Last summer, a record-setting, five-day heat wave scorched Chicago, making headlines nationwide not just because of the sizzling temperatures — as high as 106 degrees Farenheit — but because older people died by the hundreds. By the time the heat wave was over, there had been more than 700 “extra” deaths, numbers so shocking that researchers from the city, state and the federal Centers for Disease Control and Prevention began poring over the data, searching for common denominators among people who died and those who did not.
Their conclusions, published earlier this month in the New England Journal of Medicine, and those of other advocates for the elderly, are closer to common sense than rocket science.
But their advice, simple as it is, could save your life or the life of an older person you love:
Lesson One — Don’t ignore the early signs of heat-related problems, because later stages — heat stroke — can be fatal.
Heat-related problems range from the mild and reversible — heat stress and heat fatigue — to heat stroke. In the early stages, you can recover quickly by drinking fluids, taking off excess clothing and getting yourself into a cooler environment, including a cold bath. If you wait until the later stages, it may take emergency medical help — intravenous fluids, ice packs and other interventions — to save your life.
Lesson Two — Drink fluids.
You can’t rely on thirst to tell you when to drink. In older people, the thirst mechanism, a built-in safeguard against dehydration, doesn’t kick in as readily as it does in young people, says Dr. Kate Ackerman, medical director for the geriatric section at Boston Medical Center. This means you must drink before you get thirsty.
The rule of thumb is that everyone should drink six to eight glasses of fluids a day — and more during a heat wave — and this is especially true for older people. You need to drink mainly because you need to sweat — evaporation of moisture from the skin is one of the body’s main ways of getting rid of heat.
But remember, some drinks don’t count. Water is good, as are some juices and drinks that contain minerals and electrolytes that your body also needs. But anything containing alcohol or caffeine — coffee, tea and some sodas — can act as a diuretic, making you lose water through urination, not sweat, and actually making it harder for the body to cool down.
Lesson Three — Be wary of diuretics and other medications.
Many older people take diuretics to control blood pressure. But if you’re dehyrated from the heat, diuretics can make things worse, says Dr. Jeanne Wei, chief of gerontology at Beth Israel Hospital. In heat waves, she says, older people may keep taking their diuretics “because nobody told them not to. So there they are lying on the floor because they forgot to drink, they lost all that water and now they’re too weak to get up.”
If you take diuretics, she says, ask your doctor whether you should continue at the same dose in hot weather. Many of her patients, Wei says, cut back and take diuretics only on a limited, set schedule, either three or four days a week, to prevent dehydration during hot weather.
Tranquilizers, sedatives and some drugs for cardiovascular problems can also interfere with sweating, so ask your doctor whether you should modify your medications during a heat wave.
Lesson Four — Don’t be a stranger.
One of the most sobering findings of the Chicago study was that social isolation raises the risk of heat-related death. The solution is obvious, though difficult to implement for those who are shy or fearful of their neighbors.
If you know an older person living alone, check on her or him every day when the temperature soars. If you are that older person, find someone else in your building or neighborhood and create a “buddy system” for checking on each other.
“Neighbors can do this for each other. This does not require government intervention,” says Al Norman, executive director of Mass Home Care, a consumer organization for the elderly.
Lesson Five — Take off that sweater.
Your ability to perceive temperature declines with age, says Terrie Wetle, deputy director of the National Institute on Aging. Older people “tend to feel colder at higher temperatures, to bundle up in sweaters,” she says, but overdressing can be dangerous. When it’s hot, you’re better off in light-weight, loose clothes, preferably natural fabrics like cotton, not fabrics that cling to your skin like polyester.
Lesson Five — Don’t put too much faith in fans.
Fans can speed evaporation by blowing dry air over sweaty skin, which helps cool you. But when the air gets too hot and humid, “even blowing it across the skin” doesn’t boost evaporation much, says Wetle.
Dr. Knox H. Todd, an Emory University emergency medicine specialist, was even more emphatic in an editorial accompanying the Chicago study: “Many agencies give electric fans to poor citizens to help them cope with the heat, but fans are useless when heat and humidity reach dangerous levels.” Which brings us to . . .
Lesson Six — But do try air conditioning.
In the Chicago study, researchers found that having an air conditioner or spending a few hours a day in air-conditioning can be protective. So if you have an air conditioner, don’t hesitate to use it, even if this means getting someone to help you turn it on.
“I had one patient who called saying she was so hot,” says Wei. “We asked if she had an air conditioner and she said yes, but it was not turned on” because she couldn’t figure it out. Once she did, she called back, amazed that she felt much better.
Wetle adds, “If you have an air conditioner and you know someone who doesn’t, invite them in for the hot part of day.”
And if you’re worried about the electric bill, remember that your health comes first; you can fight with the electric company later. Besides, electric companies, including Boston Edison, may help by setting up a budget plan to spread payments over the year and by offering discounted rates to people on public assistance such as supplemental security income (SSI).
But there’s a caveat to this. If you are in air conditioned area and get too cold, turn it off for a while and move around if you can. Some older people with air conditioning actually win up with hypothermia — a dangerous drop in body temperature — not hyperthermia, overly high body temperature.
Lesson Seven — If you can’t stand the heat. . .
If it’s too hot at home, try to get away to an air-conditioned mall, senior center or apartment lobby. But many older people cannot or will not leave home, even for a few hours, and if that’s your situation, open the windows when it’s cooler outside than in and and cross-ventilate by opening windows on opposite sides of your home. In the morning, however, it may help to trap cooler nighttime air inside by closing windows and blinds.
Lesson Eight — . . .stay out of the kitchen.
Not really, of course, but don’t use the oven when it’s hot. Have salads or sandwiches instead.
Lesson Nine — Get help.
If you think you — or the buddy you’re checking on — are becoming ill from the heat, don’t hesitate to call your doctor, a nearby emergency room or 911.
SIDEBAR:
Heat’s many miseries
Heat fatigue is a feeling of weakness brought on by even higher temperatures. Symptoms include cool, moist skin, a weak pulse and feeling faint. Remedy: Same as above. If you don’t feel better in a hour, call someone to check on you.
Heat syncope is dizziness, often after exercising in the heat. The skin is pale, sweaty and cool. The pulse may be weak and the heart rate rapid. Body temperature is normal. Remedy: Lie down immediately. As soon as you can, call a doctor.
Heat cramps are muscle spasms in the abdomen, arms or legs that often follow strenuous activity. The skin is moist and cool and the pulse is normal or slightly raised. Body temperature is usually normal. Heat cramps are caused by a lack of salt, but don’t take salt supplements without checking with a doctor. Remedy: Drink fluids, such as tomato juice, that contain minerals and electrolytes, sodas containing sodium or preparations like Gatorade. Call a doctor if in doubt or if cramps persist.
Heat exhaustion is a sign your body is getting dangerously hot. You may be thirsty, giddy, weak, uncoordinated, nauseous and sweating profusely. Body temperature is usually normal and the pulse is normal or raised. The skin is cold and clammy. Loss of water and salt can cause heat exhaustion but again, don’t take salt supplements without checking with a doctor. Remedy: Drink fluids and call a doctor.
Heat stroke can be life-threatening — in fact it kills 1,300 to 1,500 a year. Body temperature rises above 104 degrees Farenheit. Heat stroke also can cause confusion, combativeness, bizarre behavior, faintness, staggering, strong rapid pulse, dry flushed skin, lack of sweating, possible delerium or coma. If you find someone with these symptoms, call 911 immediately and get patient to an emergency room nearby.
For more information on coping with the heat, call:
– 911 or your local hospital emergency room if you are concerned about someone with dangerous heat-related symptoms.
– Your local council on aging for tips on coping with heat and information on shelters. In Boston, call the mayor’s 24-hour hotline, 617-635-4500 begin_of_the_skype_highlighting 617-635-4500 end_of_the_skype_highlighting or the Commission for the Elderly, 635-4366. During heat emergencies — defined in part as three consecutive days of temperatures of 86 degrees or more — there is also special heat hotline, 635-HEAT (635-4362).
