Saturday, January 12, 2008

Staying Warm This Winter: Special Considerations for the Elderly

Cold weather is very risky for older people. Almost everyone knows about winter dangers such as broken bones from falls on ice or breathing problems caused by cold air. But the winter chill can also lower the temperature inside an older body. That can be deadly if not treated quickly. This drop in body temperature, often caused by staying in a cool place for too long, is hypothermia. A body temperature below 96°F may seem like just a couple of degrees below the body’s normal temperature of 98.6°F. It can be dangerous. It may cause an irregular heartbeat leading to heart problems and death.

When you think about being cold, you probably think of shivering. That is one thing the body does when it gets cold. This warms the body. Muscles shiver in response to messages sent by the nerves. Shivering increases muscle cell activity that, in turn, makes heat. But, shivering alone does not mean hypothermia. So, how can you tell if someone has hypothermia? It can be tricky because some older people may not want to complain. They may not even be aware of how cold it is.

Look for the “umbles”—stumbles, mumbles, fumbles, and grumbles—these show that the cold is affecting how well a person’s muscles and nerves work. Watch for:
■ Confusion or sleepiness
■ Slowed, slurred speech or shallow breathing
■ Weak pulse or low blood pressure
■ A change in behavior during cold weather or a change in the way they look; alot of shivering or no shivering; stiffness in the arms or legs
■ Chilly rooms or other signs that they have been in a cold place, or
■ Poor control over body movements or slow reactions.

If you think someone could have hypothermia, take his or her temperature with a thermometer. Make sure you shake the thermometer so it starts below its lowest point. If the temperature doesn’t rise above 96°F, call 911. The only way to tell for sure that someone has hypothermia is to use a special thermometer that can read very low body temperatures. Most hospitals have such thermometers. The person must be seen by a doctor. If possible, the doctor should know about hypothermia and work in a well-equipped hospital emergency room. There, the health care team will warm the person’s body from inside out. For example, they may give the person warm fluids directly into a vein using an I.V. Whether the person gets better depends on how long he or she was exposed to the cold and his or her general health. While you are waiting for help to arrive, keep the person warm and dry. Move him or her to a warmer place, if possible. Wrap the person in blankets, towels, coats—whatever is handy. Even your own body warmth will help. Lie close, but be gentle. You may be tempted to rub the person’s arms and legs. This can make the problem worse. The skin of an older person may be thinner and more easily torn than the skin of someone younger.

Some things that put any older person at risk for hypothermia and some things you can do to avoid it include:
■ Changes in the body that come with aging can make it harder to feel when someone is getting cold. It may be harder for his or her body to warm itself. Pay attention to how cold it is where you are.

■ If a person doesn’t eat well, you might have less fat under the skin. Fat can protect the
body. It keeps heat in. Make sure your loved one is eating enough food to keep his or her weight up.

■ Some illnesses may make it harder for the body to stay warm. These include:
➤ Disorders of the body’s hormone system such as low thyroid (hypothyroidism),
➤ Any condition that interferes with the normal flow of blood such as diabetes, and
➤ Some skin problems such as psoriasis that allow the body to lose more heat than normal. Regular doctor visits can keep any illness under control.

■ Other health problems might keep a person from moving to a warmer place or putting on more clothes or a blanket. For example:
➤ Severe arthritis, Parkinson’s disease, or other illnesses that make it harder to move around
➤ Stroke or other illnesses that can leave a person paralyzed and make clear thinking more difficult
➤ Memory disorders or dementia
➤ A fall or other injury.

■ Some medicines often used by older people also increase the risk of accidental hypothermia. These include drugs used to treat anxiety, depression, or nausea. Some over-the-counter cold remedies can also cause problems. Ask the doctor how the medicines your loved one is taking affect body heat.

■ Alcoholic drinks can also make a person lose body heat faster. Encourage your loved one to use alcohol moderately, if at all. He or she should not drink alcohol before bedtime when it gets colder outside—and maybe inside, too.
■ Clothing can make a person colder or help keep warm. Tight clothing can keep the blood from flowing freely. This can lead to loss of body heat. Encourage your loved one to wear several layers of loose clothing when it is cold. The layers will trap warm air between them.

Maybe you already knew that a person's health, age, what they eat or drink, even clothes can make it hard for a person to stay warm enough wherever they are. What you might not realize is that people can also get cold enough inside a building to get very sick. In fact, hypothermia can even happen to someone in a nursing home or group facility if the rooms are not kept warm enough. People living there who are already sick may have special problems keeping warm.

If someone you know is in a group facility, pay attention to the inside temperature there and to whether that person is dressed warmly enough. Homes or apartments that are not heated enough, even with a temperature of 60°F to 65°F, can lead to illness. This is a special problem if they alone because there is no one else to comment on the chilliness of the house or to notice if a person are having symptoms of hypothermia. Set the thermostat for at least 68°F to 70°F. If a power outage leaves him or her without heat, move him or her to stay with family or friend.

Avoid using space heaters if the home seems cold or if they want to keep the thermostat set lower to keep heating costs down. Some types are fire hazards, and others can cause carbon monoxide poisoning. The U.S. Consumer Product Safety Commission has information on the use of space heaters, but here are a few things to remember:

Make sure the space heater has been approved by a recognized testing laboratory.
■ Choose the right size heater for the space being heated.
■ Keep substances that can catch fire like paint, pets, clothing, towels, curtains, and papers away from the heating element.
■ Keep the door to the rest of the house open for good air flow.
■ Turn the heater off when unattended such as when leaving the room or going to bed.
■ Make sure smoke alarms are working.
■ Put a carbon monoxide detector near where people sleep.
■ Keep the right type of fire extinguisher nearby.

Don’t forget the need to stay warm when it’s cold outside. Remember that this means knowing if weather forecasts are for very cold temperatures or for windy and cold weather. Your loved one may lose more body heat on a windy day than a calm day. Weather forecasters call this the wind-chill factor. They often suggest, even when the outside temperature itself is not very low, that the wind-chill factor is cold enough for people to stay indoors. If your loved one must go out, they must dress correctly. Be sure to wear a hat and gloves, as well as warm clothes.

Sometimes older people need help making sure their home will keep them warm enough. Some help is available. If the home doesn’t have enough insulation, contact the state or local energy agency or the local power or gas company. They can give information about weatherizing the home. This can help keep the heating bills down. It is also important to think about only heating the rooms in use in the house. For example, shut the heating vents and doors to any bedrooms not being used. Keep the door to the basement closed. If your loved one has a limited income, he or she may qualify for help paying your heating bill. State and local energy agencies or gas and electric companies have special programs that he or she may qualify for. Another possible source of help is the Low Income Home Energy Assistance Program (LIHEAP). This program supports some people with small incomes who need help paying their heating and cooling bills. The Area Agency on Aging has information on programs such as these.