As Christians across the world get ready to celebrate Christmas and usher in the New Year, the relaxation of health rules, and the flood of relatives expected to join their families for re-union promises that this will be a festive season with a difference. However, Health officials are concerned that exposure to infections and accidents inside and outside their homes, could also pose a risk to one of the most vulnerable segments of our society: the Elderly. They have warned caretakers to be extra vigilant of their charges this season.
 Dr Dilhar Samaraweera |
The Sunday Observer spoke to Consultant Physician, Geriatric and Palliative Unit, Colombo South Teaching Hospital and Founder President of the Sri Lanka Association of Geriatric Medicine (SLAGM) Dr Dilhar Samaraweera to find out more about the dangers that are likely to occur at this time to elders, and what measures should be adopted to protect senior family members from injuries at this time around.
Excerpts
Q. As we look forward to enjoying the upcoming festive season, health officials are concerned that elders could be especially prone to accidents and injuries in this season of merry making and family reunions. Could you tell us what you see as being the most common accidents that can happen to an elderly person at this time around?
A. In my opinion, Falls are the most frequent accidents encountered inside and outside houses during a festive period. This is because when crowds gather for various festive activities, musical shows, street food festivals, the most vulnerable to injury are elderly who are not swift and fast as the young are likely to encounter falls and sustain injuries if they are pushed or accidentally bumped into in these crowded areas. The rainy season has started.
Hence many elders can slip while walking on a wet road or even trying to cross the road hurriedly to beat the traffic lights. Another reason could be due to over medication especially polypharmacy. Doctors and patients need to be mindful about polypharmacy as older persons have multiple problems and multiple complaints which results in frequent visits to the doctor leading to additions to the already long list of medicines resulting in adverse effects causing instability.
Q. Burns are also frequently reported at this time around when fireworks, crackers, sparklers and crackers causing explosions in the skies, are used by revellers. Your comments?
A. Burns are still a common risk for elders at this time around. This is because during the festive season fireworks are used carelessly by revellers disregarding the safety of especially elderly persons in their vicinity, thus causing burn injuries as well as eye and ear injuries to them and others close to where they are lit. There needs to be more awareness raising if we are to reduce the number of burns victims among elders as in the case of children during the festive season.
Q. Shocks from faulty electrical wiring including Christmas bulbs are also common at this time. What are the symptoms of shock to look for? Who are those most at risk?
A. Electrocution can cause cardiac arrhythmias, loss of consciousness, seizures, and burns. Older persons who have visual and intellectual impairment are vulnerable to hazards occurring due to faulty electrical wiring and equipment. In the event of an accidental electrocution disconnect the electrical supply by switching off the mains and refrain from touching the person until the main switch is switched off. The injured person should be immediately resuscitated onsite if possible. Electrocution can cause cardiac arrhythmias, loss of consciousness, seizures, and burns.
If burns are present, cover with clean cloth. If the victim has breathing difficulties, suffers from confusion, loss of consciousness or from burn injuries or severe pains rush to hospital immediately.
Q. Burns from cooking on hot stoves or open fires in elderly women helping to prepare the festive meals are also on the increase according to recent data. What should one do if an elderly woman’s dress catches fire while cooking?
A. An older person with dementia is very vulnerable. Curtains and flammable material should be away from the stove, wearing of loose clothes which could come into contact with fire in stoves should be avoided. Fire alarms and vigilance of the occupants of the whereabouts and activities of older persons with cognitive impairments could prevent many such home hazards. If the dress of a person catches fire, the person should roll over the flames reducing the oxygen supply to the flames rather than running which could aggravate burns, others can douse the fire with water, and if it’s a fire from the gas stove shutting the gas outlet or cylinder are measures to be taken.
Q. Treatment - How do you treat a burn that occurs in the home?
A. Burns are treated according to the extent and depth of the burn. Minor burns which are superficial and with an extent less than 3 inches could be attended by cooling the burn area holding it under running water until the pain ceases or by applying a wet compress, if blisters are formed do not break them, apply a moisturising 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 and make sure the person is no longer in contact with the source of the burn. Do not immerse in water as it can cause hypothermia, cover with a clean cloth, and elevate the area of the burn. Look whether the person is breathing, and take the person to the hospital immediately.
