- Email: [email protected]
Fire safety among the elderly in Western Australia
ARTICLE IN PRESS
Fire Safety Journal 41 (2006) 57–61 www.elsevier.com/locate/firesaf
Fire safety among the elderly in Western Australia Guicheng Zhanga,, Andy H. Leea, Hoe C. Leeb, Michael Clintona,c a
School of Public Health, Curtin University of Technology, GPO Box U 1987, Perth, WA 6845, Australia b School of Occupational Therapy, Curtin University of Technology, Perth, Australia c Faculty of Nursing, University of Calgary, Calgary, Alta., Canada Received 15 December 2004; received in revised form 26 April 2005; accepted 24 August 2005 Available online 6 October 2005
Abstract Unsafe dwelling environments may contribute to high morbidity and mortality of residential fire among the elderly people. This study investigated the prevalence of fire safety devices and related risk factors in elderly households. A series of convenience surveys was administered at 11 council community centres within metropolitan Perth, Western Australia, between August and October 2004. A total of 1188 older adults aged 65 years or over were recruited. The results found generally low prevalence for electric safety switches (56%), fire extinguishers (18%) and fire blankets (10%), while 72% had a functional smoke detector installed. Nearly a quarter of the participants had never thought of an escape route. Logistic regression analysis based on generalized estimating equations further showed that those living alone had a significantly lower prevalence of smoke detector and functional smoke detector, with adjusted odds ratios 0.48 (95% CI: 0.34–0.69) and 0.55 (95% CI: 0.41–0.75), respectively. Similarly, elderly people living in private rental housing appeared to be less equipped against residential fire relative to those in public rental and those occupying their own homes. As expected, elderly people with home contents insurance coverage had a significantly higher prevalence of fire safety devices. These findings have important implications for the government and policy makers if community fire safety for the elderly is to be improved. r 2005 Elsevier Ltd. All rights reserved. Keywords: Fire safety devices; Older adults; Prevalence; Risk factors; Smoke detector
1. Introduction Each year, fires cause about 300,000 deaths in the world and most of these occur in the home [1]. Residential fires comprise 75% of fires in the United States and burns are the fourth leading cause of unintentional injury-related deaths [2–4]. In Australia, there are over 10,000 house fires annually, contributing to 1500 injuries and 70 deaths [5]. It has been reported that the elderly continue to represent a disproportionate percentage of fire fatalities [6–8]. Analysis by the London Fire Brigade showed that over half of the fatal unintentional death victims in London were above 65 years of age [8]. In Australia, 41% of unintentional residential fatalities that occurred in the State of Victoria were aged 65 years or above [9].
Corresponding author.
E-mail addresses: [email protected] (G. Zhang), [email protected] (A.H. Lee). 0379-7112/$ - see front matter r 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.firesaf.2005.08.003
Similar to other developed countries, the ageing society has become a serious concern for Australia. According to the Australian Bureau of Statistics, the population aged 65 years and above is projected to increase rapidly both in numbers and as a proportion of the total population, from 2.3 million (12% of population) in 1999 to about 4.2 million (18–19%). It is also projected that by 2021, 35–40% of older Australians will live alone [10]. The ageing population, coupled with a high proportion of older people living alone, suggests that it is crucial to provide a fire safe and healthy home environment for our senior citizens. The high fire mortality rates among the elderly may be attributable to multi-factorial risk factors, such as a low prevalence of smoke detectors, socio-economic status and pre-existing diseases [11]. Nevertheless, improving fire safety is an effective measure to reduce residential fire mortality among the elderly. Concern about smoke detectors (i.e., smoke alarms that first detect smoke and then alert households) in Australia has mounted in recent years due to an increasing number of deaths from fire,
ARTICLE IN PRESS 58
G. Zhang et al. / Fire Safety Journal 41 (2006) 57–61
particularly among seniors. Although other fire safety devices such as fire extinguishers, fire blankets and electronic safety switches are important in reducing deaths from fire, the only fire safety equipment in Australia that is mandatory in new homes is a fire detector; however, most elderly people do not live in recently built properties. The present study investigates the prevalence of fire safety measures, particularly smoke detectors, and related risk factors for older adults residing in Perth, the capital of Western Australia. The purpose is to address fire prevention issues in the context of concerns in Australia, with a focus on those receiving the most attention for seniors. The findings have important policy implications for the government and other authorities to improve community fire safety for the elderly in Australia. 2. Methods 2.1. Recruitment procedure A series of convenience surveys was administered at 11 randomly selected council community centres in Perth between August and October 2004. Subjects aged 65 years or above, who understood English and resided within metropolitan Perth, were invited to participate in the survey. A structured questionnaire was distributed by an investigator (first author) to each consenting participant at community halls and centres, together with an information sheet and a verbal briefing of the objectives of the study. The self-administered questionnaire, which took about 10 min to complete, was collected immediately after completion. An appointment schedule was devised in association with each centre manager in order to maximize the capture of new subjects at each visit during the data collection period. Ethics approval to conduct the crosssectional survey was obtained from the Human Research Ethics Committee of Curtin University. 2.2. Instrument The questionnaire was developed in conjunction with experts in the field through focus group discussions. Questions were either taken from the Australian Bureau of Statistics 2002 General Social Survey [12] and the Western Australia Injury Risk Factor Survey [13], or developed after consulting a panel of stakeholders. The validity of the instrument was confirmed by a pilot test involving 115 voluntary participants recruited from the Perth Community Centre prior to actual data collection. Its reliability was further established using another test–retest sample of 32 subjects. The structured questionnaire consisted of three parts: (1) demographics, (2) fire safety measures and (3) residential factors and health status. Information relating to fire safety, such as installation of smoke detector(s), presence of functional smoke detectors, fire extinguishers, fire blankets and a safety switch on the main electric meter
box, as well as an emergency escape route, was solicited. The questionnaire also contained questions about the type of residence, household composition, basic demographic characteristics and health status. A functional smoke detector was defined as having the smoke detector checked for working status within the past 12 months. 2.3. Statistical analysis All data were screened and plausibility checks were made to ensure the quality of the information recorded. Both univariate and multivariate statistical analyses were performed. Prevalence rates (%) of fire safety devices and associated 95% confidence intervals were first estimated. Backward stepwise logistic regression models were used to investigate factors affecting the prevalence of each device, which included age, contents insurance coverage, household composition, dwelling type, home ownership, ethnic background, duration of occupancy, employment status, education level and socio-economic status. These potential factors were considered after a preliminary univariate analysis of the data as well as from an extensive literature review of fire safety for the elderly. The SEIFA1 index from the Australian Bureau of Statistics, corresponding to each individual’s postcode, was used as a proxy measure of socio-economic status. To account for the inherent correlation of observations collected from the same community centre, a generalized estimating equations approach was adopted for fitting the multivariate logistic regression model to the hierarchical data. The method accommodated the dependency of observations nested within clusters and the resulting robust standard errors of the regression coefficients provided correct inferences concerning the significance of factors of interest. The odds ratio, a measure of the increased occurrence of an event for the variable of interest, was estimated from the logistic regression models. The level of statistical significance was presented in terms of the P value. Data entry and descriptive statistics were conducted using the SPSS package [14] while the logistic generalized estimating equations analysis was performed within the STATA [15] environment. 3. Results A total of 1188 older adults aged 65 years or over participated in this study, the response rate being 70%. Among the voluntary participants, 760 of them were females (64%) and the majority were born in Australia (53.7%) and completed secondary school (89.4%). The mean age of participants was 75.5 years. At the time of the survey, 42.3% were retired (a person not in the workforce who is over retirement age, but does not necessarily receive a government pension), 69.7% were pensioners (who receive income support of various kinds from the govern1
Socio-economic index for areas.
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59
Table 1 Odds ratios and associated 95% confidence intervals of factors affecting the prevalence of smoke detector, functional smoke detector and safety switch Odds ratios
Smoke detector Live alone: yes versus no Contents insurance coverage: yes versus no Home ownership Private rental versus public rental Owned/mortgaged versus public rental Duration of occupancya 5–11 versus o5 years 11–24 versus o5 years 424 versus o5 years Functional smoke detector Live alone: yes versus no Contents insurance coverage: yes versus no Home ownership Private rental versus public rental Owned/mortgaged versus public rental Duration of occupancya 5–11 versus o5 years 11–24 versus o5 years 424 versus o5 years Safety switch Contents insurance coverage: yes versus no Duration of occupancya 5–11 versus o5 years 11–24 versus o5 years 424 versus o5 years a
P
95% CI Lower
Upper
0.48 2.43
0.34 1.49
0.69 3.96
o0.001 o0.001
0.14 0.16 Po0.001 for trend 0.46 0.34 0.27
0.05 0.06
0.41 0.42
o0.001 o0.001
0.25 0.19 0.15
0.86 0.62 0.50
0.014 o0.001 o0.001
0.55 2.66
0.41 1.73
0.75 4.10
o0.001 o0.001
0.28 0.32 P ¼ 0.04 for trend 0.94 0.76 0.67
0.14 0.17
0.56 0.60
o0.001 o0.001
0.60 0.49 0.43
1.49 1.19 1.04
0.81 0.23 0.07
2.14 P ¼ 0.002 for trend 0.98 0.81 0.61
1.55
2.95
o0.001
0.68 0.57 0.43
1.40 1.15 0.87
0.89 0.24 0.007
The cut points 5, 11 and 24 years correspond to the lower, median and upper quartiles of living period in the current residence.
