During periods of cold weather, it seems that a concerted effort is made to ensure the safety of the elderly population in most communities; however, during periods of intense heat and humidity, focus is shifted to those who are younger and live much more active lifestyles. A heat-related death in a young person inevitably leads to a great deal of publicity, especially if the victim is a well-known athlete. Yet, as statistics show, the elderly are much more at risk than any other age group.
According to the CDC, 1,700 people die in the U.S. each year as a result of heat stroke during hot, humid weather.1 Since about 80% of these deaths occur in people over age 50, it is evident that the elderly are more prone to heat-related illnesses than any other segment of the population.
A major problem in any discussion of this topic is the almost universal confusion over the names and symptoms of various heat-related illnesses. These maladies can be classified as either major or minor illnesses.
Heat cramps, probably the foremost minor illness of this category, have a high incidence in athletes. Heat cramps present as involuntary muscle spasms that usually occur after physical activity has stopped. Treatment of cramps consists of cooling the affected region of the body, rest and, most important, fluid replacement. Heat cramps are rarely found in the elderly due to their more sedentary lifestyle.
A much more common manifestation in older people during periods of extreme heat is heat edema. Most EMS personnel have had an older patient with swollen feet and ankles, which is the primary symptom of this illness. Treatment consists of leg elevation, which usually takes care of the problem. However, field medics must be careful in diagnosing heat edema; swollen feet and ankles can also be symptomatic of much more serious problems like cardiac and lymphatic diseases.
Another minor heat-related illness that can affect all ages of the population is a skin condition called prickly heat. This condition can occur when dead skin blocks sweat pores, which, in turn, can lead to development of a secondary staph infection. Prickly heat is easily prevented by wearing loose clothing during humid weather. Treatment consists of applying antibiotic lotions or, in some cases, using systemic antibiotics.
Older patients being treated with beta-blocker therapy must be especially careful of a condition called heat syncope. This condition occurs when the arteries become dilated without compensation for an increased blood flow, resulting in loss of consciousness or feeling faint. This disease can also be present in persons who are not acclimated to hot, humid weather. Treatment for heat syncope consists of leg elevation and/or removal from the extreme weather conditions. Again, however, EMS providers must be cautious, because the symptoms of heat syncope may be symptoms of more severe problems.
Heat exhaustion, which is caused by the inordinate loss of sodium and water, is also classified as a minor condition; however, heat exhaustion is difficult to diagnose because it presents a wide array of symptoms, including weakness, nausea, syncope and dizziness. According to one source, heat exhaustion is a diagnosis of exclusion once heat stroke has been ruled out.2 Treatment consists primarily of gradual cooling and rehydration. Most lay persons understandably confuse heat exhaustion with heat stroke, which means that EMS providers must be careful when compiling patients’ past medical histories.
Heat stroke is classified as a major heat-related illness due to its high mortality rate. Heat stroke is characterized by an elevated body temperature and central nervous system dysfunction.3 Body temperatures can range between 37.8º–41.1ºC (100º–106ºF), accompanied by delirium and/or seizures. In addition, these conditions can lead to a variety of clinical signs, including renal failure, alkalosis and coma. Immediate cooling, especially evaporative cooling involving misting water in front of circulatory fans, is the treatment of choice. Airway management is of utmost concern because of the threat of aspiration and seizure.