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Are you prepared for hot weather?


Doug Beardsley
By Doug Beardsley  |  July 12, 2019  |  All providers



Many parts of the state have recently experienced a round of hot, humid weather. Providers should assume we will experience additional hot days this summer. Each year in the United States, approximately 200 people die of health problems caused by high heat and humidity. Most of the victims are age 50 or older. A combination of age-linked factors helps explain why older adults and the elderly are at higher risk on very hot days. Due to age-related physical changes, older adults can't cool down as well as younger adults. Older people may not feel as hot when temperatures are dangerously high, and they are also less likely to feel thirsty, even when they're almost dehydrated. These and other factors mean that extreme heat can lead to serious health problems and increased risk of death for older adults. Heart disease, diabetes, and certain other diseases that are common in older adults can also make it more difficult to cope with high heat and humidity. The same goes for many drugs, including water pills, allergy and sinus medications, and medicines for depression and nerve problems.

Excessive building temperatures
Federal regulations require skilled nursing facilities and nursing facilities (SNF/NF) initially certified after October 1, 1990, to maintain a temperature range of 71–81°F in resident areas. A facility must also show what actions they will take when residents complain of being hot or cold, as well as when building temperatures fall below 71° or exceed 81° F. SNFs/NFs initially certified prior to October 1990 are required to maintain “safe and comfortable temperature levels.” Minnesota nursing facility rules also require comfortable humidity levels in nursing facilities, but no specific humidity level or threshold is referenced. Facilities may need to consider additional fans to improve airflow and temporary air conditioning units for extreme temperature situations. Don’t forget about your staff…particularly those working in the laundry and kitchen areas (free lemonade, iced tea, and popsicles are certainly appreciated on hot days)!

As we enter the peak of summer sun and heat, here are some tips to keeping your residents and tenants safe.

Outside activities
Don’t forget wide brimmed hats, sunglasses, and sunscreen (at least SPF 15) for residents who will be going outdoors, even for short periods of time. Try to avoid outdoor activities at times of peak sun and heat. When possible, conduct outdoor activities in shady areas and provide frequent fluids. Check with your pharmaceutical consultant for a list of medications that may make skin more prone to sunburn. 

Be aware that several different kinds of medications can pose special problems during periods of extremely hot weather. These include diuretics (water pills), many heart medicines, diabetes medicine (tablets and insulin), psychoactive drugs (antidepressants and mood-altering drugs), antihistamines (hay fever and allergy medicine) and antihypertensive (high blood pressure) drugs. If residents are able to exit to outdoor areas but unable to re-enter without assistance—check on them often to make sure they are not overheating. 

Heat stroke & heat exhaustion (heat stress)
Heat stroke is the most serious heat-related illness. It occurs when the body becomes unable to control its temperature: the body's temperature rises rapidly, the body loses its ability to sweat, and it is unable to cool down. Body temperatures rise to 106°F or higher within 10 to 15 minutes. Heat stroke can cause death or permanent disability if emergency treatment is not provided. Warning signs vary but may include the following:
  • An extremely high body temperature (above 103°F)
  • Red, hot, and dry skin (no sweating)
  • Rapid, strong pulse
  • Throbbing headache
  • Dizziness
  • Nausea

Heat exhaustion is a milder form of heat-related illness that can develop after several days of exposure to high temperatures and inadequate or unbalanced replacement of fluids. Warning signs vary but may include the following:
  • Heavy sweating
  • Paleness
  • Muscle cramps
  • Tiredness
  • Weakness
  • Dizziness
  • Headache
  • Nausea or vomiting
  • Fainting
  • Skin: may be cool and moist
  • Pulse rate: fast and weak
  • Breathing: fast and shallow

What you can do for someone with heat stress
If you see any signs of severe heat stress, you may be dealing with a life-threatening emergency. Have someone call for immediate medical assistance while you begin cooling the affected person. Do the following:
  • Get the person to a shady area
  • Cool the person rapidly, using whatever methods you can
    • For example, immerse the person in a tub of cool water; place the person in a cool shower; spray the person with cool water from a garden hose; sponge the person with cool water; or if the humidity is low, wrap the person in a cool, wet sheet and fan him or her vigorously
  • Monitor body temperature and continue cooling efforts until the body temperature drops to 101–102°F
  • If emergency medical personnel are delayed, call the hospital emergency room for further instructions
  • Do not give the person alcohol to drink
  • Get medical assistance as soon as possible

Pests
Protect residents and food from ants, bees, and flies. Ensure residents who are allergic to bee stings are easily identifiable to staff and that staff know the signs and symptoms of severe allergic reaction (swelling of the throat or tongue, constricted breathing, and /or sudden outbreak of hives) and are ready to respond immediately with emergency treatment. Note: Check your supply of auto-injector epinephrine pens for expiration dates and availability.

Foodborne illness

Picnics are great in the summer, but staff must make sure they are maintaining proper food temperatures! Foodborne illnesses can be especially debilitating for the elderly population and are most prevalent in the warmer months when food temperatures are more easily compromised.  Review food temperatures and holding times with your dietitian and/or dietary director.

Hydration
Studies have routinely identified that a significant percentage of older adults are at risk for dehydration. One study found that 48% of older adults admitted to hospital emergency departments had laboratory values indicative of dehydration. Hot weather certainly places nursing home residents and tenants of senior housing establishments at increased risk of dehydration. Make certain that you have systems in place for frequent replenishing of bedside water in nursing facilities, encourage frequent drinking of fluids, provide popsicles and ices (available both with and without sugar) as routine treats, etc.  Educate your residents and tenants about the risks and dangers of dehydration! Carafes/Dispensers of iced tea, iced water, and iced lemonade are always appreciated (as are popsicles). And don’t forget about your hard-working staff! Provide plenty of fluids to keep them hydrated as they go about their work activities.

The Center for Disease Control & Prevention (CDC) has several publications regarding the dangers of heat, including information for specific populations such as people aged 65 and older. The documents can be found at the CDC website. Another great resource is the National Integrated Health Information System website. Stay cool and safe!



Doug Beardsley  |  Vice President of Member Services  |   dbeardsl@careproviders.org  |  952-851-2489




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