HomeMy Public PortalAboutFire Risk Older Adults_1 U.S. Fire Administration/National Fire Data Center
The Fire Risk to Older Adults
Topical Fire Research Series, Volume 4 - Issue 9
December 2004
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TOPICAL FIRE RESEARCH
The Fire Risk to Older A•
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December 2004 Volume 4, Issue 9
Findings
■ In 2001, the elderly (over 64 years old) represented 12% of the U.S. population
but suffered more than 30% of all fire deaths.
■ The relative risk of individuals aged 65+ dying in a fire is 2.5 times greater than
the general population. The risk worsens as age increases: the risk is 1.8 for
adults aged 65-74, but soars to 4.6 for those over age 84.
■ Smoking fires are the leading cause of fatalities among the elderly; cooking fires
are the leading cause of injuries.
■ Older American Indians and African Americans are at much greater risk of dying
in a fire than the older white population.
■ Older males are 50% more likely to die in fires than women.
■ The elderly are more vulnerable in a fire than the general population due to a
combination of factors: mental and physical frailties, higher alcohol usage,
greater use of medications, higher smoking incidence, and elevated likelihood of
living in a poverty situation.
Older Americans are burdened with the gravest fire risk in the United States and are consistently more threat-
ened with injury or death by fire than any other segment of society. While admirable strides have been made in
lowering the overall U.S. fire death rate in the last decade, fewer gains have been realized among the oldest age
groups.
Fire caused 4,007 deaths in 2001 according to the National Center for Health Statistics (NCHS) data. Older
adults were disproportionately the victims—fire fatalities among persons aged 65 years or older in 2001 was
1,250, accounting for more than 30% of all fire casualties that year.
Currently, older adults comprise 12% of the U.S. population,I and their ranks are growing. It is estimated that
the older population will rise sharply between 2010 and 2030, the years when the baby-boom generation will be
in retirement. Better health care and new developments in medicine continue to increase American life expectancy.
By their 65th birthday, on average, Americans can expect to live another 17 years.2 At this rate, older adults would
comprise 20% of the U.S. population by 2050 (Figure 1). The oldest of these mature adults—those persons 85
years and older—are members of the fastest growing population group.
At close to one-third of total fire deaths, the number of older Americans who die in fires across the nation is
clearly high. The issue becomes even more concerning when the relative risk of fire death encountered by older
Americans is compared to the rest of the adult population.
Department . . Emergency
MarylandUnited States Fire Administration* National Fire Data Center
21727
http://www.usfa.fema.gov/statistics/reports/pubs/tfrs.shtm
1
FIGURE 1. POPULATION GROWTH PROJECTIONS
450
400
c 350 /
300
300 Total U.S.Population
25
0 200
150
a
a 100
Population 65+
50
0
1900 1920 1940 1960 1980 2000 2020 2040
Source:Population estimates 1990-2000 from Appendix A,Detailed Tables,Tables 1 and 5,Demographic
Trends in the 20th Century,Census 2000 Special Reports,November 2002,Series CENSR-4,
http://www.census.gov/prod/2002pubs/censr-4.pdf,and Population estimates 2010-2050 from U.S.
Census Bureau,2004,"U.S.Interim Projections by Age,Sex,Race,and Hispanic Origin,"
http://www.census.gov.ipc/www/usinterimproj/,file natprcjtab02a.xIs.
DEFINING RISK
There are several ways to address the concept of risk with respect to fire casualties: absolute numbers of deaths
and injuries, proportions (percent) of these casualties, rates (per unit, usually fires or population), and relative risk.
