Heat Stress and Aging:
We are fast approaching the summer of 2009. And it is hard to believe that so much time has gone since July 1995.
July 1995?
Almost 14 years ago and in our country during that summer there was a brutal heat wave that had gathered intensity and settled in over the expansive metropolitan area of Chicago, Illinois. The resulting effect – and impact – was devastating and it shocked the nation with how heat had come to claim so many (over 700 people) in that short span of time. With all of the focus on macro-scale weather events like HURRICANES or the acute devastation of TORNADO – but we forget about HEAT- heat as a major factor in weather-related disasters.
Extreme heat heat kills more Americans annually than any other natural disaster.
As the globe warms up, scientists expect ever more heat waves like the one that killed more than 700 people—many elderly and living alone—in Chicago in the summer of 1995. And this is exactly what was later discovered through a careful analysis of the “natural” and the social ecological factors of the urban setting became the basis for the book, Heat Wave: A Social Autopsy of Disaster in Chicago, by Eric Klinenberg.
(see http://www.press.uchicago.edu/Misc/Chicago/443213in.html) for an extensive interview with the author)
Klinenberg specifically indicated how it was the elderly – especially the elderly that lived alone – who were the most vulnerable to heat.
Before we will briefly examine the social ecological factors, we need to continue onward and indicate the dramatic impact of hypothermia as it relates to morbidity and mortality – and how the elderly are more at risk with this kind of event. And this public health issue is NOT just an event isolated in the US.
You will recall that France experienced a record-breaking heat wave in August 2003 (see Fouillet A, Rey G, Laurent F, Pavillon G, Bellec S, Guihenneuc-Jouyaux C, Clavel J, Jougla E, Hémon D; “Excess mortality related to the August 2003 heat wave in France.” Int Arch Occup Environ Health. 2006 Oct;80(1):16-24
Fouillet et al (2003) reported that,
- “all the French regions were affected by this heat wave, which resulted in an excess of 14, 800 deaths. The increase in the number of excess deaths followed the same pattern as the increase in temperatures. The victims were mainly elderly women older than 75 years. Excess mortality at home and in retirement institutions was greater than that in hospitals. The mortality of widowed, single and divorced subjects was greater than that of married people. Deaths directly related to heat, heatstroke, hyperthermia and dehydration increased massively. Cardiovascular diseases, ill-defined morbid disorders, respiratory diseases and nervous system diseases also markedly contributed to the excess mortality.”
And then later research by Kim Knowlton, Miriam Rotkin-Ellman, Galatea King,Helene G. Margolis, Daniel Smith, Gina Solomon, Roger Trent, and Paul English followed up with the heat wave in California with an article titled, “The 2006 California Heat Wave: Impacts on Hospitalizations and Emergency Department Visits” in Environ Health Perspect. 2009 January; 117(1): 61–67. During the heat wave, the researchers noted 16,166 excess ED visits and 1,182 excess hospitalizations occurred statewide. Knowlton (2009) et al indicated that,
- “Besides older residents with recognized heat vulnerabilities, children showed significant elevated risk for some morbidities. Strategies to prevent heat-related illness during extreme heat events should include messages and information dissemination targeted toward parents, caregivers, and other guardians of young children, continued outreach to the elderly and especially to socially isolated individuals, and geographically targeted messages about health risks of heat exposure and heat stress. By better understanding heat wave effects on morbidity, local communities can develop appropriate public health interventions and increase their adaptive capacity to cope with heat waves when they happen—both today and in a globally warming future.”
