Fire and the Older Adult - Executive Summary

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Fire is a frightening possibility for older adults (65+) and a reality for far too many. Older adults confront distinct fire risk factors every day - many of which do not affect the young. This report delineates those risk factors and presents the statistics regarding the fire problem among the elderly in the United States.

Demographics of Older Adults

In 2000, individuals 65 years and older comprised 12 percent of the America's population. By 2020, the U.S. Census Bureau projects that the proportion of older Americans will rise to 16 percent (55 million older adults) and that by 2050 there will be more than 86 million older Americans, accounting for 21 percent of the U.S. population.

More than half of older Americans are between ages 65 and 74; 88 percent are between 65 and 84. Fifty-nine percent of the elderly population are women and 83 percent are white. Seventy-three percent of elderly men are married compared with 41 percent of elderly women.

Geographically, the largest population groups of older Americans reside in California, Florida, New York, Texas, and Pennsylvania. The South and Midwest have the largest number of elderly residents as a percentage of the overall population.

Risk Factors for Older Adults

Older adults are more likely than their younger counterparts to suffer from reduced sensory abilities such as smell, touch, vision, and hearing, and from diminished mental faculties such as dementia, Alzheimer's disease, and depression. Such impairments tend to reduce older adults' reaction times and place them at a higher risk for causing fires, and thus at a higher risk of fire death and fire injury. Disabilities present additional fire risks and concerns for the elderly. Twenty percent of Medicare enrollees aged 65 and older are unable to complete at least some of the normal activities of daily living (ADL) necessary for a degree of self-sufficiency, including bathing, dressing, getting in and out of bed, getting around inside, toileting, and eating.

Economic and social concerns also contribute to the fire risk for older adults. Most live on fixed incomes and at least 10 percent live in poverty. Thus, they may be unable to afford to make necessary home improvements that could substantially reduce their risk of fire. In addition, studies have shown a relationship between income and health; lower income older adults may be at a higher risk of fire because their health is also poor.

Risk Factors for Fire in Long-Term Care Facilities

Long-term care facilities provide many opportunities and amenities for their residents and are often a safe, comfortable, and viable living alternative for older Americans. Although fire and building inspections, codes, and trained staff mitigate the fire risk in these facilities somewhat, unique fire risks do exist. These fire risks are largely due to the heightened level of resident impairment, the facility's layout, and the types of materials and equipment present.

The predominant fire risk in long-term care facilities is the impaired health of residents. At least 75 percent of nursing home patients need assistance with three or more activities of daily living. The most common medical conditions among residents are mental disorders and diseases of the nervous system and senses. Sixty-three percent of long-term care patients use wheelchairs.

In assisted living facilities, residents generally require a lesser degree of assistance. Still, 81 percent of residents need help performing at least one ADL, and 52 percent have cognitive impairments. Patient care devices, cooking equipment, electrical products, and other systems present in long-term or assisted living facilities pose fire risks as well. Compressed gases and flammable liquids used for resident care or facility maintenance increase the risk and severity of fire, and are hazardous both to residents and to the fire service during fire situations.

The architectural layout of long-term care facilities-combined with the heightened use of wheelchairs and resident mobility impairments-add to the difficulty of fire evacuation. Sprinklers are \required in long-term care facilities; they are not required in older nursing homes that have been constructed of noncombustible materials. Further, there are no federal standards requiring smoke alarms in individual nursing home rooms.

Risk Factors for Fire in Home Health and Hospice Care

Home health care and hospice care situations are other viable alternatives for older Americans with impairments and health problems. But they too pose distinct fire risks. Health is again the key risk factor in home health and hospice situations. The most common illnesses among home health care residents are circulatory system diseases, heart disease, and injuries/poisoning.

Cancer is the primary disease among residents receiving hospice care. Seventy-four percent of older adults in home care situations require assistance with activities of daily living and instrumental activities of daily living-light housework, meal preparation, getting around outside, managing money, and using the telephone.

The presence of gases, flammable liquids, and electrical devices are even riskier in home health care situations than in long-term or assisted living facilities as no enforceable regulations on storage and maintenance of such materials exist. Smoking, often banned or closely monitored in long-term care facilities, is harder to control in home health care and is a significant risk factor. As discussed above, home improvements that reduce fire risk may be postponed either because of affordability or because of lack of knowledge or attention.

Risk of Fire Fatalities

Older adults are 2.5 times more likely to die in fires than the overall population. As Americans age, their fire risk increases. There is a relationship between risk, gender, and race, as well. Older men are at a substantially higher risk of fire death than women, and African Americans are at much greater risk of dying in fires than whites.

Residential Fires and Older Adults

Data regarding residential structure fires and older adults show that, despite the differences in fire risk factors, there are many similarities between fires involving the elderly and fires involving the nonelderly. But there are also important differences, such as the time of day fatal and injurious fires occur, and the gender and racial breakdown of fire fatalities and injuries.

According to data from the National Fire Incident Reporting System (NFIRS), 34 percent of the people who died in residential structure fires and 14 percent of the people who were injured in 2002 were aged 65+. More elderly men died in residential structure fires in 2002 than did women, but more women were injured. Because females have longer life expectancies, female deaths and injuries increase as the older population ages.

Older adults are more likely to die or be injured in fires during the midmorning and early afternoon than those 18 to 64 years of age, most likely because the elderly are at home during those hours and not working. Deaths and injuries by month differ little between older adults and the 18 to 64 population, with more fatalities and injuries occurring during the winter, and the fewest in the summer and early fall.

The highest percentage of older adults were located in a bedroom at the time of fire death or injury, and the highest percentages of elderly people died or were injured while sleeping, escaping a fire, or attempting to control a fire. For injuries, more older adults were injured escaping fires than attempting to control them, while those aged 18 to 64 were more likely to be injured controlling a fire than escaping it.

The predominant causes of fires in which an older adult was killed are smoking, open flame, heating, and suspicious acts. Cooking, open flames, smoking, and heating caused more fires that resulted in injuries among the elderly than other fire causes.

Fire Education and Prevention

Many organizations address the risk of fires, deaths, and injuries to older adults through information about reducing their fire risk. In addition to the U.S. Fire Administration's public information campaign, A Fire Safety Campaign for People 50-Plus, organizations like the Florida Department of Elder Affairs, the American Health Care Association, the National Center for Assisted Living, the National Fire Protection Association, and the American Burn Association have active fire prevention and education programs for the elderly.