Clinical Geriatrics

While Daylight Savings Time starts in April and spring brings flowers and warmer weather, in many parts of the country, June begins the season when we spend a greater time outdoors. Older persons should enjoy the summer season as much as anyone else, but for many, spending time outside remains a challenge. There are special concerns this time of year for our older patients, with a little prevention going a long way toward ensuring enjoyment while minimizing risk. Some thoughts follow that came quickly to mind. I’m sure you have your own list of items that we would all be well advised to think about and adopt into our daily summer routine.

1. Avoid excessive exposure to sunlight. Data are clear that skin cancer is on the rise. Sunlight contributes to the risk, so regardless of one’s age, the proper use of sunscreens and protective clothing should be encouraged.

2. Avoid being outside in the “heat of the day.” Older persons have a more difficult time maintaining their body temperature when there are extremes of temperature. It is no coincidence that older persons die more frequently of both hypo- and hyperthermia. Certain medications may also predispose to difficulty in regulating body temperature.

3. Ensure adequate hydration. Older persons have normal age-related changes in their “osmostats” and may become significantly hyperosmolar due to dehydration without a compensatory increase in thirst. Dry climates are particularly problematic since dehydration may not be readily apparent because sweat quickly evaporates, giving a false sense of security.

4. Encourage wearing of sunglasses with 100% UV filters. Studies have demonstrated a link between UV light exposure and cataract formation, and even macular degeneration. Merely because a lens is dark does not mean it filters out potentially harmful rays of the sun. In fact, dark-colored lenses may actually dilate the pupil, allowing even more damaging rays to enter. Advise patients to choose sunglasses carefully for maximum protection.

5. Take measures to prevent insect bites. Insect bites can become infected or lead to systemic illness. They may not always be preventable, especially in individuals who sit outside during evening hours, often near parks and standing water. However, certain precautions should be taken to minimize risk, such as wearing long-sleeved, light-colored clothing and applying insect repellent.

6. Encourage gardening for those with an interest. The use of raised containers makes tending plants easier and safer than having to bend down to ground-level flower beds. (Even for older persons with adequate flexibility, orthostatic hypotension can be a serious problem—especially when coupled with vasodilation secondary to the heat.) Many of my patients with functional impairments tell me how much they enjoy gardening and appreciate the opportunity to both see and smell their “miniature” and accessible raised container gardens. Herb gardens afford a nice opportunity to grow fragrant and edible plants that can be used in the kitchen, and can bring a feeling of accomplishment to the gardener.

7. Avoid contact with poisonous plants. Summer brings with it an increased exposure to poison ivy and other plants that can lead to contact dermatitis. Once again, prevention is key, but early treatment can also go a long way in preventing weeks of agony and decreasing the potential for secondary infection.

8. Ensure safe outdoor recreational activities. Older persons need to be aware that even though they may have been participating in a particular sport or hobby for many years, they may run increased risk of injury from unexpected events and accidents. Water safety while boating and swimming, use of lifejackets, use of a “buddy system,” and taking extra care is advised. Exposure to cold water can also increase the risk of cardiac problems due to vasoconstriction and is best avoided if this is a concern.

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