Q. Falls from heights, slipping on wet floors or a banana peel or toy - how do we prevent these accidents?
A 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 that they interact with. Thus to minimise hazards and injuries to them, we need to create an elderly friendly environment. Littering the environment and cluttering of furniture can lead to falls and injuries to vulnerable older persons. Home safety should be ensured with necessary precautions. Using ladders, climbing heights by elders are physical activities which need supervision.
Q. Health impacts on elders after such accidents?
A. Older persons have reduced muscle mass strength and function, increased fragility of bones, which could result in fractures even from falls from standing height. They have degenerative disease of the spine due to ageing which result in slipped disc injuries, fractures of bones due to inappropriate lifting of weights and falls sustaining back injuries. Muscle and ligament injuries are common in older persons who have weak muscles and osteoarthritis.
Q. Choking while sharing a festive meal with the family has also been reported among many elders as well as children. How can we prevent these accidents? Your comments?
A: Older persons experience difficulty with swallowing due to weakness of muscles of mastication and decreased peristaltic contraction of the esophagus. Hence they are also less able to multitask. Talking and eating are two activities which they cannot perform at the same time and when attempted result in aspiration. Choking should be attended to immediately. And the food particle causing obstruction should be carefully removed if possible. Back blows, chest and abdominal thrusts can be attempted by one who knows these maneuvers.
Q. What about exposure to infection at this time especially from relatives visiting from countries infected with Covid-19? According to recent reports, many hospital admissions are caused due to this. Do you agree?
A. Yes. We have seen an increase in the incidence of Covid -19 SARS cov2 viral infections and viral influenza in the young and old recently in epidemic proportions. The risk of influenza in elderly will be high especially in this festive period with an increase in travel locally and internationally and with gathering of people causing a crowded environment at home and public places. The elderly are particularly at risk of pneumonia, altered level of consciousness and falls and even death when infected with viruses. Hence they should be encouraged to seek medical advice early.
Q. Elderly persons with underlying diseases like diabetes, hypertension, and cholesterol are often likely to forget to take their prescribed medication on time or over medicate themselves accidentally at this time. What are the adverse outcomes of over medication or under medication on their health?
A. Overmedication could lead to irreversible brain damage especially due to very low blood sugar. Falls and fractures could result in immobility and institutionalisation of death due to overmedication with blood pressure pills or polypharmacy (Inappropriate increased number of medicines). At the same time, under medication due to fear of adverse effects could result in strokes and heart attacks. Under medication could be by doctors as well as patients fearing adverse effects, a good example is warfarin which is given to reduce blood clotting to prevent strokes.
Q. Food poisoning and food-borne infections from eating unhygienic food from outside? How do they affect elderly persons?
A. As the festive period is also a time for eating and drinking, one should be careful about food hygiene and about the 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 elderly.
Q. Consuming wine, beer, alcohol usually spikes during a festive season especially by male members celebrating the event. What are the likely adverse impacts on their health?
A. Excess alcohol has led to altered level of consciousness, reduced blood sugar and electrolytes and fatal head injuries following falls and road traffic activities
Q. Do you have a special message on how we as a society can collectively minimise injuries in elders to allow them to lead their twilight years comfortably?
A. When celebrating Christmas next week and the New Year following week, we should make an effort to take control of ourselves, and avoid risky behaviour which in turn prevents injuries to others around us. Most importantly we should 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. My advice is that all those of us celebrating these events, should put in place the following simple measures which could prevent home injuries especially among children and elderly persons.
1) Remove obstacles in their way. 2) Ensure safety of stoves and electric switches and appliances. 3) Ensure dry floors so they won’t slip and fall. 4) Avoid driving under the influence of alcohol.
Remember that older persons have limited functional ability due to reduced mobility, senses and cognitive capacity. Hence it is the responsibility of the people around them and society as a whole to ensure safety and participation of older persons in this festive season of giving.