DIVING OVER 50 YEARS OLD

[DocVikingo]

Hey Chilly,

For openers, seizures, lack of coordination, impaired judgment and other events unsafe for scuba can occur when blood sugar drops.

Cheers,

DocVikingo

 

[mattia_v]

As for your statement that the report finding of "78% of males and 90% of females were 40 yrs of age or older; 58% of males and 59% of females were 50 years or older" only serves to show that divers 50 years or older are at less risk than divers 40 yrs of age or older--well, that "dog" flat out don't hunt.

If you would have taken the time to peruse the DAN Annual Diving Report that I linked for you in my initial post above, you would have seen on page 14 that the percent of fatalities for the age groupings 40-49, 50-59 and 60-69 frankly tower over those for the other age groupings, with the 50-59 age group by far the most elevated of the lot.

With the possible exception of the outlying 70-89 group, if one were inclined to single out an age group from which to obtain medical clearance in order to dive, these findings would appear to form a somewhat defensible basis for setting the threshold at 40 and older.

I'm not a DAN member, so I can't actually access the report, but based on what you've written about it the big problem is (as Lorenzoid said) that we don't know enough about the underlying demographics. These are raw mortality figures, so simply numbers of deaths per age category. Without knowing how many divers are in each age group (at-risk population, i.e. what the incidence of death is per 100,000 divers in a specific age group), the numbers don't really mean a thing, and you can't conclude anything about age being a specific risk factor other than in the broadest sense that chronic cardiovascular disease is more prevalent in older people.

It would not surprise me to find out that a lot of (US) divers are in the 40-60 age bracket, based on completely non-scientific observations of divers in places I have dived. So I would expect a relatively high number of deaths in that age group. I think risk profile is - by far - more important.

Age alone is a fairly poor risk marker. So there's that. Exercise / Physical activity has been proven to be beneficial in all age groups, and in pretty much every disease you care to think of (including severe heart failure, coronary artery disease, diabetes, and so forth). Finally, there is very little evidence (in fact, no convincing evidence I can find) that screening for cardiovascular disease in asymptomatic, low-risk patients (i.e. less than 2 cardiovascular risk factors) has any effect on preventing cardiovascular events.

In fact, actively screening low-risk individuals (otherwise healthy people of any age with reasonable exercise tolerance) in many cases results in false-positive results, particularly for things like treadmill tests or even even resting ECGs, resulting in unnecessary stress, healthcare consumption, and very, very rarely in anything that modifies risk. There is, for example, very little evidence for survival or morbidity benefit to a lot of the 'routine' parts of an annual medical (a fairly uniquely American proposition which I find slightly baffling from my perspective as a European MD).

Primary care physicians here do screen, based on an initial risk assessment; an otherwise health person over the age of 65, or a person under the age of 65 with risk factors (overweight (BMI and waist circumference criteria), family history of diabetes or heart disease, smoking) will have blood glucose and cholesterol checked, and blood pressure measured. No more than that, unless symptoms dictate a different diagnostic approach. Certainly no resting ECG (no evidence that it helps any) or exercise ECG (which is only a suitable test in intermediate risk patients with symptoms of coronary heart disease, due to high false negative rates in high-risk patients with typical complaints and high false positive and false negative rates in low risk patients).

too long, didn't read: the data doesn't let us conclude much of anything about age and risk. Older divers are (naturally) at greater risk because they are older, but getting a note from the doctor or a physical is not going to modify the risk appreciably, and there is no good evidence for any form of screening in terms of preventing events in mostly healthy individuals. People with e.g. diabetes or heart failure may want to observe caution and consult their physicians due to the specific complications that can occur in both diseases, but in terms of cardiovascular stress, at recreational depths, if you can exercise on land, you can probably dive safely.

(obvious disclaimer: I am a doctor, but I am not your doctor, and I am not an expert in dive medicine)

 

[Lorenzoid]

I'm not a DAN member, so I can't actually access the report, . . . .

If you click on the link that @DocVikingo originally posted, DAN notes that the report is free for anyone to download. As it states, if you're not a DAN member, all you have to do is type in a first name, last name, and an email address.

