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Special Report: Drownings among Older Swimmers on the Rise

Griffiths, Tom, EdD; Griffiths, Rachel; Sempsrott, Justin, MD

doi: 10.1097/01.EEM.0000535016.26988.2d
Special Report

Dr. Griffiths is the president and founder of the Aquatic Safety Research Group, and has spent 38 years teaching, coaching, and managing aquatics at three major universities, producing videos, textbooks, articles, and presentations about aquatic safety. He and Ms. Griffiths are authors of the third edition of The Complete Swimming Pool Reference. Follow them on Twitter at @AquaticSafetyGr. Ms. Griffiths is the communication director of the Aquatic Safety Research Group and the president of Note and Float Life Jacket Fund, which donates life jackets to aquatic facilities. She recently received a Power 10 Advocate award from Aquatics International for her work with NFLJF. Dr. Sempsrott is an emergency physician who started out as a beach lifeguard in 1996, and was a founder of the nonprofit Lifeguards Without Borders, now serving as its executive director. He also serves as the medical director for the International Surf Lifesaving Association, Starfish Aquatics Institute, and Innovative Attraction Management Starguard Elite. He is a founding member of the International Drowning Research Alliance and a frequent author and lecturer on drowning prevention, rescue, and treatment. Follow him on Twitter at @LifeguardsWB. (Clockwise from top left.)

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Odds are, when you picture a drowning victim, you visualize a child or other inexperienced swimmer. But the remarkable fact is that drownings have decreased in all age groups except for one—those aged 45 to 84.

That figure from the National Center of Health Statistics is startling, especially because the rate rose by a whopping 9.7 percent. (NCHS Data Brief No. 149, April 2014; http://bit.ly/2qIngWR.) Of course, some of these drowning deaths were precipitated by major medical events while others occurred in bathtubs and in the open water. But one study found that 17 percent of drownings in Australia between July 1, 2002, and June 30, 2012, were adults over 65. (BMJ Open 2017;7[12]:e019407; http://bit.ly/2qGCbRl.) And a case series about triathlon competitors from 1985 to 2016 concluded that deaths and cardiac arrests during the events are not rare, most occurring during the swimming portion and among men primarily middle-aged and older. (Ann Intern Med 2017;167[8]:529.)

It's no surprise that the older population is growing significantly, in large part because of increasing life spans and aging of the baby boomers. (Centers for Disease Control and Prevention and the Merck Company Foundation. The State of Aging and Health in America 2007; http://bit.ly/2HcEnaf.) In fact, the population over 65 is expected to double, and will account for approximately 20 percent of the population by 2030 in the United States; that's 71 million Americans.

Of course, most older adults aren't participating in triathalons, but swimming often tops the list as exercise for them. It is also a safe choice because swimming does not place undue stress on the joints. By the numbers alone, this equates to more individuals recreating and exercising in the water.

Older adults, however, are more likely to have medical conditions and chronic diseases and are more likely to be on medications. The CDC reported, for example, that 63 percent of men and 64 percent of women ages 65-74 and 72 percent of men and 64 percent of women ages 75 and older have high blood pressure or take antihypertensive medicine. (“Older Persons' Health,” CDC, May 3, 2017; http://bit.ly/2qJZ46e.)

Many older lap swimmers attempting to increase their longevity and quality of life chose to swim laps in the safe confines of a swimming pool with certified and qualified lifeguards on duty, meaning that older swimmers and lifeguards must maintain a high degree of vigilance.

Take the case of Penn State Professor Michael Rothkopf, who was in his mid-70s. He had a ritual of swimming a mile for time every morning, but he died in 2008 while swimming at McCoy Natatorium in State College, PA. Less than two years later, State College School Board President Rick Madore died of an apparent heart attack while swimming laps at the State College YMCA. He was 51. A third case occurred in 2011 when Pierre Henri Robert Lallement, 48, died of natural causes while swimming laps in the McCoy Natatorium at Penn State. Lap swimmer Gerard Brault suffered a major cardiac event in the Welch swimming pool in State College in 2013, but this time, the lifeguard on duty was able to respond immediately and successfully resuscitate him. Perhaps not coincidentally, Lifeguard Luc Lallement, the son of the third victim who died, was the first lifeguard to respond.

It is important to emphasize that none of the four lap swimmers suffered a drowning event but each experienced a major medical malady in the swimming pool. The lifeguards in each case responded so quickly that water did not enter the lungs, and the men did not die from drowning. The rapid recognition and response by lifeguards on duty is an important aspect in decreasing swimming deaths. Water safety experts have seen an alarming increase in actual drownings of older lap swimmers because lifeguards were too slow, leaving victims submerged for minutes before responding.

Emergency physicians can help by recommending to any older lap swimmers they see to consult with their physician to be certain that exercise, particularly swimming, is advised considering their medical history. Also recommend that they swim with a buddy who is aware of their medical background, that they know when to say when so they don't place themselves in harm's way by swimming too long or too hard, and that they do not attempt hypoxic training or extreme breath-holding, which can activate underlying medical conditions. Older swimmers should also consider informing the lifeguards on duty of their condition and ask him to keep an eye out.

Lifeguards have to be alert when protecting older lap swimmers. They should walk along with the lap swimmers, which will keep them more alert and closer to the victim for rapid response. A lap swimmer should be checked whenever he stops swimming, and the lifeguard should respond immediately especially when the swimmer is face down on the water's surface or on the bottom of the pool. Remember, “When in doubt, pull them out,” and “More than 10 (seconds), get them!” Lifeguards must also be rescue-ready with their rescue and emergency resuscitation equipment at hand, knowing and practicing their Emergency Action Plan. Swimmers do die in the water.

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