Extreme heat is dangerous for everyone, especially the elderly and disabled, and those living in nursing homes.During heatwaves, when unusually high temperatures persist for more than a few days, it can be fatal.Nearly 2,000 more people died during a hot 10-day period in south-east England in August 2003.Those with the greatest increased risk of death were those in nursing homes.The UK government’s latest climate change risk assessment suggests that the summer ahead will be even hotter.
This fact sheet uses details from the Heatwave program.It builds on our own experience in England and expert advice from the World Health Organization (WHO) and the EuroHEAT project in developing heatwave plans in other countries.It is part of a national plan to reduce health risks by advising people before heatwaves occur.
You should read this article if you work or manage a nursing home because people there are especially at risk during a heatwave.It is strongly recommended that you do the preparations in this fact sheet before anticipating a heat wave.The effects of high temperatures are rapid and effective preparations must be taken by early June.This fact sheet outlines the roles and responsibilities required at each level.
When the ambient temperature is higher than the skin temperature, the only effective heat dissipation mechanism is sweating.Therefore, anything that reduces the effect of sweating, such as dehydration, lack of breeze, tight clothing, or certain medications, can cause the body to overheat.In addition, thermoregulation controlled by the hypothalamus may be impaired in older adults and people with chronic diseases, and may be impaired in people taking certain medications, making the body more prone to overheating.Older adults appear to be more susceptible to heat, possibly due to fewer sweat glands, but also because of living alone and at risk of social isolation.
The main causes of illness and death during heatwaves are respiratory and cardiovascular diseases.A linear relationship between temperature and weekly mortality was observed in England in the summer of 2006, with an estimated 75 additional deaths per week for each degree increase in temperature.Part of the reason for the rise in death rates may be air pollution, which makes respiratory symptoms worse.Another major factor is the effect of heat on the cardiovascular system.To keep cool, a lot of extra blood circulates to the skin.This can stress the heart, and in older adults and people with long-term health problems, it can be enough to trigger a cardiac event.
Sweating and dehydration can affect electrolyte balance.It can also be a risk for people taking medications that control electrolyte balance or heart function.Medications that affect the ability to sweat, regulate body temperature, or electrolyte imbalances can make a person more susceptible to heat.Such drugs include anticholinergics, vasoconstrictors, antihistamines, drugs that reduce kidney function, diuretics, psychoactive drugs, and antihypertensive drugs.
There is also evidence that elevated ambient temperature and associated dehydration are associated with increased bloodstream infections caused by Gram-negative bacteria, particularly Escherichia coli.People over 65 are at greatest risk, emphasizing the importance of ensuring older adults consume adequate fluids during warmer temperatures to reduce the risk of infection.
Heat-related illnesses describe the effects of overheating on the body, which can be fatal in the form of heat stroke.
Regardless of the underlying cause of heat-related symptoms, the treatment is always the same—move the patient to a cool place and let them cool down.
The main causes of illness and death during heatwaves are respiratory and cardiovascular diseases.In addition, there are some specific heat-related illnesses, including:
Heatstroke – can be the point of no return, the body’s thermoregulatory mechanisms fail and cause a medical emergency, with symptoms such as:
The Heatwave Plan describes a thermal health monitoring system that runs in England from 1 June to 15 September each year.During this period, the Bureau of Meteorology may forecast heat waves, depending on forecasts for daytime and nighttime temperatures and their duration.
The thermal health monitoring system consists of 5 main levels (levels 0 to 4).Level 0 is year-round long-term planning to take long-term action to reduce health hazards in the event of severe heat.Levels 1 to 3 are based on threshold daytime and nighttime temperatures as defined by the Bureau of Meteorology.These vary by region, but the average threshold temperature is 30ºC during the day and 15ºC at night.Level 4 is a judgment made at the national level due to an intergovernmental assessment of weather conditions.Details of the temperature thresholds for each region are given in Annex 1 of the Heat Wave Plan.
Long-term planning includes joint work throughout the year to reduce the impact of climate change and ensure maximum adaptation to reduce damage from heatwaves.This involves influencing urban planning to keep housing, workplaces, transportation systems and the built environment cool and energy efficient.
During the summer, social and health services need to ensure awareness and contextual readiness are maintained by implementing the measures outlined in the heatwave plan.
This is triggered when the Bureau of Meteorology predicts a 60% chance that temperatures will be high enough to have a significant health impact for at least 2 consecutive days.This usually happens 2 to 3 days before the expected event.With mortality rising quickly after warmer temperatures, with many deaths in the first 2 days, this is an important phase in ensuring preparation and quick action to reduce harm from a potential heatwave.
This is triggered once the Bureau of Meteorology confirms that any one or more regions have reached a threshold temperature.This phase requires specific actions targeting high-risk groups.
This is achieved when a heatwave is so severe and/or prolonged that its impact extends beyond health and social care.The decision to move to level 4 is made at the national level and will be considered for an intergovernmental assessment of weather conditions, coordinated by the Civil Emergency Response Secretariat (Cabinet Office).
Environmental improvements are made to provide a safe environment for customers in the event of a heat wave.
Prepare business continuity plans for heat wave events (eg, drug storage, computer recovery).
Work with partners and staff to raise awareness of extreme heat impacts and reduce risk awareness.
Check to see if you can shade the windows, it’s better to use curtains with light reflective linings rather than metal blinds and curtains with dark linings, which can make things worse – if these are installed, check if they are can be raised.
Add exterior shade in the form of shutters, shade, trees, or leafy plants; reflective paint can also help keep buildings cool.Increase outdoor greenery, especially in concrete areas, as it increases moisture content and acts as a natural air conditioner to aid in cooling.
Cavity walls and attic insulation help keep buildings warm in winter and cool in summer – contact your local government’s energy efficiency officer or your energy company to find out what grants are available.
Create cool rooms or cool areas.High-risk individuals who are susceptible to heat physically find it difficult to cool themselves effectively once the temperature rises above 26°C.Therefore, every nursing, nursing and residential home should be able to provide a room or area that is maintained at or below 26°C.
Cool areas can be developed through proper indoor and outdoor shading, ventilation, the use of indoor and outdoor plants, and air conditioning when necessary.
Make sure staff know which rooms are easiest to keep cool and which are the hardest, and check occupancy distribution according to the most at-risk groups.
Indoor thermometers should be installed in every room (bedrooms and living and dining areas) where vulnerable people spend a lot of time – the indoor temperature should be monitored regularly during heat waves.
If temperatures are below 35ºC, an electric fan may provide some relief (note, use a fan: at temperatures above 35ºC, a fan may not prevent heat-related illnesses. Additionally, fans can cause excessive dehydration; it is recommended that fans be placed in an appropriate Keep it away from people, don’t aim it directly at the body and drink water regularly – this is especially important for bedridden patients).
Ensure business continuity plans are in place and implemented as required (must have sufficient staff to take appropriate action in the event of a heatwave).
Provide an email address to a local authority or NHS emergency planning officer to facilitate the transfer of emergency information.
Check that water and ice are widely available—make sure you have a supply of oral rehydration salts, orange juice, and bananas to help maintain electrolyte balance in diuretic patients.
In consultation with residents, plan to adjust menus to accommodate cold meals (preferably foods with a high water content, such as fruit and salads).
Make sure you know who is at highest risk (see High-risk groups) – if you’re not sure, ask your primary care provider and document it in their personal care plan.
Make sure you have protocols in place to monitor the most at-risk residents and provide additional care and support (requires monitoring of room temperature, temperature, pulse, blood pressure, and dehydration).
Ask the GP of at-risk residents about possible changes in treatment or medication during a heatwave, and review residents’ use of multiple medications.
If temperatures exceed 26ºC, high-risk groups should be moved to a cooler area of 26ºC or below – for patients who are immobile or who may be too disoriented, take steps to cool them down (e.g., liquids, cold wipes) and increase monitoring.
All residents are advised to consult their GP about possible changes in treatment and/or medication; consider prescribing oral rehydration salts for those taking high doses of diuretics.
Check the room temperature regularly during the hottest period in all areas where the patient lives.
Initiate plans to maintain business continuity – including possible surges in demand for services.
Increase outdoor shade – spraying water on outdoor floors will help cool the air (to avoid creating a slip hazard, check local drought water restrictions before using hoses).
Open the windows as soon as the temperature outside drops lower than the temperature inside – this may be late at night or early in the morning.
Discourage residents from physical activity and going out during the hottest hours of the day (11am to 3pm).
Check the room temperature periodically during the hottest period in all areas where the patient lives.
Take advantage of cooler nighttime temperatures by cooling the building through ventilation.Reduce internal temperature by turning off unnecessary lights and electrical equipment.
Consider moving visiting hours to mornings and evenings to reduce afternoon heat from increased crowds.
Post time: May-27-2022