# Getting Hotter: Heat Emergencies in Older Adults About This Podcast Climate change, and the associated increase in frequency and severity of heat waves, poses a threat to health. Amongst the most at risk for heat-related emergencies are older adults; age-associated physiologic vulnerabilities, chronic conditions, medications that disrupt thermoregulatory responses, and social determinants all contribute to an increased risk of heat-related illness in this population. When an older adult presents to the emergency department (ED) with vague or subtle symptoms of heat exhaustion or heat stroke, they may be missed by ED practitioners – a concerning thought as these patients are at a greater risk of mortality from heat-related emergencies. Optimal management of these presentations requires clinical recognition and treatment within the ED as well as pre-hospital interventions that can be given by emergency medical services (EMS). GEMCast host Dr. Christina Shenvi is joined by Geoff Comp, Associate Program Director at Creighton University School of Medicine/Valleywise Health Medical Center in Phoenix, Arizona, as the two do an in-depth review of this critical topic. Dr. Comp holds a wilderness medicine fellowship through the Wilderness Medical Society and is an expert in heat-related illness. Play the Episode https://youtu.be/8YvA8ZWdfDM Subscribe on YouTube Subscribe on iTunes Key Points The compound effect of age-related physiologic vulnerabilities, chronic medical conditions, and medications increases vulnerability to heat illnesses. Physiologically, older adults have blunted thermoregulatory responses (eg. sweating and vasodilation), decreased thirst sensation, reduced mobility, slower cardiovascular reflexes, and are generally frail. Many patients have chronic conditions and are comorbid. Cardiovascular disease, chronic kidney disease, dementia, diabetes, COPD, and other common conditions contribute to a vulnerable state. Frequently prescribed drugs such as diuretics, anticholinergics, beta-blockers, ACE inhibitors, ARBs, antipsychotics, SSRIs, SNRIs, sedatives, NSAIDs, and opioids affect the body’s usual responses to heat and dehydration. Social and environmental factors, such as lack of air conditioning, living alone and social isolation, housing instability and unsafe environments, put older adults at risk of heat-related illness. Presentations can be subtle and non-specific, and patients may not verbalize that they are hot or thirsty. Furthermore, the line between heat exhaustion and heat stroke is harder to differentiate in older adults. Non-specific presentations of confusion, delirium, falls, generalized weakness and syncope should prompt questioning about environment and a temperature check. Heat exhaustion presents with diaphoresis, weakness, nausea and mild confusion. In heat stroke, an altered mental status (AMS) may present alongside seizures, coma and/or multi-organ dysfunction. Keep heat high-related illness on the differential when suspecting sepsis, stroke or acute coronary syndrome in an older adult. Time to cooling is the single strongest predictor of outcome in heat stroke. If available, rapid, aggressive external cooling with immersion is highly effective. EMS can start evaporative cooling and cold IV fluids. Consider using ice packs to the groin, axilla or neck. Fluid resuscitation should be tailored to comorbidities to avoid overcorrection. Prevention and social support are equally important as acute medical care. Initiatives during heat waves, such as cooling centers, hydration stations and frequent welfare checks, are lifesaving. Education on prevention and recognition of heat-related illness for caregivers and families should be encouraged. JGEM | September 17, 2024 Heat-Related Emergencies in the Older Adult This article focuses on the emergency identification and management of heat-related emergencies in older patient. Read Article The New England Journal of Medicine | May 16, 2024 Climate Change, Extreme Heat, and Health Explores how climate change and extreme heat impact health. View Article The New England Journal of Medicine | September 28, 2022 Treatment and Prevention of Heat-Related Illness Article discussing the clinical aspects of heat-related illness. View Article Environment International | September 9, 2020 Physiological factors characterizing heat-vulnerable older adults: A narrative review Narrative review of age-related changes in older adults that increase susceptibility to heat-related illness. View Article Proteomics | October 25, 2019 Thermoregulation in the Aging Population and Practical Strategies to Overcome a Warmer Tomorrow Provides a comprehensive overview of pathophysiological mechanisms underlying heat-related illness in older adults. View Article BioMed Research International | August 2, 2018 Aging and Thermoregulatory Control: The Clinical Implications of Exercising under Heat Stress in Older Individuals Discusses mechanisms of thermoregulatory control and factors that affect clinical practice in the older population. View Article Next, listen to Frailty Frontline: How to identify frailty, and what to do next with Dr. James Van Oppen. Play Episode View All Frailty Resources >