0

U.S. Fire Administration/National Fire Data Center 

The Fire Risk to Older Adults


Topical Fire Research Series, Volume 4 – Issue 9 

December 2004 
T O P I C A L F I R E R E S E A R C H S E R I E S


The Fire Risk to Older Adults 

December 2004	 Volume 4, Issue 9 

Findings 

H In 2001, the elderly (over 64 years old) represented 12% of the U.S. population 

but suffered more than 30% of all fire deaths. 

H The relative risk of individuals aged 65+ dying in a fire is 2.5 times greater than 

the general population. The risk worsens as age increases: the risk is 1.8 for 

adults aged 65–74, but soars to 4.6 for those over age 84. 

H Smoking fires are the leading cause of fatalities among the elderly; cooking fires 

are the leading cause of injuries. 

H Older American Indians and African Americans are at much greater risk of dying 

in a fire than the older white population. 

H Older males are 50% more likely to die in fires than women. 

H The elderly are more vulnerable in a fire than the general population due to a 

combination of factors: mental and physical frailties, higher alcohol usage, 

greater use of medications, higher smoking incidence, and elevated likelihood of 

living in a poverty situation. 

Older Americans are burdened with the gravest fire risk in the United States and are consistently more threatened with injury or death by fire than any other segment of society. While admirable strides have been made in 

lowering the overall U.S. fire death rate in the last decade, fewer gains have been realized among the oldest age 

groups. 

Fire caused 4,007 deaths in 2001 according to the National Center for Health Statistics (NCHS) data. Older 

adults were disproportionately the victims—fire fatalities among persons aged 65 years or older in 2001 was 

1,250, accounting for more than 30% of all fire casualties that year. 

Currently, older adults comprise 12% of the U.S. population,1 and their ranks are growing. It is estimated that 

the older population will rise sharply between 2010 and 2030, the years when the baby−boom generation will be 

in retirement. Better health care and new developments in medicine continue to increase American life expectancy. 

By their 65th birthday, on average, Americans can expect to live another 17 years.2 At this rate, older adults would 

comprise 20% of the U.S. population by 2050 (Figure 1). The oldest of these mature adults—those persons 85 

years and older—are members of the fastest growing population group. 

At close to one−third of total fire deaths, the number of older Americans who die in fires across the nation is 

clearly high. The issue becomes even more concerning when the relative risk of fire death encountered by older 

Americans is compared to the rest of the adult population. 

S

S

U.S. Department of Homeland Security Federal Emergency Management Agency 

United States Fire Administration National Fire Data Center 

Emmitsburg, Maryland 21727 

http://www.usfa.fema.gov/statistics/reports/pubs/tfrs.shtm 

1 
0 

50 

100 

150 

200 

250 

300 

350 

400 

450 

POPULATION GROWTH PROJECTIONS 

Population 65+ 

Population (in millions) 

1900 1920 1940 1960 1980 2000 2020 2040 

FIGURE 1.

Total U.S. Population 

Source: Population estimates 1990–2000 from Appendix A, Detailed Tables, Tables 1 and 5, Demographic 

Trends in the 20th Century, Census 2000 Special Reports, November 2002, Series CENSR–4, 

http://www.census.gov/prod/2002pubs/censr−4.pdf; and Population estimates 2010–2050 from U.S. 

Census Bureau, 2004, “U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin,” 

http://www.census.gov.ipc/www/usinterimproj/, file natprojtab02a.xls. 

DEFINING RISK 

There are several ways to address the concept of risk with respect to fire casualties: absolute numbers of deaths 

and injuries, proportions (percent) of these casualties, rates (per unit, usually fires or population), and relative risk. 

Each measure is useful but in different ways and each has its drawbacks. The absolute number of casualties is an 

important consideration—it is a concrete measure of the size or magnitude of the problem, but does not address 

the magnitude relative to other aspects of the problem. In this case, proportions are used to compare the relative 

size of the problem. Yet, these proportions do not convey the magnitude of the problem, as does the absolute number of casualties. Neither of these two measures is useful for comparisons across different groups. For comparison 

across groups, a common basis is used to determine rates. These rates then account for any differences in group 

sizes that might affect the size of the problem.3 In comparing fire rates, the relative risk of dying or being injured is 

a helpful measure. The relative risk of a group is calculated by comparing its rate to the rate of the overall population. The result is a measure of how likely a particular group is to be affected. A detailed discussion of per capita 

rates and relative risk can be found in the Topical Series report, Fire Risk (Vol. 4, Issue 7, December 2004). 

ELEVATED RISK 

To be old is in itself a disadvantage in terms of fire risk. A disproportionate number of mature adults, aged 65 

years and older, die in fires each year. Mature adults can expect a relative risk of dying—that is, the per capita 

deaths per population of mature adults—in a fire that is 2.5 times higher than for the population as a whole. This 

statistic alone is troublesome, but when some subcategories of mature adults are more closely evaluated, the situation worsens. The relative risk of dying in a fire rises substantially for the oldest segment (Figure 2). Individuals 

aged 85 or older are 4.6 times more likely to die in a fire than the general population, while those adults aged 

65–74 are only 1.8 times more likely to suffer fire−related deaths. 

PHYSICAL AND MENTAL LIMITATIONS 

With advancing age, physical and mental capabilities decline, making it more difficult for older adults to see, 

smell, and hear clearly. Lessened senses increase the risk from fire; and when two or more senses are diminished, 

the fire risk for an individual increases dramatically. To make matters worse, older adults are more inclined to accidentally start a fire than younger adults. Often the elderly are close to the source of a fire—a cooking fire or a cigarette fire—and their clothes or bedding ignites. Because the aging process affects many of the senses, elderly persons typically have diminished sensation to pain and thus often do not seek timely treatment. All of these factors 

combine to severely increase the risk of death from fire for the elderly. 

Older persons also tend to have physical disabilities or ailments that hinder their mobility. Many are confined to 

wheelchairs. Such infirmities make it difficult for the elderly to react to a fire threat the way a younger adult could, 

and thus exacerbating the fire risk to this segment of the population. Alzheimer’s, dementia, or other disorders that 

affect mental functions (rational thought and actions) can further increase the fire risk through erratic or even dangerous behavior and the inability to recognize a hazard. 

2 
0.0 

2.0 

4.0 

6.0 

8.0 

AGE, GENDER, AND RELATIVE RISK OF FIRE FATALITY 

Male 

Female 

65–74 75–84 85+ 

Overall 

FIGURE 2.

Relative Risk 

Source: NCHS 2001 Mortality data; Table NA−EST2002−ASRO−03 − “Annual Resident Population Estimates of 

the United States by Age, Race, and Hispanic or Latino Origin: April 1, 2000 to July 1, 2002,” Population 

Division, U.S. Census Bureau, Release Date: June 18, 2003, http://www.census.gov/popest/ 

archives/2000s/vintage_2002/NA−EST2002−ASRO−03.html; and Population Division, U.S. Census 

Bureau, detail files for Monthly Population Estimates, 2000 to 2002, http://www.census.gov/popest/ 

archives/2000s/vintage_2002/files/2002RESIDENT2001MONTHS07_12.txt. 

Adults 65 years of age and older receive 35% of all prescribed medications in this country.4 Some medications 

cause drowsiness or affect judgment; others do not combine well with alcohol. This latter observation is important, 

as alcohol use is prevalent among elderly adults. According to NCHS data, more than 23% of adults 65 years and 

older report drinking alcohol 21 to 31 days per month. In comparison, only 6% of adults under age 35, 9% age 35 

to 44, and 13% age 45 to 54 drink alcohol as frequently. Alcohol alone can impair mental acuity, and older adults 

who combine medications and alcohol, or who abuse alcohol, face an even higher risk of starting a fire, not 

responding quickly enough to extinguish one, or not escaping the premises where a fire is in progress. 

Home healthcare for the elderly is accompanied by an elevated fire risk. Older adults often elect to remain at 

home, rather than confront long−term stays in healthcare facilities. Three−fourths of all home healthcare patients 

are over the age of 65.5 Only 4% of all Americans 65 years and over live in nursing homes and these tend to be the 

very elderly.6 Census data for 2000 support this—Americans are increasingly more likely to live in assisted living 

and nursing facilities as they age. For example, 18% of Americans 85 years and over live in nursing homes.7 While 

no one factor is solely responsible for the increased fire risk to elderly persons receiving home healthcare, smoking 

in the presence of oxygen is recognized as one important problem. 

