Keeping Our Seniors Safe During Summer Heatwaves
by Don Drake, Connelly Law Offices, Ltd.
It's no shock when we start this blog by saying it has been an extremely sweltering summer. In fact, some weather observers are saying that 2022 rivals some of the heat waves of the mid-1930s, and those who suffer the most are our seniors.
As we enter the second week of August, the temperatures here in southern New England are beginning to moderate and may even fall below average for a bit, but make no mistake, we still have two months where temperatures and humidity can still become oppressive -- and the temperature does not need to be in the nineties to cause heat-related illnesses.
"Not surprisingly, our seniors are more vulnerable to summer heat waves than other groups," stated certified elder law Attorney RJ Connelly III. "Records show that people 65 years of age and older comprise most of the added emergency room visits and deaths during periods of hot weather."
"Records show that people 65 years of age and older comprise most of the added emergency room visits and deaths during periods of hot weather."
As stated in multiple previous blogs, this country is aging rapidly. In just eight short years, one in five Americans will be 65 years of age or older. By 2060, the median age of our population will rise from the current 38 years to 43 years. And even more surprising, the number of people 80 years of age and above is increasing at a rate of 3.8% per year. This is important because periods of intense heat or excessive cold will present with increased medical events if we do not prepare our seniors for weather extremes.
Paul's Heat Stroke
By any measure, Paul M., from the New Bedford, Massachusetts area, was a fit and healthy 72-year-old man who had jogged and worked out daily. His schedule consisted of a morning workout at Planet Fitness and a jog along the New Bedford seaport area. "I couldn't ask for a more beautiful place to run," Paul told us. "The busy water area, the ferries departing, the smell of the salt water, it was invigorating with something new happening around me almost daily." But on the day Paul got sick, he knew something wasn't right.
"At the gym, I didn't feel all that great. During the weekend before this happened, I spent a lot of time doing yard work, to the point that my wife had to tell me to take a break. It wasn't terribly hot outside, only in the mid-eighties, but it was humid," Paul said.
After his run, he returned home and sat outside, telling his wife that he was dizzy and felt nauseous. "I then blacked out and she called the rescue for me. I was told that my body temperature was nearly 105 degrees, and my blood pressure was bottoming out. I was in bad shape."
Upon reaching the hospital, emergency room doctors fought to keep him alive. They had to stabilize his blood pressure, reduce his heart rate, and pump his body with fluids to keep his kidneys from shutting down and he began to hallucinate. "I saw myself back in Vietnam as I was lying prone on the bed with medics working on me," Paul stated. "I actually thought I smelled burning oil and the toxic smoke that I was so used to in Da Nang. Then I saw my wife there and wondered how she got to the military base. I started panicking for her safety. It was a horrible feeling."
"Upon reaching the hospital, emergency room doctors fought to keep him alive. They had to stabilize his blood pressure, reduce his heart rate, and pump his body with fluids to keep his kidneys from shutting down..."
Paul spent a week in the hospital as doctors had to flush out the by-products of the heat stroke to keep his renal system functioning. "I thought that because I was in good shape, tried hard to eat healthily, and listened to my body that something like this would not happen to me, but I was so wrong," Paul stated. "What I learned the hard way was that age changes how our body functions and it's a lesson I won't forget."
Aging and Heat
There are multiple reasons why seniors are more susceptible to heat-related illnesses than younger people. They include:
A changing body - As our bodies age, there are physiological changes that occur that do not allow the body to adjust to temperature extremes.
Hydration - Along with those body changes comes the tendency for an older body not to feel a need for water even though dehydration may be occurring. Plus, because of other physical changes, seniors may have a tough time swallowing or drinking.
Health Issues - Older adults are likely to have other health issues that could be affected by temperature extremes.
Medications - Seniors are more likely to be taking medications like water pills and anticholinergics that affect the body's ability to cool itself (more on this later).
COVID-19 - Let's not forget this, those with or recovering from COVID may be more vulnerable to heat-related illnesses.
Medications and Heat Illnesses
As stated earlier, there are certain medications that can lead to heat-related illnesses, especially in the elderly for the reasons we have previously stated. "Before we discuss this, I want to make clear that anyone taking medications should never stop using them without first consulting with your doctor," said Attorney Connelly. "This discussion is for informational and educational purposes and should not be relied on to make medical decisions."