Based on what you said, it seems to me that a better procedure for a dive op would be to have each prospective diver fill out a medical history form, and then ask for a doctor's statement from only those whose completed forms indicate they have some known health risk. This is similar to what most dive training agencies require when registering to take a course. I wouldn't object to this requirement, so long as I had the form made available to me in advance of my trip.

 

[mattia_v]

If you click on the link that @DocVikingo originally posted, DAN notes that the report is free for anyone to download. As it states, if you're not a DAN member, all you have to do is type in a first name, last name, and an email address.

Ah, didn't look far enough, thanks! Had a look, basic conclusions don't change. It's lots of raw data that means little for true risk assessment without a better handle on the underlying population statistics. What does strike me is that numbers are really quite low (few deaths), and are a combination of deaths while diving and deaths due to diving.

 

[Colliam7]

Is that "spike" based upon percentages or is it simply a sum total? If there are more divers now who are over 50 then it might be logical for there to be more fatalities in that age group.

That is a reasonable point to consider. And, DAN (nor any other entity as far as I know) is not in a position to quantify the overall denominator - distribution of age across all dives made, globally, in a given year. In this case, the denominator is the total number of diving-associated fatalities. From that perspective, in each year of the 4-year window (2010-2013), for which data are currently available, the largest percentage of fatalities were recorded in the 50-59 y.o. age group.

Yes, in fairness, it is possible that, if you look at dive fatalities as a percentage of total dives made, across each decade of life, the fatality rate might not be highest for the 50-59 y.o. age group, simply because the denominator of dives made by individuals in that group might be larger. But, that would be a stretch of speculation. What is far more telling, is that actuarial tables show an ever-increasing percentage death rate with advancing age (infant mortality within the first year of life perhaps being a notable exception) - the death rate, as a percentage of the total number of individuals in each decade of life, increases with age. That is reality. In the US, the lowest rate is seen in the 5-14 y.o. category. It gradually increases after that with each additional decade of life. The first noticeable spike - abrupt increase - is seen when the data for 35-44 and 45-54 y.o. groups are compared. The rate of death then doubles, when the 45-54 and 55-64 y.o. groups are compared. (These are US data but I suspect the trends are similar in Western Europe). The spike in diver deaths in the 50-59 y.o. group in the DAN data is quite consistent with this. One could reasonably ask, 'Why does it go down in the 60-69 y.o. group? Probably because - despite the comments about the aging diver population - more than a few people hang up their fins as they get into their 60s. Again, that is another reality. Citing anecdotes about individual older divers that we might know, and how fit they are, etc., may evoke heart-warming, fuzzy feelings. But, those individuals become less and less common (much less) when you move from the 50-59 age group, to the 60-69 and the 70-79 age groups.

My reaction to the original post has changed considerably - it has essentially completely reversed - as I have thought more about it over seven months. I confess that I was a bit offended at first. I am well over 60, a reasonably good and experienced diver, an active instructor, with generally good health and no notable cardiovascular history. Why should I be singled out? I initially found the premise of the thread - that because of my age I would need to have more documentation of my health status than a 49 y.o. if I chose to visit the location to dive - insulting. BUT, the more I have thought about it, the more it makes good sense to me - certainly, from the perspective of the dive op - and the more I agree with, and appreciate, the initial post. I think the dive op is trying to find a reasonable way to mitigate risk to the extent possible. And, the OP was simply asking for feedback on how best to do that.

As an operator of a dive shop in a remote location we are a long way from decent medical facilities . . . . in my experience insurance companies, including DAN, are useless in this area and I have not seen one yet been able to provide any assistance to someone needing medical treatment and customers have been left to make their own transport arrangements with local fishermen, in cash, and then worry about trying to reclaim money back later. . . . we are going to introduce a policy for over 50s to have medical clearance, irrespective of whether they answer yes or no to the medical questions.