CAUSES 

Fire and burns were the fifth leading cause of unintentional deaths among adults aged 65 and older in 2002.8 

Of theses deaths, smoking is the most common cause of fire deaths and the second leading cause of injury. Cooking 

is the most likely cause of fire injuries in older adults. Smoking, suspicious acts, and heating fires resulted in 59% 

of the fire deaths of older persons (Table 1). As also shown in the table, cooking, smoking, and open flame 

(including lighters, matches, and candles) fires caused 52% of the injuries. 

Smoking is common among the elderly. Smokers age 65 and older face a greater risk of fire injury and fatality 

than nonsmokers. Some elderly smoke in bed or while sitting in upholstered furniture and then fall asleep. Diminished sensory capabilities can result in longer response times for recognizing a danger. Diminished physical abilities 

can result in problems that are not an issue for more agile persons, such as knocking over an ashtray and not 

responding quickly enough to prevent a fire. Cooking is also a concern. The elderly may leave food cooking unattended or their clothing may catch on fire from a cooktop’s burner. They may also be incapable of extinguishing a 

cooking fire due to physical limitations or a confused mental state. 

WHERE OLDER ADULT FIRE DEATHS OCCUR 

Data from the National Fire Incident Reporting System (NFIRS) for 2001 indicate that 83% of fire injuries and 

deaths among individuals age 65 or older occur in residential structures. Of the 1,053 residential fire fatalities 

reported by NFIRS in 2001, 259 of them (25%) were adults 65 years and over. Of the 5,158 residential structure 

fire injuries reported that year, 578 (11%) were among adults 65 years and over. 

3 
TABLE 1. CAUSE OF FIRE DEATHS AND INJURIES IN ADULTS (percent) 

18–64 65+ 65–74 75–84 85+ 

DEATHS 

26.6 13.0 9.7 

0.9 0.0 0.0 0.0 0.0 

Smoking 33.5 35.9 32.3 

Heating 4.2 19.4 

Cooking 9.8 9.4 6.5 

Electrical Distribution 5.4 9.7 

Appliances, A/C 3.6 1.8 1.6 0.0 6.5 

8.8 9.4 5.8 9.7 

Other Heat, Flame, Spark 9.4 8.7 0.0 

Other Equipment 1.8 4.3 5.8 3.2 

Natural 0.9 0.0 0.0 0.0 0.0 

Exposure 1.5 3.0 2.9 3.2 

INJURIES 

12.7 8.2 8.4 8.6 6.9 

3.3 1.0 1.5 0.0 2.0 

Smoking 9.9 18.2 

Heating 6.9 8.6 9.4 

Cooking 22.2 26.3 26.7 

Electrical Distribution 5.4 9.6 8.9 

Appliances, A/C 6.2 8.4 

9.4 12.9 9.9 

Other Heat, Flame, Spark 6.3 5.9 6.5 6.9 

Other Equipment 4.5 2.4 3.9 1.6 1.0 

Natural 1.4 1.4 2.0 1.0 

Exposure 2.3 2.2 3.0 1.6 2.0

Fire Cause 

Incendiary/Suspicious 14.0 17.2 

Children Playing 

24.2 31.9 

11.0 7.8 10.1 

11.2 11.6 

7.3 3.1 10.1 

Open Flame, Ember, Torch 7.9 

10.9 7.3 

3.1 

3.1 

Incendiary/Suspicious 

Children Playing 

16.3 14.0 16.8 

8.1 7.9 

24.6 24.7 

11.3 7.9 

7.4 8.1 10.9 

Open Flame, Ember, Torch 15.8 10.8 

7.0 

1.1 

 Source: NFIRS 2001 data 

POVERTY 

When poverty and infirmity accompany old age, the fire risk is compounded. Elderly persons often live on 

fixed incomes. Old people who live alone live in poverty more frequently than those who live with a spouse or 