"Medications and dosages are designed for your body...it's not always what the drug does to your body, but what your body can do to the drug."
Heat and medication can be complicated subjects to understand. It's not just the side effect of the drug, but also the physiological changes that occur because of dehydration. For example, medications and their dosage are designed specifically for your body and its chemistry. When you sweat and become dehydrated, this raises the level of the medication because it is not being diluted by the water volume in your body - the result can be that the level of the drug is too high, which can lead to grave consequences. Remember, it's not always what the drug does to your body, but what your body can do to the drug. Given that, let's look at some classes of medications that can cause problems in the heat.
Blood pressure medications - Two of the most popular medications that can increase the sensitivity to heat are thiazide diuretics (chlorothiazide, chlorthalidone, hydrochlorothiazide, indapamide, and metolazone) and beta blockers (atenolol, bisoprolol, carvedilol, labetalol, metoprolol, propranolol and sotalol). The thiazide diuretics force fluid out of the body and the beta blockers decreases blood flow to the skin thereby decreasing sweating.
Antihistamines - Those who take these medications to control allergies can also prevent you from sweating. This is more common with the older antihistamines like Benadryl but does not occur with the newer medications like Claritin, Zyrtec, and Allegra. This occurs because the very nature of antihistamines is to "dry the body" to slow mucous production. This drying also produces less sweat which affects the body's ability to cool itself through sweating.
Decongestants - We don't usually associate warm weather with getting a cold, but it can still happen. And with COVID causing flu symptoms and congestion, people have been using over-the-counter medications like Sudafed for help. Decongestants can be dangerous by decreasing blood flow to the skin which again affects the body's ability to cool itself.
Bladder Control Treatments - Aging can produce bladder issues in some. In such cases, individuals may be prescribed anticholinergics. This class of medication blocks the action of involuntary muscle movements that cause the feeling of urgency to use the bathroom. The side effects of meds like Ditropan (oxybutynin) or Detrol (tolterodine) can be reduced sweating.
Stimulants - Although normally thought to be medications for younger people, some adults are prescribed stimulants for ADHD and narcolepsy. These medications include Adderall and Ritalin. Stimulants can raise body temperature, increase heat tolerance, and constrict blood vessels affecting the body's ability to cool itself.
Psychiatric medications - Meds used to treat some psychiatric conditions and Parkinson's disease affect the hypothalamus portion of the brain, which is essential to cool down the body. Additionally, these meds reduce the thirst reflex resulting in dehydration. Some of the psych meds that can lead to heat intolerance include Tricyclic antidepressants like Elavil and Pamelor, Antipsychotics such as Haldol and Thorazine, and Dopaminergics like Sinemet.
As we wrap up this discussion on medications and heat intolerance, a new study published on August 1 in the journal Nature Cardiovascular Research found that among people suffering non-fatal heart attacks associated with hot weather, an outsize portion was using both beta-blockers and antiplatelet medications -- this includes over the counter aspirin.
“Patients taking these two (types of) medications have a higher risk,” said Kai Chen, an assistant professor in the Yale School of Public Health Department of Epidemiology and first author of the study. “During heat waves, they should really take precautions.”
According to Chen, "users of beta-blockers or antiplatelet medications were more likely to have heart attacks during the hottest days compared to control days. Antiplatelet medication use was associated with a 63% increase in risk and beta-blockers with a 65% increase. People taking both drugs had a 75% higher risk. Non-users of those medications were not more likely to have a heart attack on hot days."
And here's an interesting part about this study, when the scientists compared younger patients (25 to 59 years) to older ones (60 to 74 years), they found, as expected, that the younger ones were a healthier group, with lower rates of coronary heart disease. Yet younger patients taking beta-blockers and antiplatelet medications were more susceptible to heat-related heart attack than older patients, despite the older ones having more heart disease.
"Younger patients (25 to 59 years) taking beta blockers and antiplatelet medications [including aspirin] were more susceptible to heat related heart attack than older patients, despite the older ones having more heart disease."
"We hypothesize that some of the medications may make it hard to regulate body temperature,” Chen said. Future studies are needed to understand why this occurs.
More On Heat-Related Illness
"As we stated earlier, although summer and the heat are starting to wind down, we still have well into September to be concerned about heat-related illnesses among seniors," said Attorney Connelly. "The Centers for Disease Control (CDC) has identified these illnesses grouped under one name called hyperthermia. Let's look at them."
Heat syncope is a sudden dizziness that can happen when you are active in hot weather. If you take a heart medication called a beta blocker or are not used to hot weather, you are even more likely to feel faint. Rest in a cool place, put your legs up, and drink water to make the dizzy feeling go away.
Heat cramps are the painful tightening of muscles in your stomach, arms, or legs. Cramps can result from demanding work or exercise. Though your body temperature and pulse usually stay normal during heat cramps, your skin may feel moist and cool. Find a way to cool your body down. Rest in the shade or in a cool building. Drink plenty of fluids, but not those with alcohol or caffeine (which can lead to dehydration).
Heat edema is a swelling in your ankles and feet when you get hot. Put your legs up to help reduce swelling. If that doesn’t work quickly, check with your doctor.
Heat exhaustion is a warning that your body can no longer keep itself cool. You might feel thirsty, dizzy, weak, uncoordinated, and nauseated. You may sweat a lot. Your body temperature may stay normal, but your skin may feel cold and clammy. Some people with heat exhaustion have a rapid pulse. Rest in a cool place and get plenty of fluids. If you don’t feel better soon, get medical care. Be careful—heat exhaustion can lead to heat stroke.
Heat stroke requires that a person seek help immediately, as described earlier in this blog by Paul who almost died because of having one. According to the CDC, signs of heat stroke are as follows:
Fainting (possibly the first sign) or becoming unconscious.
A change in behavior—confusion, agitation, staggering, being grouchy or acting strangely.
Body temperature over 104°F (40°C).
Dry, flushed skin and a strong, rapid pulse or a slow, weak pulse.
Not sweating even if it is hot.
"Know the signs of heat-related illnesses and what medicine you are taking," said Attorney Connelly. "It doesn't mean that you can't enjoy the summer season, just that you need to plan accordingly by taking some very basic precautions." Here are some basic tips to take during heatwaves:
Try to stay in the shade, keep hydrated, and do not over-exert yourself.
Use air-conditioning to stay cool.
If you don't have air-conditioning, try to find a cooling center or a place with air-conditioning like a library, store, senior center, or restaurant.
Have a conversation with your medical professional and discuss how much fluid you should be taking if you are on a medication that acts like a diuretic. Even during the summer heat, your fluid intake may need to be kept to a minimum.
If you have an elderly family member who lives independently, there are some things you can do as well to stave off heat-related emergencies.
Try to visit them twice a day during the hot weather. A phone call may not be enough because seniors may not be able to communicate distress due to the way the body changes as discussed earlier. Seeing the person is the best way to assess how they are dealing with the hot weather.
If possible, provide them with an air conditioner. 5000 BTU air-conditioners are inexpensive and can cool off a small room and keep a senior safe. If this is not possible, locate a cooling center in your area and make plans to have them spend the day.
Remember that electric fans can provide some relief, but when temperatures reach the nineties, they will not prevent heat-related illnesses.
Drinking a lot of water is important but remind them that drinks that contain caffeine or alcohol can be detrimental and lead to dehydration. There is a caveat to this, if your loved one is using a diuretic because of water retention, their medical professional must be contacted to make sure increased fluids are appropriate.
Make sure they are wearing loose-fitting or light clothing.
Make sure they have access to cool water such as a shower, or bath or can use wet towels to cool off.
"One other thing that's important in this time of inflation and increased utility costs, make sure that your loved one is able to pay their utility bill," said Attorney Connelly. "Many seniors that we are working with are cutting back on air conditioner use due to the increase in electricity rates and when the winter arrives, natural gas rates are expected to skyrocket, causing another whole set of issues for those heating their homes. Make sure the bills are paid and they are not in danger of having their service disrupted. There is help available. Please click on the photo below to begin the process of seeking assistance paying utility bills for your loved ones."
In Wednesday's blog: