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Why weather kills older adults — and how to keep loved ones safe

Vulnerability can sneak up on even active, healthy older folks

A paramedic treats a man suffering from heat exposure in Salem, Oregon, in June 2021.
A paramedic with Falck Northwest ambulances treats a man experiencing heat exposure during a heat wave, Saturday, June 26, 2021, in Salem, Ore.
Nathan Howard, Associated Press

The man was found dead in his recliner and his wife was rushed to the hospital, barely alive. After a crippling arctic blast ripped through a good portion of the nation in February, hitting even their usually sunny section of Texas, the inside of their home in Abilene was as cold as the weather outside their door. Officials told KTXS news they’d been without power for three days.

Texans know a lot more about dealing with temperatures on the sizzling side of the thermometer; this year they learned what folks in northern states like Idaho and Montana know about the cold.

The unexpected consequences of February’s cold snap revealed a year-round truth: Weather can kill — and a family’s older adults are especially at risk, whether the temperature’s too low or too high.

“Extreme heat or cold is no joke for older people, including older workers. And they may be in medical crisis before they even recognize it,” said Dr. Ronda McCarthy, an environmental and occupational exposure specialist near Waco, who’s on the steering committee for the Medical Society Consortium on Climate and Health.

The National Institute on Aging says older adults lose body heat faster than when they were young. They may not even know how cold they are. But heat’s not benign, either. Hyperthermia — being too hot — can have heart-stopping consequences for the elderly, the institute says. While heat, like cold, can be dangerous for anyone, those over 60 are especially vulnerable.

And what’s considered “extreme” heat or cold may seem pretty benign. Older adults can overheat at 80 degrees. Their internal temperatures can drop enough to be dangerous when the house feels cool, not cold to others. Below 70 indoors is risky for some.

The Centers for Disease Control and Prevention estimates more than 650 people — mostly older adults — die each year in the United States of heat-related illness. Some years are dramatically bad: More than 750 died in Chicago during a 1994 heat wave.

The Associated Press reported around 70 people died in the recent arctic blast that froze parts of the country. Reportedly, more than half were at least 50 years old. Some froze to death, while others succumbed to carbon monoxide trying to keep warm.

A study published in the New England Journal of Medicine said at least 1,500 deaths result from the cold — hypothermia — each year.

Winter’s still delivering punches and what summer will bring is anyone’s guess. McCarthy believes Americans will continue to see increasingly wild swings in weather and they ought to figure out how to protect themselves, their families and others when Mother Nature throws a weather curve.

In 40 years in Texas, she’d never seen anything like the frosty, frigid February storm, said McCarthy, also national medical director over Medical Surveillance Services for health care company Concentra.

“No one was prepared for the cold,” she said of her community. Elsewhere, folks don’t know how to deal with heat.

Naomi Lawlis, left, speaks with Betty Sims as they take shelter at Beltway Park North Church in Abilene, Texas, on Monday, Feb. 15, 2021. Lawlis, 73, said she lost power at 1 a.m. Monday morning and by 5 p.m. was still without it, making the decision to escape to the warmup center at the church. “I couldn’t take it, I was too cold,” she said.
Ronald W. Erdrich, The Abilene Reporter-News via Associated Press

Weather extremes

What imperils older adults is a combination of mechanics — the internal thermostat of an older adult may not function well — and an inability to recognize or at least extricate oneself from danger. Older adults may not feel thirsty in extreme heat, for instance.

“Our thermoregulatory system is slower to respond. For environmental exposures, being 60 and older can impact someone differently that it will a younger person,” McCarthy said.

Older adults are also more likely to take medicine that can interfere with temperature regulation. And certain conditions more common in older people, like heart disease or diabetes, increase risk.

Vulnerable seniors can be nearly invisible, said April Lipinski, a mass care specialist for the Federal Emergency Management Agency who works with vulnerable populations, including older adults. Those living alone without a lot of support may not reach out.

Exertion and temperature can both generate heat. Hyperthermia can stop the heart, according to warnings from the National Institute on Aging. Signs can be vague or even contradictory: a headache, nausea, a little dizzy. One might have cramps in the stomach, arms and legs. Feet and ankles may balloon. Sweat may pour out — or stop entirely. Temperature can rise or stay normal while skin becomes cold and clammy. The pulse might race or slow.

If you don’t feel well and it’s very hot, cool down and see if it resolves. If it doesn’t, get medical attention fast, as if your life depends on it. It might, experts warn.

Cold in aging bodies may be even harder to spot. An internal temperature below 95 degrees Fahrenheit is perilous. When one’s temperature drops, heart attack, kidney failure, liver damage and other problems can occur. When it’s cold, the National Institute on Aging, said older people should keep homes between 68-70 degrees. Instead of turning the furnace down to save money, close off rooms that aren’t in use. Make sure heat’s not leaking to the outside and keep curtains closed.