other persons. Many in this category are women who have outlived their husbands. One in ten older adults lives at 

or below the poverty level.9 

Housing for the poor is often substandard. Typically, such housing has not been well maintained. Building 

structures can be compromised, and building systems such as electrical and mechanical are often outdated, inadequate, or not operational. The result is a higher likelihood of damaged or fraying electrical wiring, faulty heating, 

and worn out household appliances. Heating in particular represents an elevated fire danger to the elderly, who 

frequently feel cold. When the central heating plant of a home does not work properly, the elderly will often rely 

on temporary sources of heat, such as portable space heaters, fireplaces, or even cooking ovens. This problem is 

especially severe in southern locales, which experience only intermittent demands for heating. Indeed, many residences in the South do not have central heating, and occupants are forced to rely solely on alternative heating. 

Smoke alarms have saved many lives since the mid−1970s when their use was widely encouraged for the first 

time. But many elderly persons live in housing without smoke alarms, or with alarms that do not work. Even in 

homes with operable smoke alarms, an elderly person with impaired hearing is at an elevated risk of not responding in time. 

RACE AS A RISK FACTOR 

The risk of death or injury from fire is not uniform among the U.S. population, and in some ways the distribution of casualties and injuries among the elderly reflect this disparity. The disadvantages of age are compounded for 

some races, and both race and gender affect an older adult’s fire risk. The problem is substantially more severe for 

African Americans and American Indians (Table 2). 

4 
TABLE 2. FIRE RISK


2001 2001 Death Rate Relative 

Gender/Race Population Fire Deaths (per million) Risk 

TOTAL POPULATION 

Total 285,317,559 4,007 14.0 1.0 

Male 140,075,610 2,455 17.5 1.2 

Female 145,241,949 1,552 10.7 0.8 

White 230,664,347 2,908 12.6 0.9 

African American 36,283,895 1,006 27.7 2.0 

American Indian 2,713,047 49 18.1 1.3 

Asian/Pacific 11,602,700 44 3.8 0.3 

White Male 113,863,214 1,777 15.6 1.1 

African American Male 17,256,399 616 35.7 2.5 

American Indian Male 1,357,962 33 24.3 1.7 

Asian/Pacific Male 5,609,267 29 5.2 0.4 

White Female 116,801,133 1,131 9.7 0.7 

African American Female 19,027,496 390 20.5 1.5 

American Indian Female 1,355,085 16 11.8 0.8 

Asian/Pacific Female 5,993,433 15 2.5 0.2 

Source: NCHS 2001 Mortality data; Table NA−EST2002−ASRO−03 − “Annual Resident Population Estimates of the United 

States by Age, Race, and Hispanic or Latino Origin: April 1, 2000 to July 1, 2002,” Population Division, U.S. Census 

Bureau, Release Date: June 18, 2003, http://www.census.gov/popest/archives/2000s/vintage_2002/ 

NA−EST2002−ASRO−03.html; and Population Division, U.S. Census Bureau, detail files for Monthly Population Estimates, 

2000 to 2002, http://www.census.gov/popest/archives/2000s/vintage_2002/files/2002RESIDENT2001 

MONTHS07_12.txt. 

Note: Relative risk may not compute due to rounding. 

0 

3 

6 

9 

12 

15 

AGE AND RACE AND RELATIVE RISK OF FIRE FATALITY 

African 

American 

White 

65–74 75–84 85+ 

Overall 

FIGURE 3.

Relative Risk 

Source: NCHS 2001 Mortality data; Table NA−EST2002−ASRO−03 − “Annual Resident Population Estimates of 

the United States by Age, Race, and Hispanic or Latino Origin: April 1, 2000 to July 1, 2002,” Population 

Division, U.S. Census Bureau, Release Date: June 18, 2003, http://www.census.gov/popest/ 

archives/2000s/vintage_2002/NA−EST2002−ASRO−03.html; and Population Division, U.S. Census 

Bureau, detail files for Monthly Population Estimates, 2000 to 2002, http://www.census.gov/popest/ 

archives/2000s/vintage_2002/files/2002RESIDENT2001MONTHS07_12.txt. 

American Indians have a 30% elevated risk for fire death and their older populations are even more vulnerable. 

