During an average
summer, approximately
7,500 people die from
excessive heat events
in the U.S.' A single
heat wave in Chicago
killed more than 700
people in 7995. In
Europe, a record heat
wave claimed an
estimated 35,000 lives
in 2003. In both cases,
most of the victims
were 65 or older.
September 2004
"it's Too Darn Hot"' —
Planning for Excessive
Heat Events
Information for Older Adults and
Family Caregivers
Did you know that each
year more people die
from "excessive heat
events" than from
hurricanes, lightning, tornadoes,
floods, and earthquakes
combined?2 Anyone can be
adversely affected by excessive
heat, but older adults are
particularly vulnerable.
Excessive heat events are
prolonged periods when
temperatures reach 10 degrees
Fahrenheit or more above the
average high temperature for
a region.3
Excessive heat events are
believed to have a dispropor-
tionate public health impact in
cities. One reason is that roads
and buildings absorb the sun's
energy and contribute to the
formation of "heat islands."
While rural areas cool off at
night, cities retain this absorbed
heat. As a result, urban resi-
dents get less nighttime relief
from high temperatures.
Fortunately, there are simple
steps that older adults, their
care-givers, and community
leaders can take to decrease the
impact of excessive heat events.
Who is At Risk from
Extreme Heat?
Older adults, as well as young
children, are at high risk from
excessive heat events. For the
growing number of aging
Americans, the body's cooling
mechanisms may become
impaired. Living alone or being
confined to a bed and unable
to care for one's self further
increases risk.
Existing health conditions such
as chronic illness, mental
impairment, and obesity can
also heighten an individual's
vulnerability. Persons taking
certain medications are likewise
susceptible.
"Excessive heat events" are surprisingly deadly. Vulnerable
groups like older adults are at particularly high risk.
The good news is that there are simple steps
people can take to protect themselves.
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In addition, people who live on the
top floors of buildings without air-con-
ditioning are more likely to be exposed
to excessive heat. Participating in stren-
uous outdoor activities and consuming
alcohol during unusually hot weather
likewise exacerbates heat-related
health effects.
How Does Excessive Heat
Affect the Body?
The body normally cools itself by increas-
ing blood flow to the skin and perspiring.
Heat-related illness and mortality occur
when the body's temperature control
system becomes overloaded. When this
happens, perspiring may not be enough.
High levels of humidity can make it even
harder for the body to cool itself.
How are Excessive Heat
and Heat Stroke Related?
Heat stroke is the most serious health
effect of excessive heat events. It is the fail-
ure of the body's temperature control sys-
tem. When the body loses its ability to cool
itself, core body temperature rises rapidly.
As a result, heat stroke can cause severe
and permanent damage to vital organs.
victims can be identified by skin that
appears hot, dry, and red in color. Other
warning signs are confusion, hallucinations,
and aggression. If not treated immediately,
heat stroke can result in permanent disabil-
ity or death. The good news is that heat
stroke can be prevented by taking the easy
steps outlined on this page.
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What Can Your Local
Government Do to Help?
Local governments can play an important role in
predicting and responding to excessive heat
events. Two increasingly common strategies are
heat alert systems and heat reduction measures.
Heat Alert Systems
Heat Health Watch-Warning Systems identify when
a heat-related public health threat is likely. These
systems use computer programs that analyze
National Weather Service forecasts and other local
data to predict dangerous conditions. Heat Health
Watch-Warning Systems have been established in
Philadelphia, Seattle, Chicago, St. Louis, and other
cities in the U.S. and Europe.
After a warning has been called, city health
authorities communicate this information to older
adults, their care-givers, and other at-risk groups.
What Cost-Effective Steps Can
Communities Take to Cool the Air?
Two steps that communities can take include
using construction material that reflect the sun's
rays, and planting trees and vegetation to pro-
vide shade and natural cooling. Both strategies
reduce the urban heat island effect - urban
temperatures 2-10 degrees Fahrenheit hotter
than surrounding rural areas - and may limit the
frequency, duration, and magnitude of excessive
heat events.
Heat reduction strategies such as using reflective
"cool roofs" and light-colored pavements, and
planting shade trees, have numerous benefits.
These measures:
• Lower ambient temperatures
• Slow heat-driven reaction that forms
ozone air pollution
• Decrease energy consumption
• Improve comfort and livability
Assist the Homeless and Those With
Mental Health Illness
The following steps are "best-practices" that city
officials can take to alert residents and provide
direct assistance:
• Distribute media advisories
• Activate telephone hotlines
• Alert neighborhood volunteers, family
members, and friends
• Provide air-conditioned buildings and offer
transportation to these facilities
• Assist the homeless
• Work with local "area agencies on aging"
to educate at-risk individuals
Cities may also coordinate with local utilities to
ensure that no customer's electricity is turned
off during a heatwave.
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How Does Extreme Heat Affect Me?
The body normally cools itself by increasing blood flow to the skin and perspiring.
Heat-related illness and mortality occur when the body's temperature control system
becomes overloaded. When this happens, perspiring may not be enough.
High levels of humidity can make it even harder for the body to cool itself.
Learn More
The EPA Aging Initiative is working to protect the
environmental health of older adults through the
coordination of research, prevention strategies,
and public education. For more information or
to join the listserve visit: www.epa.gov/aging
Other References
Environmental Protection Agency,
Heat Island Reduction Initiative
http://www.epa.gov/heatisland
Center for Disease Control and Prevention
h ttp://www. cdc.go v/aging/
http://www.cdc.gov/nceh/hsb/extremeheat
http://www.cdc.gov/MMWR
Environmental Health Perspectives
http://www.ehp.niehs.nih.gov
American Medical Association,
Heat-Related Illness During Extreme
Emergencies
http//:www.ama-assn.org
National Weather Service,
Heatwave and Heat Index
http://www.nws.noaa.gov/pa/secnews/heat/
Medline Plus,
Heat Illness
http://www.niapublications.org/spnagepages/
hyperthermia-sp.asp
National Weather Service
http://www.nws.noaa.gov/om/hazstats.shtml
Heat Wave Awareness Project
http://www.esig.ucar.edu/heat/literate.html
Footnotes
1 Kallkstein, L.S. and J.S. Greene, 1997.
An Evaluation of Climate/Mortality Relationships
in Large U.S. Cities and the Possible Impact of a
Climate Change. Environmental
Centers for Disease Control and Prevention,
2003. Extreme Heat. Available online:
http://www.cdc.gov/nceh/hsb/extremeheat/
defaulthtm
3 Federal Emergency Management Administration,
Backgrounder on Extreme Heat, Feb. 2003
Health Perspectives, 105(l):84-93.
4 Naughton MP, Henderson A, Mirabelli MC,
Kaiser R, Wilhelm JL, Kieszak SM, Rubin CH,
McGeehin MA. Heat-related mortality during a
1999 heat wave in Chicago. Am J Prev Med.
2002 May;22(4):328-9.
5 McMichael, A.J., LS. Kalkstein and other lead
authors, 1996. Climate Change and Human
Health, (eds. A.J. McMichael, A. Haines, R. Slooff,
S. Kovats). World Health Organization, and
United Nations Environment Programme
(Who/WMO/UNEP), Geneva, 297 pp.
Protecting the Health
of Older Americans
Publication Number 100-F-04-008
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