Carbon Monoxide Risks for Seniors

Seniors are at Increased Carbon Monoxide Risk

Senior citizens face increased carbon monoxide risk, both because of the character and the age of there homes and increased vulnerability because of aging.

By Rebecca Martin

We have discussed in depth the impact and considerations regarding carbon monoxide safety on one of the most vulnerable factions of our population, children. However, the other most vulnerable citizens in our population are at the other end of the spectrum, seniors.  Seniors, whether living independently or in the many forms of assisted living, are at high risk for devastating consequences from carbon monoxide exposure.

Our society defines a senior citizen as any older adult and especially those over the age of 65. Typically, the term, senior citizen, implies an adult who is retired and subsisting on retirement. However, our older population is working longer and even facing the prospect of higher retirement age. “Roughly one-in-five Americans ages 65 and older (19%) were employed in 2023 – nearly double the share of those who were working 35 years ago.” https://www.pewresearch.org/social-trends/2023/12/14/older-workers-are-growing-in-number-and-earning-higher-wages/#:~:text=Roughly%20one%2Din%2Dfive%20Americans,has%20grown%20in%20recent%20decades.

Even seniors who live in retirement communities or retirement homes are at increased carbon monoxide risk because of increased cardiac and neurological vulnerability.

For our purposes here, we define a senior citizen as one who needs assistance, whether due to health or circumstance.

The number of seniors living in public housing has increased with 2.9 million living in publicly supported housing in 2019, “a 2.9% increase since 2018.” https://nlihc.org/resource/growing-number-assisted-and-unassisted-seniors#:~:text=The%20Public%20and%20Affordable%20Housing,a%202.9%25%20increase%20since%202018. The figures, released by The Public and Affordable Housing Research Corporation (PAHRC), take into account that HUD classifies seniors as anyone over the age of 62.

The problems with many types of public housing are well documented. According to the Urban Institute, “much of the nation’s public housing stock is in poor condition, creating health hazards that put older adults at serious risk. Broken boilers, mold and mildew, rodent infestations, and fires—to name a few—have damaging effects on residents of all ages, including vulnerable seniors.” https://www.urban.org/urban-wire/our-aging-public-housing-puts-older-americans-risk

Because Medicaid does not provide for long term care, many older Americans are remaining in units that they have lived in for many years. Most of these units were not designed for aging in place. And often seniors remain behind in units that were not designed to be economically managed by a single person and so improvements and modifications may be out of financial reach.

Seniors are more likely to be at risk due to carbon monoxide exposure because they may have compromised health conditions as well. Breathing problems, heart disease and anemia can make it more likely that they will become ill due to carbon monoxide exposure. And that exposure may go undetected or misdiagnosed as other illnesses, , such as flu or food poisoning, or written off as the signs of aging. Because of this, the prevalence of carbon monoxide exposure in our elderly population is most likely highly underestimated. Seniors are more likely to be diagnosed with sequelae related to heart problems such as chest pain, myocardial infarction, arrhythmias or congestive heart failure; all symptoms which can be brought about by chronic exposure to carbon monoxide.  We also continue to believe that a significant portion of carbon monoxide heart attacks goes misdiagnosed because it happens to people with preexisting heart disease.

The diseased heart is more likely to be impacted by CO poisoning than the healthy heart.

Because of this, CO toxicity may go undiagnosed and result in neurocognitive damage. The senior is treated for the signs of heart issues, eventually returned to their home, and becomes vulnerable to even more damage due to carbon monoxide exposure. https://www.hmpgloballearningnetwork.com/site/altc/articles/carbon-monoxide-toxicity-older-adults

While the winter months bring increased risks across the entire population, the likelihood that the nonspecific symptoms of carbon monoxide poisoning will be mistaken for other chronic geriatric illnesses in the elderly population are more likely and the frequency of those occurrences is basically unknown at this time.

Some of the issue may be in the way we perceive the elderly population. If we compare the delayed sequelae of carbon monoxide poisoning in a younger person against the same sequelae in an elderly person, there is a medical bias. A young person may experience mental and psychological changes days, weeks or months following a carbon monoxide incident. An altered performance at school, work and in social surroundings might be noted and documented by teachers, coworkers and friends and follow up with medical professionals may observe a correlation between the event and the delayed symptoms.

