COLD STRESS (HYPOTHERMIA)

Much like high blood pressure, hypothermia can be called a "silent killer" in the sense that many of its victims are not aware of the threat. In the case of hypothermia, elderly persons may not be aware they are becoming cold as readily as younger people, and their bodies may not adjust to changes in temperature.

Hypothermia (literally "low-heat") is a condition marked by an abnormally low internal body temperature. It develops when body heat is lost to a cool or cold environment faster than it can be replaced. Temperatures do not have to be below freezing for hypothermia to occur, especially in vulnerable individuals. Many older adults can develop a low body temperature after exposure to conditions of mild cold, which would only produce discomfort in younger people. Who Is At Risk? Although older adults are more vulnerable to hypothermia than younger members of the population, infants under one year are also particularly susceptible. Among the elderly, those most likely to develop hypothermia are the sick, the frail, the very old, the poor who can't afford enough heat, and those medically vulnerable individuals who do not know how to keep warm when exposed to the cold. Others who are susceptible include individuals who (1) live alone or in isolated areas (particularly if they don't have access to nearby phones to reach help in case of accident or illness); (2) do not shiver or react to cold; and (3) take certain medications that prevent the body from regulating temperatures normally, such as anti-depressants, sedatives, tranquilizers, and cardiovascular drugs. Drugs deserve special mention because they are thought to be a major predisposing factor to hypothermia in older adults, who, while comprising little more than 10 percent of the population, consume 25 percent of the nation's prescription drugs. Check with a doctor or pharmacist for information on other drugs that increase susceptibility to hypothermia.

Hypothermia can cause illness and death. Although there are no accurate data on the number of elderly persons dying of this condition, it is estimated that about 10 percent of all persons over 65 have some sort of temperature-regulating defect, and between three and four percent of all hospital patients over 65 are hypothermic. The National Institute on Aging (NIA) estimates that over 2.5 million older Americans are especially vulnerable to hypothermia, and Dr. Richard Besdine of the Harvard Medical School estimates that 25,000 older adults may die from hypothermia each year in the United States.

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What You Can Do

To avoid being harmed by hypothermia, now that cold weather has come to many parts of the United States, here is some practical advice:

• If you live alone, arrange for a daily check-in call with a friend, neighbor, relative, etc
• Insulate your home properly Caulking is a particularly low-cost and effective technique
• Wear warm clothing Instead of tight clothing, wear several loose, warm layers Wear a hat and scarf to avoid significant heat loss through your head and neck Stay dry Moisture from perspiration, rain, or melting snow can seriously reduce or destroy the insulating value of clothing because water conducts body heat over 25 times faster than air
• Use extra blankets because hypothermia can develop during sleep
• Eat nutritious foods and exercise moderately; proper diet and physical conditioning help protect you against abnormal heat and cold
• Get proper rest; fatigue makes you more vulnerable to subnormal heat and cold
• Drink adequate amounts of liquids, such as water Limit your alcohol intake because alcohol speeds up body heat loss

What To Look For

Some people die of hypothermia because they or those around them do not recognize the symptoms. Here are some signs to watch for:

• Muscles: The muscles are often unusually stiff, particularly in the neck, arms, and legs This stiffness may be accompanied by a fine trembling, perhaps limited to only one side of the body or one arm or leg
• Shivering: Shivering is a sign that the body is having trouble keeping warm The shivering response is frequently diminished or absent in older adults, and the fact that an older person is not shivering in a cool or cold environment does not GUARANTEE that the person is not cold
• Face: The face is frequently puffy or swollen, and this can be an important sign, especially when found in combination with cold skin and signs of confusion
• Coordination: The person often has difficulty walking and has problems with balance Look for poor coordination and jerky movements
• Breathing and Heart Rate: Both are slowed at low body temperatures, and may be very difficult to detect in severe hypothermia
• Skin: The skin is cool or cold Pay special attention to the stomach, lower back, arms, legs, hands, and feet The skin color is usually very pale, but it may also have large, irregular blue or pink spots
• Consciousness: As the body cools, consciousness is depressed Some hypothermia victims will still be conscious when their body temperatures are as low as 80 degrees Remember, though, that "conscious" and "mental clarity" are two different things A person can be "conscious and reactive" and yet still be in a confused, disoriented, and hypothermic state, so the level of consciousness is not always a reliable indicator of the victim's condition
• Confusion: One of the first changes brought on by hypothermia is a growing mental confusion, which becomes progressively worse as body temperature falls Logical thinking becomes impossible and the person may become completely disoriented Memory is affected and familiar things are often forgotten
• Attitude: Apathy is common Often the person doesn't care what happens and will do nothing to help reduce the danger; he or she may behave strangely, or become irritable, hostile, mean, and aggressive

Note: Keep in mind that these signs do not necessarily mean a person is suffering from hypothermia; they are listed to alert you to the possibility.

