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Monday
August 07, 2006
FEATURE ARTICLE
Disadvantaged Elderly Particularly Vulnerable to Heat Wave
By Crystal Phend, MedPage Today Staff Writer
NEW YORK Aug. 5 -- The summer is barely half over, and much of the country has had enough -- enough of heat-related illness, enough heat-related power outages, and enough heat-related misery from a sweltering wave of extraordinary heat that broke records from coast to coast.
In the hours before the oppressive temperatures began to moderate, more than 50,000 baseball fans sweated through a three-hour day game here at Yankee Stadium in temperatures that hovered near 100 degrees. They were given free bottles of water.
Ironically, though, the outdoor gathering was healthier than staying home in sweltering conditions, which a study in the August issue of the American Sociological Review called the primary cause of the deaths of more than 700 elderly Chicago residents in a 1995 heat wave.
Of course, watching the game on TV in an air conditioned living room would have been better, but many Americans in the path of the heat wave had no air conditioning. Even if they owned an air conditioner, they may have lost the power to run it.
Following the 1995 Chicago pattern, the majority of the 200 or more heat-related deaths in the past 20 days were older persons who were not using or did not have access to air conditioning but stayed in their homes nevertheless.
In New York City alone, there were 20 heat-related deaths by the end of the week, all among elderly persons in stifling apartments with the windows closed.
In California, more than 160 deaths were suspected to have been caused by the heat.
In Maryland, there were six heat-related deaths during the week and 21 overall this summer.
Cook County, including Chicago, has had 17 heat-related deaths since Sunday and 26 in 2006.
Philadelphia has seen five heat-related deaths during the heat wave.
Sociologist Christopher R. Browning of Ohio State University in Columbus said the elderly who stay home in the heat are often acting rationally. "Many times the older folks don't want to leave their apartments because they have gotten conditioned to be afraid of the community."
Browning and colleagues found that when retail stores move out of a neighborhood in economic decay, many times only liquor stores, bars and youth-oriented businesses remain, drawing clientele that may frighten older individuals into essentially putting themselves on "house arrest."
Mount Sinai Hospital of Queens, in a neighborhood of New York that has suffered some of the "commercial decline" cited by Browning, not to mention a notorious 10-day loss of power, saw many patients who needed supplemental oxygen or nebulizers during the power outage.
However, others waited at home until heat-related problems necessitated required emergency transport to the hospital, said Paul Hamilton, M.D., of the emergency department.
During the three worst days of the heat wave in New York, when the thermometer hovered near 100 degrees Fahrenheit, emergency medical services saw a 20% higher call volume than the same time last year, according to Mayor Michael R. Bloomberg. There were at least 103 heat-related calls.
Heat-related illness spans from dehydration to heat exhaustion and heat stroke, all of which can be life threatening.
Dehydration may be treatable at home with extra water and fluids such sports drinks.
Heat cramps cause intense, persistent pain with muscle contractions. Light stretching and massage may ease the pain while rehydration, particularly with sports drinks, is required.
Heat exhaustion causes heavy sweating, weakness and sometimes fainting and vomiting. It should be immediately treated by hydration and cooling with misting, a wet towel or sheet, and fanning to promote evaporation.
Heat stroke occurs after the body's thermal regulation systems are overwhelmed and temperatures quickly rise above even the hottest possible fever and can cause permanent cardiac, brain, muscle, kidney and other organ damage.
Although dehydration, heat cramp and heat exhaustion may have no long term consequences, the opposite is often true for severe heat stroke.
"I don't think most of these patients that get to this stage get back to normal," said Dr. Hamilton said. "It's even worse than having the highest fever you can have."
Along with the elderly, those who are overweight, have hypertension or heart disease, diabetes, or suffer from chronic respiratory illnesses are more susceptible to heat-related illness.
Infants and children are also at heightened risk in part because they can become dehydrated faster than adults.
Heat-related illness is more difficult to diagnose in young infants. Rather than headache and nausea, they may present as fussy and irritated, said Dee Hodge, M.D., an associate professor of pediatrics at Washington University in St. Louis. Taking a good history will generally help in these cases, he said.
Primary care physicians and general internists who typically see most of the older people in communities should be alert to opportunities to educate elderly patients and their families about coping with the heat, said geriatrician Sharon A. Brangman, M.D., of the State University of New York in Syracuse.
"Ask patients how are they handling the heat and what are they doing," she recommended. "I try to impress on them the fact that air conditioners are a necessity now, not a luxury."
Although the heat wave is winding down with cooler temperatures expected over the weekend, individuals need to stay alert to the danger of heat-related illness, he said.
"It's something people need to be aware of all the time," cautioned Charles Pattavina, M.D., an emergency physician at Saint Vincent Hospital in Worcester, Massachusetts.
Primary source:American
Sociological Review Source reference:
Christopher R. Browning, et al "Neighborhood Social Processes,
Physical Conditions, and Disaster-Related Mortality: The Case of the
1995 Chicago Heat Wave" American Sociological Review,
2006:71 (August:665-682)
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