Healthy living Hot weather: protecting older people and people in need of care

High temperatures and persistent periods of hot weather can have a severe adverse effect on health, particularly for older people or people receiving care. Heatwaves are increasingly causing a sharp rise in the number of deaths.

Older people and people in need of care are particularly likely to experience health problems after just a few hot days if there is no relief even during “tropical” nights – when temperatures remain above 20 degrees Celsius. In general, a temperature that feels like more than 30 degrees Celsius (even if the air temperature is lower than 30 degrees) is considered to have an impact on health and wellbeing. 

Simple precautions can help to reduce the risks to health significantly. But they need to be implemented consistently and quickly.

Heat-related health conditions are especially likely to develop unnoticed in older people as their bodies cannot cope well with overheating because of their age. People in need of care require special support – particularly if they live alone, as they cannot usually implement measures against heat on their own. For this reason, it’s important that they and their carers (who may also be family members) appreciate the risks and indications of heat-related conditions and know how vital the precautions are.

Older people’s bodies are often unable to respond appropriately to high temperatures. People in need of care, particularly if they are cognitively impaired or have restricted mobility, also find it difficult to adjust to high temperatures. Hot weather can cause health problems that can become severe.

High levels of humidity, experienced as mugginess, place additional strain on the body.

How much time the body has to get used to high temperatures is also a factor. Deaths related to hot weather can occur on the first hot days in the year.

The reasons for this include:

Difficulty adapting

• Lower emissions of body heat: circulation in the skin is reduced in old age. Older people also tend to perspire later and less than younger people.
• Failure to perceive heat: wearing clothing that is too warm or too tight, too much physical activity or spending too long in a very hot environment often leads to heat-related health problems.
• Older people are less likely to feel thirsty and can suffer from low fluid and electrolyte levels as a result.

Conditions

People with the following diseases and restrictions find it more difficult to adjust to high temperatures:

• being bed-bound or with restricted mobility
• cardiovascular disease such as coronary heart disease, cardiac insufficiency or stroke
• nervous system disorders, such as polyneuropathy
• conditions that affect memory and perception such as Alzheimer’s disease (dementia)
• other chronic conditions such as diabetes, chronic lung and kidney disease
• infectious diseases
• diarrhea 
• high temperature, fever

Medication

People who are taking certain drugs can also find it difficult to adjust to heat, for example diuretic or antiperspirant medication. Heat can also affect the duration of action of some medication and medical patches.

The brochure “Gut durch die Sommerhitze. Informationen für Menschen ab 65 Jahren” (Coping with summer heat. Information for people from 65 years of age) provides detailed information (in German) about heat-related problems in older people as well as medication that may need to be adjusted during hot weather.

People perceive heat in different ways. As well as air temperature, the apparent temperature (more commonly referred to as the “felt” or “feel like” temperature) is also an important factor. However precautions should be taken at latest in response to heat warnings or when indoor temperatures rise above 26 degrees Celsius.

The following precautions can help to protect your health in hot weather:

Everyday routine

• Schedule physically demanding activities, and sports in particular, for the mornings.
• On hot days, relatives, neighbors or support services may be able to run errands such as shopping. Ask your care services or doctor how additional support can be arranged.

Body and the circulatory system

• Wear loose clothing, keep your head covered, protect yourself against the sun, wear sunglasses and stay in the shade as much as possible when you are outdoors.
• Water is refreshing: it’s a good idea to take quick showers or bathe your feet or arms in cool water. Wet cloths or water atomizers are also a pleasant way to cool your face, neck, arms and legs.
• Take care when climbing stairs, getting up or walking: hot weather increases the risk of falls, as heat can cause circulatory problems.
• People on regular medication should discuss with their doctor at the start of the summer whether and how their medication needs to be adjusted in heatwaves. However you should never alter the dose unless advised to do so by your doctor.
• Many medicines are less effective in hot weather and need to be stored in a cool place. The package insert will also contain warnings about this.
• Light bed linen or blankets help to stop heat building up. This is particularly important for people who are bedridden.
• If disposable pants are used for bladder weakness or incontinence, mesh trousers with pads can provide a temporary alternative to avoid overheating.