ment), and 1.7% were still in employment or selfemployed. In terms of home ownership, 78.6% had a fully owned or mortgaged house, while 10.5% and 8.9% lived in public and private rental dwellings, respectively. For this sample of older adults, about half of them (49%) lived alone and on average they had been living in their current residence for 16.4 years (SD 14.7). With regard to fire safety devices, 83.4% (95% CI: 81.3–87.3%) of households had installed at least one smoke detector, 72.0% (95% CI: 69.4–75.9%) had functional smoke detector(s), 56.1% (95% CI: 53.3–60.0%) had a safety switch on the main electric meter box, 17.8% (95% CI: 15.6–21.7%) had a fire extinguisher at home and 10.0% (95% CI: 8.3–13.9%) had fire blanket(s). Although 81.3% (95% CI: 79.1–83.5%) had contents insurance coverage, 24.6% (95% CI: 22.1–28.5%) of the participants confessed they had not planned for an escape route in case fire broke out. It should be noted that Western Australian legislation requires all new homes to be fitted with smoke detectors. Therefore, the relatively high proportion of households with a smoke detector may reflect when the homes of the respondents were built rather than any safety consciousness on their part. Table 1 presents the results of fitting separate logistic generalized estimating equations for smoke detector, functional smoke detector and safety switch. Four sig-
nificant factors were identified: namely, living alone, contents insurance coverage, home ownership and duration of occupancy. Analysis was not undertaken for the other fire safety devices due to their relatively low prevalence among the study participants. Compared to elderly people who lived with their spouse, children, relatives or others, those living alone had a significantly lower prevalence of smoke detector and functional smoke detector, with adjusted odds ratios 0.48 (95% CI: 0.34–0.69) and 0.55 (95% CI 0.41–0.75), respectively. As expected, elderly with home contents insurance coverage had a significantly higher prevalence of these three fire safety devices. The type of home ownership played an important role too, as participants living in private rental housing appeared to be less equipped against residential fire relative to those in public rental and those occupying their own homes. Moreover, the duration of occupancy at the current residence was negatively associated with the prevalence of the safety devices, and the time trends were significant. The lower, median and upper quartiles were, respectively, 5, 11 and 24 years for this variable. Tables 2 and 3 further contrast the differences in terms of the influencing factors. Apart from smoke detector and functional smoke detector, those living alone had a significantly lower prevalence of installing a safety switch
ARTICLE IN PRESS G. Zhang et al. / Fire Safety Journal 41 (2006) 57–61
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Table 2 Prevalence of fire safety devices by living alone and contents insurance coverage status Live alone
Smoke detector Functional smoke detector Safety switch Fire extinguisher Fire blanket
Na
n
%
Na
n
%
572 540 572 572 572
447 351 292 79 51
78.1 65.0 51.0 13.8 8.9
594 564 594 594 594
527 443 362 127 66
88.7 78.5 60.9 21.4 11.1
With contents insurance
Smoke detector Functional smoke detector Safety switch Fire extinguisher Fire blanket a
P
Live with others
o0.001 o0.001 0.001 0.001 0.21 P
Without contents insurance
Na
n
%
Na
n
%
937 894 937 937 937
797 676 563 178 103
85.1 75.6 60.1 19.0 11.0
216 201 216 216 216
165 117 89 27 14
76.4 58.2 41.2 12.5 6.5
0.002 o0.001 o0.001 0.024 0.048
Missing data are present.
Table 3 Prevalence of fire safety devices by home ownership status P
Home ownership Owned/mortgaged
Smoke detector Functional smoke detector Safety switch Fire extinguisher Fire blanket a
Private rental
Public rental
Na
n
%
Na
n
%
Na
n
%
892 847 892 892 892
731 607 523 169 95
82.0 71.7 58.6 18.9 10.7
101 99 101 101 101
77 59 44 13 8
76.2 59.6 43.6 12.9 7.9
119 110 119 119 119
113 88 61 14 9
95.0 80.0 51.3 11.8 7.6
o0.001 0.005 0.007 0.065 0.43
Missing data are present.
and a fire extinguisher, but conversely for participants with their home contents insured. In relation to home ownership, it is evident that elderly living in a private rental house had the lowest prevalence of smoke detector, functional smoke detector and safety switch, the differences being statistically significant between them and those who fully owned/mortgaged their house and those living in public rental. However, the three groups were similar in terms of fire extinguisher and fire blanket prevalence. 4. Discussion It has been suggested that the high fire morbidities and mortalities among the elderly include the lower prevalence of smoke detector, although other factors may also be associated, such as being hearing impaired, mobility impaired and using old and under-standard electric appliances [11]. From both individual and ecologic levels, the value of smoke detectors in reducing residential firerelated morbidity and mortality has been confirmed [16–19]. Many developed countries, including Australia, have legislated the compulsory installation of smoke
detectors in the Building Code [18,20]. Consequently, the prevalence of smoke detector in homes across Australia has increased from 58% in May 1998 to 69% in February 2000 [5]. A recent study estimated the prevalence of smoke detectors in Western Australian households to be 73.2% (95% CI: 66.3–80.1) in 2002 [13]. Although the present study found a prevalence of 83.4% among elderly households, almost 30% of participants did not check the functionality of their smoke detector during the past 12 months, while a quarter of them did not plan for a fire escape route. Moreover, relatively few have installed other fire safety devices such as a safety switch, a fire extinguisher and fire blanket(s) in their homes. This study also found significant variations in prevalence of fire safety devices among older Australians. For elderly people who live alone, the proportions having smoke detector and functional smoke detector were low, which appeared to be consistent with the literature [21]. Since living alone was a contributing factor for unintentional dwelling fire deaths [8] and almost half of the participants lived alone, factors relating to loneliness should be targeted in future fire prevention and safety strategy.
