BRANZ annual report confirms poorer outcomes for older burns patients

New data released by the Burns Registry of Australia and New Zealand (BRANZ) reveals for the first time the impact of burns on Australia’s over 65 year-olds, and researchers are calling on a diverse cross-section of professionals to take one small step to reduce the number of burns in this group. The latest registry report confirms previous anecdotal evidence that elderly burns patients require longer hospital stays, are less likely to be discharged to their usual residence, and have a higher mortality rate than their younger counterparts.

The BRANZ is a collaboration between Monash University’s School of Public Health and Preventive Medicine and the Australian and New Zealand Burn Association. The Ninth Annual Report analysed data from all 17 specialist burns units across Australia and New Zealand between the 1st July 2017 and 30th June 2018. This is the first time the researchers have focussed on burns in the elderly, who were chosen because they were believed to be at risk of poorer outcomes. Recent trends towards extended independent living and the ageing boom make reducing burns vital to maintain length and quality of life, and reduce treatment costs.

Elderly burns patients were found to spend on average twice as long in hospital as young and middle-aged burns victims (nine days versus four and five days respectively). Only 67% of older adults were discharged to their house or usual place of residence, compared to the 87% of young adults and the 82% of middle-aged adults. Older adults were also more at risk of dying during their hospital admission (5% versus 1% of young adults and 2% of middle-aged adults).

Of note, the elderly are more at risk of scald injuries (42% of cases) compared to younger cohorts (23% of young adults and 27% of middle aged adults), with younger cohorts experiencing more flame burns. Older Australians were more likely to experience their burn in their house (81%), while for young adults only 42% happened in the home and 59% of middle aged Australians.

Monash University Adjunct Clinical Associate Professor Heather Cleland, Chair of the BRANZ Steering Committee and Director of the Victorian Adult Burns Service at The Alfred Hospital says, “We now know just how much the elderly are affected by burns. The poorer outcomes often happen because they have pre-existing medical conditions which complicate recovery, and they tend to have thinner skin, leading to deeper burns. The good news is that because we know how and where burns tend to happen in this group, we have a golden opportunity to reduce them.

Safety-proofing houses with simple devices such as hot water system tempering valves can greatly reduce the number of scald burns in the elderly. Plumbers can install these devices that mix cold and hot water together to ensure a consistent flow no greater than 50°C. Laws currently mandate these in new or renovated buildings, but many elderly people live in older houses, which are not regulated. We strongly recommend plumbers, master builders, occupational therapists, general practitioners, and all other professional groups associated with either residential building or elderly care consider the risk of burns and suggest retrofitting.”

In September 2016, 80 year old Noelene collapsed in her shower and sustained serious scald burns to 30% of her body. After an initial stint in intensive care, Noelene spent more than 80 days at the Alfred Hospital under the care of the Victorian Adult Burns Service, where she underwent more than 40 procedures including multiple surgeries.

Noelene’s husband Bob remembers, “The first week was very touch and go. I knew the injuries were bad, but I didn’t realise how bad until the staff were asking me how far we wanted to go with artificial resuscitation. It was a very shocking experience.”

Three years on, and transitioning back to life at home has not been easy. “It takes longer for her to get into bed at night than it used to”, said Bob. “She tries to take advantage of anything she can to avoid getting into the shower.” Noelene also has trouble sleeping and experiences tiredness. Being unable to wear her wedding ring also greatly upsets her.

Noelene says, “To other elderly people—just be careful in the shower. I know what it’s like, and I am very worried about other people who live by themselves or are in retirement villages. You need to be careful.”

The full report can be accessed on the BRANZ website.

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