Dying To Keep Warm

Old Age Psychiatrist (60) September 2014
Dying To Keep Warm
Dying To Keep Warm
Dr Alister Gomes-Pinto MRCPsych
Specialty Doctor in Geriatric Psychiatry
Complex Intervention and Treatment Team, The Hollies, High Street, Midsomer
Norton, Radstock, BA3 2DP
[email protected]
Introduction
I am a volunteer for the charity Dying To Keep Warm (http://www.dyingtokeepwarm.org),
and one of two psychiatrists on the team. The other is Dr Peter Metcalfe, Liverpool-based
Consultant in Old Age Psychiatry. Afroza Ahmed, the charity lead, tends to ask me to handle
publications. The idea for this piece is to raise awareness of some of the difficulties
vulnerable older adults face in deprived communities during the winter months in the UK.
Excess winter death figures (EWD) are calculated as the difference between the number of
deaths in the ‘winter months’ (December – March), compared to the rest of the year:
•
An estimated 31,100 excess winter deaths occurred in England and Wales in 2012/13 – a
29% increase compared with the previous winter
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The majority of deaths occurred among those aged 75 and over
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Dementia was among the leading causes of death
•
Respiratory diseases caused the largest number of excess winter deaths in 2010/11,
accounting for 33% of all EWDs
•
Deaths from circulatory disease still accounted for 30% of all EWDs in 2011/121
Dr Peter Metcalfe highlights the dangers older people face during the winter months:
Older people, especially over the age of 75, who live alone and are socially deprived
and ill, are at especially high risk of dying in cold weather. Certain drugs such as
sedatives and alcohol can further impair the body’s ability to regulate temperature.
Also they can increase the risk of accidental exposure to cold environments and
hypothermia. Patients with heart disease, who’ve suffered strokes or have dementia,
uraemia or diabetes, are all at particular risk.
Cold temperature, fire, gas and carbon monoxide risk factors
Many vulnerable people resort to unsafe means of heating in order to keep warm during cold
spells, not just during the winter months. Some older people have dated or dangerous gas
fires or portable heaters within their home. This can significantly increase their fire risks.
Vulnerable people with mental health conditions such as dementia often struggle with gas
appliances and some are at risk of gas leaks and explosions due to poor maintenance.
Ongoing NHS care costs following non fatal burns runs into tens of thousands of pounds
annually.
1. Office for National Statistics Bulletin, Excess Winter Mortality in England and Wales, 2012/13 (Provisional)
and 2011/12 (Final). Published 26 November 2013:http://www.ons.gov.uk/ons/dcp171778_337459.pdf
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Old Age Psychiatrist (60) September 2014
Dying To Keep Warm
Figure 1: A 90-year old lady who lived alone. Medical history: Alzheimer’s disease, blindness,
deafness and weight loss. She confused electric kettles with hob kettles and managed to set one on
fire. Most of her house was unheated. She was found wrapped up in newspaper to keep warm.
People with dementia are more likely to leave the gas on, leave pans unattended and burn
food due to memory problems. They may cook food for deceased relatives and leave food in
the oven to keep warm. In some conditions, such as Lewy Body dementia, people tend to
suffer from impaired spatial awareness and can incorrectly position hot items or pans on their
cooker; this leads to handles burning or items being dropped, increasing the risk of burns or
scalds.
One of the hallmarks of Parkinson’s disease is the presence of a tremor; lighting gas
appliances with matches can have near-fatal consequences. Visual impairment is another risk
factor in these conditions.
Figure 2: A 77-year old Parkinson’s disease sufferer who lived alone and was found sitting in a
garden chair dangerously close to a gas fire. His hands were wrapped in socks to keep warm. His gas
cooker was condemned and gas fire disconnected; he has since been provided with a new gas cooker
with flame supervision detectors, and oil filled radiators.
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Old Age Psychiatrist (60) September 2014
Dying To Keep Warm
The charity: Dying To Keep Warm - DTKW
‘Dying To Keep Warm’ (DTKW) is a registered charity founded by Afroza Ahmed, an
Occupational Therapist. DTKW is currently running a pilot project in Liverpool, Wyre and
Fylde and Blackpool with
•
Care and Repair and Healthy Homes as the main delivery agencies
•
Community Mental Health Services, Social Services and Fire and Rescue Services as
key partner and referring agencies.
During their home visits, partner agencies identify vulnerable older people at high risk from:
the cold, fires, gas leaks and carbon monoxide poisoning. They refer such vulnerable people
to the delivery agencies to seek provision of a range of heating equipment and safety services,
funded by DTKW.
Safety and heating appliances provided by the charity include Dimplex oil-filled radiators to
replace portable heaters; long-life carbon monoxide detectors; lockable microwaves for carers
to use; and ordinary microwaves for vulnerable adults to use if they are deemed safe to heat
food. All faulty cookers are replaced with microwaves and microwaveable crockery. All
goods are provided free of charge to the vulnerable adult and are issued on a needs and risk
assessment basis.
In addition, DTKW provide a unique service in funding gas safe engineers who respond
quickly to make safe any gas powered cooking or heating appliances, by fitting lockable gas
isolation switches or disconnecting gas appliances.
The aims of DTKW
DTKW endeavours to aid local communities by aiming to:
•
Keep vulnerable people warm and safe in their own home, thereby maintaining their
independence and their place within their community
•
Reduce the number of hospital admissions for cold and fire related illnesses (e.g.
strokes, heart attacks, pneumonia, bronchitis, other respiratory diseases) and
admissions for people, including with dementia, deemed at risk of harm to self and
others from accidents in their home (e.g. falls and accidents, hypothermia, burns and
smoke inhalation)
•
Lower costs to public services relating to emergency call outs, fire and rescue,
ambulance and police services
•
Reduce long-term costs and disability from chronic illness following a stroke, heart
attack, respiratory disease and surgery following severe burns and falls
•
Avoid property damage due to fire or gas leak with ensuing explosion
•
Lower costs to funding long-term 24 hour care for vulnerable people by keeping them
safer at home
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Old Age Psychiatrist (60) September 2014
Dying To Keep Warm
Figure 3: A 78-year old dementia sufferer who was deaf, mute, lived alone and was at risk around gas
appliances (burnt nightgown visible). She had no means of calling for assistance. Her smoke alarms
were found disconnected. A gas safe registered engineer funded by DTKW disconnected her gas fire
immediately. Oil filled radiators were provided as a safe alternative.
Figure 4: An 89-year old lady with dementia. She was burning food whilst cooking for deceased
relatives, believing them to be still alive. She suffered two burns in one week with dangerous use of a
portable convector heater, which left grill marks on her skin. Her gas cooker was disconnected and
her convector heater removed and replaced. She was placed into 24 hour care following these burns.
The long term aspiration is to take the project across the UK with the support of various fire
services and funding sources in order to reduce unnecessarily high excess winter death rates,
and safeguard people with dementia and the vulnerable older population.
Acknowledgements
The images were taken in clients’ homes with their and their families' consent by the charity lead,
Afroza Ahmed. Permission has been granted for the images to be used in any content involving the
charity, to raise awareness and out of gratitude for the charity’s work to date.
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