Nursing Older Adults in Summer

Many people look forward to the warm, summer weather. But many Australians are also aware of the dangers of the Australian summer’s heat. You have likely suffered sunburn, lack of energy, sleep disturbance, irritability, dehydration, or other heat-related issues at some point in your life.

Certain people are more vulnerable than others to heat-related illness. People at risk of heat-related illness can include: pregnant women, babies, young children, ill people, women that breastfeed, and older adults (over 65 years of age) (Better Health Channel 2016).

Ageing processes may result in older adults lacking awareness that they are overheating and in need of increased fluid intake (Department of Social Services, 2014).

Dehydration

NPS Medicinewise highlights that older adults are at risk of dehydration for several reasons, including:

• A diminished sense of thirst
• Decreased kidney function
• Less total body water stores
• Difficulty mobilising to drink sources; and
• Troubles communicating with others that they are thirsty or require assistance to access fluids.

(NPS Medicinewise 2014)

As a nurse, you need to be aware also that certain medications affect fluid balance (Department of Social Services, 2014) such as diuretics, ACE inhibitors and laxatives (NPS Medicinewise 2014).

Common catalysts for heat-related illness can involve: sun exposure, dehydration, inadequate ventilation/airflow, crowded and hot areas, and bushfires (Better Health Channel 2016).

What Signs Do Nurses Need to Watch For?

• Prickly heat rash
• Worsening of medical state
• Heat cramps and spasms
• Muscle pains
• Dizziness
• Fainting
• Heat exhaustion (heavy sweating can decrease blood volume – therefore watch for tachycardia, headache, muscular aching, pale colour, dizziness, fainting, nausea, and vomiting); and
• Heatstroke (core body temperature >40 degrees – this damages organs and tissue, and you may observe seizures, unconsciousness, or staggering).

(Better Health Channel 2016)

Heatstroke

‘The symptoms of heatstroke may be the same as for heat exhaustion, but the skin may be dry with no sweating and the person’s mental condition worsens.’ (Better Health Channel 2016)

‘Heatstroke is fatal in up to 80% of cases’ (Better Health Channel 2016).

Evidently, heatstroke and heat exhaustion are medical emergencies, and you need to call 000 to have emergency services treat the affected person. Medical officers need to be contacted immediately if a person shows signs of heat-related illness or dehydration.

Queensland Health (2015) suggest some ways to provide initial first aid for heat-related issues here.

You will also need to perform comprehensive assessments and observations on your client, as well as maintain their safety at all times (Department of Social Services 2014). You will need to educate your client (NPS 2014) and as always perform contemporaneous nursing documentation.

Suggestions for Improving the Care of Older Adults in Hot Weather?

• Ensure adequate hydration of older clients to prevent constipation, falls from postural hypotension, and possibly prevent urinary tract infections (UTIs)
• Assess and document/chart hydration status accurately
• Identify and seek treatment for dehydration as early as possible
• Promote small frequent drinks of water over the day, particularly between meals
• Offer a little extra water to clients when they are taking their oral medicines
• Perform extra rounds and observations as appropriate on your clients, ensuring that they have access to the buzzer at all times and a full glass of water
• Educate clients about the need for hydration and how to maintain hydration
• Ensure older people are in rooms/areas with appropriate, comfortable temperatures. You may need to test that the air-conditioning is working properly and that blinds/curtains can be closed to limit the entry of heat
• Promote safety by ensuring that clients/residents do not go unsupervised outdoors, and that they try to avoid alcohol and caffeinated drinks
• Sun and skin protection – ensure loose fitting appropriate clothing, hats and sunscreen are worn as needed
• Lukewarm sponging to cool off
• If in doubt or if concerns arise, ask supervisors, medical officers or relevant health professionals to review the person.

(NPS Medicinewise 2014; Department of Social Services 2014)

References

• Better Health Channel 2016, Heat stress and heat-related illness, Department of Health & Human Services, State Government of Victoria, Melbourne, VIC, viewed 22 November 2016, https://www.betterhealth.vic.gov.au/health/healthyliving/heat-stress-and-heat-related-illness
• Department of Social Services 2014, Important reminder about caring for older people in warmer weather, Australian Government, Canberra, ACT, viewed 23 November 2016, https://agedcare.health.gov.au…warmer_weather_-_resicare.pdf
• Johns Hopkins Medicine 2016, Dehydration and Heat Stroke, MD, USA, viewed 23 November 2016, http://www.hopkinsmedicine.org/…dehydration_and_heat_stroke_85,P00828/
• NPS Medicinewise 2014, ‘The balancing act of hydration’, Health News and Evidence, 3 December, viewed 23 November 2016, http://www.nps.org.au/…dehydration
• Queensland Health 2015, Heat-related illness, Queensland Government, viewed 23 November 2016, https://www.health.qld.gov.au/disaster/heat/heat-illness.asp