As we prepare for the New Year and get caught up in the celebratory mood, many of us with elders in our families, often forget to anticipate the risks they face, especially, during the festive period. Consequently, we expose them to numerous dangers outside their homes on the roads and worse inside their homes where they expect to feel safe.
To find out what these dangers are, and how we could make environments safe for all elders, the Sunday Observer spoke to a specialist in the field, Consultant Physician Geriatrics Unit, Kalubowila Teaching Hospital, Dr Dilhar Samaraweera.
Excerpts …
Q. Most Lankan households are now in the midst of last minute preparations to usher in the New Year. However, the chances are their celebratory mood could end up with tragic outcomes both outside and inside their homes. If excessive holiday spirits drove them to late night partying and driving under the influence of liquor, senior citizens especially could be vulnerable to road accidents and even injuries from lighted fireworks thrown into their cars by youthful merry makers. Your comments?
A. We have a rapidly ageing population in the country. As a person grows old there is a progressive reduction in the intrinsic capacity. The person’s intellectual functions, mobility, and the senses decrease with ageing. The functional ability of an older person is affected by the environment they interact with. To minimize hazards and injuries we need to create an elderly friendly environment.
During festive seasons fireworks are lit carelessly which have caused burn injuries as well as eye and ear injuries. Crowds gather for various activities, shopping festivals, musical shows, etc. The elderly who are not swift as the young are likely to encounter falls and sustain injuries in this environment due to the ignorance of people who litter the environment and push through crowds aggressively causing stampedes.
We have seen an increase in the incidence of viral influenza in the young and old recently in epidemic proportions. The risk of influenza in the elderly would be high especially in this festive period with increase in travel locally and internationally and gathering of people at home and in public places. The elderly, particularly at risk of pneumonia, altered level of consciousness and falls and even death when infected with the influenza viruses, are advised to seek medical advice early.
The festive period is also a time for eating and drinking. One should be careful about food hygiene and food bought from outside due to the risk of food poisoning and food borne infections which could lead to vomiting and dehydration and imbalance of electrolytes, particularly, salt which can cause fatal outcomes in the elderly. Drinking excess alcohol has lead to altered level of consciousness, reduced blood sugar and electrolytes and fatal head injuries following falls and road traffic activities.
Q. As a Consultant Geriatric Physician tell us how road accidents which spike at this time around impact on their health?
A. Older persons have weak and porous bone, medically termed as osteoporosis and reduced muscle mass strength and function, known as sarcopenia. Elderly pedestrians are especially at risk due to their decreased senses and slow reactivity. Thus even minor road traffic accidents can cause fractures of bone irrespective of them being passengers or pedestrians. Fracture of the hip and whiplash injuries to the spine and bleeding into the brain could cause permanent disabilities. In recent years there have been many reported incidents of elderly deaths due to being run over by speeding vehicles.
Q. Many elders tend to get neglected by their own families and care givers during the festive period, resulting in serious health risks. One category includes Alzheimer patients who may wander outside their homes and get lost. Or get lost inside their own homes ending up in kitchens with open fires that could harm them. This could happen to young children, especially, toddlers. Your comments?
A. One must have the presence of mind while enjoying the festivities, especially, when an older person with dementia is at home. The noise of the fireworks and the hustle and bustle due to celebrations could cause confusion in demented elders and result in them wandering and getting lost and also subject to injuries due to falls and road traffic accidents. There have been instances where the elderly had forgotten to switch off the stove or the kettle and eruption of fires killing the occupants of the house. Curtains and flammable material should be away from the stove, wearing of loose garments which could come in contact with fire in stoves should be avoided. Fire alarms and vigilance of the occupants of the whereabouts and activities of elders with cognitive impairments could prevent many such hazards.
Q. What are the most common home injuries in elders at this time around?
A. The most common home injuries in elders are falls, which have resulted in fatal and nonfatal injuries, followed by injuries due to road traffic accidents from erratic driving and ignorance of drivers. Burns due to irregularities with gas cookers and contact with stoves are also seen during this period.
