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
 "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.

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.

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.

                     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

Center for Disease Control and  Prevention
h ttp://www. cdc.go v/aging/

Environmental Health Perspectives

American Medical Association,
Heat-Related Illness During Extreme

National Weather Service,
Heatwave and Heat Index

Medline Plus,
Heat Illness

National Weather Service

Heat Wave Awareness Project

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:

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