Burn injuries in the elderly burn victims need to be treated as aggressively as is done in young people, yet special considerations are necessary. Burn injuries are common in the elderly because they cannot get away from fire and have medical conditions such as arthritis and dementia, which interfere with handling hot substances like food or coffee without spilling them.

One study out of Tokyo indicated that up to 25 percent of burn victims are elderly over 65. 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 people sustain many burns and 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.

The mortality rate is 50 percent in all older people 60 years of age or older when the burn is 35 percent off, 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 80 years for all types of burns.

Disability over the long term is more significant in the elderly population. Only about half of all elderly burn victims can return home a year after the onset of the burn, compared to 90 percent of young adults who sustain a major burn.

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 heart and lungs’ demands are much greater than the baseline. They are more prone to pulmonary 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 exacerbated by the hypermetabolism of being burned. Their protein levels are low already, and skeletal muscle gets used for fuel at a surprising rate after being burned. Therefore, the geriatric population needs even more protein supplementation than young people.
• Infection. The elderly are associated with a greater chance of lethal infections such as sepsis and cases of pneumonia. Urinary infections are also common infections following a burn. Inhalation injury, being male and having a large total body surface area burned to 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 rate after being burned. Therefore, the geriatric population needs even more protein supplementation than young people.
• Infection. The elderly are associated with a greater chance of lethal infections such as sepsis and types of pneumonia. Urinary infections are also common infections following a burn. Inhalation injury, being male and having a large total body surface area burned to 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 the skin isn’t as strong as in young people’s skin. There are fewer infection-fighting macrophages and fibroblasts in older skin, leading to a greater risk of infection. Burns tend to be deeper in the elderly because of the thinning of their skin.

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

In many cases, burned skin in older people still needs to be excised and surgically covered with a graft. Grafts must be thinner in keeping with the delicate skin of the elderly. Healing of burns is a much slower process, and 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 to maintain reasonable blood sugar and help glucose be utilized by the cells. Intensive therapy with intravenous insulin has been shown to reduce morbidity and mortality, and infection complications are also lessened. Even testosterone restoration is helpful, whether the burn victim is male or female.

A medication that is an analog of testosterone is called oxandrolone—it processes 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 to maintain reasonable blood sugar and help glucose be utilized by the cells. Intensive therapy with intravenous insulin has been shown to reduce morbidity and mortality, and infection complications are also lessened. Even testosterone restoration is 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 yet increase lean muscle mass in the same way testosterone can. It has been shown to increase the speed of wound healing and is increasingly being used to manage burn 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 due to 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 80 have heart disease. Therefore the patient must be monitored more closely for evidence of cardiac compromise during surgery. Their ability to tolerate anesthesia in their lungs is an added problem.

The educational video below explains how to treat a second-degree burn.

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 more significant in the elderly, and, as mentioned, many with large wounds cannot return home after sustaining their injury.

A severe burn is a catastrophe. Anyone who has a severe burn through another’s negligence can contact our Sacramento burn injury attorneys at (916) 921-6400 or (800) 404-5400 for free, friendly advice.

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Editor’s Note: This page has been updated for accuracy and relevancy [cha 6.7.22]

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