Burn Injuries in the Elderly

Burn injuries in the elderly burn victim need to be treated as aggressively as is done in young people; yet, special considerations are necessary.  Burn injuries are common in the elderly, in part because they lack the ability to get away from fire and have medical conditions such as arthritis and dementia which interfere with their ability to handle hot substances like food or coffee without spilling it.

One study out of Tokyo indicated that up to 25 percent of burn victims are elderly—over the age of sixty five.  Another study of more than 186,000 Europeans showed that 10-16 percent of burn victims are in this age group.  Similar numbers are found in the US statistics.   These are people who not only sustain a great number of burns; they also have the greatest mortality rate, along with the infant and toddler population.

Among the elderly, contact with some sort of flame causes fifty percent of burns, while 30 percent of burns happen from cooking accidents (20 percent from scalds and 10 percent from contact with hot surfaces).    The death rate from burns in the over 75 years of age population is 4 times the average burn victim in the US.  Ninety five percent of these burns arise in the home and most burn victims are female.

Mortality rate is 50 percent in all older people 60 years of age or older when the burn is 35 percent of the body surface area is covered by burns.  Most die of secondary infection or lung-related injuries.  Mortality is higher in women than in men and approaches 29 percent in those over the age of 80 years for all types of burns.

Disability over the long term is greater in the elderly population.  Only about half of all elderly burn victims are able to return home a year after the onset of the burn.  This is compared to 90 percent of young adults who sustain a major burn.
 
What are the risk factors for complications of a burn in the elderly?

The elderly have unique factors regarding their underlying conditions that make them at higher risk for complications.  These include the following:
 
  • Decreased heart and lung reserves.  When an elderly person sustains a burn, the demands of the heart and lungs are much greater than baseline.  They are more prone to getting pulmonary failure and heart failure after sustaining the burn.  The demands on the heart and lungs become too much for their elderly organs to manage.
  • Preexisting chronic illnesses.   Elderly people often suffer from underlying malnutrition which is exacerbated by the hypermetabolism that comes with being burned.  Their protein levels are low already and skeletal muscle gets used for fuel at a surprising rate after being burned.  The geriatric population, therefore, needs even more protein supplementation than young people.
  • Infection.  The elderly are associated with a greater chance of lethal infections such as sepsis and pneumonias.  Urinary infections are also common infections following a burn.  Inhalation injury, being male and having a large total body surface area burned all correlate with a high chance of secondary infection and death.
  • Aging skin.  Aged skin can’t handle burns as well as young skin.  There is a decrease in the degree of epidermal turnover and arate after being burned.  The geriatric population, therefore, needs even more protein supplementation than young people.
  • Infection.  The elderly are associated with a greater chance of lethal infections such as sepsis and pneumonias.  Urinary infections are also common infections following a burn.  Inhalation injury, being male and having a large total body surface area burned all correlate with a high chance of secondary infection and death.
  • Aging skin.  Aged skin can’t handle burns as well as young skin.  There is a decrease in the degree of epidermal turnover and a thinning of the dermis.  The circulation isn’t as good in older skin and it heals much more slowly.  The important collagen matrix laid out in and just beneath skin isn’t as strong as in young people’s skin.  There are fewer infection-fighting macrophages and fibroblasts in older skin and this leads to a greater risk of infection.  Burns tend to be deeper in the elderly because of the thinning of their skin.
The Treatment of the Elderly Burn Victim

Burns are treated in the elderly burn victim in much the same way as in young people with special attention made to not giving them too much or too little fluid and providing early metabolic and nutritional support.

Burned skin in older people still needs to be excised and surgically covered with a graft in many cases.  Grafts must be thinner in keeping with the thin skin of the elderly.  Healing of burns is a much slower process as a result.  There is a greater incidence of wound infections, which complicate healing.

Some elderly burn victims respond better to being given anabolic hormones.   Continuous insulin drips can be given in order to maintain a reasonable blood sugar and to help glucose to be utilized by the cells.  Intensive therapy with intravenous insulin has been shown to reduce morbidity and mortality.  Infections complications are also lessened.  Even testosterone restoration is found to be helpful, whether the burn victim is male or female.

A medication that is an analog of testosterone is called oxandrolone.  Itprocess as a result.  There is a greater incidence of wound infections, which complicate healing.
Some elderly burn victims respond better to being given anabolic hormones.

Continuous insulin drips can be given in order to maintain a reasonable blood sugar and to help glucose to be utilized by the cells.  Intensive therapy with intravenous insulin has been shown to reduce morbidity and mortality.  Infections complications are also lessened.  Even testosterone restoration is found to be helpful, whether the burn victim is male or female.

A medication that is an analog of testosterone is called oxandrolone.  It has only 5 percent of the virilizing effects of testosterone and can yetincrease lean muscle mass in the same way as testosterone can.  It has been shown to increase the speed of wound healing and is increasingly being used in the management of burned victims who are elderly.

Elderly patients need attention paid to their pain and anxiety needs.  Care must be taken not to overmedicate these patients as they can suffer respiratory depression and death.  The pain medication plan must be carefully made so that the patient doesn’t suffer from post-traumatic stress disorder as a result of prolonged pain and suffering.
Elderly patients tolerate surgery to a lesser degree than do young people. 

Anesthesiologists must be aware that about 80 percent of all people over the age of 80 have some form of heart disease andtherefore the patient must be monitored more closely for evidence of cardiac compromise during surgery.  Their ability to tolerate anesthesia with regard to their lungs is an added problem.

Burn Rehabilitation

Rehabilitation from burns is much harder in the elderly, in part because they come by their burn in an already weakened state in many cases.  Physical and occupational therapy needs are greater in the elderly and, as mentioned, many with large wounds are unable to return to home after sustaining their injury. 

A serious burn is a catastrophe. Anyone who has a serious burn thru the negligence of another should contact an experienced catastrophic injury lawyer.
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