Sue Ieraci: Protecting old blokes

PICTURE this: an elderly couple and a ladder. A tall ladder, specifically an extension ladder, extended to its maximum.

This is the scene I witnessed on a recent walk. The base of the ladder was in the front garden, its top section leaning against the bull-nose iron of the front veranda; the elderly man stood at the base, wearing sheepskin boots (safety-Uggs? I wondered).

My offer of help refused, I walked on with unease.

Working for so long in emergency medicine, images danced in my mind of other elderly men and ladders — “silly old bugger injuries”. This syndrome is common when older men, with too much time on their hands and too proud to ask for help, interact with ladders and roofs.

My late father sustained such an injury. Having tied his extension ladder to the trunk of a tree that he wanted to trim, when he climbed up, the ladder stayed put, but he fell several metres into the garden. The resulting injuries, hospital stay and secondary pulmonary embolus led to a slow recovery at his advancing age.

The interaction of (usually) older men with ladders is a fruitful area for injury prevention. What are the risk factors? The man is generally retired — finally he has lots of time on his hands to get up there and finish all those jobs. Next, he has been collecting all the right tools for years — now is the chance to use them.

And what happens up that ladder? Well, a combination of loss of youthful balance, slowing of reflexes and increasing frequency of dizziness come together to create chaos.

The general focus of injury prevention in the elderly relates to preventing falls by looking at various home modifications and medication management issues. There is relatively little work, however, on injury prevention for the older home handyman.

The winter 2006 issue of Hazard (the newsletter of the Victorian Injury Prevention Unit) described the epidemiology of ladder-related injuries. The article noted that ladder fall fatalities and injuries peak in middle-aged and older men.

Research published in the MJA shows that most major trauma involves men aged over 50 years conducting maintenance activities in the home or garden. Risky tasks include painting, pruning and clearing out gutters.

While industrial sites are regulated by occupational health and safety laws, including regulations for working at heights, no such controls exist in the home environment.

As the Hazard article notes, older men conduct home maintenance tasks for a range of reasons — not just financial — including satisfaction and pride in task completion. “Knowing when to give up DIY tasks appeared to be a complex and emotive issue”, the authors said.

Perhaps every elderly man presenting for a prostate or blood pressure check should also be given injury prevention information that relates to the risks involved with being a home handyman. A preventive history could include questions about ladder use, home maintenance practice, and some tactful counselling about the hazards of ladders.

Alternatively, the focus could be on the wives. “Whatever you do, if you want to hang on to the silly old bugger, don’t let him get up a ladder!”

Dr Sue Ieraci is a specialist emergency physician with 25 years’ experience in the public hospital system. Her particular interests include policy development and health system design, and she has held roles in medical regulation and management. She also runs the health system consultancy SI-napse.

Posted 12 September 2011