As Kovats and Hajat (20080 have indicated (see “Heat stress and public health: a critical review”; in Annu Rev Public Health. 2008;29:41-55),
- “Heat is an environmental and occupational hazard. The prevention of deaths in the community caused by extreme high temperatures (heat waves) is now an issue of public health concern. The risk of heat-related mortality increases with natural aging, but persons with particular social and/or physical vulnerability are also at risk. Important differences in vulnerability exist between populations, depending on climate, culture, infrastructure (housing), and other factors. Public health measures include health promotion and heat wave warning systems, but the effectiveness of acute measures in response to heat waves has not yet been formally evaluated. Climate change will increase the frequency and the intensity of heat waves, and a range of measures, including improvements to housing, management of chronic diseases, and institutional care of the elderly and the vulnerable, will need to be developed to reduce health impacts.”
The connection between the degree (or lack thereof) of social capital and well-being (or in contrast: vulnerability and risk) has been established and elobroated upon, epscially with the trends in the US by Robert Putnam (see Bowling Alone) and others.
Thus, we have had – and appears will continue to have – an unfortunate triangulation of demographic, social and natural forces (and events) that can expose segments our society (e.g., elderly who live alone with minimal social capital) to even greater risk if (or as many would say: not if, but when) catastrophe occurs either by natural or human made- disasters (or some combination of both).
We have Harrell (2008) has done a nice job of articulating the cocenr of challenge of older adults who live alone in our midst – in her article, The Elderly: Living and Dying Alone.
- “Many elderly people in cities, live alone, with their windows sealed or nailed shut because they are so afraid of crime-afraid that someone will break in, and they will be defenseless. So many are poor and sick, hardly able to care for themselves, with no family or friends, and are often dealing with some level of confusion or dementia. When the elderly die, they usually die alone, just as they have lived in their later years. Sometimes they die at home alone, and sometimes they die in hospitals, or nursing homes. It is such a tragic end for a person who has given so much of their lifetime to others, and yet, when it is their time to depart, there is no one to be there for them. Many times their bodies are not discovered for a long time, because no one cares, or notices that they are missing.
They are sometimes referred to as “elder orphans.” It is estimated, by Kenneth W. Wachter, Ph. D., Chair of the Department of Demography, at the University of California at Berkeley, that “the number of Americans between the ages of 70 and 85, without a living spouse, without any biological or stepchildren, and without living siblings or half-siblings, will total more than 2 million people by the year 2030.” It is an increasing problem as the Baby Boomers age, due to their low birth rate, and their longer lifespan. After age 80, Alzheimer’s disease increases to between 22% and 40%. This cognitive impairment, leads to the elderly without family, being unable to care for themselves properly.”
(for more information see http://www.associatedcontent.com/article/529693/the_elderly_living_and_dying_alone.html?cat=12
And Klinenberg went on to write about how community organization is essential for disaster preparation. Klinenberg (2008) in an article for The New York Times (July 6, 2008) said that,
- “The two deadliest recent US environmental disasters, Katrina and the 1995 Chicago heat Wave, highlighted the vulnerability of socially isolated people, for whom the safe house becomes a tomb. Efforts to build strong, durable connections among neighbors, local organizations, businesses and government agencies will help improve community resilience in crises of all kinds.”
(see http://www.nytimes.com/2008/07/06/magazine/06wwln-idealab-t.html for full article)
The are several key points to be prepared for addressing the challenges of hyperthermia in persons of all ages, but as the blog focuses in on ages issues, we highlight vulnerable older adults – in our families, neighborhoods, and communities in this summer 2009 – and beyond.
Heat can be extremely dangerous, but there are many factors that contribute to hypothermia. Please be on the lookout – and help to monitor those older adults who are living alone – and espcially those who may those who may be cut off from social capital and social resources. The following represent excellent resources for further information.
thanks, Scott Wright
The EPA Aging Initiative has two great resources to check into:
http://epa.gov/aging/resources/factsheets/itdhpfehe/index.htm
http://www.epa.gov/naturalevents/extremeheat.html
http://www.nia.nih.gov/HealthInformation/Publications/hyperthermia.htm
http://www.press.uchicago.edu/Misc/Chicago/443213in.html
Marcus Aurelius
0 Responses to “Senescence and Summer 2009 (and beyond): Heat and Hyperthermia”