During the summer months, older adults are at a significantly increased risk of suffering from heat-related illnesses, which are also known as hyperthermia. Hyperthermia includes heat stroke, heat edema, heat syncope, heat cramps, and heat exhaustion.
MDLinx spoke with Basil Eldadah, MD, PhD, chief, Geriatrics Branch, Division of Geriatrics and Clinical Gerontology, National Institute on Aging, National Institutes of Health (NIH). Dr. Eldadah also oversees the Claude D. Pepper Older Americans Independence Centers.
He offered an overview of heat-related illnesses in older adults, along with some tips for clinicians in preventing these illnesses in their older patients.
MDLinx: At what age do older people start having a significantly increased risk of heat-related illnesses? 50? 55? 60? 65?
Basil Eldadah, MD, PhD (BE): There are some data from the CDC (Centers for Disease Control and Prevention) looking at death rates from heat-related causes according to age groups—from infants to the oldest-old. The lowest death rate is in the age group of older children and young teenagers. Then there is a gradual increase in death rate with each successive decade of life. However, there is a sharp increase in the death rate in the 75- to 84-year-old category, and it’s even sharper in the 85+ category.
Older age is a major risk factor, but it’s not the only risk factor for heat-related illnesses. Medical conditions and a variety of medications can increase an individual’s risk. So, it’s possible that an 80-year-old person in robust health without any significant medical conditions might have a similar susceptibility to heat-related illness as a 65-year-old person with diabetes or cardiovascular disease (CVD), and who may be taking medications that are known to increase risk for heat-related illness.
MDLinx: What do these heat-related illnesses include?
BE: There are several different terms that are used in the vernacular that reflect the primary symptoms or presenting features: heat syncope or heat fainting, heat cramps, and heat exhaustion. And these are the milder forms.
Then you have heat stroke, defined as a core body temperature of 104°F or higher with evidence of organ damage or failure.
MDLinx: Are the older adults suffering heat stroke generally aware of what is wrong when symptoms start to present, or are they unaware of what is happening until it is too late?
BE: That’s one of the pernicious things about heat stroke: it affects the very systems that could help to address the condition. Heat stroke can affect brain functioning in a way that results in confusion, agitation, drowsiness, or stupor. It can look like someone is intoxicated.
As heat-related illnesses progress, the individual may not be aware of what is happening. Or if they are aware, they may not be able to take effective action to cool down.
The cognitive impairment that may accompany heat stroke can interfere with the recognition of it or the ability to do something about it.
MDLinx: What steps can older adults take to decrease their risks of heat-related illnesses?
BE: There are a variety of “common sense” measures aimed at prevention. When it comes to heat-related illnesses, it really is true that an ounce of prevention is worth a pound of cure.
- Stay out of the heat. Pay attention to not just the temperature, but also heat index, which incorporates both temperature and humidity.
- Wear light-colored, loose-fitting clothing.
- Wear a hat to protect against the sun.
- Maintain hydration.
- Take frequent breaks.
- Be in a cool environment. If home is not cool enough, seek out places that are, like libraries, malls, or community centers.
- Be aware of what the symptoms are. Be vigilant about whether those symptoms are occurring. Get away from the heat and cool down if they are occurring.
These are things that for many people are relatively easy to take care of. But for a lot of people, there are fundamental, structural issues that are not as easily addressed. For example, for those living alone or living in a place where there’s no ready access to A/C, or for those with restricted mobility. These are things that pose challenges in terms of prevention.
It’s not as easy as just flipping a switch to take care of them. These things require more social and policy interventions to ensure that our older family members or neighbors are looked after and taken care of, and that social or economic status doesn’t get in the way of older peoples’ ability to avoid heat-related illnesses.
MDLinx: What can clinicians do to decrease these risks in their older patients?
BE: The most important thing is to just be attentive to the risk factors that their individual patients have. There are risk factors beyond just age itself: the presence of medical conditions like diabetes, CVD, or respiratory or kidney diseases.
Be aware of patients’ medications that could interfere with their ability to regulate body heat. Things like antidepressants and other psychoactive agents, or medications that are given for heart disease or blood pressure, like beta blockers or diuretics.
Be aware of other risk factors, such as cognitive impairment that may interfere with somebody’s ability to take action; mobility restrictions that will interfere with somebody’s ability to get out of the heat; and an older individual’s social network.
Do they live alone? Do they have family who are nearby? Do they have neighbors who can check in on them frequently? Do they live in a place that has ready access to A/C? Do they live on the top floors of a multistory dwelling? If there is a power failure, would they be able to get downstairs and out of the building?
MDLinx: Should clinicians engage family members in working to decrease these risks? If yes, how?
BE: Family members can play an important role in decreasing those risks by checking in frequently and being aware of hot weather events. If family members are not geographically close, they can at least maintain frequent contact remotely and coordinate with neighbors who are close by to do frequent check-ins and ensure that older patients have access to air-conditioned spaces, and that they are taking appropriate preventive measures when necessary.
MDLinx: What is the take-home message to stress to clinicians regarding heat-related illnesses in older adults?
BE: Be attentive to all of the different risk factors and take appropriate measures to mitigate those risks.
Be attentive not only to the oldest-old, where the incidence of heat-related illness is highest, but also in older adults who may have predisposing conditions or living situations that elevate their risk.