Heatwaves and the elderly: A silent threat we can prevent | Alexander Attard

Alexander Attard is the Commissioner for the Elderly 

Global warming has led to yearly increases in ambient temperatures resulting in heat waves, which unfortunately affect older persons in a disproportionate manner when compared to the younger age groups. 

High temperatures can be easily life threatening in older adults. This is due to a variety of factors including physiological changes associated with aging, chronic health conditions and medication which are more prevalent in the older person, and social considerations. It is therefore essential that older people are conscious of their vulnerability in high temperatures and it is our duty to educate those that perhaps are not aware of this. 

Normal thermoregulation (the way living organisms maintain a stable internal body temperature irrespective of ambient temperatures) is essential to maintain a safe body temperature. This regulation can be defective in the older person for a variety of reasons. 

Sweating is an important mechanism by which the human body cools down. In older adults this may be deficient either because they sweat less or because the maximum body temperature which triggers sweating is raised.  

In hot weather, the body tries to cool down by sending more blood to the skin’s surface, but this becomes harder with age. Hardened blood vessels and a weaker heart can limit this process, causing the body to retain heat. The brain may also react more slowly to temperature changes, further delaying the cooling response. Meanwhile, older adults may not feel thirsty as easily, which increases the risk of dehydration, especially when conditions like diabetes are also present. 

Chronic health conditions are commoner in the older adult. These include cardiovascular diseases, which as outlined above could affect thermoregulation, but which may also lead to an increased risk of heart attacks and strokes. Chronic respiratory diseases, such as bronchitis and asthma, are particularly exacerbated by hot air especially in combination with environmental pollution. Such situations increase oxygen demand which cannot be met by the diseased lung. Dehydration can lead to acute kidney failure when chronic renal disease is already present. 

The ever-increasing presence of dementia is also a factor here since the need to drink or cool down may not be appreciated. Many medications commonly used in the elderly such as diuretics (water tablets) may exacerbate all of the above. 

Social issues are also an important consideration. Social isolation and limited mobility may result in persons, whose clinical status is worsening in the heat, being missed with potentially serious consequences. Pensioners on limited income may not be able to afford investing in air conditioners to minimise the risk and may not be in a position to venture out to cooler environments. 

The effects of overheating range from simple muscle cramps due to electrolyte loss, heat exhaustion with weakness, dizziness and headaches and finally heat stroke which is a medical emergency where the core body temperature rises above 40oC leading to confusion, seizures, loss of consciousness and multi organ failure. The latter, potentially fatal stage, is commonest in older persons. 

Prevention is better than cure. Relatives of older persons should ensure their loved ones maintain adequate hydration and should regularly check in on their status during heat waves. Social and local community services should identify those that live alone and do not have family backup and establish a service for monitoring the condition of these individuals. Education is paramount and public campaigns highlighting the perils of high temperatures and how to mitigate them should be an annual undertaking. 

As in all cases, the first step towards reducing the deleterious effects of high temperatures in the older population is recognition of the problem. It is only then that steps can be taken to minimise the risk and reduce fatalities. 

It was reported that the heat wave in 2023 resulted in approximately 80 deaths in Malta but specific statistics for older people were not given. Heat related problems in older adults should be totally preventable. A single death from overheating is a death too many.