Summer Safety for Older Adults

Last June, as summer temperatures were climbing, I wrote about the risk of summer heat and strategies to help older patients avoid dehydration. That’s one of the serious health conditions that occur as temperatures reach 90°. Another risk is hyperthermia, leading to heat exhaustion and its most serious form, heat stroke. As you now “think like a geriatrician,” focus on helping older adults keep their cool this summer.

If you want a refresher on tips to avoid dehydration, check the June 2015 archives.

Every summer, as temperatures and humidity indices rise, I have a more than a few flashbacks to the summer of 1995, specifically the month of July. As the chief resident for the department of internal medicine at University of Chicago Hospital, I was steeling myself for the challenges of welcoming and supervising the newest cadre of recently degreed medical interns to our urban home on Chicago’s south side. Little did I know how quickly we would be tested beyond anything we could have anticipated.

In his book, Heat Wave: A Social Autopsy of Disaster in Chicago, Eric Klinenberg sets the scene:

“On Thursday, July 13, 1995, Chicagoans awoke to a blistering day on which the temperature would reach 106°. The heat index, which measures how the temperature actually feels on the body, would hit 126° by the time the day was over. Meteorologists had been warning residents about a two-day heat wave, but these temperatures did not end that quickly. When the heat wave broke a week later, city streets had buckled; the records for electrical use were shattered; and power grids had failed, leaving residents without electricity for up to two days. And by July 20, more than 700 people had perished—more than twice the number who died in the Chicago Fire of 1871 and 20 times the number of those struck by Hurricane Andrew in 1992—in the great Chicago heat wave, one of the deadliest in American history.”

Klinenberg’s book presents a comprehensive analysis of the numerous social factors that played a role in the catastrophe. It’s an intelligent and important analysis that highlights the interconnectivity of an elder’s health status and social status. It is a powerful example of the fact that anyone aiming to provide quality health care to an elder necessarily must know the world in which an elder lives.

Two of the critical medical issues that created morbidity and mortality in the heat wave were dehydration and hyperthermia. Elderly patients are at increased risk for both conditions. Below are some key points to keep in mind.

Recall from Physiology 101 the term “homeostasis.” It occurs when the body’s physiologic checks and balances function properly to keep all systems operational and appropriate in relation to each other. Circulating blood volumes are normal, keeping blood pressure normal so that arterial tone is normal, and all are appropriately responsive. A key and nearly universal change in the aging process is the diminution of the abilities of homeostatic processes, termed homeostenosis. Imagine any process being just a bit slower, less reactive, less able to respond in a timely fashion to a normal physiologic change, and far less able to respond to a large perturbation of normal function.

As we age, we are more prone to heat stress for the following reasons:

• An older adult’s body does not adjust as well as a younger body to sudden changes in temperature.
• Older adults may not feel hot even when their temperature is dangerously high.
• Older adults are more likely to have a chronic medical condition that changes normal body responses to heat. Examples can include thyroid disease and peripheral vascular disease.
• Older adults are more likely to take prescription medicines that impair the body’s ability to regulate its temperature, inhibit perspiration, or blunt the response to developing dehydration.

Teach your patients and their families that temperatures above 90° are dangerous. When temperatures reach 90°, caregivers should check on older adults, and older individuals should heed the following recommendations:

• Turn on the air conditioning or go to an air-conditioned facility such as a shopping mall, grocery store, senior center, movie theatre, museum, or library. (Fans are not adequate.)
• Drink lots of water and other clear drinks that don’t contain alcohol or caffeine (these can “dry you out.”)
• Take cool showers, baths, or sponge baths.
• Wear lightweight light-colored, loose-fitting clothing. Clothes made of lightweight cotton are a good choice.
• Stay out of the sun and wear a hat when going outside.
• Avoid exercise outdoors if the temperature is 90° or higher. Keep exercising but adjust the time to avoid the 90°+ temps. Walk at the mall, cruise the grocery store aisles, or use an indoor swimming pool.

The American Geriatrics Society’s Health in Aging Foundation offers an excellent handout created for patients. Find “Hot Weather Safety” at www.healthinaging.org. Included in the handout are emergency steps to take if you observe someone with signs of heat stress.

What to Do for Heat Stress

If you observe any signs of severe heat stress, you may be dealing with a life-threatening emergency. Have someone call for immediate medical assistance while you begin cooling the affected person. Perform the following:

• Get the person to a shaded area.
• Cool the person rapidly, using whatever methods available. For example, immerse the person in a tub of cool water, place the person in a cool shower, spray the person with cool water from a garden hose, sponge the person with cool water, or—if the humidity is low—wrap the person in a cool, wet sheet and fan him or her vigorously.
• Monitor body temperature and continue cooling efforts until the body temperature drops to between 101° and 102°.
• If emergency medical personnel are delayed, call the hospital emergency department for further instructions.
• Do not give the person alcohol to drink.
• Get medical assistance as soon as possible.

— Rosemary Laird, MD, MHSA, AGSF, is a geriatrician, executive medical director of senior services for Florida Hospital at Winter Park, and past president of the Florida Geriatrics Society. She is a coauthor of Take Your Oxygen First: Protecting Your Health and Happiness While Caring for a Loved One With Memory Loss.