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EMS: Courage and Compassion in Action: The Cold ShoulderBy Shawn Godfrey - November 12, 2007
According to many U.S. media sources, home heating fuel costs are expected to rise this year anywhere from 20 to 30 percent from last year. Whether it's gas or oil, the price of home heating fuel today is almost double the average price it was in 2001, and increases in this estimate are expected while many Gulf refineries remain inoperable.
In addition, many charitable groups and advocacy organizations are warning that requests for financial assistance are projected to be far above last year's volume, while available funds are frozen at last year's amounts.
Unfortunately, because of already limited finances and restrictions for heating assistance eligibility, many elderly Americans will be forced to dial down their thermostats in order to save money.
Many are already juggling their budgets to pay for necessary drugs and food, often choosing between eating properly and purchasing all of their prescribed medications. Adding the burden of high heating costs to the equation can only enhance the risk for unsafe decision making.
Etiology
For many of us, conserving home heating fuel typically means tolerating slightly chilly temperatures in the home, where donning an extra sweater or adding extra blankets to the bed will do. However, for the elderly, it could bring serious health implications, including hypothermia.
It only takes a slight drop in a home's temperature to impact the health of an elderly adult. In fact, hypothermia can occur even in mildly cold weather, when air temperatures are in the 60-to-65-degree range. As the body ages, it produces less heat and it becomes more difficult to regulate the body's temperature. This occurs because the heart rate slows, blood vessels no longer contract as well, and muscle tone and body fat have been lost. Moreover, the signs of hypothermia are subtle and slow, making it especially difficult for elderly adults or their caregivers to recognize.
Hypothermia most often occurs when the body's temperature gradually drops from 98.6 degrees to below 97.5 degrees, and can lead to dehydration, confusion and an irregular heart beat. If left untreated, it may result in coma or even death.
The Merck Manual of Geriatrics reports that "in the USA, about 75,000 'excess winter deaths' occur among the elderly, including deaths from hypothermia and deaths associated with many other winter risks, such as influenza and pneumonia. Among identified cases of hypothermia, the mortality rate is 50 percent. Of persons with hypothermia, those over 75 years are five times more likely to die than those under 75 years."
Risk Factors
●Risk factors for hypothermia in the elderly include reduced physical activity, immobility, dementia, malnutrition, and many commonly used drugs.
●Elderly patients may not recognize that they are cold and may not shiver. Symptoms may be nonspecific, so, again, the diagnosis is easily missed.
●Elderly patients with hypothermia require more extensive routine laboratory testing than younger patients.
●In stable elderly patients with hypothermia, warming should proceed slowly. Treatment for unstable elderly patients is the same as that for younger patients.
●Elderly patients undergoing surgery require special precautions to prevent hypothermia.
Prevention
Hypothermia is a devastating but potentially avoidable condition, making public awareness and education the basis for prevention. The U.S. Centers for Disease Control and Prevention recommends creating a winter survival kit for indoor safety, including nonperishable food, blankets, a first aid kit, water and necessary medications. Other measures, such as weather stripping and insulated doors, are important, especially for elderly persons.
To prevent hypothermia while indoors, elderly people should keep room temperatures at about 70 degrees. Room temperature should be checked daily with a reliable thermometer separate from the thermostat, especially during severely cold weather. Extra clothing, particularly for hands, feet, and head, should be worn indoors, and extra layers of linen added to the bed will help conserve endogenous heat loss, especially during the nighttime and early morning hours. Sufficient caloric intake and, if possible, exercise will help sustain heat production as well.
Shivering, which can accompany hypothermia, should be prevented if possible. As a result, it increases the body's oxygen and glucose (sugar) consumption. If the body's oxygen and glucose demand exceeds supply, respiratory, circulatory and neurological changes occur, and elderly patients may be unable to adequately compensate for these changes. Again, appropriate dress to meet or exceed the temperature while in the home is paramount.
Treatment
Mild hypothermia can be treated by passively warming the affected person. Wet clothing should be removed and replaced with dry, warm clothing and blankets. Other techniques include using hot-water bottles, warm baths, or heat packs placed under the arms and on the chest, neck and groin. Use caution when using hot-water bottles and heat packs. When placed directly on the skin, these applications may easily cause burns because the blood circulation in the cold skin of the elderly is usually poor.
While in the ambulance, emergency medical technicians will use warm intravenous fluids as well as employing strategies like those listed above. In the hospital setting, the person may be wrapped with blankets in a warm room or put into a large tub of warm water.
Conclusion
Hypothermia prevention and awareness programs should focus on elderly persons at risk to hypothermia and those likely to be exposed to unusually cold environments. Individuals caring for the elderly should be keenly aware of hypothermia's signs and symptoms, and elderly persons living alone should be visited often. Enrollment in organized home-heating assistance programs may also help prevent hypothermia in the elderly.
For more information: The Merck Manuel, Chapter 67: www.merck.com
The Centers for Disease Control and Prevention: www.cdc/gov |
| Good article. | | from: Jenn | on: 11-15-2007 |
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| Thanks for this article I found it to be very informative especially since my mother is getting older and I have a 95yr old grandmother. I will make sure when they visit my heat is on!! | | from: LISA | on: 11-13-2007 |
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| I hate the Winter!! Let's keep check on our elderly neighbors this Winter. ;) | | from: Wendy | on: 11-12-2007 |
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| Shawn another good article. Read ya in another week and thanks. | | from: Beaker | on: 11-12-2007 |
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