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Elderly residents of private rental housing had a lower prevalence of smoke detector and functional smoke detector than those in public rental housing, which reflected to a large extent the effort placed by the state Housing Commission to reinforce fire safety regulations in public housing properties. It should be remarked that the variables ‘‘home ownership’’ and ‘‘contents insurance coverage’’ may correlate with each other, as home owners tend to insure their properties while those who rent properties may not do so to the same extent. However, seniors are more likely to have paid off their mortgages and may not continue with property insurance if they are living on fixed incomes. We intend to investigate this matter in more detail in a future survey. In this study, backward stepwise logistic regression analyses were conducted to minimize the effect of potential collinearity among the independent variables. The negative association between duration of occupancy and safety device prevalence is logical, because the elderly might have a false sense of security and ignore the fire hazard after a long period of stay in the same dwelling. Alternatively, the house they occupied tended to be older and not necessarily meeting fire safety standards. Some limitations should be considered in conjunction with the findings. To improve response rate, participants were recruited from council community centres. This convenience sample of older adults might not be representative of the entire elderly population in Western Australia. People in dependent situations, such as those residing in nursing homes and hostels, or cared for by their relatives, were excluded in particular. Some selection bias was expected as participants attending community centre functions and events tended to have relatively good mobility and health. Nevertheless, all consented participants remained anonymous (name and address not required), and therefore had no reason to provide a misleading response. To increase participation, a short questionnaire was administered in view of the limited time available for the survey. Although income, smoking, alcohol consumption and medication are factors known to influence the prevalence of fires in the family home [22,23], we have not collected data on these variables because soliciting such sensitive information from seniors in Australia would be regarded as blaming the victims for preventable fires. Nevertheless, we will investigate behavioural factors in a follow-up study. To the best of our knowledge, this was the first study conducted in Australia to investigate the prevalence of fire safety devices and associated influencing factors for the elderly population. The findings provided valuable information to develop intervention programs for improving fire safety among the elderly. Acknowledgements We are indebted to Mr. Nigel Barker, Executive Director of Council on the Ageing (WA) for valuable advice and
61
suggestions. Assistances from the various city councils, particularly the City of Melville, are gratefully acknowledged. Thanks are also due to two anonymous reviewers for helpful comments.
References [1] Roberts I, Diguiseppi C. Smoke alarms, fire deaths, and randomised controlled trials. Injury Prev 1999;5:244–5. [2] Thompson CJ, Jones AR, Davis MK, Caplan LS. Do smoke alarms still function a year after installation? A follow-up of the get-alarmed campaign. J Community Health 2004;29:171–81. [3] Jones AR, Thompson CJ, Davis MK. Smoke alarm ownership and installation: a comparison of a rural and a suburban community in Georgia. J Community Health 2001;26:307–29. [4] Shults RA, Sacks JJ, Briske LA, Dickey PH, Kinde MR, Mallonee S, et al. Evaluation of three smoke detector promotion programs. Am J Prev Med 1998;15:165–71. [5] Australian Bureau of Statistics. Australian social trends 2000 housing–housing stock: home fire safety; 2000. [6] Elder AT, Squires T, Busuttil A. Fire fatalities in elderly people. Age Ageing 1996;25:214–6. [7] Gulaid JA, Sacks JJ, Sattin RW. Deaths from residential fires among older people, United States, 1984. J Am Geriatr Soc 1989;37:331–4. [8] Holborn PG, Nolan PF, Golt J. An analysis of fatal unintentional dwelling fires investigated by London Fire Brigade between 1996 and 2000. Fire Safety J 2003;38:1–42. [9] Brennan P. Victims and survivors in fatal residential building. Fire Mater 1999;23:305–10. [10] Australian Bureau of Statistics. Population special article—looking into the future—Australian population projections; 2002. [11] Warda L, Tenenbein M, Moffatt ME. House fire injury prevention update. Part I. A review of risk factors for fatal and non-fatal house fire injury. Injury Prev 1999;5:145–50. [12] Australian Bureau of Statistics. 2002 General social survey, Western Australia; 2004. [13] Stevenson M, Cercarelli L, Rimajova M. Western Australian injury risk factor survey. Technical report no. OR8, Injury Research Centre, University of Western Australia; 2003. [14] SPSS Inc. SPSS for Windows. Release 11. Chicago, IL; 2001. [15] Stata Corporation. STATA release 8. Texas: College Station; 2003. [16] Bruck D. The who, what, where and why of waking to fire alarms: a review. Fire Safety J 2001;36:623–39. [17] Stevenson MR, Lee AH. Smoke alarms and residential fire mortality in the United States: an ecologic study. Fire Safety J 2003;38:43–52. [18] Warda L, Tenenbein M, Moffatt ME. House fire injury prevention update. Part II. A review of the effectiveness of preventive interventions. Injury Prev 1999;5:217–25. [19] Marshall S, Runyan C, Bangdiwala S, Linzer M, Sacks J, Butts J. Fatal residential fires: who dies and who survives. J Am Med Assoc 1998;279:1633–7. [20] Arena G, Cordova S, Gavin A, Palamara P, Rimajova M. Injury in Western Australia: a review of best practice, stakeholder activity, legislation, and recommendations for selected injury areas. Technical report no. RR122, Injury Research Centre, University of Western Australia; 2002. [21] McKnight RH, Struttmann TW, Mays JR. Finding homes without smoke detectors: one step in planning burn prevention programs. J Burn Care Rehab 1995;16:548–56. [22] Leth PM, Gregersen M, Sabroe S. Fatal accidents in house fires. The most significant causes, such as smoking and alcohol abuse, multiplied by four the incidence during the last 40 years. Ugeskrift For Laeger 1998;160:3403–8. [23] McGwin Jr. G, Chapman V, Curtis J, Rousculp M. Fire fatalities in older people. J Am Geriatr Soc 1999;47:1307–11.
