BY COMMITTEE ON ENVIRONMENTAL & OCCUPATIONAL HEALTH MEMBERS BETSY SISSON, MD, AND ROGER LUCKMANN, MD, WITH SPECIAL THANKS TO MARISSA HAUPTMAN, MD, MPH
Photo by FG Trade via Getty Images.
Climate forecasters predict that Massachusetts will have progressively hotter summers in the future. By 2050 we may see as many as 40 days of heat over 90 degrees each summer. New Englanders have been relatively lucky they have not faced the oppressive
heat that southern states have faced, but in 25 years our summers will look more like those in Maryland. Even now, data shows that we have 5 to 7 more deaths per day in New England when the temperature rises above 85 degrees.
Among the most vulnerable to heat in our population are older adults who lose the ability to adapt to the heat as they
age. They often also have comorbid chronic conditions that increase their sensitivity to overheating and dehydration, like cardiovascular disease, renal disease, and diabetes and are often on drugs that dehydrate and make the effects of heat illness worse.
In some cases, memory issues and cognitive impairment are present. Heat illness is often subtle in onset and can easily be missed and worsen unless a caregiver recognizes that the person in their care is struggling. This vulnerability is exacerbated by
isolation and financial difficulties. Thirty percent of Massachusetts residents over 65 live alone, and another 30 percent of those struggle to meet living expenses, including having and running an air conditioner. This population is also growing.
As of 2020, Massachusetts had 1.2 million people over 65 years of age, a 32 percent increase from 2010. Those over 65 are projected to grow from 19 percent to 27 percent of our state population by 2050.
How to better serve vulnerable populations
Recent efforts to develop efficient and effective heat response plans for health care practices to better serve vulnerable populations can be distilled into three major points:
- Focus on the most vulnerable populations in your practice.
- Provide preventative education to those patients by whatever means that will reach them.
- Partner with resources in the community to educate them about the symptoms and treatment of heat illness. This can extend the reach of preventative actions to a larger percentage of vulnerable older adults.
In terms of focusing on the most vulnerable, many practitioners are likely already following older and sicker individuals on a frequent basis. Because patients are more likely to focus on and retain information on heat risks leading up to and during the
hotter months, having a discussion with these patients during the heat is most effective. For those whose visits do not occur during that time, communication through phone calls, email, or portal blasts can reinforce heat risks.
Electronic media can provide heat warnings, advice, and a communication portal in times of high heat. With older populations, it has some limitations. A 2020 article from Pew Reports found that nationally, of those over 65 years of age, 61 percent had a smartphone. Forty-five percent used social media, 44 percent owned a tablet computer, and 64 percent had broadband connections.
To the extent that electronic media is reaching older adults, it can be a resource for education about managing the heat. There is excellent guidance by several websites that
provide content for social media, email campaigns, text messaging, and phone messaging programs. These campaigns can be started before the season as well as during heat advisories. For some populations this just may not be an option, highlighting
the need for in-office care visits or phone check-ins for some patients. Even if they are reached by whatever means, it is important to appreciate there is some resistance from seniors to see themselves as vulnerable enough to take precautions and use local services.
Care visits can include heat-related advice, reminding patients and caregivers that heat symptoms are subtle at onset. Fatigue, dizziness, mild headache, and dry mouth can be subtle early signs and may be passed off as something else. Air conditioning
and hydration goals can be emphasized, and local cooling centers can be encouraged, if needed. The Chan School of Public Health has developed a Heat Action Plan form that physicians might find helpful. The form can be filled out with the patient present to guide the conversation. Besides discussing home-based cooling treatments and goals for increased hydration, the guide prompts a discussion of the risks
of medications in the heat and when to reach out for help. A copy of the personalized plan can go home with the patient, perhaps land on the refrigerator, and remind the patient and other caregivers of what was said during the visit once they are
home and in the middle of a heat wave.
Community resources
Community resources can be the most crucial part of a heat illness response, particularly to those most isolated. It is likely that practitioners in Massachusetts already provide their most vulnerable patients, particularly those living on their own,
with home outreach services. Because this help is in the home regularly, they know the patient, can recognize they are not at their baseline, provide intervention, and report to those that supervise them.
Massachusetts, through its Bureau of Climate and Environmental Health, has expanded a program to send a heat alert advisory when three days of high heat are expected. A heat alert went out
three times last summer to a wide range of health professionals throughout the state, as well as local governments and community groups, including home health aides. When it gets hot outside, home service providers who are being prompted to look for
heat illness can improve the reaction time for intervention, getting those in trouble help either in the home, at the doctor’s office, or in the ER, depending on the case.
Physicians’ offices, home health aides, and local senior center personnel can all provide information about state-sponsored breaks for energy expenses
to keep the air conditioner running. Health aides can bring in pamphlets for Hot Weather Safety Tips for Older Adults to the home. Emphasis on local services like cooling centers, including availability of transport, can also be encouraged by community outreach personnel.
A focused effort leading up to and during high heat times, using opportunities for guidance during medical visits and using a variety of methods of communication physicians have at their disposal, as well as partnering with local outreach services, can
help keep vulnerable patients safe.
