TAKEN BY THE WIND: FRAIL ELDER WIND ADVISORIES?

To the Editor: My mentor in geriatric medicine, Dr. Robert Luchi, taught me that aging is an uneasy truce between the individual and the environment. After two of my patients recently died from complications of wind-related injuries, it occurred to me that perhaps we should be issuing wind advisories for frail elderly people. The first patient was a frail 76-year-old woman with numerous health problems related to her severe generalized atherosclerotic vascular disease. Her husband had parked their car facing into the wind. As the patient was exiting from the passenger side, a gust of wind slammed the car door against her. She sustained a comminuted, distal humerus fracture, a clavicular fracture, and lacerations with severe ecchymoses to her face and scalp. The distal humerus fracture required surgical stabilization. The patient died suddenly in the postoperative period. The second patient was an active 96-year-old church organist who was walking into a neighborhood liquor store when she discovered a friend sitting in the passenger seat of a car in the parking lot. My patient went over to speak to her friend. The car was parked with the wind behind it. The 96year-old approached the door from the front of the car. As the friend began to open the car door to exit, a gust of wind ripped the door from her hand and slammed it into the 96year-old, knocking her to the ground. She sustained a hip fracture, several pelvic fractures, and a distal forearm fracture. The hip and forearm fractures required surgical stabilization. She survived her surgery. Postoperatively, the patient, who was known for her wit and wisdom, mused, ‘‘This is what happens when the church organist is caught going into the liquor store.’’ She died of complications weeks later during rehabilitation. The friend who had been sitting in the car fell into a deep depression over these events. Although wind awareness is an integral part of sailing, it is rare to worry about the direction of the wind when driving or exiting a car. Gusty winds can turn car doors into lethal objects. Frail elderly people are no match for gusty winds hurling heavy car doors. Diminished muscle strength, balance, and bone density may leave them vulnerable to unexpected environmental forces. Although physicians can treat osteoporosis and can encourage proper diet and exercise to optimize strength and balance, should we also be issuing wind advisories for frail elderly people, much like the small craft wind advisories issued from the National Weather Service? As geriatricians, we help frail elderly people maintain the uneasy environmental truce, although ultimately gravity wins and pulls us all back to the earth.