Fire Safety Journal 41 (2006) 57–61 www.elsevier.com/locate/firesaf
Fire safety among the elderly in Western Australia Guicheng Zhanga,, Andy H. Leea, Hoe C. Leeb, Michael Clintona,c a
School of Public Health, Curtin University of Technology, GPO Box U 1987, Perth, WA 6845, Australia b School of Occupational Therapy, Curtin University of Technology, Perth, Australia c Faculty of Nursing, University of Calgary, Calgary, Alta., Canada Received 15 December 2004; received in revised form 26 April 2005; accepted 24 August 2005 Available online 6 October 2005
Abstract Unsafe dwelling environments may contribute to high morbidity and mortality of residential fire among the elderly people. This study investigated the prevalence of fire safety devices and related risk factors in elderly households. A series of convenience surveys was administered at 11 council community centres within metropolitan Perth, Western Australia, between August and October 2004. A total of 1188 older adults aged 65 years or over were recruited. The results found generally low prevalence for electric safety switches (56%), fire extinguishers (18%) and fire blankets (10%), while 72% had a functional smoke detector installed. Nearly a quarter of the participants had never thought of an escape route. Logistic regression analysis based on generalized estimating equations further showed that those living alone had a significantly lower prevalence of smoke detector and functional smoke detector, with adjusted odds ratios 0.48 (95% CI: 0.34–0.69) and 0.55 (95% CI: 0.41–0.75), respectively. Similarly, elderly people living in private rental housing appeared to be less equipped against residential fire relative to those in public rental and those occupying their own homes. As expected, elderly people with home contents insurance coverage had a significantly higher prevalence of fire safety devices. These findings have important implications for the government and policy makers if community fire safety for the elderly is to be improved. r 2005 Elsevier Ltd. All rights reserved. Keywords: Fire safety devices; Older adults; Prevalence; Risk factors; Smoke detector
1. Introduction Each year, fires cause about 300,000 deaths in the world and most of these occur in the home [1]. Residential fires comprise 75% of fires in the United States and burns are the fourth leading cause of unintentional injury-related deaths [2–4]. In Australia, there are over 10,000 house fires annually, contributing to 1500 injuries and 70 deaths [5]. It has been reported that the elderly continue to represent a disproportionate percentage of fire fatalities [6–8]. Analysis by the London Fire Brigade showed that over half of the fatal unintentional death victims in London were above 65 years of age [8]. In Australia, 41% of unintentional residential fatalities that occurred in the State of Victoria were aged 65 years or above [9].
Corresponding author.
E-mail addresses: [email protected] (G. Zhang), [email protected] (A.H. Lee). 0379-7112/$ - see front matter r 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.firesaf.2005.08.003
Similar to other developed countries, the ageing society has become a serious concern for Australia. According to the Australian Bureau of Statistics, the population aged 65 years and above is projected to increase rapidly both in numbers and as a proportion of the total population, from 2.3 million (12% of population) in 1999 to about 4.2 million (18–19%). It is also projected that by 2021, 35–40% of older Australians will live alone [10]. The ageing population, coupled with a high proportion of older people living alone, suggests that it is crucial to provide a fire safe and healthy home environment for our senior citizens. The high fire mortality rates among the elderly may be attributable to multi-factorial risk factors, such as a low prevalence of smoke detectors, socio-economic status and pre-existing diseases [11]. Nevertheless, improving fire safety is an effective measure to reduce residential fire mortality among the elderly. Concern about smoke detectors (i.e., smoke alarms that first detect smoke and then alert households) in Australia has mounted in recent years due to an increasing number of deaths from fire,
ARTICLE IN PRESS 58
G. Zhang et al. / Fire Safety Journal 41 (2006) 57–61
particularly among seniors. Although other fire safety devices such as fire extinguishers, fire blankets and electronic safety switches are important in reducing deaths from fire, the only fire safety equipment in Australia that is mandatory in new homes is a fire detector; however, most elderly people do not live in recently built properties. The present study investigates the prevalence of fire safety measures, particularly smoke detectors, and related risk factors for older adults residing in Perth, the capital of Western Australia. The purpose is to address fire prevention issues in the context of concerns in Australia, with a focus on those receiving the most attention for seniors. The findings have important policy implications for the government and other authorities to improve community fire safety for the elderly in Australia. 2. Methods 2.1. Recruitment procedure A series of convenience surveys was administered at 11 randomly selected council community centres in Perth between August and October 2004. Subjects aged 65 years or above, who understood English and resided within metropolitan Perth, were invited to participate in the survey. A structured questionnaire was distributed by an investigator (first author) to each consenting participant at community halls and centres, together with an information sheet and a verbal briefing of the objectives of the study. The self-administered questionnaire, which took about 10 min to complete, was collected immediately after completion. An appointment schedule was devised in association with each centre manager in order to maximize the capture of new subjects at each visit during the data collection period. Ethics approval to conduct the crosssectional survey was obtained from the Human Research Ethics Committee of Curtin University. 