Each measure is useful but in different ways and each has its drawbacks. The absolute number of casualties is an
important consideration—it is a concrete measure of the size or magnitude of the problem, but does not address
the magnitude relative to other aspects of the problem. In this case, proportions are used to compare the relative
size of the problem. Yet, these proportions do not convey the magnitude of the problem, as does the absolute num-
ber of casualties. Neither of these two measures is useful for comparisons across different groups. For comparison
across groups, a common basis is used to determine rates. These rates then account for any differences in group
sizes that might affect the size of the problem.3 In comparing fire rates, the relative risk of dying or being injured is
a helpful measure. The relative risk of a group is calculated by comparing its rate to the rate of the overall popula-
tion. The result is a measure of how likely a particular group is to be affected. A detailed discussion of per capita
rates and relative risk can be found in the Topical Series report, Fire Risk (Vol. 4, Issue 7, December 2004).
ELEVATED RISK
To be old is in itself a disadvantage in terms of fire risk. A disproportionate number of mature adults, aged 65
years and older, die in fires each year. Mature adults can expect a relative risk of dying—that is, the per capita
deaths per population of mature adults—in a fire that is 2.5 times higher than for the population as a whole. This
statistic alone is troublesome, but when some subcategories of mature adults are more closely evaluated, the situa-
tion worsens. The relative risk of dying in a fire rises substantially for the oldest segment (Figure 2). Individuals
aged 85 or older are 4.6 times more likely to die in a fire than the general population, while those adults aged
65-74 are only 1.8 times more likely to suffer fire-related deaths.
PHYSICAL AND MENTAL LIMITATIONS
With advancing age, physical and mental capabilities decline, making it more difficult for older adults to see,
smell, and hear clearly. Lessened senses increase the risk from fire; and when two or more senses are diminished,
the fire risk for an individual increases dramatically. To make matters worse, older adults are more inclined to acci-
dentally start a fire than younger adults. Often the elderly are close to the source of a fire—a cooking fire or a ciga-
rette fire—and their clothes or bedding ignites. Because the aging process affects many of the senses, elderly per-
sons typically have diminished sensation to pain and thus often do not seek timely treatment. All of these factors
combine to severely increase the risk of death from fire for the elderly.
Older persons also tend to have physical disabilities or ailments that hinder their mobility. Many are confined to
wheelchairs. Such infirmities make it difficult for the elderly to react to a fire threat the way a younger adult could,
and thus exacerbating the fire risk to this segment of the population. Alzheimer's, dementia, or other disorders that
affect mental functions (rational thought and actions) can further increase the fire risk through erratic or even dan-
gerous behavior and the inability to recognize a hazard.
2
FIGURE 2. AGE, GENDER, AND RELATIVE RISK OF FIRE FATALITY
8.0
/ Male
6.0 /
Mn
Mn
� Overall
> 4.0
Female
of
2.0
0.0
65-74 75-84 85+
Source:NCHS 2001 Mortality data;Table NA-EST2002-ASRO-03-"Annual Resident Population Estimates of
the United States by Age,Race,and Hispanic or Latino Origin:April 1,2000 to July 1,2002,"Population
Division,U.S.Census Bureau,Release Date:June 18,2003,http://www.census.gov/popesV
archives/2000s/vintage_2002/NA-EST2002-ASRO-03.html;and Population Division,U.S.Census
Bureau,detail files for Monthly Population Estimates,2000 to 2002,http://www.census.gov/popesv
archives/2000s/vi ntage_2002/files/2002RESI DENT2001MONTHS07_12.txt.
Adults 65 years of age and older receive 35% of all prescribed medications in this country.4 Some medications
cause drowsiness or affect judgment; others do not combine well with alcohol. This latter observation is important,
as alcohol use is prevalent among elderly adults. According to NCHS data, more than 23% of adults 65 years and
older report drinking alcohol 21 to 31 days per month. In comparison, only 6% of adults under age 35, 9% age 35
to 44, and 13% age 45 to 54 drink alcohol as frequently. Alcohol alone can impair mental acuity, and older adults
who combine medications and alcohol, or who abuse alcohol, face an even higher risk of starting a fire, not
responding quickly enough to extinguish one, or not escaping the premises where a fire is in progress.