Older American Indians have 3.7 times the risk of fire death as the overall population (Table 3). But it is the African 

American elderly, over age 85, who are most at risk—elderly African American males had over 21 times the risk of 

the general population and over 4 times the risk of all elderly in this age group; elderly African American females 

have 11 times the risk of the general population and over twice the risk of all elderly in this age group. As a group, 

older African American’s risk of death from fire rises at a much higher rate than the older white population (Figure 

3). Although it is not likely that race itself predetermines a person’s fire risk, poverty, access to adequate health 

care, and subsequent poorer health are recognized risk factors.10 But whatever the reason, African American 

elderly face a higher relative fire fatality risk than the white population, and that risk rises with age. 

GENDER AS A RISK FACTOR 

The risk of fire is not even across the genders as well. For the population as a whole, men are 50% more likely 

than women to be victims of fires (Table 2). This disparity holds for older adults as well, and increases slightly as 

the population ages. 

5 
TABLE 3. FIRE RISK FOR OLDER ADULTS (AGES 65 AND OLDER)


2001 2001 Death Rate Relative 

Gender/Race Population Fire Deaths (per million) Risk 

Total 

Male 

Female 

White 

African American 

American Indian 

Asian/Pacific 

White Male 

African American Male 

American Indian Male 

Asian/Pacific Male 

White Female 

African American Female 

American Indian Female 

Asian/Pacific Female 

35,353,266 

14,619,070 

20,734,196 

31,182,858 

2,915,629 

154,885 

904,344 

12,972,922 

1,112,495 

66,748 

384,994 

18,209,936 

1,803,134 

88,137 

519,350 

1,250 

638 

612 

942 

283 

8 

17 

473 

151 

5 

9 

469 

132 

3 

8 

35.4 

43.6 

29.5 

30.2 

97.1 

51.7 

18.8 

36.5 

135.7 

74.9 

23.4 

25.8 

73.2 

34.0 

15.4 

2.5 

3.1 

2.1 

2.2 

6.9 

3.7 

1.3 

2.6 

9.7 

5.3 

1.7 

1.8 

5.2 

2.4 

1.1 

Total 

Male 

Female 

White 

African American 

American Indian 

Asian/Pacific 

White Male 

African American Male 

American Indian Male 

Asian/Pacific Male 

White Female 

African American Female 

American Indian Female 

Asian/Pacific Female 

18,322,480 

8,301,935 

10,020,545 

15,908,293 

1,655,175 

95,278 

549,906 

7,283,120 

685,757 

43,615 

238,155 

8,625,173 

969,418 

51,663 

311,751 

471 

271 

200 

342 

119 

5 

5 

190 

75 

3 

3 

152 

44 

2 

2 

25.7 

32.6 

20.0 

21.5 

71.9 

52.5 

9.1 

26.1 

109.4 

68.8 

12.6 

17.6 

45.4 

38.7 

6.4 

1.8 

2.3 

1.4 

1.5 

5.1 

3.7 

0.6 

1.9 

7.8 

4.9 

0.9 

1.3 

3.2 

2.8 

0.5 

Total 

Male 

Female 

White 

African American 

American Indian 

Asian/Pacific 

White Male 

African American Male 

American Indian Male 

Asian/Pacific Male 

White Female 

African American Female 

American Indian Female 

Asian/Pacific Female 

12,582,484 

4,996,556 

7,585,928 

11,261,249 

934,936 

45,354 

279,498 

4,498,839 

337,353 

18,504 

117,658 

6,762,410 

597,583 

26,850 

161,840 

493 

243 

250 

381 

100 

2 

10 

188 

49 

1 

5 

193 

51 

1 

5 

39.2 

48.6 

33.0 

33.8 

107.0 

44.1 

35.8 

41.8 

145.2 

54.0 

42.5 

28.5 

85.3 

37.2 

30.9 

2.8 

3.5 

2.3 

2.4 

7.6 

3.1 

2.5 

3.0 

10.3 

3.8 

3.0 

2.0 

6.1 

2.7 

2.2 

ALL OLDER ADULTS (AGE 65+) 

AGE 65–74 

AGE 75–84 

(continued) 

