Combating heatwave threat to vulnerable people

If there’s one thing you can count on, it is the unpredictability of the British weather. And now that global warming is a reality, the extremes of climate are proving to be increasingly dangerous.

Although this summer has so far been one of the wettest in living memory, centuries-old records for high temperatures have been broken in recent years – and this trend looks set to continue.

Some experts think that by 2080 heatwaves similar to the one that hit England in 2003 could be commonplace. In that year there were nearly 2,000 extra deaths, and those at the greatest risk were residents of care homes. In London, the number of excess deaths of the over-75s increased dramatically by 60%. In France the heatwave was estimated to have resulted in nearly 15,000 deaths, many of them older people.

After that wake-up call, the Department of Health issued advice for care home managers and staff on how to deal with heatwaves. It recommended that advance preparations should be put in place before June, but the erratic weather has shown this may not be adequate. With a peak of 260C, April 2007 proved to be a hotter month than July. Soaring temperatures
could hit at almost any time so care homes need to be prepared in case September turns out to be the hottest month this year.

The Commission for Social Care Inspection has urged care homes to take notice of the guidance. In 2003, inspectors visited a care home in which two elderly residents had been hospitalised because the central heating could not be turned down.

Ginny Storey, CSCI’s senior nursing adviser, says that this sort of thing is rare. “If care homes take the simple precautions that are recommended, there shouldn’t be major problems,” she advises. “Care homes responded positively last year to the Department of Health guidelines, and I know that many bought fans and provided extra water and cold drinks to help cope
with the heatwave.”

Age Concern England is rather more concerned about the state of affairs. “We are worried that care services that have been
pared down to the minimum possible level will be unable to cope,” says policy adviser Stephen Lowe. “For example we hear of
care homes where people do not receive the support they need with eating, and homes where doors are locked because staff are not available to take people into the garden or supervise them. There must be concern that these problems could well extend to help with liquid intake and ensuring adequate ventilation.”
 
Sue Brand is the manager of two care homes housing 38 older people. A nurse by profession, she highlights the importance of
training staff to recognise the symptoms of heat-related illnesses. “They should be well aware of the symptoms,” she says. “They
should realise when it is an emergency. You can’t say ‘well, I’ll wait to see what happens in about six hours’ time’. Older people are less tolerant, they don’t feel the heat so well – particularly if they are on medication, that can complicate matters.”

Brand’s homes are based in Hove, Sussex an ideal location. “We’re near the sea so we get the sea breeze, but very few care homes in England have air conditioning,” she says. “Our buildings are Victorian, they keep the heat in the winter and the cool in the summer. They’re so well insulated and with high ceilings the air can circulate. These modern buildings have very thin walls and are much smaller. Also you often can’t open the windows very well because of health and safety considerations, depending on the client group. Obviously, this means you’re limited on the amount of air you can get in. For a new build I would suggest looking at getting air conditioning in.”

Brand is keenly aware of the threat posed by weather extremes exacerbated by the effects of global warming. “The deaths
in France in 2003 were terrible. [Almost 15,000 people died during the summer heatwave, the majority were older people.] It affects the most vulnerable people, and I do think it’s a major problem. Each year gets more difficult.”

HEAT-RELATED ILLNESSES

● Heat rash. Symptoms include small, itchy papules.
● Head oedema. A swelling of the hands and feet when blood vessels expand.
● Heat syncope. Occurs when blood pressure is lowered as the body dilates. Causes dizziness and fainting, and can be  exacerbated by certain medications.
● Heat exhaustion. A more common affliction due to dehydration or sodium depletion. Can lead to vomiting and circulatory collapse.
● Heatstroke. This is where the body’s heatregulating systems become overwhelmed.

Symptoms include confusion, disorientation, convulsions, unconsciousness, hot dry skin and a core body temperature exceeding 40oC.

KEY STEPS TO TAKE

Some steps care homes should take during a heatwave.

● If temperatures exceed 26oC, high-risk individuals should be moved to a cool area.
● Indoor thermometers should be installed in each room where vulnerable individuals spend substantial time, such as bedrooms, living rooms and eating areas.
● Indoor temperatures should be monitored at least four times a day.
● Windows should be able to be shaded by curtains rather than metal venetian blinds, which can make the situation worse.
● There should be an adequate supply of fans and water sprays and cold drinks should be regularly distributed.
● Staff should receive training to recognise the symptoms of heat-related illnesses.
● Local weather forecasts should be regularly checked.

This article appeared in the 2 August issue under the heading “Remember this?”