Vol. 19 Issue 14
Home can be a Burn Hazard for Older Adults
Household dangers are the leading cause of burns in the elderly.
This year, the American Burn Association chose Senior Safety as the theme for Burn Awareness Week, Feb. 2-8. The ABA is fully aware of the growth of the aging population, as well as its increased risk for fire and fire-related morbidity and mortality. According to the U.S. Fire Administration, older adults comprise 25 percent of all fire deaths.
A recent study of elderly burn victims in the Journal of Burn Care and Rehabilitation found that 70 percent of the burn victims surveyed were burned in their homes ("A Survey of Risk Factors for Burns in the Elderly and Prevention Strategies," 2002). The U.S. Fire Administration's National Fire Incident Reporting System found that the leading causes of fire injury in the elderly were cooking, smoking and heating-related. The leading causes of death were the same, though in different order: smoking, heating and cooking-related.
Physical and cognitive deficits that frequently accompany the aging process increase the risk for fire injury. Motor or balance deficits, for example, can slow a person's escape from a fire. Vision and hearing deficits reduce an individual's ability to detect common signs of fire or hear smoke detectors.
Reduced tactile sensation and slow response time can diminish an older adult's ability to sense a burn when it happens. Older adults often sustain scald burns from tap water due to prolonged exposure to water that is too hot. An elderly individual with cognitive deficits may forget to turn off the stove or heating appliance, may leave food cooking and wander away, and is often less aware of safety hazards that can increase burn risk.
An ancillary factor contributing to the severity of the injury and its ability to heal is the long waiting period before many older adults with burn injuries seek treatment. A 1996 German study by Buttemeyer and Flechsig found that the elderly burn victims they studied were admitted to the hospital an average of 4.4 days post injury, with an infection rate of 50 percent.
Treating elderly burn patients isn't very different from treating young adults. Depending on the severity of the burn, the patient may require surgery for skin grafts. "In the acute phase, we address splinting, range of motion, contractures and family education," explained Allison Helm, MOT, OTR/L, an occupational therapist on the burn unit at University of California San Diego Medical Center. "Once they are able to participate in traditional OT, then we do ADL retraining such getting out of bed and dressing themselves."
Often, however, factors related to aging can complicate the rehabilitation process. Skin degradation, for example, can slow healing and limit achievable ROM. "The majority of the older patients have much thinner epidermis, almost paper thin," explained Jonathan Niszczak, MS, OTR/L, a senior burn therapist at Temple University Hospital in Philadelphia. "From our standpoint, when we try to help them regain their range of motion, we need to take into consideration what is possible. Their skin often can't take the tension of stretching to their full flexion, so we focus on getting them to the point of doing their basic activities in a safe manner."
Another major concern during treatment is whether the patient has any cognitive deficits. Cognitive issues can make treating elderly burn patients "different and more difficult," said Helm. "Elderly patients may have more issues with memory, maybe early onset of dementia, or a lesser awareness of safety which may have contributed to their burns."
Memory problems also can be an obstacle to follow-through on prescribed exercises, Helm continued. Niszczak and his colleagues make sure that patients are able to follow the program and can repeat the instructions they are given. Often, he says, a burn patient may have shown signs of cognitive decline, but the family doesn't address it until it culminates in a dropped cigarette or a burner left on.
Other co-morbidities such as congestive heart failure may limit providers' ability to administer fluid to the patient. Overall, Niszczak estimates that at his unit it takes roughly two to three weeks longer to return an elderly patient to his or her targeted functional status, if all other conditions are the same. However, he does see a high rate of success with these patients; roughly 90 percent of burn patients over 65 return to their previous settings after discharge.
Because a significant percentage of burns among the elderly population happen in the home, modifying the home environment to reduce burn risk is a major concern.
"From the first moment they walk into the unit we are doing constant patient education," added Niszczak. "[We cover topics] from skin and sun precautions whether they had a skin graft or not, but more importantly we look at what is going on in their home environment. We get the family involved as well."
Niszczak does a full safety check with each patient a few days prior to discharge. This includes working in the hospital's kitchen to talk about hazards and try out modifications. Niszczak prefers to do the safety check just prior to discharge because the emotional and physical trauma of the burn have subsided. The patient can be more receptive to suggestions and precautions, and the information will be fresh in his mind when he returns home.
Unfortunately, older adults can be reluctant to make changes in the way they do things.
"We still see a lot of injuries that could be prevented, and simple modifications could change that," Niszczak emphasized. "[Most older adults] have a routine in their own environment, and they don't want to change that. Their children will tell us they don't want us to come over and change what they are doing, they feel that is an infringement on their independence."
To continue to encourage adoption of safety measures, the information is reinforced at both Helm's and Niszczak's facilities when patients return for outpatient therapy and/or follow up visits. Suffering another burn is a much quicker and more costly route to loss of independence.
"Prevention is really the key, no matter who you are," Niszczak concluded. "Make an escape plan. Check smoke alarms. Keep a fire extinguisher in the house. If you love your family, you'll do this for them."
For more information, visit the American Burn Association website at www.ameriburn.org. The ABA's National Burn Awareness Week Campaign Kit on Senior Safety, which includes extensive tips and checklists for home prevention and modifications, is available on the site at http://www.ameriburn.org/Preven/2003%20Burn%20Awareness%20Kit.pdf
Jill Glomstad is ADVANCE senior associate/online editor. She can be reached at firstname.lastname@example.org.
Burn Prevention Tips
• Lower the thermostat on the hot water heater to 120 degrees F. It takes nearly five minutes to sustain a third-degree burn at this temperature, versus one second at 155 degrees F.
• Remove any non-decorative items from over or above the stove. Older adults often catch clothing on fire or fall into a hot burner when reaching for spices, potholders, etc. located over the stove.
• Wear snug clothes made of cotton while cooking. Loose clothes like housecoats and robes easily catch fire. Synthetic materials melt and further damage the skin, whereas cotton will burn off.
• Never leave the kitchen while cooking. Use reminders, like a kitchen timer, to remember to turn the stove/oven off.
• Check all smoke/fire alarms regularly.
• Devise a realistic fire escape plan. Purchase escape ladders for the second floor.