6 
TABLE 3. FIRE RISK FOR OLDER ADULTS (AGES 65 AND OLDER) (cont’d) 

2001 2001 Death Rate Relative 

Gender/Race Population Fire Deaths (per million) Risk 

AGE 85+ 

Total 4,448,302 286 64.3 4.6 

Male 1,320,579 124 93.9 6.7 

Female 3,127,723 162 51.8 3.7 

White 4,013,316 219 54.6 3.9 

African American 325,518 64 196.6 14.0 

American Indian 14,253 1 70.2 5.0 

Asian/Pacific 74,940 2 26.7 1.9 

White Male 1,190,963 95 79.8 5.7 

African American Male 89,385 27 302.1 21.5 

American Indian Male 4,629 1 216.0 15.4 

Asian/Pacific Male 29,181 1 34.3 2.4 

White Female 2,822,353 124 43.9 3.1 

African American Female 236,133 37 156.7 11.2 

American Indian Female 9,624 – – – 

Asian/Pacific Female 45,759 1 21.9 1.6 

Source: NCHS 2001 mortality data; Population Division, U.S. Census Bureau, Table NA–EST2002–ASRO–03— 

National Population Estimates—Characteristics, Release Date: June 18, 2003, 

http://www.census.gov/popest/archives/2000s/vintage_2002/NA−EST2002−ASRO−03.html 

and Population Division, U.S. Census Bureau, detail files for Monthly Population Estimates, 2000 to 2002, 

http://www.census.gov/popest/archives/2000s/vintage_2002/files/2002RESIDENT2001MONTHS07_12.txt. 

Note: Relative risk may not compute due to rounding. 

CONCLUSION 

With an aging population, the U.S. demographic profile is changing rapidly. The elderly population is expected 

to increase from its current 12% of the total population to nearly 20% within a few decades.11 The assumption is 

that there will be a corresponding increase in fire deaths and injuries among older adults. Medical advances and 

improved healthcare could keep elderly persons vital for a longer time, but eventual physical and mental limitations 

are likely, and the increased risks of fire injury and death to this population merit special 

attention. 

Because older adults account for more than 30% of fire deaths and over 10% of fire injuries, the USFA has been 

working toward the goal of reducing fire deaths and injuries to older adults. A number of resources to help address 

the fire problem for adults are available. A Fire Safety Campaign for People 50−Plus (http://www.usfa.fema.gov/50plus) 

addresses lifestyle strategies of safe smoking, safe cooking, and safe heating to reduce the incidence of fires that 

traditionally affect older adults. 

To request additional information or comment on this report, visit 

http://www.usfa.fema.gov/applications/feedback 

Notes: 1 U.S. Census Bureau population estimates for 2001.


2 U.S. Department of Health and Human Services, Administration on Aging, The Growth of America’s Population, Washington, DC, 1997.


3 In the case of fire casualties, this common basis is a population of 1 million, which means that fire rates are measured by inci-


dents, deaths, or injuries per million persons population. 

4 B.G. Pollock, “Psychotropic Drugs and the Aging Patient,” Geriatrics, Volume 53, Supplement 1, September 1998. 

5 National Center for Health Statistics, Public Health Service, Advance Data No. 297, 1998. 

6 Nursing home estimate is computed from data from Before the Boom: Trends in Long−Term Supportive Services for Older Americans With Disabilities, AARP Public Policy Institute, 2002, http://research.aarp.org/health/2002_15_trends.pdf and 2000 census data.


7 “The 65 Year and Over Population: 2000,” 2000 Census Brief, October 2001.


8 Centers for Disease Control, National Center for Injury Prevention and Control, WISQARSt (Web−Based Injury Statistics Query


and Reporting System) interactive database system, http://www.cdc.gov/ncipc/wisqars.


9 U.S. Census Bureau, Poverty in the United States: 2002, Current Population Reports, Consumer Income, September 2003.


10 Socioeconomic Factors and the Incidence of Fire, United States Fire Administration, June 1997.


11 Older Adults and Fire, United States Fire Administration, Topical Report Series Vol. 1, Issue 5, Jan 2001 (rev. Dec 2001).


7