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Prevent dehydration, heat exhaustion or heat stroke in elders

by Carol Bradley Bursack, Editor-in-Chief

Heat can be a killer. Rarely does a summer pass when we don't read about social workers in large cities trying to find isolated elders and get them into air conditioning, since many seniors are living on tight budgets and can't afford this so called luxury. For these seniors, air conditioning, when the city temperatures reach the mid-nineties, is not a luxury. It can be a life saver. Cooler air and plenty of fluids are necessary for our elders' health and welfare. Caregivers must be hyper-vigilant during hot weather to make sure our loved ones have basic heat relief. Hiring an in-home agency can help at this critical time.

My Dad, in his twenties, suffered a traumatic closed brain injury because of heat, so all of my life I've been aware of what extreme heat can do to us. I've also come close to collapsing from heat, since my body doesn't cool efficiently. My running joke is that our ancestors came from cloudy England and our bodies haven't caught up to a sunnier climate of North Dakota.

In general, if younger people use some sense, they tend to get along fairly well in heat. However, as our bodies age, they become less efficient in many things, and self-cooling is one of them. Also, seniors often don't receive the "I'm thirsty" signal that their bodies send out, or else their bodies don't send the signal soon enough to avoid illness.

When my parents and mother-in-law were in a local nursing home, pushing fluids was something I became very aware of. The home was terrific about that. I learned from observing the professionals.

Mom's appetite was pretty well shot due to illness, but the nurses and aids were constantly trying to ply her with appetizing liquids. Most fresh fruit is full of water, so I'd bring in fruit, even though the nursing home provided quite a bit as well. Sometimes, I could get Mom to poke down some fresh fruit - especially during cherry season. It all helped, but they'd still bring in more fluids and keep track of what she ate and drank. She didn't like that, but it was essential. Dehydration is very dangerous to elders and can happen quite easily.

Centers for Disease Control and Prevention has an informative article on this topic. What You Can Do to Help Protect Elderly Relatives and Neighbors is packed with information on preventing heat exhaustion, dehydration and worse.

When my mother-in-law was in her own condominium, she was always a worry because she wouldn't use her air conditioner. She'd shut off fans and keep her windows tightly shut. When I read the tip in the CDC Web site that said, "Visit older adults at risk at least twice a day and watch them for signs of heat exhaustion or heat stroke," I thought about her. I did my best, but there were times when her condo may as well have been a sauna.

Since her dementia was getting to a point that she was too paranoid to live alone anyway, we had her on a list for the excellent nursing home near her home (and mine). Moving her to the home solved many other problems, as well. She thrived in that setting, and she stayed cool enough and hydrated. My visits went to once daily, which was helpful to me, since at the time I was looking after five elders. The lack of worry during heat waves was a blessing for me.

Check with Doctor About Fluid Intake

Important: The CDC site also gives this warning, which shows how even seemingly harmless step of pushing liquids can be wrong for some people: "If their doctor generally limits the amount of fluid they drink or they are on water pills, they will need to ask their doctor how much they should drink while the weather is hot." Air conditioning is also mentioned on their list of "dos." Elders should not be in a direct flow for the AC or in a draft. The temperature should be one that agrees with their body's needs.

Signs of Heat Exhaustion from the CDC site:

• 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

It's common for caregivers to go by their own comfort level when determining how comfortable an elder is. In fact, a friend who is an excellent caregiver for a disabled daughter always makes sure to offer her a drink if he feels thirsty, since she can't tell him.

This is an excellent strategy, especially since his daughter is quite young. For elders, this strategy can still be a good one, but we may need to take it a step farther, since elderly bodies are less efficient than most younger bodies when it comes to temperature regulation and fluid signals. I feel we need to put ourselves in our loved one's place to try to figure out what could make them comfortable, but we also must educated ourselves about the special needs of this any age group.

Hire Help If Needed

I learned a great deal about the kind of temperature and fluid control elders' need while watching the nurses at the home. However, most elders aren't in nursing homes. For elders living in their own homes, a long, hot summer could be an ideal time to introduce an in-home service to your elder. Having a companion/caregiver in the home a few hours can help ease your mind about whether your loved one is getting proper care during heat waves.

The companionship may also revive the social instinct within the elder and make him or her more aware of physical needs.

For you, the caregiver, the knowledge that your loved one is being monitored can go a long way toward letting you get on with your work or your other family members' needs without having to check twice daily, as recommended by the CDC. Such a schedule can be unrealistic for many family caregivers.