Home healthcare for the elderly is accompanied by an elevated fire risk. Older adults often elect to remain at
home, rather than confront long-term stays in healthcare facilities. Three-fourths of all home healthcare patients
are over the age of 65.5 Only 4% of all Americans 65 years and over live in nursing homes and these tend to be the
very elderly.6 Census data for 2000 support this—Americans are increasingly more likely to live in assisted living
and nursing facilities as they age. For example, 18% of Americans 85 years and over live in nursing homes.7 While
no one factor is solely responsible for the increased fire risk to elderly persons receiving home healthcare, smoking
in the presence of oxygen is recognized as one important problem.
CAUSES
Fire and burns were the fifth leading cause of unintentional deaths among adults aged 65 and older in 2002.8
Of theses deaths, smoking is the most common cause of fire deaths and the second leading cause of injury. Cooking
is the most likely cause of fire injuries in older adults. Smoking, suspicious acts, and heating fires resulted in 59%
of the fire deaths of older persons (Table 1). As also shown in the table, cooking, smoking, and open flame
(including lighters, matches, and candles) fires caused 52% of the injuries.
Smoking is common among the elderly. Smokers age 65 and older face a greater risk of fire injury and fatality
than nonsmokers. Some elderly smoke in bed or while sitting in upholstered furniture and then fall asleep. Dimin-
ished sensory capabilities can result in longer response times for recognizing a danger. Diminished physical abilities
can result in problems that are not an issue for more agile persons, such as knocking over an ashtray and not
responding quickly enough to prevent a fire. Cooking is also a concern. The elderly may leave food cooking unat-
tended or their clothing may catch on fire from a cooktop's burner. They may also be incapable of extinguishing a
cooking fire due to physical limitations or a confused mental state.
WHERE OLDER ADULT FIRE DEATHS OCCUR
Data from the National Fire Incident Reporting System (NFIRS) for 2001 indicate that 83% of fire injuries and
deaths among individuals age 65 or older occur in residential structures. Of the 1,053 residential fire fatalities
reported by NFIRS in 2001, 259 of them (25%) were adults 65 years and over. Of the 5,158 residential structure
fire injuries reported that year, 578 (11%) were among adults 65 years and over.
3
TABLE 1. CAUSE OF FIRE DEATHS AND INJURIES IN ADULTS (percent)
Fire Cause 18-64 65+ 65-74 75-84 85+
DEATHS Incendiary/Suspicious 26.6 14.0 17.2 13.0 9.7
Children Playing 0.9 0.0 0.0 0.0 0.0
Smoking 24.2 33.5 35.9 31.9 32.3
Heating 4.2 11.0 7.8 10.1 19.4
Cooking 11.2 9.8 9.4 11.6 6.5
Electrical Distribution 5.4 7.3 3.1 10.1 9.7
Appliances,A/C 3.6 1.8 1.6 0.0 6.5
Open Flame,Ember,Torch 8.8 7.9 9.4 5.8 9.7
Other Heat,Flame,Spark 10.9 7.3 9.4 8.7 0.0
Other Equipment 1.8 4.3 3.1 5.8 3.2
Natural 0.9 0.0 0.0 0.0 0.0
Exposure 1.5 3.0 3.1 2.9 3.2
INJURIES
Incendiary/Suspicious 12.7 8.2 8.4 8.6 6.9
Children Playing 3.3 1.0 1.5 0.0 2.0
Smoking 9.9 16.3 18.2 14.0 16.8
Heating 6.9 8.6 9.4 8.1 7.9
Cooking 24.6 24.7 22.2 26.3 26.7
Electrical Distribution 5.4 9.6 8.9 11.3 7.9
Appliances,A/C 6.2 8.4 7.4 8.1 10.9
Open Flame,Ember,Torch 15.8 10.8 9.4 12.9 9.9
Other Heat,Flame,Spark 7.0 6.3 5.9 6.5 6.9
Other Equipment 4.5 2.4 3.9 1.6 1.0
Natural 1.4 1.4 2.0 1.1 1.0
Exposure 72.3 2.2 3.0 1.6 2.0
Source:NFIRS 2001 data
POVERTY
When poverty and infirmity accompany old age, the fire risk is compounded. Elderly persons often live on
fixed incomes. Old people who live alone live in poverty more frequently than those who live with a spouse or
other persons. Many in this category are women who have outlived their husbands. One in ten older adults lives at
or below the poverty level.9
Housing for the poor is often substandard. Typically, such housing has not been well maintained. Building
structures can be compromised, and building systems such as electrical and mechanical are often outdated, inade-
quate, or not operational. The result is a higher likelihood of damaged or fraying electrical wiring, faulty heating,
and worn out household appliances. Heating in particular represents an elevated fire danger to the elderly, who
frequently feel cold. When the central heating plant of a home does not work properly, the elderly will often rely
on temporary sources of heat, such as portable space heaters, fireplaces, or even cooking ovens. This problem is
especially severe in southern locales, which experience only intermittent demands for heating. Indeed, many resi-
dences in the South do not have central heating, and occupants are forced to rely solely on alternative heating.
