Statement on Older Adult Burn Prevention

The following statement was developed by the American College of Surgeons (ACS) Subcommittee on Trauma Subcommittee on Injury Prevention and Control to educate surgeons and other medical professionals about the significance of older adult burns and evidence-based prevention activities. The ACS Board of Regents reviewed and approved the statement at its October 2015 meeting in Chicago, IL.

The ACS recognizes the following facts:

• Changes occur to the skin of the elderly that increase their risk for burns. These changes include the following:
  • Intrinsic skin changes—those changes due solely to aging and which include loss of hair follicles and thinning and looseness of skin—increase the risk of deep burn and difficulty healing
  • Extrinsic skin changes, such as exposure to ultraviolet light and smoking, which accelerate aging effects
• Metabolic changes in the elderly that increase mortality after burns, including the following:
  • The lethal dose 50 or LD50 (total body surface area [TBSA] burn leading to 50% mortality) decreases markedly with age (LD50 value for a teenager is approximately 85% TBSA; for an 80 year old, it is approximately 10% TBSA).
  • The elderly have slower reflexes, resulting in an inability to react quickly in dangerous situations.
• Diseases associated with aging predispose the elderly to higher risk for burns, including the following:
  • Neurologic diseases:
    • Tremors, seizures, and syncope may lead to spills and flame and hot liquid exposure can result in deep burns.
    • Dementia is associated with poor choices that increase burn risk.
  • Diabetes mellitus increases burn risk and poor burn healing in three ways:
    • Higher risk for peripheral vascular disease, which leads to poor healing
    • Neuropathy, which leads to an inability to sense heat related to hot water, hot pavement, and heaters
    • Impaired resistance to infection, placing patients at increased risk for amputation
  • Pulmonary diseases:
    • Smoking while on oxygen may lead to face and inhalation burns.

Supported by the evidence, the ACS champions efforts to promote, enact, and sustain policies and legislation that encourage the following:

• Healthcare provider and public education regarding increased mortality of burns in geriatric patients compared with younger populations
• Public and healthcare provider education and prevention programs targeted to specific burns that are unique to the elderly population

Prevention programs to reduce burns in the elderly should include the following:

• Physicians educating elderly patients using material that highlights the increased risk for burns and how minor burns can lead to death
• Education about appropriate water heater temperature of 120-degrees Fahrenheit
• Caution when handling hot liquids
• Use of alternate forms of accelerant other than gasoline
• Recommendation to use electric rather than flame candles
• Promotion of safe cooking practices without the use of flame (gas)
• Public education about the risk of burn and death when smoking while on oxygen
• Education on safe cooking and bathing practices for people with seizures, syncope, and history of falls
• Reminders for people with diabetes mellitus or any cause of decreased sensation to keep in mind the following:
  • Never walk barefoot on hot days
  • Never warm their feet in hot water or with heaters
  • Report even minor burns or injuries to their physician

Bibliography

Barsun A, Sen S, Palmieri TL, Greenhalgh DG. A ten-year review of lower extremity burns in diabetics: Small burns that lead to major problems. J Burn Care Res. 2013;34(2):255-260.

Greenhalgh DG. Management of the skin and soft tissue in the geriatric surgical patient. Surgical Clinics of North America. 2015;95(1):103-114.

Ramos-e-Silva M, Boza JC, Cestari TF. Effects of age (neonates and elderly) on skin barrier function. Clinics Dermatol. 2012;30(3):274-276.

Zouboulis CC, Makrantonaki E. Clinical aspects and molecular diagnostics of skin aging. Clinics Dermatol. 2011;29(1):3-14.