We are experiencing the hottest days in history. Extreme
heat can be deadly for anyone, but older adults are uniquely vulnerable. In the
heat wave that suffocated Europe in summer 2022, people age 65 and older
accounted for approximately 90 percent of heat-related deaths.
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Experts say that three factors combine to increase older
adults’ risk: biological changes that occur naturally with age, higher rates of
age-related chronic diseases and greater use of medications that can alter the
body’s response to heat.
Here’s how to gauge the risk for a heat-related illness for
you or a loved one and how to stay safe.
How heat affects an aging body
The human body has two main mechanisms to cool itself:
sweating and increasing blood flow to the skin. In older adults, those
processes are compromised — they sweat less and they have poor circulation
compared with younger adults.
“Because older individuals are not able to release the heat
as well, their core temperature goes up faster and higher,” said Craig
Crandall, a professor of internal medicine specializing in thermoregulation at
the University of Texas Southwestern Medical Center. “And we know that core
temperature is the primary driver for heat-related injury and death.”
Because older individuals are not able to release the heat as well, their core temperature goes up faster and higher
These changes don’t suddenly emerge when someone reaches 65;
they start gradually in middle age, said Glen Kenny, a professor of physiology
at the University of Ottawa. “It’s a slow decline,” he said. But you start to
see noticeable differences “by the age of 40, no question.”
Chronic conditions that are more common in old age, most
notably cardiovascular disease and diabetes, can exacerbate these issues. A
diseased heart isn’t able to pump as much blood, further reducing blood flow to
the skin. And if the nerves become affected in people with severe diabetes, the
body might not receive the message that it needs to start sweating. (Younger
people with these conditions are also at a heightened risk for heat-related
problems.)
As people age, they also stop feeling as thirsty and so they
tend to drink less. In hot conditions, that can cause them to become dehydrated
faster, which is “hugely detrimental for temperature control,” Crandall said.
In addition, some older adults, particularly if they have
some form of dementia or cognitive decline, may not perceive temperature
changes as well. As a result, they won’t respond appropriately to heat, both
biologically (through sweating) and behaviorally (by moving to someplace cool).
Finally, certain medications can affect people’s hydration,
blood flow and even the sweat response, so be sure to ask your doctor about any
medications you’re taking.
Of course, not everyone the same age responds to heat in the
same way. Older adults who are physically fit are typically more resilient,
Crandall said, because they have better blood flow and they sweat more than
their sedentary peers.
How to stay safe
People often think that heat needs to be extreme (say, over
38°C) to cause
illness, but in older adults, signs of heat exhaustion can emerge when
temperatures are as low as 27°C.
“Twenty-year-olds can go out in 80-degree [27°C] weather for hours and
generally be OK,” said Dr. Angela Primbas, a geriatrician at UCLA Health.
“That’s not true for older adults.”
Physical exertion increases a person’s risk for heat illness
because the body starts to generate even more heat. On hot days, Primbas said,
older adults and people with serious health conditions should limit outdoor
activities like walking and gardening to the cooler mornings and evenings, take
frequent breaks and drink plenty of water. Listen to your body, too: If the
activity starts to feel harder than normal, that’s a signal to stop and find a place
to cool down.
And we know that core temperature is the primary driver for heat-related injury and death.
Signs of dehydration or heat exhaustion include dizziness,
lightheadedness, headache, a racing heart or feeling lethargic. Low energy — if
someone is not talking or interacting as much as usual — is especially
important to watch out for in people with cognitive impairment, who may not
realize how hot they are or be able to express it.
While older adults face unique challenges when it comes to
heat, the ways to cool down are the same for any age. If you or a loved one
start to experience any of the above symptoms, the best thing you can do is to
go somewhere that has air conditioning, Kenny said. The indoor temperature
doesn’t have to be “subzero,” he added, just aim for 25°C or below. If air conditioning isn’t available in
the home, check if there’s a local cooling center.
In the absence of air conditioning, water is “extremely
helpful in reducing our risk for heat-related injury,” Crandall said. He
advised rubbing an ice cube over your skin, spraying yourself with cool water,
drenching your shirt, or taking a cool shower or bath.
Whatever you do, take heat seriously. It’s the No. 1 cause
of weather-related deaths in the United States, and many of those fatalities
are preventable.
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