What To Do:

If you believe someone may be a victim of hypothermia, call an ambulance or rescue squad immediately. Hypothermia is a dangerous, complicated medical problem and the victim needs professional attention. However, before help arrives, here are some suggestions:

• Be very careful in handling the person Failure to do so can cause sudden death because the heart is very weak when the body is cold
• Insulate the victim with available covering such as blankets, towels, pillows, scarves or newspapers
• Some steps can worsen a victim's condition:
• Do not attempt to rewarm the victim at home Hot baths, electric blankets, and hot water bottles can be dangerous
• Do not give the victim any food or drink
• If the victim is unconscious, do not raise the feet This will cause blood from the legs to flow into the body "core" and further depress the body temperature

HEAT STRESS

"Energy issues are truly life and death issues for the elderly. The ultimate risk is death from hypothermia or heat stress," said Virginia H. Knauer at last winter's energy conference of utility, consumer, senior citizen, and energy public interest groups.

According to the Center for Environmental Physiology, the body needs time to adjust to hot weather. A sudden increase in temperature, especially at this time of year, is particularly serious because it can place a dangerous strain on the heart and blood vessels before the body can acclimate itself.

Heat stress, which can lead to heat exhaustion, heart failure, and strokes, may well be a life threatening problem for the elderly this summer. Remember, the blistering heat during the summer of 1980 claimed several thousand more lives than during previous years. The death toll was highest among people over 65. This Special Report describes warning signs and offers precautions that may avert the recurrence of problems for the elderly, similar to those encountered in 1980.

The elderly are more vulnerable to heat stress than younger people because they do not adjust as well to heat. They perspire less. They are also more likely to have health problems requiring medicines that work against the body's natural defenses to adjust to heat. For example, diuretics (often prescribed for high blood pressure, a common disease of the elderly) prevent the body from storing fluids and restrict the opening of blood vessels near the skin's surface. Certain tranquilizers and drugs used to treat Parkinson's disease interfere with perspiring. These and other chronic conditions (such as circulatory problems, diabetes, a previous stroke, overweight, and a weak or damaged heart) often upset normal body responses.

Warning Signs

Early symptoms - feeling hot, uncomfortable, and listless - are mild and usually pose no threat unless they persist. However, because the serious signs of heat stress listed below are usually preceded by the milder ones, it is important that you get medical attention if you experience any of the following:

• Dizziness
• Rapid heartbeat
• Diarrhea
• Nausea
• Cramps
• Throbbing headache
• Dry skin (no sweating)
• Chest pain
• Great weakness
• Mental changes
• Breathing problems
• Vomiting

NOTE: These symptoms can also signal other major problems, such as heart failure. Again, if you experience any of them, call a doctor immediately.

Keeping Cool

The best advice for avoiding heat stress is to keep as cool as possible. So if you are up in years or have a loved one who faces a special risk from heat stress, this information may help you avoid problems:

• Air conditioning can provide lifesaving relief from heat stress, especially if you have heart disease If you don't have air conditioning, spend as much time as possible in cool shopping malls, senior centers, libraries, movie theaters, or in the coolest room in your home
• Fans can draw cool air into your home at night or help to circulate indoor air during the day Air movement reduces heat stress by removing extra body heat
• Cool baths or showers provide relief from the heat because water removes extra body heat 25 times faster than cool air Placing ice bags or wet towels on the body is also helpful
• Loose fitting, lightweight, light colored clothing is more comfortable in hot weather Hats and umbrellas protect your head and neck when you are outdoors
• Your body needs more water in hot weather Don't wait until you are thirsty to have a drink If you have a disease, a medical condition, or a problem with body water balance, CHECK WITH YOUR DOCTOR for advice on how much water you should drink
• Special Precautions
• Curtail physical activity during extremely hot weather Activity adds to heart strain
• Avoid hot foods and heavy meals They add heat to your body
• Watch salt use Check with your doctor before increasing the amount of salt or potassium in your diet Don't take salt tablets without your doctor's permission
• Avoid alcohol Alcohol acts as a diuretic, resulting in fast water loss In addition, alcohol can promote a sense of well-being, making you less aware of the danger signs of heat stress
• If you live alone, make sure a relative or neighbor checks on you regularly
• Take the heat seriously, pay attention to the danger signs and call your doctor at the first sign of trouble

FOR MORE INFORMATION

This Special Report is based on information furnished by the National Institute on Aging; and the Center for Environmental Physiology, a non-profit organization which conducts research and develops educational programs about heat and cold stress with particular emphasis on the needs of older Americans.

Additional information can be found in your local library, public health agencies, energy offices, and Area Agencies on Aging. Check your telephone directory's white pages under U.S. Government for the address and telephone number.

Permission to reproduce this Special Report is granted. ??

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