2.2. Instrument The questionnaire was developed in conjunction with experts in the field through focus group discussions. Questions were either taken from the Australian Bureau of Statistics 2002 General Social Survey [12] and the Western Australia Injury Risk Factor Survey [13], or developed after consulting a panel of stakeholders. The validity of the instrument was confirmed by a pilot test involving 115 voluntary participants recruited from the Perth Community Centre prior to actual data collection. Its reliability was further established using another test–retest sample of 32 subjects. The structured questionnaire consisted of three parts: (1) demographics, (2) fire safety measures and (3) residential factors and health status. Information relating to fire safety, such as installation of smoke detector(s), presence of functional smoke detectors, fire extinguishers, fire blankets and a safety switch on the main electric meter
box, as well as an emergency escape route, was solicited. The questionnaire also contained questions about the type of residence, household composition, basic demographic characteristics and health status. A functional smoke detector was defined as having the smoke detector checked for working status within the past 12 months. 2.3. Statistical analysis All data were screened and plausibility checks were made to ensure the quality of the information recorded. Both univariate and multivariate statistical analyses were performed. Prevalence rates (%) of fire safety devices and associated 95% confidence intervals were first estimated. Backward stepwise logistic regression models were used to investigate factors affecting the prevalence of each device, which included age, contents insurance coverage, household composition, dwelling type, home ownership, ethnic background, duration of occupancy, employment status, education level and socio-economic status. These potential factors were considered after a preliminary univariate analysis of the data as well as from an extensive literature review of fire safety for the elderly. The SEIFA1 index from the Australian Bureau of Statistics, corresponding to each individual’s postcode, was used as a proxy measure of socio-economic status. To account for the inherent correlation of observations collected from the same community centre, a generalized estimating equations approach was adopted for fitting the multivariate logistic regression model to the hierarchical data. The method accommodated the dependency of observations nested within clusters and the resulting robust standard errors of the regression coefficients provided correct inferences concerning the significance of factors of interest. The odds ratio, a measure of the increased occurrence of an event for the variable of interest, was estimated from the logistic regression models. The level of statistical significance was presented in terms of the P value. Data entry and descriptive statistics were conducted using the SPSS package [14] while the logistic generalized estimating equations analysis was performed within the STATA [15] environment. 3. Results A total of 1188 older adults aged 65 years or over participated in this study, the response rate being 70%. Among the voluntary participants, 760 of them were females (64%) and the majority were born in Australia (53.7%) and completed secondary school (89.4%). The mean age of participants was 75.5 years. At the time of the survey, 42.3% were retired (a person not in the workforce who is over retirement age, but does not necessarily receive a government pension), 69.7% were pensioners (who receive income support of various kinds from the govern1
Socio-economic index for areas.
ARTICLE IN PRESS G. Zhang et al. / Fire Safety Journal 41 (2006) 57–61
59
Table 1 Odds ratios and associated 95% confidence intervals of factors affecting the prevalence of smoke detector, functional smoke detector and safety switch Odds ratios
Smoke detector Live alone: yes versus no Contents insurance coverage: yes versus no Home ownership Private rental versus public rental Owned/mortgaged versus public rental Duration of occupancya 5–11 versus o5 years 11–24 versus o5 years 424 versus o5 years Functional smoke detector Live alone: yes versus no Contents insurance coverage: yes versus no Home ownership Private rental versus public rental Owned/mortgaged versus public rental Duration of occupancya 5–11 versus o5 years 11–24 versus o5 years 424 versus o5 years Safety switch Contents insurance coverage: yes versus no Duration of occupancya 5–11 versus o5 years 11–24 versus o5 years 424 versus o5 years a
P
95% CI Lower
Upper
0.48 2.43
0.34 1.49
0.69 3.96
o0.001 o0.001
0.14 0.16 Po0.001 for trend 0.46 0.34 0.27
0.05 0.06
0.41 0.42
o0.001 o0.001
0.25 0.19 0.15
0.86 0.62 0.50
0.014 o0.001 o0.001
0.55 2.66
0.41 1.73
0.75 4.10
o0.001 o0.001
0.28 0.32 P ¼ 0.04 for trend 0.94 0.76 0.67
0.14 0.17
0.56 0.60
o0.001 o0.001
0.60 0.49 0.43
1.49 1.19 1.04
0.81 0.23 0.07
2.14 P ¼ 0.002 for trend 0.98 0.81 0.61
1.55
2.95
o0.001
0.68 0.57 0.43
1.40 1.15 0.87
0.89 0.24 0.007
The cut points 5, 11 and 24 years correspond to the lower, median and upper quartiles of living period in the current residence.
