Diving More Deadly Over Age 50?

Aviva Diodato came from Surprise, AZ to the Florida Keys for a dive trip with Islamorada’s Key Dives in April, but things did not go as planned. According to the Monroe County Sheriff’s Office, the group began its first dive of the day to the Eagle wreck when Diodato, 51, indicated she wanted to return to the surface. The instructor helped her to the surface, then returned to the group underwater. Diodato made it back to the stern of the Giant Stride and was removing her gear when she started to drift. When crew couldn’t reach her, they banged on the ladder to call divers to the surface. Once they were on board, the boat went after Diodato. They found her 20 minutes later, floating on the surface, not breathing. The crew pulled her onto the boat and started CPR but her heart had stopped.

At the time of her death, Diodato was the third diving fatality in the Florida Keys this year. And like her, the two other victims were in their 50s. Monroe County Medical Examiner’s records dating back to September 2008 show that 10 of the 16 divers who died during that time were at least 50 years old. So, when this information was reported in an April issue of the Key West Citizen, it was entitled: “50s More Deadly for Divers.” The same month, an article in the London newspaper The Telegraph was headlined: “Extreme Sports Killing the Elderly.” It reported that nearly 20 percent of all injury claims resulting from sports like diving and skiing, were made last year by Britons aged 70 or older, compared to just 5 percent in 2006. A third of the 212 people in British diving incidents requiring medical treatment last year were over 50, a significant increase compared to previous years.

Putting Death Rates in Perspective

Are the deaths among age 50-plus divers on the rise? Should senior divers stay out of the water? We know plenty well how editors write eye-catching headlines to hook readers, and figure multiple mentions of “deadly” and “dangerous” will keep eyeballs glued to the page. But we decided to ask researchers tracking dive deaths whether these articles are blowing things out of proportion.

Nicholas Bird, head of the medical department at Diver Alert Network (DAN), said, “as the general U.S. population ages and the number of people with disposable income also ages, the relative percentage of divers over age 50 is increasing. So it is safe to say that in the population over age 50, age- or cardiac-related deaths are increasing.”

Jim Watson, safety manager at the British Sub-Aqua Club (BSAC), told us that U.K. incident statistics show that “the number of ‘older’ divers who are dying when engaged in diving activities is disproportionate to their representation within the diving population, rather than more older divers dying.” He said the data reported in the Telegraph article are less comprehensive than those in the BSAC Incident Report (www.bsac.com/incidents) because they only include incidents where there was some Coastguard involvement. BSAC reports that around 16 percent of the U.K. diving population is aged over 50, but of fatalities in the last two years, 57 percent were those over 50. However, the 12-year average records 27 percent of fatalities were over 50.

The 50-plus group also has more money to take high-risk dives. Some dive shop owners say the reason many dive fatalities occur among older people is simply that they are the majority of people putting on a tank these days. Who else can afford buying pricey dive gear, plus $125 for a two-tank dive day?

“The recent changes may in part reflect an aging diving population, but they may equally reflect a temporary perturbation due to the very small sample size,” Watson said. “Given that the over-50 group is generally at an increased risk of death through medical related problems and that many, if not most, of the diving deaths seem to have a non-diving medical problem associated with them, then the 50+ mortality rate may not be significantly out of line with the overall population’s mortality rate. The numbers are relatively small to be statistically significant.”

Studying the ages of DAN members and all dive fatalities from 1992-2003, researchers found the annual fatality rates for divers up to age 25 were 10 per 100,000 divers, while for divers age 65 and over, the rate was 35 per 100,000 divers. The number of cardiac-related deaths in divers under age 35 was less than five percent, but for divers over age 50, it was 30 percent. They are 13 times more likely to have a disabling cardiac injury than younger divers.

Diving Itself Isn’t the Only Stressor

DAN medical researcher Petar Denoble told the Key West Citizen earlier this year that chronic - - and frequently unknown - - cardiac problems are often at the root of diving fatalities. “They cause acute episodes that exacerbate underwater, and divers drown.” In looking at pre-diving health screening, DAN researchers note that a diver could follow all the available medical advice, get an annual physical checkup, and still have a health-related problem on a dive.

Diving is a big stressor but it doesn’t necessarily lead to a diver having major cardiac problems under the surface. Dive deaths for the over-50 set can also be precipitated by other factors. Lack of conditioning is a big one, and older divers lack it greatly, says Ern Campbell, M.D., a.k.a. the blogger ScubaDoc. “The majority of elderly divers do not exercise regularly or adequately,” he writes on his website. Therefore, while the fatality rate will be skewed because so many deaths are from heart attacks, one’s fitness level, agility, flexibility and strength - - or lack of these -- also play a role in what happens underwater.

DAN suggests that all divers 35 and older have an annual physical exam. But one doesn’t need a physical exam to be certified. Instead, trainees typically fill out a liability waiver, which includes multiple questions about their health and medical conditions. However, as we wrote earlier this year, it is easy for divers to lie and write “no” on the “do you have these conditions” checklist when they should be writing the opposite.

Some people in the industry say common sense is the best way for all divers, young and old, to stay safe. “They’re certified divers. They have a right to dive,” Brenda Mace, owner of Conch Republic Divers in Tavernier, told the Key West Citizen. “We cannot nor should the dive operator be responsible for the health of divers. It is an extreme sport.” She said that a few times through the years, she has refused a customer due to his physical condition, but such a move by a dive shop is extremely rare.

Bird says dive shops should not play medical gatekeeper and be in a decision-making place that is not appropriate for them. “It puts them in direct conflict with their customers. It falls on the shoulders of individual divers to make their medical decisions.” He recommends divers with questions about health issues call DAN. “We can help you find referral doctors, explain how health issues can affect diving, and try to liaise with your dive store or resort. Our goal is to promote upfront communication instead of lying on the dive shop questionnaires.”

Overall, however, age is just a number, and should not be the primary reason for not diving. “Really the issue is a diver’s underlying health status,” Bird says. “You can have a healthy 60-year-old diver and an unhealthy 40-yearold diver on the same boat, so if you’re looking at an accident waiting to happen, age should not be the factor to rely upon.”

Nonetheless, staying physically fit and being realistic about your health issues can keep you diving for a good long while. Doing the opposite, however, means you may not see the other end of age 65.

- - Vanessa Richardson