Smoke alarms have saved many lives since the mid-197Os when their use was widely encouraged for the first
time. But many elderly persons live in housing without smoke alarms, or with alarms that do not work. Even in
homes with operable smoke alarms, an elderly person with impaired hearing is at an elevated risk of not respond-
ing in time.
RACE AS A RISK FACTOR
The risk of death or injury from fire is not uniform among the U.S. population, and in some ways the distribu-
tion of casualties and injuries among the elderly reflect this disparity. The disadvantages of age are compounded for
some races, and both race and gender affect an older adult's fire risk. The problem is substantially more severe for
African Americans and American Indians (Table 2).
4
TABLE 2. FIRE RISK
2001 2001 Death Rate Relative
Gender/Race Population Fire Deaths (per million) Risk
TOTAL
Total 285,317,559 4,007 14.0 1.0
Male 140,075,610 2,455 17.5 1.2
Female 145,241,949 1,552 10.7 0.8
White 230,664,347 2,908 12.6 0.9
African American 36,283,895 1,006 27.7 2.0
American Indian 2,713,047 49 18.1 1.3
Asian/Pacific 11,602,700 44 3.8 0.3
White Male 113,863,214 1,777 15.6 1.1
African American Male 17,256,399 616 35.7 2.5
American Indian Male 1,357,962 33 24.3 1.7
Asian/Pacific Male 5,609,267 29 5.2 0.4
White Female 116,801,133 1,131 9.7 0.7
African American Female 19,027,496 390 20.5 1.5
American Indian Female 1,355,085 16 11.8 0.8
Asian/Pacific Female 5,993,433 15 2.5 0.2
Source:NCHS 2001 Mortality data;Table NA-EST2002-ASRO-03-"Annual Resident Population Estimates of the United
States by Age,Race,and Hispanic or Latino Origin:April 1,2000 to July 1,2002,"Population Division,U.S.Census
Bureau,Release Date:June 18,2003,http://www.census.gov/popest/archives/2000s/vintage_2002/
NA-EST2002-ASRO-03.html;and Population Division,U.S.Census Bureau,detail files for Monthly Population Estimates,
2000 to 2002,http://www.census.gov/popest/archives/2000s/vintage_2002/files/2002RESIDENT20Cl
MONTHS07_12.txt.
Note:Relative risk may not compute due to rounding.
FIGURE 3. AGE AND RACE AND RELATIVE RISK OF FIRE FATALITY
1�
African
American
12
s
iE
9
m
`6 6
of Overall
3 White
0
65-74 75-84 85+
Source:NCHS 2001 Mortality data;Table NA-EST2002-ASRO-03-"Annual Resident Population Estimates of
the United States by Age,Race,and Hispanic or Latino Origin:April 1,2000 to July 1,2002,"Population
Division,U.S.Census Bureau,Release Date:June 18,2003,http://www.census.gov/popesV
archives/2000s/vintage_2002/NA-EST2002-ASRO-03.html;and Population Division,U.S.Census
Bureau,detail files for Monthly Population Estimates,2000 to 2002,http://www.census.gov/popest/
archives/2000s/vi ntage_2002/files/2002RESI DENT2001MONTHS07_12.txt.
