SAFETY continued
something. You should pay attention when you see trends, especially if others notice them too. Potential warning signs in older divers include repeatedly forgetting critical pre-dive steps such as turning on breathing gas, opening the cylinder valve fully, or checking dive computer batteries. There may be increased reliance on others to set up or verify gear prepa- ration and configuration when the diver previously handled this independently. Some divers start having trouble remem- bering the dive plan, even after reviewing it several times shortly before the dive. Others become confused about nav- igation cues, have difficulty retracing a simple route, or find themselves getting turned around more often than in the past. Difficulty following multi-step instructions can appear, such as “If we lose the line, we’ll do this, then that, then ascend to a specific depth.” Underwater, there may be slower responses to hand signals or delayed understanding of basic communication. Anxiety or disorientation at depth may increase compared with previous years, even on routine dives at familiar sites. Decision-making may become uncharacteristic, either more impulsive (“We’ll just go a bit deeper, it’s fine”) or more hesitant and indecisive than before. Importantly, these signs should trigger curiosity and evaluation, not fear
Any medication that can cause drowsiness, confusion, or slowed thinking on land is certainly a red flag underwater. Divers should review all medications with a physician or a specialist familiar with diving medicine, or call the Medical Department at Divers Alert Network (DAN) to get information to help understand how these drugs might interact with depth, narcosis, and exertion. The interaction of aging, narcosis, and breathing gas choices is particularly important. Age doesn’t “cause” narcosis, but slower processing and reduced cognitive reserve can make the effects of narcosis more impactful. A younger diver with sharp working memory may remain functional at a narcotic load that would seriously impair an older diver already working near their cognitive limits. Even modest narcosis can tip an older diver from “a bit slow” to “unable to manage multiple tasks” at depth. That has practical implications. As we age, it makes sense to be more conservative with depth. What felt easy at 100 feet at 35 may not be quite as manageable at 65. Breathing gas choices for the older technical diver require thought; using mixes that reduce narcosis, such as trimix on deeper dives, may be beneficial but only as part of a comprehensive training and risk-management strategy. Above all, we must recognize that narcosis plus cognitive aging plus environmental stress can multiply risk, not just be additive.
or shame. The goal is to understand what’s happening and adapt, not to ground someone from diving unneces- sarily. Not all cognitive decline is “just aging.” Some causes are preventable, treatable, or at least modifiable. Cardiovascular disease and hypertension, for example, can reduce brain perfusion or lead to
The key to safe diving at any age is safety margin and proper risk management. As cognitive reserve gradually changes, we can preserve safety by increasing those margins and simplifying our dives.
The key to safe diving at any age is safety margin and proper risk man- agement. As cognitive reserve gradually changes, we can preserve safety by in- creasing those margins and simplifying our dives. That starts with the dive profile. Older divers do well to prefer
small-vessel disease that affects memory and cognitive function. Diabetes, especially if poorly controlled, can impair cognition both acutely and chronically. Sleep disorders, especially sleep apnea, can dramatically affect attention, reaction time, and judgment by disrupting sleep night after night. Depression and anxiety often reduce concentration and working memory. Then there is mild cognitive impairment or early dementia, which may be quite subtle at first but worsen under stress or in unfamiliar contexts, such as an underwater emergency. Medications add another layer. Older divers are more likely to be taking sedatives or sleep medications, certain “Z-drugs” or benzodiazepines. Anticholinergic medications used for bladder issues, allergies, or nausea can impair cognition. Pain medications, especially opioids, and some anti-anxiety or anti-seizure medications can cause drowsiness or confusion.
shallower, shorter dives, especially in challenging environments. We should avoid combining stressors; deep, cold, current, and low visibility are not the conditions to test limits. Breathing gas reserves can be increased beyond what we once considered acceptable; larger rock-bottom reserves, more conservative turn pressures, and generous surface intervals all help. Task loading is another area where we can build margin. It’s worth taking an honest look at equipment and procedures. If gear complexity is no longer adding value, consider sim- plifying. If you’re not actively using a piece of equipment, ask whether it is truly necessary or just one more thing to monitor or misconfigure. Underwater, limit significant mul- titasking. If you’re doing photography or video, treat navigation and breathing gas checks as priority tasks with scheduled SCUBA DIVING INDUSTRY | 9
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