Jun. 9, 2011 -- As the Northeast prepares for nearly record-breaking temperature spikes over the next several days, urban hospitals are bracing for heat-related illnesses that invariably strike the elderly during the dog days of summer.
This pre-summer heat wave has already contributed to the deaths of four elderly citizens in Maryland and Tennessee, according to The Associated Press. Now the National Weather Service is predicting temperatures reaching into the 90s and 100 degrees with high humidity for the East Coast and Southeast states -- compared with the normal highs for this time of year in the upper 70s to low 80s.
"The main issue is that the elderly are not thinking about [the risks]," says Phillip Russertt, 38, a registered nurse for MJHS Homecare who provides home care for the elderly in Queens, N.Y. "They don't get warm like we do; they tend to drink fewer fluids on a regular basis. They feel like they're fine but that doesn't mean they are not at risk."
Because of this, Russertt says the first thing he is checking for in the patients he visits is dehydration .
"It's a real public health issue," says Dr. Michael Stern, co-director of the Geriatric Emergency Medicine Fellowship at New York-Presbyterian Hospital/Weill Cornell Medical Center. "Between the 1980s and early 2000s there were more heat-related deaths than deaths from all natural disasters combined."
Infants, Elderly Susceptible to the Heat
The National Weather Service has issued heat advisories for the Baltimore-Washington region and parts of Ohio, Indiana and Michigan. Air quality concerns, which cause problems for children, the elderly and those with respiratory problems, were issued along the Northeast and Mid-Atlantic coastline.
As always with summer heat waves, everyone is susceptible to heat exhaustion or the more severe heat stroke, but the young, the elderly and those with chronic medical conditions, especially heart disease, are most at risk.
Since temperatures have been on the rise in New York City, Dr. Stern says they are seeing more patients with heat exhaustion -- the precursor to heat stroke.
"They present with headache, nausea, dizziness, muscle cramps and excessive sweating," he says. "The more dangerous cousin to this is heat stroke, which is when the body stops sweating and loses its ability to cool itself. The body temperature rises to 103 or higher, and you run the risk of organ failure, coma and death."
Among young, healthy individuals, heat stroke can occur after exerting oneself outside in the heat, but for the elderly, especially those on certain medications that affect hydration and body temperature, simply sitting in a hot, un-air-conditioned apartment in the summer can result in heat stroke "in a matter of hours," Stern says.
This is why "hydration is so key" among the elderly, or anyone exerting themselves outdoors in the heat, says Stern. Two to four 8 oz. glasses of water per hour is the rule of thumb for those working outside on a day with temperatures in the 90s, he says. And everyone at risk for dehydration should be avoiding alcoholic, caffeinated and/or sugary beverages as they will only dehydrate further.
Counter-intuitively, more fluids is not the answer for the other side of the at-risk spectrum: infants.
It's actually quite dangerous for infants six months and younger to be given straight water, nor should they have their formula diluted with water, says Dr. Nathan Timm, an emergency medicine physician at Cincinnati Children's Hospital Medical Center.
"They will get water intoxication, where the water dilutes the sodium in their body and leads to seizure and coma and sometimes even death. If the infant is thirsty, they should be given more formula or Pedialyte, but not straight water," he says. If the baby is hot and extremely sweaty, and attempts to cool the infant don't seem to work, parents should seek medical help.
With toddlers and young children who may be playing outside, water is O.K, but in moderation. Supplement water with fruit juices and/or sports drinks, and make sure that kids take breaks in the shade every so often and wear plenty of sun block, as sunburn can impede the body's ability to cool itself. Those three tips for the most part apply to everyone, ER docs say.