In Hot Water

A hot shower is a must for many people to either start or finish the day. For the elderly, it can be the same, but also a risky undertaking. In all age groups, tap water scalds are the second most common cause of burn injuries. Elderly loved ones, however, are at a greater risk for scalding than other populations for a variety of reasons.

The Burn Foundation says that hot water causes third-degree burns in one second at 156 degrees F, in two seconds at 149 degrees F, in five seconds at 140 degrees F, and in 15 seconds at 133 degrees F. Scalding is a second-degree burn that is deep and results in splitting of skin layers and/or blistering. 

The solution would seem to be to simply decrease the water temperature; the Occupational Safety and Health Administration’s (OSHA) manual on Legionnaire’s disease (a potentially fatal infectious disease) says differently, however. Water is to be stored at a minimum of 140 degrees F, but can be delivered at a minimum of 122 degrees F to ensure harmful bacteria are killed.

A caregiver must first recognize the level of risk their loved one has for scalding, and also know ways to prevent unnecessary burns, while maintaining a safe water temperature.

Risks

The number one risk an elderly person has for scalding is simply a decreased reaction time. Many seniors will unknowingly subject themselves to the danger of severe burns and realize it too late. There are a couple things to know about skin changes as people age. First, elderly people have thinner skin, which burns at a lower temperature than those who are younger. It also burns faster. In addition, an elderly loved one is 50 percent less likely to survive a severe burn.

The mental capacity of a loved one will also affect their ability to prevent scalding while alone. Whether Parkinson’s, dementia or another illness that affects mental reasoning, a caregiver must realize that a person may not have the ability they previously had to determine a safe water temperature. The risk is further heightened by mobility issues, increased falls and trips that may unintentionally cause a slip on a bathroom fixture.

The same precedent goes for a loved one who has just had surgery, and may think a wound is healed enough for a warmer water immersion, when it actually is not.

Caregivers are on not off the hook, either. If an inexperienced caregiver leaves a love one unattended, runs water at too high a temperature, or allows a person to change the water temp without assistance, the chances for scalding increase greatly. What may feel warm to a caregiver could be a very hot experience for a loved one.

As with many tasks involving an elderly loved one, not rushing through bathing is important. Scalding is more likely to occur when a caregiver is in a hurry, stressed or distracted.

It’s also risky to leave a loved one with a history of heart attacks and/or strokes alone. It is not uncommon for a loved one to have a medical emergency in the shower and, while losing consciousness, accidentally turn the water hotter and end up with severe, debilitating burns.

Another possible risk for scalding is the potential for hot water “spikes” that occur when someone nearby flushes a toilet, starts the washing machine or runs water from a different tap.

With all these risks, it’s hard to manage all the possibilities.  A caregiver can take a look at their loved one’s health and lifestyle, and then determine which is the best action for them.

Next steps

• If a loved one is scalded, the first thing to do is reduce the skin temperature and pain level, and prevent wound infection. Here are some tips on steps for a caregiver to take:
• Keep calm.
• Immerse or rinse the wound with cold water for at least 10 minutes to reduce temperature and pain.
• Do not apply ice pack directly to the wound to avoid further tissue damage.
• Remove objects such as watches, wristbands, rings, tight clothing, belts, boots or shoes as the wound may become swollen.
• Do not remove clothes stuck to the wound because they may tear the skin and increase the risk of infection.
• Do not pierce the blisters to prevent wound infection.
• Do not apply herbal oil, toothpaste, lotion, soap or cooking oil to the wound to avoid irritation and further tissue damage.
• Cover the wound with sterile lint-free dressing or clear cling film for protection.
• Do not put adhesive materials such as a cotton wool swab or adhesive bandage directly on the wound.
• Aspirin or acetaminophen may help reduce the pain.

A burn that is painful for longer than 48 hours needs to be seen by a physician. If a severe burn is unmanageable by a caregiver, it also needs prompt attention and may necessitate hospitalization. The Mayo Clinic says that large portions of hands, feet, face, groin or buttocks require immediate care.

Prevention

The number one preventative measure for scalding is testing the water temperature. If it’s too hot, the Burn Foundation recommends setting the water heater thermostat at low, about 120 degrees F, for safety. Few people bathe above 110 degrees F anyhow. A tap water temperature of 120 to 125 degrees F is hot enough for washing clothes and dishes.

To check the tap water temperature, let it run hot for three to five minutes and use a candy, meat or water thermometer. When getting into the tub, move a hand rapidly and carefully through the water flow.  It’s recommended to run the cold water first, and then add hot; for a bath, 100 degrees is sufficient.

Elderly or handicapped people are prone to falling. They should never be left alone in the tub, even momentarily. Non-slip mats on the bathroom floor and in the tub and shower can prevent unnecessary falls.  Mobility problems may prevent getting out quickly, increasing the risk for serious burns even more. If left alone, a loved one may not have an opportunity to escape the source of the scalding.

Not only does reaction time decrease as people age, sensory perception decreases as well. An older person may be bathing in too hot water and not realize it.

If the water that comes out of the tap is too hot, valves can be installed in the plumbing lines to reduce the temperature of the water delivered by mixing in cooler water. Another option is to install anti-scald devices at individual taps and shower heads, which slow the water drastically if it becomes overly hot.

A caregiver can also place a padded safety cover over the tub spout to protect against the sharp edges and hot surface. A washcloth wrapped around the faucet will work well, too.  The American Hospital Association reports that more than 112,000 people are admitted to emergency rooms each year for scald-related injuries. In many cases, these injuries are preventable. A caregiver can take some precautionary measures ahead of time to help keep a loved one safe, yet still able to enjoy the comfort of a hot bath or shower.