely home, road and sports grounds.
Table 1 Injury rate among residents of 60 years old and above in 2008 and 2013
Year
Falling over injury rate
Traffic injury rate
Other injury rate
Total injury rate
2008
1.11%
0.27%
0.55%
1.93%
2013
0.61%
0.21%
0.43%
1.24%
682
EASTERN ACADEMIC FORUM
Secondly, a team of community safety service organizations has come into existence and is on the track
of development. Starting from zero, organizations and teams providing community safety services are
developing rapidly, as a community safety service team constituted by professionals, part-time workers
and volunteers. From an organizational perspective, a community safety service network has been
structured with the sub-district and community residents’ committee both playing a major role and
providing support and various social resources actively engaged.
5.2 Existing problems in project
Although this project has produced obvious effect for the elderly safely, however, the following
problems are seen in the process of facilitating community safety resource integration. First of all,
detailed and practical guidelines for safety resource integration have not yet been promulgated, which
has limited implementation on grass-root level. Some community administration staff have expressed
during the interviews that due to ambiguity of certain regulations, they have to rely on their own trials
and understanding. Secondly, absence of comprehensive coordination has resulted in formalization and
fragmentation of resource integration, as is seen in certain social organizations, hence compromising the
sustainability of community safety resource integration. Thirdly, due to insufficient incentives, the
number of social organizations willing to engage in safety resource integration remains very limited;
while the long-term and sustainable engagement of those already participating in such initiative is less
than ensured.
6 Conclusions
The following proposals are therefore provided to tackle the problems in facilitating community safety
resource integration:
(1) Detailed guidelines for implementation should be promulgated for better targeted and clarified
policies, hence making the resource integration initiative more practical on the community level.
(2) The government is suggested to approach from a holistic perspective and coordinate available
resources within the jurisdiction in a comprehensive manner, building a resource integration work
mechanism in the form of written documents, hence guaranteeing the legal and administrative
foundation of resource integration. Such comprehensive coordination is contributive to the sustainability
of the resource integration initiative, ensuring its efficiency, quality and responsibility while avoiding
formalization and fragmentation of resource integration. Therefore, an integrated approach of resource
integration shall be adopted.
(3) Stronger and more diversified incentives to encourage organizations into resource integration should
be adopted:
(i) Stronger financial support from local government and other organizations are strongly suggested.
Specific fund may be started in support of the resource integration initiative. As some organizations
have expressed their willingness to financially support this initiative, the possibility of using these
finances to start a resource integration fund is worth considering, with its flow and use announced in
public on a regular basis.
(ii) Diversified forms of rewards are in great need. Many social organizations engage in resource
integration with the goal of better recognition by the government. Besides reward in cash, various forms
such as posting honor board, holding award ceremony, conferring cup of honor, etc. may be taken into
consideration so that these organizations, would be able to receive more preferable policies in future.
(iii) More publicity for organizations and institutions engaged in safety resource integration is also
critical. Enterprises, in particular, desires more governmental publicity, especially in its industry so as to
build a positive image and generate brand effect for higher reputation and trust, hence sharpening its
competitiveness and eventually achieving a win-win result in safety resource integration.
683
EASTERN ACADEMIC FORUM
References
[1]. China Research Center on Aging. Annual Report on Development of the Cause of Aging
Newsletter for 2013. Beijing: Social Sciences Academy Press. 2013, 2 (in Chinese)
[2]. Weng Xueqing, Liang Wannian, Liu Ying, et al. Study on Injury and Disease Burden on the Elderly
in Urban Communities in Beijing. Chinese Journal of Disease Control & Prevention. 2005, 9:
302-305 (in Chinese)
[3]. Lin Peixian, Zhong Qianhong. Survey on Senile Injury and Life Quality in Guangzhou
Communities. Chinese Journal of Gerontology. 2010, 30: 94-95 (in Chinese)
[4]. Xue Chengbing, Liu Xiaoqiang. Epidemic Status and Risk Factors of the Elderly Injuries in
Jiangsu. Chinese Journal of Disease Control & Prevention. 2010, 10: 945-948 (in Chinese)
[5]. Kannus P, Sievanen H, Palvanen M, et al. Prevention of Falls and Consequent Injuries in Elderly
People. Lancet. 2005, 366: 1885-1893
[6]. Zhan Xianmei. Study on Features and Preventive Measures of Senior Population Injuries.
Occupation and Health. 2009, 25: 1057-1059 (in Chinese)
[7]. Li Qingyu. Study on Accidental Injuries in the Elderly and Community Intervention. The Journal
of Nursing Research. 2006, 20: 2635-2636 (in Chinese)
[8]. Chang JT, Morton SC, Rubenstein LZ, et al. Interventions for the Prevention of Falls in Older
Adults: Systematic Review and Meta-analysis of Randomized Clinical Trials. BMJ. 2004, 328:
676-682
[9]. Ma Jing, Xi Shuhua. Influence of Health Education on Live-Alone the Elderly’ Knowledge,
Attitude and Behavior of Accidental Injuries. Nursing Journal Of Chinese People’s Liberation
Army. 2010, 27: 1287-1289 (in Chinese)
[10]. Xia Qinghua, Jiang Yu. Study on Intervention Effects and Needs of the Elderly Falling Risk
Factors at Home. Chinese Journal of Health Education. 2010, 26: 607-611 (in Chinese)
684