ment), and 1.7% were still in employment or selfemployed. In terms of home ownership, 78.6% had a fully owned or mortgaged house, while 10.5% and 8.9% lived in public and private rental dwellings, respectively. For this sample of older adults, about half of them (49%) lived alone and on average they had been living in their current residence for 16.4 years (SD 14.7). With regard to fire safety devices, 83.4% (95% CI: 81.3–87.3%) of households had installed at least one smoke detector, 72.0% (95% CI: 69.4–75.9%) had functional smoke detector(s), 56.1% (95% CI: 53.3–60.0%) had a safety switch on the main electric meter box, 17.8% (95% CI: 15.6–21.7%) had a fire extinguisher at home and 10.0% (95% CI: 8.3–13.9%) had fire blanket(s). Although 81.3% (95% CI: 79.1–83.5%) had contents insurance coverage, 24.6% (95% CI: 22.1–28.5%) of the participants confessed they had not planned for an escape route in case fire broke out. It should be noted that Western Australian legislation requires all new homes to be fitted with smoke detectors. Therefore, the relatively high proportion of households with a smoke detector may reflect when the homes of the respondents were built rather than any safety consciousness on their part. Table 1 presents the results of fitting separate logistic generalized estimating equations for smoke detector, functional smoke detector and safety switch. Four sig-
nificant factors were identified: namely, living alone, contents insurance coverage, home ownership and duration of occupancy. Analysis was not undertaken for the other fire safety devices due to their relatively low prevalence among the study participants. Compared to elderly people who lived with their spouse, children, relatives or others, those living alone had a significantly lower prevalence of smoke detector and functional smoke detector, with adjusted odds ratios 0.48 (95% CI: 0.34–0.69) and 0.55 (95% CI 0.41–0.75), respectively. As expected, elderly with home contents insurance coverage had a significantly higher prevalence of these three fire safety devices. The type of home ownership played an important role too, as participants living in private rental housing appeared to be less equipped against residential fire relative to those in public rental and those occupying their own homes. Moreover, the duration of occupancy at the current residence was negatively associated with the prevalence of the safety devices, and the time trends were significant. The lower, median and upper quartiles were, respectively, 5, 11 and 24 years for this variable. Tables 2 and 3 further contrast the differences in terms of the influencing factors. Apart from smoke detector and functional smoke detector, those living alone had a significantly lower prevalence of installing a safety switch
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Table 2 Prevalence of fire safety devices by living alone and contents insurance coverage status Live alone
Smoke detector Functional smoke detector Safety switch Fire extinguisher Fire blanket
Na
n
%
Na
n
%
572 540 572 572 572
447 351 292 79 51
78.1 65.0 51.0 13.8 8.9
594 564 594 594 594
527 443 362 127 66
88.7 78.5 60.9 21.4 11.1
With contents insurance
Smoke detector Functional smoke detector Safety switch Fire extinguisher Fire blanket a
P
Live with others
o0.001 o0.001 0.001 0.001 0.21 P
Without contents insurance
Na
n
%
Na
n
%
937 894 937 937 937
797 676 563 178 103
85.1 75.6 60.1 19.0 11.0
216 201 216 216 216
165 117 89 27 14
76.4 58.2 41.2 12.5 6.5
0.002 o0.001 o0.001 0.024 0.048
Missing data are present.
Table 3 Prevalence of fire safety devices by home ownership status P
Home ownership Owned/mortgaged
Smoke detector Functional smoke detector Safety switch Fire extinguisher Fire blanket a
Private rental
Public rental
Na
n
%
Na
n
%
Na
n
%
892 847 892 892 892
731 607 523 169 95
82.0 71.7 58.6 18.9 10.7
101 99 101 101 101
77 59 44 13 8
76.2 59.6 43.6 12.9 7.9
119 110 119 119 119
113 88 61 14 9
95.0 80.0 51.3 11.8 7.6
o0.001 0.005 0.007 0.065 0.43
Missing data are present.
and a fire extinguisher, but conversely for participants with their home contents insured. In relation to home ownership, it is evident that elderly living in a private rental house had the lowest prevalence of smoke detector, functional smoke detector and safety switch, the differences being statistically significant between them and those who fully owned/mortgaged their house and those living in public rental. However, the three groups were similar in terms of fire extinguisher and fire blanket prevalence. 4. Discussion It has been suggested that the high fire morbidities and mortalities among the elderly include the lower prevalence of smoke detector, although other factors may also be associated, such as being hearing impaired, mobility impaired and using old and under-standard electric appliances [11]. From both individual and ecologic levels, the value of smoke detectors in reducing residential firerelated morbidity and mortality has been confirmed [16–19]. Many developed countries, including Australia, have legislated the compulsory installation of smoke
detectors in the Building Code [18,20]. Consequently, the prevalence of smoke detector in homes across Australia has increased from 58% in May 1998 to 69% in February 2000 [5]. A recent study estimated the prevalence of smoke detectors in Western Australian households to be 73.2% (95% CI: 66.3–80.1) in 2002 [13]. Although the present study found a prevalence of 83.4% among elderly households, almost 30% of participants did not check the functionality of their smoke detector during the past 12 months, while a quarter of them did not plan for a fire escape route. Moreover, relatively few have installed other fire safety devices such as a safety switch, a fire extinguisher and fire blanket(s) in their homes. This study also found significant variations in prevalence of fire safety devices among older Australians. For elderly people who live alone, the proportions having smoke detector and functional smoke detector were low, which appeared to be consistent with the literature [21]. Since living alone was a contributing factor for unintentional dwelling fire deaths [8] and almost half of the participants lived alone, factors relating to loneliness should be targeted in future fire prevention and safety strategy.