It is too easy to initially see this as some sinister form of age discrimination. It isn't. The OP is addressing the reality of his situation. If an incident does occur with a student taking a course through the dive op, whether the dive op is in any way responsible or not, it will inevitably require considerable additional effort on the part of that operation. Moreover, what happens when a certified diver suffers an injury while diving from the dive ops charter boat. Even if the incident was entirely the fault of the diver - ran out of air because they weren't paying attention - the op has to bring them back to shore, arrange communication with medical resources etc. They can't just carry the diver off the boat and dump them in the sand or on the dock, and say, 'Good luck.' And, if there are not good medical resources in the locale, and there are not readily available transport facilities, the time and effort involved for the op may be even greater. That is also reality. His proposed approach will not eliminate all risk. A 40 y.o. might have a cardiovascular event while taking a course through the dive op. But, setting 50 as the age above which to require a 'real' medical will mitigate at least some of the risk.

I think the dive op is considering taking a reasonable step, to protect themselves. If I don't want to have to deal with a 'real' medical in order to dive there, I can choose not to go there (wherever 'there' is). And, if I decide that the diving there is phenomenal, and that is THE place I want to travel to, having to have a 'real' medical evaluation isn't a big deal. If I am over 50 I should be having periodic physicals anyway.

So, to the OP, in response to your original comment:

I am going to ask all course students over 50 to have a medical at home in order to be allowed to start a course, my only doubt at the moment is whether to have the same requirement for certified divers, or just to require them to have comprehensive insurance covering diving. My preference is for all over 50s to have a medical

Requiring it of students is more than reasonable. I think it is a very good idea. Requiring it of all certified divers over 50 is not at all outrageous. I suspect the time required of YOU / YOUR staff to verify insurance coverage is probably more than would be needed if you simply required a 'real' medical evaluation at home.

 

[tursiops]

I'm 75. I get an annual full physical, and a semi-annual checkup. I answer YES to four questions on the RSTC medical questionnaire. I do 125-200 dives a year, all over the world. I cave dive. I 'm a bi-weekly volunteer diver in a nearby aquarium. At my annual physical, I get my RSTC form signed on page 2, and use that during the year if needed. I get a special physical every two years to satisfy the aquarium requirements.

Now I'm committed to a dive location (not in the US) that wants a signed medical form (for over 70's) that is no older than one month.
I understand why, but it is irritating none the less, and it is my last time that I will deal with that operator.

 

[Colliam7]

Now I'm committed to a dive location (not in the US) that wants a signed medical form (for over 70's) that is no older than one month. I understand why, but it is irritating none the less, and it is my last time that I will deal with that operator.

I am sure it is irritating. I would feel the same way. And, discontinuing a relationship with the operator in the future is your privilege.

The harsh truth is that, as we age, conditions are imposed on us because of our demographics, that may not (in our completely objective and unbiased view, of course) necessarily be applicable to us individually. Some we can choose to not accept. For others, we have no choice IF we do not wish to give up something of value. As a pilot, if I am under 40, I only have to have a (3rd class) medical every 5 years. At age 40 and above, it is every 2 years. If I don't want to go through it every 2 years, I can choose not to fly. More than a few states require more frequent driver's license renewals for individuals over 65. In NC, if I am under 66, the renewal period is 8 years. If I am 66 or over, the renewal period is 5 years. If I feel I am being discriminated against because of my age, I can choose not to drive. In both cases, I have actively chosen to put up with the discrimination.

As my orthopedic surgeon likes to tell me (when I complain that some joint or boney structure doesn't work as well as it once did, or hurts a lot more when I use it than it did before), 'Getting old is not for sissies.'

 

[BRT]

If all dive operations decide they need to take this course it will open up opportunity for new dive operations.

 

[Colliam7]

If all dive operations decide they need to take this course it will open up opportunity for new dive operations.

Probably true. I don't get the sense that this is a trend, however. Rather, the OP made it clear that he is dealing with a particular environment, which is both remote and lacking in a well-developed medical infrastructure. So, my take is that he is just trying to limit the possible hassles that would be associated with a customer having a diving incident that required serious medical attention.

 

[BRT]

Most people I see doing lots of diving are over 50, many over 70. I'm sure there are active young divers but I sure don't see many of them. Here in the Northwest it is old gray haired people on the shores and on the boats. Down in Mexico often the same. If young people do come on the boat they usually are not there for the week, just for a day or two. If you want to tell us we are restricted in diving with your operation go ahead. There is another operation. We are going to die doing something. Might as well be diving.