How Do We Protect Older Population From Frequent Heat Waves?

Thomas Kron, MD

July 25, 2022

It is well known that severe heat is not only uncomfortable but also dangerous, especially for older people and their cardiovascular systems. However, heat exposure is often overlooked as a cardiovascular risk factor, according to the authors of a systematic study analysis.

The researchers who conducted the analysis discovered a significant correlation between temperature increases and mortality and cardiovascular diseases. As per the results of a meta-analysis by the Australian working group, even a temperature increase of 1 °C can lead to a marked increase in deaths from cardiovascular diseases, reports Coliquio. The widespread exposure to heat in connection with the increase in the proportion of older people could lead to a rise in cardiovascular diseases, write the authors. They say that evidence-based preventive measures are therefore necessary to reduce the worldwide total burden of heat-related morbidity and cardiovascular mortality.

Longstanding Concerns

These concerns are not new. For years, climate researchers, such as Camilo Mora, PhD, at the University of Hawaii in Honolulu, have been warning us about the increase in dangerous heat waves. Around 30% of the world's population is exposed to potentially lethal heat for at least 20 days per year, says the climate scientist. In 2100, this figure could increase to 48%, or maybe even more, especially if greenhouse gas emissions are not drastically lowered. Even Germany will become increasingly affected. For example, as reported by the news program the Tagesschau at the end of 2020, heat-related deaths are becoming a more frequent occurrence in Germany.

A report by Working Group I of the Intergovernmental Panel on Climate Change (IPCC) also demonstrated that the subject of extreme heat-related health risks is growing in importance, according to the Science Media Center last year. The report once again establishes a direct connection between man-made climate change and the frequency of extreme weather events.

The consequences of extreme heat became apparent across Europe, and in Germany too, during the "Summer of the Century" in 2003. In Europe, more than 50,000 people — and in Germany, around 5000 people — died of heat stress, reported Dr Maxie Bunz and Dr Hans-Guido Mücke from the German Environment Agency in Berlin in the Federal Health Bulletin a few years ago.

"Physicians in private practices could play a crucial role in the prevention of heat-related health risks," explained Henny Annette Grewe, MD, professor at the Faculty of Health and Care of the Fulda University of Applied Science in Germany, via the Science Media Center. Private practice physicians know "which of their patients have which diseases and consequent risk factors, who is taking which medication, where these people live and, in an ideal scenario, how their social network is doing and which resources their patients have."

Protecting Older People

"Heat can cause significant injuries to health in senior citizens," said Nils Schneider, MD, MPH, director of the Institute for General Medicine and Palliative Medicine at the Hannover Medical School (MHH) in Germany. Together with a team of geriatric–general medicine experts, he therefore created a guideline, Help with Heat in Homes. The guideline contains numerous tips for the directors and nursing staff of care homes, for family doctors, and for relatives of care-home residents. Many of the practical measures can also be applied outside of care homes, for example when caring for older people at home, a statement from the MHH explained.

For older people and people with chronic preexisting conditions, high temperatures bring the danger of falls, dehydration, confusion, and circulatory collapse or arrest. The Help with Heat in Homes guideline contains expert advice on how to avoid health risks. The guideline includes detailed information about heat warning levels, symptoms of dehydration, and fluid intake and monitoring, among other things.

In addition, the guideline includes a reminder about what needs to be taken into consideration for older patients and patients with certain diseases, as well as with the administration and dose of medications such as diuretics, antihypertensives, and neuroleptics. "At particular risk are people who take a variety of medications. For these people, a dose reduction for certain medications can be useful, following discussion with their physician," said Olaf Krause, MD, geriatric medicine specialist at the DIAKOVERE Henrietten Foundation Hospital and head of the interdisciplinary team of experts from the MHH.

"The staff in care homes have multiple options to stave off the effects of high summer temperatures," said Krause. "There is also a large number of fairly simple measures that can help the elderly to get through hot periods, regardless of whether in a care home or at home." These measures include, for example:

  • Blinds or curtains in the rooms

  • Fans in the rooms

  • Pocket fans for airflow onto the face

  • Changing the menu (such as chilled fruit soup instead of hot soup)

  • Sufficient fluid intake (~ 1.5 L/day, mineral water with little carbon dioxide, juice spritzer).

This article was translated from Univadis Germany.

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