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Elderly residents of private rental housing had a lower prevalence of smoke detector and functional smoke detector than those in public rental housing, which reflected to a large extent the effort placed by the state Housing Commission to reinforce fire safety regulations in public housing properties. It should be remarked that the variables ‘‘home ownership’’ and ‘‘contents insurance coverage’’ may correlate with each other, as home owners tend to insure their properties while those who rent properties may not do so to the same extent. However, seniors are more likely to have paid off their mortgages and may not continue with property insurance if they are living on fixed incomes. We intend to investigate this matter in more detail in a future survey. In this study, backward stepwise logistic regression analyses were conducted to minimize the effect of potential collinearity among the independent variables. The negative association between duration of occupancy and safety device prevalence is logical, because the elderly might have a false sense of security and ignore the fire hazard after a long period of stay in the same dwelling. Alternatively, the house they occupied tended to be older and not necessarily meeting fire safety standards. Some limitations should be considered in conjunction with the findings. To improve response rate, participants were recruited from council community centres. This convenience sample of older adults might not be representative of the entire elderly population in Western Australia. People in dependent situations, such as those residing in nursing homes and hostels, or cared for by their relatives, were excluded in particular. Some selection bias was expected as participants attending community centre functions and events tended to have relatively good mobility and health. Nevertheless, all consented participants remained anonymous (name and address not required), and therefore had no reason to provide a misleading response. To increase participation, a short questionnaire was administered in view of the limited time available for the survey. Although income, smoking, alcohol consumption and medication are factors known to influence the prevalence of fires in the family home [22,23], we have not collected data on these variables because soliciting such sensitive information from seniors in Australia would be regarded as blaming the victims for preventable fires. Nevertheless, we will investigate behavioural factors in a follow-up study. To the best of our knowledge, this was the first study conducted in Australia to investigate the prevalence of fire safety devices and associated influencing factors for the elderly population. The findings provided valuable information to develop intervention programs for improving fire safety among the elderly. Acknowledgements We are indebted to Mr. Nigel Barker, Executive Director of Council on the Ageing (WA) for valuable advice and
61
suggestions. Assistances from the various city councils, particularly the City of Melville, are gratefully acknowledged. Thanks are also due to two anonymous reviewers for helpful comments.
References [1] Roberts I, Diguiseppi C. Smoke alarms, fire deaths, and randomised controlled trials. Injury Prev 1999;5:244–5. [2] Thompson CJ, Jones AR, Davis MK, Caplan LS. Do smoke alarms still function a year after installation? A follow-up of the get-alarmed campaign. J Community Health 2004;29:171–81. [3] Jones AR, Thompson CJ, Davis MK. Smoke alarm ownership and installation: a comparison of a rural and a suburban community in Georgia. J Community Health 2001;26:307–29. [4] Shults RA, Sacks JJ, Briske LA, Dickey PH, Kinde MR, Mallonee S, et al. Evaluation of three smoke detector promotion programs. Am J Prev Med 1998;15:165–71. [5] Australian Bureau of Statistics. Australian social trends 2000 housing–housing stock: home fire safety; 2000. [6] Elder AT, Squires T, Busuttil A. Fire fatalities in elderly people. Age Ageing 1996;25:214–6. [7] Gulaid JA, Sacks JJ, Sattin RW. Deaths from residential fires among older people, United States, 1984. J Am Geriatr Soc 1989;37:331–4. [8] Holborn PG, Nolan PF, Golt J. An analysis of fatal unintentional dwelling fires investigated by London Fire Brigade between 1996 and 2000. Fire Safety J 2003;38:1–42. [9] Brennan P. Victims and survivors in fatal residential building. Fire Mater 1999;23:305–10. [10] Australian Bureau of Statistics. Population special article—looking into the future—Australian population projections; 2002. [11] Warda L, Tenenbein M, Moffatt ME. House fire injury prevention update. Part I. A review of risk factors for fatal and non-fatal house fire injury. Injury Prev 1999;5:145–50. [12] Australian Bureau of Statistics. 2002 General social survey, Western Australia; 2004. [13] Stevenson M, Cercarelli L, Rimajova M. Western Australian injury risk factor survey. Technical report no. OR8, Injury Research Centre, University of Western Australia; 2003. [14] SPSS Inc. SPSS for Windows. Release 11. Chicago, IL; 2001. [15] Stata Corporation. STATA release 8. Texas: College Station; 2003. [16] Bruck D. The who, what, where and why of waking to fire alarms: a review. Fire Safety J 2001;36:623–39. [17] Stevenson MR, Lee AH. Smoke alarms and residential fire mortality in the United States: an ecologic study. Fire Safety J 2003;38:43–52. [18] Warda L, Tenenbein M, Moffatt ME. House fire injury prevention update. Part II. A review of the effectiveness of preventive interventions. Injury Prev 1999;5:217–25. [19] Marshall S, Runyan C, Bangdiwala S, Linzer M, Sacks J, Butts J. Fatal residential fires: who dies and who survives. J Am Med Assoc 1998;279:1633–7. [20] Arena G, Cordova S, Gavin A, Palamara P, Rimajova M. Injury in Western Australia: a review of best practice, stakeholder activity, legislation, and recommendations for selected injury areas. Technical report no. RR122, Injury Research Centre, University of Western Australia; 2002. [21] McKnight RH, Struttmann TW, Mays JR. Finding homes without smoke detectors: one step in planning burn prevention programs. J Burn Care Rehab 1995;16:548–56. [22] Leth PM, Gregersen M, Sabroe S. Fatal accidents in house fires. The most significant causes, such as smoking and alcohol abuse, multiplied by four the incidence during the last 40 years. Ugeskrift For Laeger 1998;160:3403–8. [23] McGwin Jr. G, Chapman V, Curtis J, Rousculp M. Fire fatalities in older people. J Am Geriatr Soc 1999;47:1307–11.