Strategies to avoid heatstroke, other illness on sweltering days

 Hundreds of heat records are being set with temperatures upwards of 107 degrees in states like California, Arizona, Utah, Wyoming and Montana. Some planes are being grounded because the shimmering heat makes it dangerous to fly. And some municipalities are asking residents to turn their thermostats way up to protect the energy grid.

A “mega-heat wave,” as some weather experts have dubbed it, has scorched western areas of the U.S., forcing people to stay indoors to seek out cooler spots. These spiking temperatures bring an increased risk of heat-related illnesses like dehydration and heatstroke.

“As you age, you don’t notice the heat anymore,” says Charles Maddow, M.D., the director of emergency geriatrics at McGovern Medical School at UTHealth in Houston. Older bodies are not as hydrated and don’t sweat as much — making it more difficult to cool down, he says.

The risk of illness from hot weather is particularly high for those over 65, according to the Centers for Disease Control and Prevention, which found that 36 percent of heat-related deaths in the U.S. were in that age category. As people age, bodies don’t adjust well to sudden changes in temperature, and prescription medications and chronic illnesses can affect a response to heat.

“Heat can really be threatening to older adults,” says Christine E. Kistler, a physician in the Department of Family Medicine and the Division of Geriatric Medicine at the University of North Carolina School of Medicine. “The heat you might have been able to take in your 30s, you’re not physiologically able to cope with in your 80s.”

Cindy Bagwell, 62, lives in Dallas, where the temperature has been over 100 this week. Bagwell says she tries to stay inside in the air conditioning and walks her dog, Rosie, for 15 minutes or less in the morning, before the hottest part of the day.

But Bagwell has struggled to meet the request of the Texas electricity grid operator for residents to set thermostats at 78 degrees or higher. Keeping the lights off and drying most of her laundry outside has helped Bagwell conserve power, but she says it feels uncomfortable pushing the temperature in her home way up. To acclimate, she’s raised the thermostat by a degree every day or so and is currently set at 76. “I’m inching my way up,” she says. “I’ll see how it goes.”

Kistler, says this latest heat wave — which isn’t even coming at the peak of summer hot weather — raises concerns.

“My worry is that this is something we’re going to have to face year after year,” she says. She bristles at the idea that power grid operators are urging older adults to push their home temperatures way up, saying that request should be targeted at a younger population.

“Heat can really be threatening to older adults,” Kistler says. “The heat you might have been able to take in your 30s, you’re not physiologically able to cope with in your 80s.”

Existing health conditions like diabetes, a history of heart disease and high blood pressure — more common in older adults — can also make people more susceptible to heat-related illnesses, she says. Plus, diuretics, sedatives, beta blockers and other heart and high blood pressure medicines may make it more difficult for people to cool themselves. Check with your doctor about whether medications you take could contribute to overheating.

What to watch out for

Heatstroke and heat exhaustion top the list and can be quite dangerous, Kistler says. If you start to feel sluggish, light-headed, nauseated or dizzy after being outside, listen to your body. Get into the shade or seek out air-conditioned areas. A cool shower or pouring cold water over wrists, ankles and the back of the neck can also help get body temperature down, Kistler says.

If you’re wearing a mask because of the coronavirus pandemic, make sure to take it off so you can breathe freely. If you still feel unwell after cooling down and hydrating, seek medical treatment. Kistler says she worries that people will be reluctant to seek treatment this summer because of the COVID-19 outbreak, but failure to do so for heatstroke can be dangerous.

The best thing to do if you know you’ll be out in hot weather is to prepare behaviorally, says Maddow. Wear thin layers of light-colored clothing that can easily be shed. If you’re outside, set a timer for 15 minutes to remind you to seek out a shady or air-conditioned spot after being in the sun, he says.

Dehydration is a serious problem for older people. It’s very important to keep up fluid intake in hot weather, says Krystal Culler, the founder of Virtual Brain Health Center in Poland, Ohio, and a behavioral health expert who has worked with community-based senior programs and adult day programs. Culler said behavioral strategies such as drinking a full cup of water with vitamins or medication, instead of a sip, can encourage people to drink more fluids. “Adding it into something that is already a part of your daily routine helps,” she says.

The CDC’s guide for protecting older adults in the heat notes that people shouldn’t wait until they feel thirsty to start drinking fluids. The National Academy of Medicine suggests men drink 15.5 cups of fluid per day and women drink about 11.5 cups daily.

Culler says she has found that older people tend to drink more if they use small cups which are refilled often, rather than giant “big gulp” style containers, which can look overwhelming.

Also, avoid alcohol and caffeine, as they can be dehydrating.

How to Keep Older Adults Safe in Extreme Heat

Avoiding sunburn goes beyond making sure you aren’t pink and peeling to the point of discomfort, says Kistler. Older people have an increased risk of skin cancer, so wear sunscreen with broad spectrum protection, a broad-brimmed hat and sunglasses.

Heat rash, that prickly, itchy skin condition, can develop if you’re out in the sun. Wearing light-colored, loose clothing made of breathable fabrics can help keep you cool and prevent rashes.

Cooling strategies

Stay inside on the hottest days. Seek out air-conditioned areas. If you don’t have air conditioning at home, some communities offer cooling centers during heat waves. There are also low-income energy assistance programs if you’re having trouble paying your electric bill. Contact the nearest office for the Low-Income Home Energy Assistance Program (LIHEAP) for more information.

Take a dip. That could mean going for a swim or a float in a pool or a lake, but it can also mean taking a cool shower or running through a backyard sprinkler (with the kids or not).

Seek out shade. Take a walk in the woods instead of on a path in full sun, or do some gardening under a tree. If you need to go out, shift your timing to early morning or evening when the sun isn’t as strong and more shade is available.

Get more water. Get in the habit of sipping regularly. As people age, the ability to sense thirst wanes, so drink liquids often in hot weather, Maddow says. Flavoring water with fruits and even vegetables like cucumber can make it more inviting, Culler says, and some reusable water bottles include a core to load with lemons, apples or strawberries. Some fruits have a high water content, so choose watermelon or grapes for snacking.

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