American Indians have a 30% elevated risk for fire death and their older populations are even more vulnerable.
Older American Indians have 3.7 times the risk of fire death as the overall population (Table 3). But it is the African
American elderly, over age 85, who are most at risk-elderly African American males had over 21 times the risk of
the general population and over 4 times the risk of all elderly in this age group; elderly African American females
have 11 times the risk of the general population and over twice the risk of all elderly in this age group. As a group,
older African American's risk of death from fire rises at a much higher rate than the older white population (Figure
3). Although it is not likely that race itself predetermines a person's fire risk, poverty, access to adequate health
care, and subsequent poorer health are recognized risk factors.1 0 But whatever the reason, African American
elderly face a higher relative fire fatality risk than the white population, and that risk rises with age.
GENDER AS A RISK FACTOR
The risk of fire is not even across the genders as well. For the population as a whole, men are 5 0% more likely
than women to be victims of fires (Table 2). This disparity holds for older adults as well, and increases slightly as
the population ages.
5
TABLE 3. FIRE RISK FOR OLDER ADULTS (AGES 65 AND OLDER)
2001 2001 Death Rate Relative
Gender/Race Population Fire Deaths (per million) Risk
ALL OLDER ADULTS
Total 35,353,266 1,250 35.4 2.5
Male 14,619,070 638 43.6 3.1
Female 20,734,196 612 29.5 2.1
White 31,182,858 942 30.2 2.2
African American 2,915,629 283 97.1 6.9
American Indian 154,885 8 51.7 3.7
Asian/Pacific 904,344 17 18.8 1.3
White Male 12,972,922 473 36.5 2.6
African American Male 1,112,495 151 135.7 9.7
American Indian Male 66,748 5 74.9 5.3
Asian/Pacific Male 384,994 9 23.4 1.7
White Female 18,209,936 469 25.8 1.8
African American Female 1,803,134 132 73.2 5.2
American Indian Female 88,137 3 34.0 2.4
Asian/Pacific Female 519,350 8 15.4 1.1
Total 18,322,480 471 25.7 1.8
Male 8,301,935 271 32.6 2.3
Female 10,020,545 200 20.0 1.4
White 15,908,293 342 21.5 1.5
African American 1,655,175 119 71.9 5.1
American Indian 95,278 5 52.5 3.7
Asian/Pacific 549,906 5 9.1 0.6
White Male 7,283,120 190 26.1 1.9
African American Male 685,757 75 109.4 7.8
American Indian Male 43,615 3 68.8 4.9
Asian/Pacific Male 238,155 3 12.6 0.9
White Female 8,625,173 152 17.6 1.3
African American Female 969,418 44 45.4 3.2
American Indian Female 51,663 2 38.7 2.8
Asian/Pacific Female 311,751 2 6.4 0.5
Total 12,582,484 493 39.2 2.8
Male 4,996,556 243 48.6 3.5
Female 7,585,928 250 33.0 2.3
White 11,261,249 381 33.8 2.4
African American 934,936 100 107.0 7.6
American Indian 45,354 2 44.1 3.1
Asian/Pacific 279,498 10 35.8 2.5
White Male 4,498,839 188 41.8 3.0
African American Male 337,353 49 145.2 10.3
American Indian Male 18,504 1 54.0 3.8
Asian/Pacific Male 117,658 5 42.5 3.0
White Female 6,762,410 193 28.5 2.0
African American Female 597,583 51 85.3 6.1
American Indian Female 26,850 1 37.2 2.7
Asian/Pacific Female 161,840 5 30.9 2.2
(continued)
6
TABLE 3. FIRE RISK FOR OLDER ADULTS (AGES 65 AND OLDER) (cont'd)
2001 2001 Death Rate Relative
Gender/Race Population Fire Deaths (per million) Risk
Total 4,448,302 286 64.3 4.6
Male 1,320,579 124 93.9 6.7
Female 3,127,723 162 51.8 3.7
White 4,013,316 219 54.6 3.9
African American 325,518 64 196.6 14.0
American Indian 14,253 1 70.2 5.0
Asian/Pacific 74,940 2 26.7 1.9
White Male 1,190,963 95 79.8 5.7
African American Male 89,385 27 302.1 21.5
American Indian Male 4,629 1 216.0 15.4
Asian/Pacific Male 29,181 1 34.3 2.4
White Female 2,822,353 124 43.9 3.1
African American Female 236,133 37 156.7 11.2
American Indian Female 9,624 - - -
Asian/Pacific Female 45,759 1 21.9 1.6
Source:NCHS 2001 mortality data;Population Division,U.S.Census Bureau,Table NA-EST2002-ASRO-03-
National Population Estimates-Characteristics,Release Date:June 18,2003,
http://www.census.gov/popesUarchives/2000s/vintage-2002/NA-EST2002-ASRO-03.html
and Population Division,U.S.Census Bureau,detail files for Monthly Population Estimates,2000 to 2002,
http://www.census.gov/popesUarchives/2000s/vintage.2002/files/2002RESIDENT2001 MONTHS07-12.txt
Note:Relative risk may not compute due to rounding.
CONCLUSION
With an aging population, the U.S. demographic profile is changing rapidly. The elderly population is expected
to increase from its current 12% of the total population to nearly 20%within a few decades.I I The assumption is
that there will be a corresponding increase in fire deaths and injuries among older adults. Medical advances and
improved healthcare could keep elderly persons vital for a longer time, but eventual physical and mental limitations
are likely, and the increased risks of fire injury and death to this population merit special
attention.
Because older adults account for more than 30% of fire deaths and over 10% of fire injuries, the USFA has been
working toward the goal of reducing fire deaths and injuries to older adults. A number of resources to help address
the fire problem for adults are available. A Fire Safety Campaign for People 50-Plus (http://www.usfa.fema.gov/50plus)
addresses lifestyle strategies of safe smoking, safe cooking, and safe heating to reduce the incidence of fires that
traditionally affect older adults.
To request additional information or comment on this report, visit
http://www.usfa.fema.gov/applications/feedback
Notes:
1 U.S.Census Bureau population estimates for 2001.
z U.S.Department of Health and Human Services,Administration on Aging,The Growth of America's Population,Washington,DC, 1997.
3 In the case of fire casualties,this common basis is a population of 1 million,which means that fire rates are measured by inci-
dents,deaths,or injuries per million persons population.
4 B.G.Pollock,"Psychotropic Drugs and the Aging Patient,"Geriatrics,Volume 53,Supplement 1,September 1998.
5 National Center for Health Statistics,Public Health Service,Advance Data No.297, 1998.
6 Nursing home estimate is computed from data from Before the Boom:Trends in Long-Term Supportive Services for Older Americans With Disabili-
ties,AARP Public Policy Institute,2002,http://research.aarp.org/health/2002_15_trendspdf and 2000 census data.
7 "The 65 Year and Over Population: 2000,"2000 Census Brief,October 2001.
8 Centers for Disease Control,National Center for Injury Prevention and Control,WISQARS- (Web-Based Injury Statistics Query
and Reporting System)interactive database system,http://vvww.cdc.gov/ncipc/wisqars.
9 U.S.Census Bureau,Poverty in the United States:2002,Current Population Reports,Consumer Income,September 2003.
10 Socioeconomic Factors and the Incidence of Fire,United States Fire Administration,June 1997.
11 Older Adults and Fire,United States Fire Administration,Topical Report Series Vol. 1,Issue 5,Jan 2001 (rev.Dec 2001).
7