By Dr. Amy Ehrlich, associate chief, Division of Geriatrics, Montefiore Medical Center
BRONX, NEW YORK (BRONX NEWS)- Mrs. K. came to see me in the Geriatrics Ambulatory Practice at Montefiore on the third day of a major heat wave.
She was scheduled for a routine follow-up visit for her multiple medical problems. Mrs. K is 95 years old and has mild dementia, diabetes, congestive heart failure and mild kidney disease. She takes eight different medications, including a "water pill" or diuretic for her heart disease. Mrs. K was born in South Carolina and moved to New York when she was 20 years old. She has very strong opinions about many things, including what foods she should eat during the summer months and the dangers of air conditioners. She came to my office wearing long underwear underneath a long-sleeved shirt and a jacket. She informed me that the air conditioners were too cold in the office, so she had to come prepared. Luckily, she has a devoted aid who is with her six hours a day. I inquired about her apartment and whether she has an air conditioner for the heat wave. She informed me that she has an air conditioner but absolutely will not use it because it irritates her sinus condition. She told me she uses a fan and that her apartment does not get too warm, despite the 100-degree weather outside. Meanwhile, her aid was vigorously shaking her head, stating the apartment was unbearably hot. Fortunately, I was able to counsel both Mrs. K and her aid about the risks of heat illness, and together we agreed upon a plan that will keep Mrs. K safe. This is not the case for many older adults during heat waves. Every year, vulnerable older adults are hospitalized and even die due to heat-related illnesses.
Who is at risk for heat-related illness and death?
· Adults ages 65 years and older who do not use or have home air conditioning are at increased risk of heat-related illness and death.
· Certain chronic health conditions increase the risk, including dementia or other cognitive problems that impair a person's judgement.
· Older adults with multiple chronic medical problems, including heart and lung disease, diabetes and obesity are also at increased risk.
· Many common medications can impair an older adult's ability to respond to sustained exposure to high temperatures, including "water pills" or diuretics, anticholinergic agents and neuroleptic medications.
· Older adults who live alone, are socially isolated and have limited mobility are at high risk. Additionally, older adults without a strong safety network of formal services or informal support of family and friends are more vulnerable during times of severe weather.
What should older adults do to keep safe during hot weather?
· Use air conditioners or go to places with air conditioning on very hot days. Most communities open cooling centers for use during extreme heat events.
· Fans do not provide adequate cooling during extreme heat. Fans should ideally be used to bring in cool air at night, when the windows are open or when the air conditioner is already on.
· Older adults should drink extra fluids during hot weather.
· Family members, friends and community groups should frequently check on older adults and assist them to keep cool and well hydrated.
· Older adults and or their caregivers should contact their primary care providers if they have questions regarding an older adult during times of extreme heat.
*Names and identifying details of patients have been changed to protect their confidentiality.