– For general information, call 1-800-AGE-INFO begin_of_the_skype_highlighting 1-800-AGE-INFO end_of_the_skype_highlighting (or 800-243-4636 begin_of_the_skype_highlighting 800-243-4636 end_of_the_skype_highlighting), a hotline run by Mass Home Care, a consumer rights group.
– For more general information, 1-800-882-2003 begin_of_the_skype_highlighting 1-800-882-2003 end_of_the_skype_highlighting, the hotline of the state Executive Office of Elder Affairs.
– Your local electric company, if you have SSI (supplemental security income) and want a discount on your electric bill.
Heat stress is a general term for the strain placed on the body by hot weather. Remedy: Drink fluids — a quart an hour — and try to stay out of the heat. If you can’t, doctors suggest that you sit in a cold bath with light clothes on, get your hair wet, then walk around the house with your wet clothes on.
SIDEBAR:
Heat’s many miseries
Heat fatigue is a feeling of weakness brought on by even higher temperatures. Symptoms include cool, moist skin, a weak pulse and feeling faint. Remedy: Same as above. If you don’t feel better in a hour, call someone to check on you.
Heat syncope is dizziness, often after exercising in the heat. The skin is pale, sweaty and cool. The pulse may be weak and the heart rate rapid. Body temperature is normal. Remedy: Lie down immediately. As soon as you can, call a doctor.
Heat cramps are muscle spasms in the abdomen, arms or legs that often follow strenuous activity. The skin is moist and cool and the pulse is normal or slightly raised. Body temperature is usually normal. Heat cramps are caused by a lack of salt, but don’t take salt supplements without checking with a doctor. Remedy: Drink fluids, such as tomato juice, that contain minerals and electrolytes, sodas containing sodium or preparations like Gatorade. Call a doctor if in doubt or if cramps persist.
Heat exhaustion is a sign your body is getting dangerously hot. You may be thirsty, giddy, weak, uncoordinated, nauseous and sweating profusely. Body temperature is usually normal and the pulse is normal or raised. The skin is cold and clammy. Loss of water and salt can cause heat exhaustion but again, don’t take salt supplements without checking with a doctor. Remedy: Drink fluids and call a doctor.
Heat stroke can be life-threatening — in fact it kills 1,300 to 1,500 a year. Body temperature rises above 104 degrees Farenheit. Heat stroke also can cause confusion, combativeness, bizarre behavior, faintness, staggering, strong rapid pulse, dry flushed skin, lack of sweating, possible delerium or coma. If you find someone with these symptoms, call 911 immediately and get patient to an emergency room nearby.
For more information on coping with the heat, call:
– 911 or your local hospital emergency room if you are concerned about someone with dangerous heat-related symptoms.
– Your local council on aging for tips on coping with heat and information on shelters. In Boston, call the mayor’s 24-hour hotline, 617-635-4500 begin_of_the_skype_highlighting 617-635-4500 end_of_the_skype_highlighting or the Commission for the Elderly, 635-4366. During heat emergencies — defined in part as three consecutive days of temperatures of 86 degrees or more — there is also special heat hotline, 635-HEAT (635-4362).
– For general information, call 1-800-AGE-INFO begin_of_the_skype_highlighting 1-800-AGE-INFO end_of_the_skype_highlighting (or 800-243-4636 begin_of_the_skype_highlighting 800-243-4636 end_of_the_skype_highlighting), a hotline run by Mass Home Care, a consumer rights group.
– For more general information, 1-800-882-2003 begin_of_the_skype_highlighting 1-800-882-2003 end_of_the_skype_highlighting, the hotline of the state Executive Office of Elder Affairs.
– Your local electric company, if you have SSI (supplemental security income) and want a discount on your electric bill.
Heat stress is a general term for the strain placed on the body by hot weather. Remedy: Drink fluids — a quart an hour — and try to stay out of the heat. If you can’t, doctors suggest that you sit in a cold bath with light clothes on, get your hair wet, then walk around the house with your wet clothes on.