Summer clinical alert: Caring for older people in hot weather

14 November 2023

The unprecedented high temperatures across Australia during spring and confirmation of an El Niño weather phenomenon for the 2023-24 summer both foreshadow the likelihood of multiple heatwaves in coming months.

It is vital that aged care providers recognise and prepare for the risks that heatwaves present for older people.

While very high temperatures can affect people differently, it is known that frail older people are at higher risk of hospitalisation and even death when exposed to extreme heat. A recent report from the Australian Institute of Health and Welfare indicated that extreme heat accounted for 7,104 injury hospitalisations and 293 deaths in Australia over the 10 years from July 2012 to June 2022. Heatwave-related deaths during this period spiked during severe El Niño years, such as during 2014, 2016, and across 2019 and 2020. In the 3 years from July 2019 to June 2022, people aged 65 and over were the most commonly hospitalised age cohort of all those admitted to hospital for heat-related injuries.

Research just published in the journal Nature Medicine reporting on the number of people who died during the recent heat waves across Europe showed that heat stress caused more heat-related deaths than heatstroke. In most cases, these deaths are caused by the very high temperatures interfering with how the body usually copes with existing health problems like heart and lung disease.

Both residential and home services aged care providers need to be aware that older people, especially those with comorbidities such as heart disease, are more likely to suffer from severe clinical and physical problems associated with extreme heat events. Older people living in the community may be at an even higher risk of heat exhaustion/stress, especially those who live alone without frequent contact from others.

Key advice: prioritise and monitor

1. Ensure that your workforce is aware of the individual vulnerabilities of elderly people they care for, and that they know to prioritise and monitor the most vulnerable people during extreme hot weather events.

2. Create a vulnerable people list to identify and record care recipients at particular risk such as those who:

live alone or with other vulnerable people
are socially isolated and may not have family and friends available to check on them frequently or help in case of an emergency
have cognitive impairment, which may reduce awareness of situations and ability to respond, problem solve, or identify and communicate their discomfort or thirst
take certain medications—such as allergy medicines (antihistamines), blood pressure and heart medications (betablockers), fluid tablets (diuretics) and antidepressant or anti-psychotic medications
have an alcohol or other substance use
have mobility problems or another disability and may not be able seek help
live in certain environmental settings that make them more at risk of heat stress e.g., no air conditioning or other cooling means, or a home that is particularly hot.

3. Have an action plan in place for each vulnerable person that includes strategies for reducing and minimising their exposure to extreme heat, and also contains information about who needs to be contacted if the individual becomes unwell in an extreme heat event and requires medical attention.

4. Remind staff to check that care recipients minimise the time they spend outside during extreme heat events, that their clothing is appropriate, that they have access to adequate fluids such as water, and that cooling devices are working and switched on. If no air conditioning is available, a fan blowing with a wet sheet or towel in front of it (not over it) can be highly effective for cooling the air.

5. Educate care staff to enable them to recognise any deterioration in a person’s condition due to heat, and how to provide first aid and an emergency response for heat exhaustion/stress, dehydration and heat stroke.

Clinical assessment

A clinical assessment is required if a care recipient shows any signs of deterioration. The effects of heat-related illnesses can range from mild to very serious signs and symptoms (see lists below), and can progress quickly.

If you are concerned about a care recipient's wellbeing in a heatwave, you should act. Depending on your level of concern, you should call a family member, and/or the person’s general practitioner or another medical professional, or emergency services.

Heat stroke and heat exhaustion/stress

These two heat-related illnesses exert different physical effects on a person’s body, but each can be dangerous, especially for older people.

Heat exhaustion, also called heat stress, is related to dehydration (not getting enough non-alcoholic fluids such as water) and a person’s cardiovascular system struggling to pump blood through the body.
Heat stroke occurs when a person’s body temperature gets so dangerously high that it begins overheating tissues and organs.

Elderly people are much more likely to be affected by heat exhaustion/stress.

Heat exhaustion/stress

Heat exhaustion/stress is the body’s response to an excessive loss of water and salt, usually through profuse sweating. People taking fluid tablets or on fluid restrictions may be unable to recognise and respond to thirst and are particularly vulnerable. Drinking too much water can also be dangerous, so monitoring the amount and colour of urine is important. The optimal level of water consumption should ensure that urine is light yellow.

Drinks with high levels of sugar, caffeine, and alcohol should be avoided.

Symptoms of heat exhaustion can include:

headache
nausea
dizziness
weakness
irritability
thirst
heavy sweating
elevated body temperature
decreased urine output.

Heat stroke

Heat stroke occurs when a person’s body can no longer control its temperature: their body temperature rises rapidly, their sweating mechanism fails and they are unable to cool down. When heat stroke occurs, body temperature can rise to 40°C or higher within minutes. This can cause permanent disability or death if the person does not receive emergency treatment.

Symptoms of heatstroke can include: