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 of older people or people receiving care. Heatwaves are increasingly causing a sharp rise in the number of deaths.

They can have health problems after just a few hot days, with no relief even during “tropical” nights with temperatures above 20 °C. In general, apparent temperatures above 30 °C put strain on people’s 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 conditions can come on unnoticed by older people as their bodies cannot cope well with overheating because of their age. People in need of care who are cared for at home are in particular need of help as in most cases they cannot implement measures against heat on their own. So 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 precautions are.

Older people’s bodies are often unable to respond appropriately to high temperatures. People in need of care, particularly if they are mentally 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: common consequences of this are wearing clothing that is too warm or too tight, too much physical activity or spending too long in a very hot environment.
• They are less likely to feel thirsty and can suffer from low fluid and electrolyte levels (dehydration) as a result.

Conditions

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

• being bed-bound or with restricted mobility
• stroke
• cardiovascular disease such as coronary heart disease or cardiac insufficiency
• nervous system disorders (polyneuropathies)
• 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 and high temperature

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”; in German) published by Munich University Hospital provides detailed information on 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” is also an important factor. However precautions should be taken in response to heat warnings or if indoors temperatures rise above 26°C.

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.
• Relatives, neighbors or support services may be able to take on errands such as shopping. Ask your care services or doctor how additional support can be arranged.
• Remember to 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.

Body and the circulatory system

• 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 it can have an adverse effect on circulation.
• 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.
• Mesh pants with pads can be used as a temporary solution to disposable incontinence diapers.

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 with mineral water or 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. High fluid intake may be harmful in people with cardiac or renal insufficiency. The doctor will draw up special drinking schedules for them.
• People with incontinence problems may want to drink less in the evenings.
• The salt lost from heavy sweating can be replaced with, for example, water with added sodium or 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: they go bad more quickly in hot weather and this can cause diarrheal diseases.

Home and the 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.
• Turn off electrical devices to avoid generating extra heat.
• Light clothing and light bed linen or blankets help to stop heat building up. This is particularly important for people who are bedridden.
• Keep to the cooler parts of your home if possible. Consider sleeping there too in tropical nights when the temperature remains above 20 °C.
• 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 Federal Center for Health Education (BZgA) portal www.klima-mensch-gesundheit.de provides more suggestions 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 the medication plan to see potential risks from hot weather

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 at the first 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.
• Daily temperature readings should be taken in all rooms.

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