Feb. 24, 2000 (Atlanta) - The man left his 88-year-old grandmother alone for just a few minutes. When he returned, the bottle of pine cleaner he had left on a countertop sat empty. She stood nearby, in a state of confusion. He called 911. At the emergency room, the woman didn't respond to voices, and her breathing was labored.
This true story, say the authors of an article in the medical journal Chest, illustrates a growing problem: that of people with dementia swallowing toxic substances, especially popular cleaning solutions containing pine oil. As the elderly population grows, and more people with dementia are cared for at home, they expect such stories to become more common.
In 1997, the U.S. Poison Control Registry reported nearly 10,000 instances of people drinking pine oil, with nearly 90% of those incidents taking place in the home, writes Gary P. Zaloga, MD, of the Washington (D.C.) Hospital Center.
While the elderly accounted for only 5% of those cases, Zaloga expects that number to rise. According to the American Geriatrics Society, more than 34 million Americans (12% of the U.S. population) are 65 and older, and this number will almost triple within 50 years.
When they swallow toxic substances, the elderly are at a greater risk of death than younger victims. Because of their aging bodies, their livers and kidneys do not remove toxins as well, and their stomachs allow greater amounts of toxins to be absorbed. Also, their immune systems are suppressed, meaning they are more susceptible to infections acquired after ingestion.
Zaloga notes that pine cleaners are particularly attractive because of their consumer-friendly labels, color and fragrance. "In addition," he writes, "pine oil is reported to have a pleasant taste."
After 16 days in intensive care, the grandmother in the case Zaloga cites died of pneumonia. Zaloga says that while death due to pine oil ingestion is relatively rare, occurring in less than 0.1% of cases, he saw a need to increase awareness of the issue.
The story points to other areas of concern, such as how homes where demented elderly patients live can be made safer, and how caretakers can prepare to deal with emergencies.
The Alzheimer's Association recommends that caretakers keep a list of emergency phone numbers, check fire extinguishers and smoke alarms, and regularly conduct fire drills. People with dementia who tend to wander can be enrolled in the association's national Safe Return program; call (800) 272-3900 to register.
While people with dementia diseases such as Alzheimer's may see precautions as a threat to their independence, experts say the dangers can be minimized. According to the Alzheimer's Association and the Alzheimer's Outreach organization, ways that caregivers and family members can unobtrusively create a safer environment include:
- Installing door locks out of sight
- Using safety devices such as childproof locks and doorknobs to limit access to places where knives, appliances, equipment, and cleaning fluids are stored
- Adding extra lighting in entries, outside landings, areas between rooms, stairways, and bathrooms, as changes in levels of light can be disorienting. Bright light can be diffused by removing or covering mirrors and glass-top furniture and cover windows with blinds, shades or sheer draperies
- Placing contrasting colored rugs in front of doors or steps to help the patient anticipate staircases and entrances
- Supervising the person in taking all medications
- Limiting the use of appliances and equipment such as mixers, grills, knives, and lawnmowers
- Putting safety caps over electrical outlets
- Keeping matches and lighters out of reach
- Using flame retardant sheets and mattresses
- Enclosing a portion of the yard to provide a secure area for enjoying the outdoors. Remove all poisonous plants, and keep garden chemicals in a locked cabinet
- Removing locks from bathroom doors and making sure medication, sharp objects and toxic chemicals are removed or locked away
- Elderly family members with dementia have been known to swallow harmful household products, particularly those that are fragrant and attractively packaged, like pine cleaners.
- Doctors say that fatalities are rare, but the risks merit attention.
- Organizations like the Alzheimer's Association provide information on how prevent many different types of accidents in the home.