June 2011
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 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.
"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
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
     "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.

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

•  Ask your doctor or other health care
   provider if the medications you take could
   increase your susceptibility to heat-related

•  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.
during unusually hot weather likewise
exacerbates heat-related health effects.

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.

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 livability

Other References
Environmental Protection Agency,
Excessive Heat Events Guidebook
Quick Tips for Responding to Excessive
Heat Events

Poster:  Beat the Heat—8 Simple Steps for
Older Adults

Heat Island  Reduction Initiative

Center for Disease Control and Prevention

American Medical Association, Heat-Related
Illness During Extreme Emergencies

National Weather Service, Heat Wave and Heat

Heat and Other Natural Hazard Statistics

Heat Wave Awareness Project

United States Department of Commerce,
National Oceanic and Atmospheric
Heat Wave: A Major Summer Killer
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:
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., 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.

Learn A/lore
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

             Protecting the Health
             of Older Americans
Publication Number: 100-F-l 1-017