Q. Recent data from the Accident Service reveals that slips and falls among elders have spiralled especially, during festive seasons. Considering their advanced age, tell us what sort of injuries are likely to occur in such accidents?
A. Injuries due to falls are commonly fracture of the hip and wrist, others are vertebral fractures causing spinal injuries, shoulder and elbow dislocations, contusions, abrasions and head injuries. These injuries are due to decreased vision, instability, osteoporosis and decreased muscle mass and strength. Hospitalization and rapid response with hip surgery, relocation of displaced joints, assessment and monitoring, and surgery for head injuries would enable the elderly to live longer with better quality of life
Q. What about home remedies?
A. Home remedies are not recommended as the window of opportunity for correctional procedures preventing disability could be lost. Home remedies could help minor aches and sprains only.
Q. Accidental burns among both, very young and adults, from open cooking hearths, kerosene stoves, oil lamps and candles are also frequently reported during a festive period. How are these burns treated? What are their adverse health impacts?
A. Burns are treated according to the extent and depth, minor burns which are superficial and less than 3 inches in extent could be attended by cooling it by holding under running water until pain ceases or by applying a wet compress, if blisters are formed do not break them, apply a moisturizing lotion and antibiotic cream if necessary with a doctor’s advice. Cover the burn area with sterile gauze bandage. In large burns remove the person from the danger area make sure the person is no longer in contact with the source of burn, do not immerse in water as it can cause hypothermia.
Cover with a clean cloth, elevate the area of burn, look whether the person is breathing, shout for help and take the person to the hospital immediately.
Q. Accidental electrocution from festive illuminations with faulty wiring and sub quality multi plug sockets is now an emerging danger to children and adults. What is the first thing one should do if a person suffers from an electric shock at home?
A. First, switch off the mains and cut off the electric supply. Never touch the patient while the person is still in contact with the electric supply.
Q. What happens to a victim of electrocution? How soon should he be rushed to hospital?
A. Electrocution can cause cardiac arrhythmia, loss of consciousness, seizures, burns. If burns are present, cover with clean cloth. If victim has breathing difficulties, suffers from confusion, loss of consciousness or from burn injuries or severe pains rush to hospital immediately.
Q. Eating too much rich food and allergic reactions to certain foods is also common at this time . Your comments?
A. Food can cause infections, food poisoning and increased blood sugar in patients with Diabetes mellitus. Especially, cakes with many mixed ingredients and fried food items including various meats cooked in large quantities with reused oil can result in food allergies during this period.
Q. More food poisoning cases are also reported during a festive season due to housewives cooking their meals in bulk to save time, and not de-frosting the food especially, meats properly. What are the symptoms of food poisoning?
A. Symptoms of food poisoning are nausea, vomiting, diarrhoea which can be watery or bloody, abdominal cramps and fever which usually occurs within hours of consuming the contaminated food. However, symptoms may occur a few days later or a week later. They can be mistaken for indigestion or heart burn, one should seek medical advice if unable to drink due to persistent vomiting, bloody vomit or diarrhoea, fever, severe abdominal pain/cramps and reduced urine output or weakness.
Q. Any special message on how we can collectively minimise injuries in elders and allow them to lead their twilight years comfortably?
A. When celebrating the New Year, we should first take control of ourselves. Avoid risky behaviour, spare a thought for the not so quick and agile older persons who have decreased resilience and vulnerability to injuries who could easily injure themselves due to the ignorance of the merry makers. Adopt simple measures to avoid home injuries. Remove obstacles in their way, ensure safety of stoves and electric switches and appliances. Ensure dry floors so they won’t slip and fall.
Avoid driving under the influence of alcohol and don’t exceed speed as if you own the roads. Older persons have limited functional ability due to reduced mobility, senses and cognitive capacity, the young and the able should create an environment free of hazards for this vulnerable population and move a step further to bring a smile on the faces of our elders during this festive period.