October 2007
During an average
summer, approximately
1,500 people die from
excessive heat events in
the U.S.' A single heat
wave in Chicago killed
more than 700 people
in 1995. 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.
"It's Too Dam 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 disproportionate 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 residents 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.
In addition, people who live on
the top floors of buildings without
air-conditioning are more likely
to be exposed to excessive heat.
Participating in strenuous outdoor
activities and consuming alcohol
during unusually hot weather likewise
exacerbates heat-related health effects.
"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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How Can I Reduce Exposure
to Excessive Heat?
The best defense against excessive heat is
prevention. Air-conditioning is one of the
best protective factors against heat-related
illness and death.4 Even a few hours a day in
air conditioning can greatly reduce the risk.
Electric fans may provide comfort, but when
temperatures are in the high 90s fans do not
prevent heat-related illness.
During excessive heat events, the following
prevention strategies can save lives:
• Visit air-conditioned buildings in your
community if your home is not air-conditioned.
These may include: senior centers, movie
theaters, libraries, shopping malls, or
designated "cooling centers."
• Take a cool shower or bath.5
Drink lots of fluids. Don't wait until you are
thirsty to drink. If a doctor limits your fluid
intake, make sure to ask how much to drink
when if s hot. Avoid beverages containing
caffeine, alcohol, or large amounts of sugar.
These drinks cause dehydration.
• Ask your doctor or other health care provider if
the medications you take could increase your
susceptibility to heat-related illness.
• Wear lightweight, light-colored, and
loose-fitting clothing.
• Visit at-risk individuals at least twice a day.
Watch for signs of heat-related illness such as
hot, dry skin, confusion, hallucinations, and
aggression.
• Call 9-1-1 if medical attention is needed.
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How Does Excessive Heat
Affect the Body?
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.
How are Excessive Heat and
Heat Stroke Related?
Heat stroke is the most serious health
effect of excessive heat events. It is the
failure of the body's temperature control
system. 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
disability 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.
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 heat wave.
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 provide 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 liability
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Other References
Environmental Protection Agency,
Excessive Heat Events Guidebook
Quick Tips for Responding to Excessive
Heat Events
http://www.epa.gov/aging/resources/epareports.
htm#ehe_hw
Poster: Beat the Heat-8 Simple Steps for
Older Adults
http://www.epa.gov/aging/resources/posters/index.
htm#beattheheat-es
Heat Island Reduction Initiative
http://www.epa.gov/heatisland
Center for Disease Control and Prevention
http ://www.cdc.gov/aging/
http://www.bt.cdc.gov/disasters/extremeheat/
http://www.cdc.gov/mmwr/preview/mmwrhtml/
mm5529a2.htm
American Medical Association, Heat-Related
Illness During Extreme Emergencies
http://search.ama-assn.org/Search/query.htm l?qc=
public+amnews+pubs&qt=heat
National Weather Service, Heat Wave and Heat
Index
http://usasearch.gov/search?v°/o3Aproject=firstgov
&query=heat+wave&affiliate=nws.noaa.gov
Heat and Other Natural Hazard Statistics
http://www.nws.noaa.gov/om/hazstats.shtml
Heat Wave Awareness Project
http://www.isse.ucar.edu/heat/
United States Department of Commerce,
National Oceanic and Atmospheric
Administration
Heat Wave: A Major Summer Killer
http://www.noaawatch.gov/themes/heat.php
Endnotes
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 Health
Perspectives, 105(l):84-93.
2 Centers for Disease Control and Prevention,
2003. Extreme Heat. Available online:
http://www.bt.cdc.gov/disasters/extremeheat/
3 Federal Emergency Management Administration,
Backgrounder on Extreme Heat, Feb. 2003
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., L.S. 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, 297pp.
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
Publication Number: EPA 100-F-07-025
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