Clinical Geriatrics

In last month’s issue of Clinical Geriatrics, we ran a timely article on “Heat-Related Illness in the Elderly.”1 While there are many problems that can result from the heat itself, the elderly are more prone to many of the dangers inherent during this time of the year. Last year I wrote in a similar forum about items we should be well advised to think about and adopt into our daily summer routine regardless of one’s age. I thought it would be good to update these, as summer is here and the need to be aware of its potential dangers has not changed.

1. Avoid excessive exposure to sunlight. Data are clear that skin cancer is on the rise, with skin cancers now the most common cancer affecting the elderly. Furthermore, it is not just the more benign basal-cell carcinomas that are on the rise, but also life-threatening melanomas. Regardless of age, the proper use of sunscreens and protective clothing should be encouraged.

2. Avoid being outside in the “heat of the day.” You know that popular song of the ‘50s, “Mad Dogs and Englishmen Go Out in the Mid-day Sun”? Well, nothing has changed. 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 avoid 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. (See this month’s CME article titled “Prevention and Prophylaxis of Malaria in Older Travelers” on page 36 for tips on mosquito avoidance.)

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 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 to preventing weeks of agony and decreasing the potential for secondary infection.

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