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June 17, 2014
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Older people more susceptible to hot weather complications


Despite the recent dip in temperature, one thing is certain — the hot weather will be back. In preparation for the inevitable summer heat wave, county health workers are eager to remind seniors to take precautions once the thermometer starts to rise.

Because people 65 and older in Nevada County comprise a much higher percentage of the population than in California as a whole, there are likely to be higher instances of heat-related health problems here this summer, said Tamaran Cook, the county’s program manager for Adult Services.

Those projections have already been confirmed by Dr. Jaron Ross, an emergency physician at Sierra Nevada Memorial Hospital.

“This year, as in most early summer seasons, we have seen a quick rise in the number of visits related to heat exposure and dehydration,” said Ross.

“While rarely an isolated cause, the warmer temperatures challenge the physique and quickly amplify any pre-existing medical issues. Actual diagnoses are myriad, from urinary tract infections (bacteria are the cause, but dehydration hastens the course) to strokes (increased blood pressure as the body tries to compensate for circulatory volume loss) and even congestive heart failure, as people unwittingly drink more fluids than normal to satiate increased thirst.”

In a UC Davis Medical Center article, “Elderly need special care in hot weather,” Calvin Hirsch, a geriatrics specialist, states that “seniors account for a disproportionate number of heat-related hospitalizations and deaths.”

The elderly are more prone to heat stress, and do not adjust as quickly to sudden changes in temperature, according to the U.S. Centers for Disease Control and Prevention.

“An elderly person may not even be aware of being thirsty or too hot, especially if suffering from dementia or diabetes, which diminishes sensation,” continued Hirsch. “Many medicines, such as tranquilizers, can blunt an individual’s awareness of discomfort, as can alcohol.”

Experts warn that the temperature does not have to reach 100 degrees Fahrenheit to pose a risk to some individuals.

According to the National Institute on Aging, health factors that could increase risk include poor circulation, inefficient sweat glands, changes in the skin caused by the normal aging process, heat, lung, and kidney diseases — as well as any illness that causes general weakness or fever.

Risks are also associated with obesity, high blood pressure and other conditions that require a change in diet. Some individuals on salt-restricted diets may increase their risk, but supplementing with salt pills should only be considered after consulting a physician.

Some medications — such as diuretics, sedatives and blood pressure drugs — can even contribute to an inability to perspire, and older adults can become dehydrated quickly.

Ross concurs.

“Generally speaking, older adults are more vulnerable to dehydration and heat-related illnesses — this is true for a variety of reasons — thinner skin has fewer active sweat glands and warms faster. Less hair to reflect light. And most importantly, at adulthood, all bodies lose approximately 1 percent of their cardiopulmonary capacity (the efficiency with which blood and oxygen circulate) per year of life,” he said.

“An 80-year old, even in perfect health and having never smoked, could therefore be functioning at only 40 percent of the reserve they had when 20 years old.”

These factors are further aggravated by the fact that most older adults use prescription medicines, which while genuinely needed, may worsen water loss and the body’s ability to cope, added Ross.

“Take for instance an otherwise healthy woman using a single blood pressure medicine that lowers her heart rate and causes increased urination,” he said. “When she is exposed to more warm or arid conditions, the body’s reflex is to conserve water and raise her heart rate to improve circulation. The medicines blunt both these preserving mechanisms, and serious problems more quickly ensue.”

Experts say it’s not just physical health conditions that can increase risk. There are lifestyle factors common to many seniors, many of which are unavoidable.

These might include housing without air conditioning or fans, lack of transportation to cooler buildings, inappropriate clothing choices or an inability to understand weather forecasts.

Altitude can also play a role, said Ross, as even the 1,000 to 3,000 feet above sea level of Western Nevada County exposes residents to greater “ambient radiation,” heat index and lower oxygen levels that further exaggerate heat exposure.

According to the NIA, it’s important to know the differences among the various heat-related conditions.

“Heat stress” occurs when a strain is placed on the body as a result of hot weather.

“Heat fatigue” is a feeling of weakness brought on by high outdoor temperature. Symptoms include cool, moist skin and a weakened pulse. The person may feel faint.

“Heat syncope” is sudden dizziness experienced after exercising in the heat. The skin appears pale and sweaty but is generally moist and cool. The pulse may be weakened, and the heart rate is usually rapid. Body temperature is normal.

“Heat cramps” are painful muscle spasms in the abdomen, arms, or legs following strenuous activity. The skin is usually moist and cool and the pulse is normal or slightly raised. Body temperature is mostly normal.

Heat cramps often are caused by a lack of salt in the body, but salt replacement should not be considered without advice from a physician.

“Heat exhaustion” is a warning that the body is getting too hot. The person may be thirsty, giddy, weak, uncoordinated, nauseous, and sweating profusely.

The body temperature is usually normal and the pulse is normal or raised.

The skin is cold and clammy. Although heat exhaustion often is caused by the body’s loss of water and salt, salt supplements should only be taken with advice from a doctor.

“Heat stroke” can be life threatening. Victims of heat stroke are in serious danger of dying, so immediate medical attention is essential when problems first begin.

A person with heat stroke has a body temperature above 104° F. Other symptoms may include confusion, combativeness, bizarre behavior, faintness, staggering, strong rapid pulse, dry flushed skin, lack of sweating, possible delirium or coma.

Many people die of heat stroke each year; and not surprisingly, most are older than 50, reports the NIA.

What are some key ways to stay cool?

Use common sense, suggests Cook, such as avoiding strenuous activities during the hottest part of the day. Avoid hot foods and heavy meals. Never leave infants, children, elderly or disabled people in the car.

Establish a buddy system — check on those you know who are sensitive to the heat.

“Seek shade, dress lightly and in light-colored more reflective clothing, added Ross. “Wear hats, use air conditioning if available. Most importantly — keep hydrated. There is no universal rule for how much water to drink, but a simple rule-of-thumb is ‘Lemonade in Summer,’ whereby in hot climes you drink enough that your urine is light yellow, not dark orange. And when in doubt, for any reason, people should see their physician for a check-up.”

To contact Staff Writer Cory Fisher, email cfisher@theunion.com or call 530-477-4203.

“This year, as in most early summer seasons, we have seen a quick rise in the number of visits related to heat exposure and dehydration.”
Dr. Jaron Ross
emergency physician at Sierra Nevada Memorial Hospital


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The Union Updated Jun 17, 2014 03:37PM Published Jun 17, 2014 03:31PM Copyright 2014 The Union. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.