For older people (aged over 65 years), the risk of dying in a residential fire is
doubled compared to the general population. Obvious causes of death mainly
include smoke inhalation and burn injuries. That older people are more fragile
and have more concurrent diseases is inherent, but what is it that makes them
more vulnerable? It is known that the number of elderly people is increasing
globally and that the increased risk of death in fires can be explained, at
least in part, by physical and/or cognitive disabilities as well as
socioeconomic and behavioural factors. The possibility that medical illnesses
and an aging organism/tissues might explain this increased risk has not been
shown to the same extent. Therefore, this narrative literature review focuses on
medical and biological explanations. An initial search using the terms
‘elderly’, ‘fatal’, ‘residential’ and ‘fire’ yielded some interesting articles.
Using a broader snowball search also accepting grey literature, several
additional risk factors could be identified. Cardiovascular diseases, in
particular atherosclerotic heart disease, greatly increases the vulnerability
to, for example, carbon monoxide and probably also other asphyxiating gases.
Cardiovascular diseases and lack of physical fitness may also increase
vulnerability to heat. Burned elderly patients are also at a higher risk of
death than younger patients, but it is controversial whether it is age itself or
the pre-existing illnesses that come with age that increase the risk.
Immunosenescence, malnutrition and female gender are other risk factors for
poorer outcome after burns, all of which are common among older people.