An older person, displaying the same symptoms following exposure to carbon monoxide may not only be less likely to have been diagnosed in the emergency room but the subsequent mental sequelae may be misdiagnosed as a declining mental state due to aging.

We live with so many potential sources of carbon monoxide poisoning; faulty furnaces, appliances, cars left running in attached garages, generators improperly used during power outages and other sources of carbon monoxide. And statistics show that deadly exposure is more likely to occur during winter months or during winter storms. We are becoming more aware on the medical front that testing for carbon monoxide exposure during the winter or during a natural disaster can improve the outcome for thousands of patients annually. However, the younger victims of carbon monoxide poisoning are much more likely to be diagnosed by first responders or in the emergency room.

Another factor that places elderly Americans at risk is that if a pre-existing health condition such as heart or lung disease is present, a much lower carboxyhemoglobin level requires hospitalization.

“Taken with other symptoms of carbon-monoxide poisoning, carboxyhemoglobin levels of over 25 percent in healthy people, over 15 percent in patients with a history of heart or lung disease, and over 10 percent in pregnant women usually indicate the need for hospitalization.  In the hospital, fluids and electrolytes are given to correct any imbalances that have arisen from the breakdown of cellular metabolism.” https://hhs.iowa.gov/epi-manual-guide-surveillance-investigation-and-reporting/environmental-disease/carbon-monoxide#:~:text=Everyone%20is%20at%20risk%20of,are%20also%20at%20high%20risk.

Are Seniors Getting a Lower Standard of Care?

While lower levels can produce lifechanging and long-term complications, ER standards may not reflect the specific needs of the elderly population. Even when correctly diagnosed, the standard of care may differ drastically based on the individual health profile of the individual.

While HUD has issued reminders that all HUD-assisted housing, as of December 27, 2022, is required to have carbon monoxide detectors or alarms installed, not all types of senior housing are covered. Seniors receiving some assistance to remain in their homes, for instance, may not be protected by carbon monoxide detectors. They may be receiving aid in the way of medical support or for in-home meal delivery, but depending on their location, not required to have appropriate protection from carbon monoxide exposure.

Even those in Congregate Care are at Carbon Monoxide Risk

Seniors living semi-independently or independently are not the only ones at risk. The residents of the Northfield Retirement Community in Minnesota had to be evacuated this past week due to high levels of carbon monoxide. The source was determined to be a vehicle with a push-button ignition that was accidentally left running in a closed garage. https://bringmethenews.com/minnesota-news/car-left-running-in-garage-sparks-co-alert-at-northfield-retirement-home

Cars with push-button ignitions are particularly hazardous to the elderly because a lifetime of habit can potentially result in a vehicle not being properly turned off. Because the elderly often have hearing impairments, quieter engines may not provide an alert that a vehicle is still running. As a result of the evacuation at the Northfield Retirement Community, the facility will be working with the fire department to install more carbon monoxide detectors, undoubtedly in areas that could be impacted by vehicles left running in garages.

With winter months quickly approaching, it is a good time for seniors to examine their own carbon monoxide safety needs. Ideally, family members should check on seniors to make sure HVAC maintenance is done and carbon monoxide detectors are installed and functioning.  For seniors with hearing deficits there are many options which use visual cues or vibration to sound an alarm.  Some fire departments provide free or low-cost carbon monoxide detectors for seniors or low-income households as well, offering installation in some circumstances.

Poor Accessibility Increases Carbon Monoxide Risk

Accessibility is another issue seniors face. Fires and carbon monoxide are major reasons to have a safety plan. It is always safer to sleep on the first floor of a house if mobility is an issue. Glasses, canes, wheelchairs, hearing aids and charged cell phones should be kept close by at night. Seniors should be familiar with any security bars or locks on windows and how to release them. There are more safety tips at Kidde.

The two most important things to remember are the proper placement of functioning, maintained carbon monoxide detectors and the importance of requiring medical staff test for carbon monoxide exposure even though symptoms may be thought to be indicative of geriatric health issues. The potential to be returned to a lethal environment is too high for those most at risk to succumb to continued exposure to carbon monoxide. While we may never know the statistical prevalence of the exposure of the elderly to carbon monoxide, we can be proactive in reducing the number of injuries and fatalities.