International research consistently shows that, as people get older, they have increased vulnerability to death and injury from fire. New Zealand fire-related mortality rates for older people triple for each decade beyond the age of 75. Between 1996 and 2006, there were 212 unintentional residential fire deaths in New Zealand. Children and young people (under 17 years) comprised 32% of deaths, older people (aged 65 and over) 23%, and other adults 45%. On a proportional basis older people are over-represented in fire fatalities. A review of fatal fires in residential care facilities identified eight deaths in five incidents.
A local study (2007) and international comparisons show a similar range of factors that contribute to the fire risk affecting older people (see endnote). Some of these are associated with ageing processes, but older people share many of the same risks as the general population, especially risks arising from unsafe behaviour. However, older people may find it more difficult to escape from fire and may suffer more serious consequences (not only physical but also psychological consequences and loss of independence).
Roughly in order of importance, the contributory factors to serious house fires include:
· Electric Blankets: Faulty electric blankets, and their misuse, are the highest single cause of fatal fires for older people (20% of deaths compared with 4.5% for other adults). Electric blankets are often seen as a convenient and economic means of heating. If they are used as wrap-around warmers this damages wiring and greatly contributes to the fire risk, as does leaving blankets on too long. Some fatalities resulted from careless actions, such as not dealing with a smouldering blanket. The advice is that electric blankets should be checked annually to ensure they are safe. Many of the fire fatalities involved old blankets that had not been checked in some time, if ever.
· Smoking: Smoking is the second most important cause of fatal residential fires – responsible for 18% of deaths of older people and 19% of other adults. Smoking-related deaths involving older people have resulted from fires in clothing, furniture, or bedding. Many victims were bed-ridden or had limited mobility, which affected their ability to escape from the fire.
· Heating: Fires caused by heaters are second equal with smoking as a fire risk for older people. There are serious risks from sparks and burning embers around open fires and wood burners. Those on low incomes may use older or cheaper heaters which may not be as stable as higher quality appliances. They may also contribute to falls or tripping up. Locating small heaters close to furniture or bedding is a further risk. There have been instances of older people using stove or oven elements for heating, which is inefficient and unsafe.
· Unattended Cooking: This is the largest cause of fatal residential fires; but it ranks sixth for older people, causing 9% of deaths, compared to 28% for other adults. Overheated oil or fat is a major ignition factor. Many cooking fires are dealt with by occupants and neighbours without Fire Service involvement and these do not appear in official records. Poor memory and becoming distracted are often the causes of cooking fires. Design features of stoves can contribute to fires, such as switches without stops at the ‘off’ position to prevent inadvertent turning back to the ‘on’ position and stove switches which require the operator to reach over active elements or gas rings.
· Other Risky Behaviours: These include hoarding of newspapers, boxes and other flammable materials (which may also make it harder to escape a fire); throwing burning or hot items into the rubbish, and misuse of inflammables near naked flame. These of course are not restricted older people. Alcohol plays a significant role in fire fatalities and injuries, but less so for older people than for other adults. There is no data on the role medication plays in fire fatalities, but complex medication regimes may affect the judgement of some older people.
· Lack of Smoke Detectors and Fire Safety Equipment: In the 2007 study, nearly two thirds of properties involved in fatal fires and occupied by older people either had no detectors installed or these were disabled or had no batteries.
· Living Alone: Social isolation may be a problem for those who live alone, especially for older people with limited resources and poor safety practices, and may lead to increased risks in a number of areas, including from fire. A progressive deterioration in health or living standards may not be identified until a crisis occurs. Ongoing contact with neighbours is important; they played significant roles in some fires by coming to the occupants’ assistance and by calling emergency services.
Examples to illustrate these risk factors and the effects of a fire.
Mrs J is a widow, aged 71. While she was out shopping locally, a fire broke out in her kitchen. She returned to find a fire engine and police car at her house. It appears that a neighbour must have seen the smoke as a window blew out. At first Mrs J had no idea what could have caused the fire, but the fire officer said that a pot on the stove had exploded. Mrs remembered that she had been melting lard, preparing to roast a chicken, and thought she had turned the element off. Most of Mrs J’s household contents were replaced, but precious souvenirs from overseas were lost, as well as treasured family photos and sports trophies. Mrs. J is feeling some long-term psychological effects of the fire, although she has no significant sensory or physical impairments. She feels she has lost confidence and slowed down and she has left her voluntary work. “I feel I aged a lot – I feel really old now – mentally.”
Mrs R, aged 89, had been in the garden when she came in for tea. At first she saw nothing amiss until she opened the cupboard next to the enclosed wood fire. There was a puff of smoke and the smoke alarm went off. She didn’t try to put the fire out, but closed the cupboard door and rang 111 for the fire brigade as the smoke began to spread. No one was hurt and there was little damage except to the inside of the cupboard and to a hearth brush hanging in the cupboard. It appears that a spark from the hearth must have been picked up by the brush and had been smouldering in the cupboard. It was amazing that a stack of newspapers there, used to light the fire, had not caught alight.
There is a need for national fire safety initiatives to address the risks affecting older people, recognising that many are vulnerable and that they are a growing proportion of the population. Effective interventions will require the collective involvement of health and social agencies, voluntary organisations, the NZ Fire Service, and, most importantly, older people themselves. The goal for such programmes must be enduring behavioural change to reduce the potential risks from fires, given the central role of human agency in fire ignition and spread, and in fatal or injurious outcomes.
This study highlights a range of fire safety issues affecting older people. In some cases these issues are not distinct from issues affecting other groups in the community, while in other cases the risks for older people are more specific. The vulnerability of older people to fire is one facet of a range of health and safety factors which are challenging at the beginning and end of the life cycle. With increasing numbers of people living longer, and many living alone, the need to address and ameliorate these age-related risks becomes apparent, including recognition of wider health and safety implications.
Summary: The fire risks affecting older people are similar to other groups, but also reflect the vulnerabilities of very old people, especially those with mobility restrictions and sensory loss. Projections indicate a marked increase in the numbers of very old people, many with significant disabilities, who will continue to live in the community in conventional housing. A high proportion of these will be living alone, especially older women, and most will also be receiving home-based services provided through health agencies and voluntary organisations. Therefore there is a need for attention to reduce fire risks for older people.
In 2007 NZiRA and Heimdall Consulting Ltd undertook a study to look at the experiences and perceptions of fire risks among older people, including an analysis of fatal fires, consultation with housing agencies and ACC. The aim was to produce safety and prevention initiatives to lessen fire risks for this group, especially older people living in the community.
Dr Judith A. Davey, Age Concern New Zealand voluntary policy advisor
Senior Research Associate, Institute for Governance and Policy Studies
Victoria University of Wellington