The institute says certain conditions make it harder to stay warm, including thyroid issues and diabetes. Arthritis and Parkinson’s disease may stop someone from dressing right or going outside safely. Dementia can increase the risk of not dressing appropriately. Getting too cold can surprisingly cause the phenomenon of people shucking their clothes.

Early signs of hypothermia include cold hands and feet, a puffy face, pale skin, shivering (which stops with advanced hypothermia), slow or slurred speech, acting sleepy or being combative or confused. Clumsiness, stiff or jerky movement, slow heartbeat, shallow breathing and blacking out warn of advanced hypothermia.

Still toiling

An older adult can be capable of working long hours, but not be able to overcome temperature distress, McCarthy said.

She said she loves outdoor endurance activities like hiking and biking, but knows to schedule outdoor exertion early in the day, before temperatures and humidity climb. Those earning a living roofing, laying pipe or harvesting crops are unlikely to have the luxury of stopping because it’s hot.

McCarthy treats workers who have worked in hot environments for years with no problem and then find it bites them. Some work where there’s little shade and no time to take a break — or no restroom or drinking water nearby. She tells of a woman who got heat sick grooming baseball fields all day. She was too tired to walk the 200 yards to water and even take a drink, had she made it that far.

Older men with prostate issues may limit fluid intake, a potentially deadly decision. Aunt Jane sitting at home or Grandma visiting the zoo with the kids or Rex landscaping a stranger’s yard may all cut back on fluids to avoid the need to urinate. Even those who know they’re at risk may not want to look like they’re slowing down or not doing their share.

Tech and ties

Telemedicine and other technology offer great opportunities to help older adults stay safe, including during weather events, said Kenneth Thorpe, a policy and public health expert at Emory University.

“Two things I see promising: Remote monitoring in telemedicine and technology that continues to improve,” said Thorpe, who chairs the Partnership to Fight Infectious Disease and the Partnership to Fight Chronic Disease.

Increasingly, companies and care providers offer monitoring technology to older adults: A reading of too-high blood pressure or a waning heart beat or low oxygen level could alert a doctor that someone needs help, even if the person didn’t recognize it himself, said Thorpe.

These tools that help people stay healthier and more connected to others can make a difference in a weather crisis. But some folks may not be able to afford the technology that could be life-enabling or haven’t learned how to use tools like texting, which can be useful to reach help when phone lines are overwhelmed.

Still, Lipinski thinks the increase in technology use spurred by COVID-19 will make a big difference going forward. “Learning how to use those tools has been good in more ways than one,” she said.

Calling all hands

In occupational medicine, McCarthy preaches the value of a buddy system because people who get too hot or cold may not recognize the danger.

“Once you start having some mental status changes from cold, heat or sustaining an illness, you can’t get yourself out of it,” McCarthy warned. “Someone else may first see signs.”

For older adults those buddies can be a neighbor, a younger relative, a friend to check on them when outside temperatures sink or climb.

Prevention is key, starting with talking over one’s risk factors with a doctor.

When employers provided a shady place to rest during breaks and water so people don’t get dehydrated, her research showed employees had far fewer heat-related health issues, McCarthy said.

Because workplace protections related to temperature are usually voluntary, McCarthy emphasizes that promoting safety and health raises productivity. Researchers didn’t find workers feigning issues to take breaks, as some employers feared. They did find water and rest breaks, along with weather-related education, also cut the cost per injury by half.

State and local governments can set standards that improve safety for all workers, not just older ones, McCarthy added. California, Washington and Minnesota have heat standards when temperatures are high indoors or out.

Lipinski said FEMA partners a lot with states. Most of its evacuations and sheltering are weather-based responses to flooding, big winter storms, severe heat waves and wildfires. States have volunteer agency liaisons and rely heavily on local groups and individuals for manpower. And because many older adults would rather risk danger than leave beloved pets, FEMA shelter plans make way for Spot and Kitty.

Communities are resource-rich if they can rally folks to check on their older neighbors and teach them what to look for. At that friendly, manageable level folks can be taught the dangers of trying to keep warm in their cars or bringing heaters inside without adequate ventilation.

Community businesses like local theaters and senior centers have historically served as warming centers or places to cool down. County programs like Meals on Wheels that serve especially vulnerable older adults provide services and check in on frail residents. The delivery driver may be the first to notice that something is awry.

Faith communities have historically been a formidable asset against bad weather. People who worship together tend to know who’s vulnerable and might need help. Their buildings often serve as shelters, their members providing the hands that bring others to safety, Lipinski said.