Eating and drinking

• It’s important to drink at least 1.5 to 2 liters of liquid per day, evenly spaced throughout the day if possible. Cool drinks such as herbal or fruit teas, fruit juice and sodium-rich or lightly salted mineral water are best. Cold or iced drinks are not advisable. Drinks containing caffeine may be taken in moderation or if diluted but alcoholic drinks should be avoided.
• Fluid intake should be carefully monitored by people with pre-existing conditions. Excessive fluid intake may be harmful in people with cardiac or renal insufficiency, and so their doctors provide them with special drinking schedules.
• People with incontinence problems may want to drink less in the evenings.
• The salt loss from heavy sweating can be replaced, for example with mineral water that is sodium-enriched or lightly salted or with lukewarm broth.
• Light meals of vegetables, salad and fruit with a high water content are ideal. Lightly salty food helps to replace minerals lost from sweating.
• You should keep perishable foods in a cool place or use them quickly, as they go bad more quickly in hot weather and this can cause diarrheal diseases.

Home and environment

• Placing a thermometer in a prominent position in rooms helps you to keep an eye on the temperature. 
• Air the rooms at night and early in the mornings. Keep rooms shaded during the day, with blinds or roller blinds if possible. Hanging up wet towels helps to cool the room as the water evaporates. (Caution: this should be done in combination with ventilation and avoided in humid atmospheres, as it could otherwise increase humidity even further and make the growth of mold more likely). 
• Prevent any additional heat, for example by switching off any electrical devices that are not in use.
• Keep to the cooler parts of your home if possible. Consider sleeping there too on “tropical” nights when the temperature remains above 20 degrees.
• Fans and air conditioners can sometimes help, too. But you should ensure that fans are not directed straight onto people and air conditioners are not set too cold. 

The “Klima Mensch Gesundheit” (Climate People Health) portal of the Federal Institute for Public Health (Bundesinstitut für Öffentliche Gesundheit) provides more tips for people aged 65 or over and their relatives (in German).

Simple measures can often help protect against the effects of heat. People in need of care who are living on their own frequently need support with this. This applies particularly to people with memory and perception problems.

The people themselves as well as their relatives often don’t realize the importance of acting quickly when temperatures rise. Doctors or outpatient care services cannot usually cover the rise in demand for daily home visits during a heatwave.

So it’s advisable to build up a network of people who can help implement the precautionary measures. This network may consist of relatives, friends and people willing and able to help, but also ancillary workers from welfare associations, charities and self-help associations.

It’s often enough just to ring the person up and ask how they’re doing and to remind them of simple but important measures like ensuring they have a drink at regular intervals. 

It’s also advisable to make an appointment with the doctor to talk about “hot weather and health” just as summer is starting. 

Doctors:

• explain the risks to the individual patient from hot weather and what action should be taken
• offer advice on drinking behavior and can draw up a drinking schedule
• review medication plans and adjust them for hot days if necessary

Residential care homes are in a better position to provide continuous professional support to care recipients during heatwaves.

But residents of care homes or their relatives shouldn’t hesitate to inform care staff if they notice signs of health problems.

Examples of actions for care homes:

• Residents could be temporarily moved to cooler areas within the home.
• Supplies of beverages and meal schedules should be adjusted to reflect the hot weather.
• Water should be readily available at all times and at all locations and staff should ensure that residents drink the recommended volumes of water.
• Daily temperature readings should be taken in all rooms.

The “Bundeseinheitliche Empfehlung des Qualitätsausschusses Pflege zum Einsatz von Hitzeschutzplänen in Pflegeeinrichtungen und ­-diensten” (Quality Committee for Care’s National Recommendations on the Implementation of Heat Protection Plans in Care Facilities and Services) brings together the most important heat protection measures for outpatient and residential care facilities (in German).

The “Alter und Hitze” (Older people and hot weather) brochure provides suggestions (in German) on how older people can avoid damage to their health during hot weather.

The Heat Protection Plan for Health (Hitzeschutzplan für Gesundheit) developed by the Federal Ministry of Health (Bundesministerium für Gesundheit) is designed to make people more aware of the topic of heat protection. It includes specific suggestions for municipalities, care facilities, hospitals and individuals (in German).