Editor’s note: The Caregiving Chronicles blog has partnered with Century Health Systems to bring additional expert information and advice to the MetroWest caregivers we strive to serve at CaregivingMetroWest.org. Century Health Systems, the parent corporation of Distinguished Care Options and the Natick Visiting Nurse Association, has allowed Caregiving Chronicles to get some valuable insight from its staff for our ongoing series of Q&A sessions with caregiving experts.

In this entry, just in time for the dog days of summer, we discuss some summer safety tips and hot weather concerns as the heat and humidity steadily rise. Providing insight is Judith Boyko, MBA, MS, RN, who has served as the CEO of Century Health Systems since it was established in 2001.

Boyko holds a Bachelor of Science degree in Nursing from the University of Pittsburgh, a Master of Science in Public Health from the University of Massachusetts, Amherst and a Master of Business Administration from Clark University. She has been recognized by the Home & Health Care Association of Massachusetts as Manager of the Year in 1997 and received the Deborah Blumer Community Health Leader Award from the MetroWest Community Health Care Foundation in 2007. She can be reached at info@natickvna.org or 508-651-1786.

Caregiving MetroWest: What are some of the biggest concerns someone caring for an older adult should consider preparing for as we head into the heart of summer?
Boyko: Due to the natural changes in their bodies, older adults are more susceptible to heat-related illness. Chronic medical conditions and certain medications further contribute to that susceptibility. For instance, heart disease makes it more difficult for one’s body to effectively circulate blood and eliminate heat. Older adults don’t sweat as much as they did when they were young, which can limit the body’s ability to cool itself down. This makes them less aware of how the heat might be affecting them. Those who have respiratory issues may find it harder to breathe comfortably when temperatures are elevated.

Additionally, if an older adult suffers from heat-related illness – which can cause dizziness and compromise balance – he or she is at an increased risk of falling.

Therefore, ensuring that their home is comfortable; that they have a place to go to cool down; and that they have the proper equipment in place (like a fan and/or an air conditioner) is paramount.

CGMW: One risk for anyone, but particularly for older adults, is dehydration. What are the warning signs? How can you prevent it? What should you do if you notice symptoms? How much water should an older adult drink?
Boyko: Our bodies are two-thirds water. Dehydration refers to the lack of enough water in one’s body to maintain normal function. Warning signs of dehydration include dizziness; a dry mouth; headaches; muscle cramps; and weakness. At the first sign of a headache, give your loved one half a cup of water every 30 minutes and see if they feel better. However, if your loved one’s level of responsiveness decreases or changes, call for emergency help immediately.

Juanita Allen Kingsley, Century Health Systems’ Director of Business Development, is a Wilderness EMT and warns:
•    Even a 2% level of dehydration can impair cognitive function. We simply don’t feel as sharp.
•    Skin can feel dry and less elastic when dehydrated.
•    Dehydration causes bad breath. Why? We need saliva to keep breath fresh, and dehydration reduces the amount of saliva our bodies make.

The best way to see if your loved one is properly hydrated is to check their urine color. It should be clear or light yellow. Bright or dark yellow urine is a sign of dehydration. But remember: some medications can change urine’s color. Keep a water bottle handy, drink fluids with meals, and opt for “wetter” snacks, like yogurt or fruit over “drier” snacks like pretzels.

Older adults, depending on a variety of factors, may need different amounts of fluids to stay hydrated. Talk to your loved one’s doctor to find out what’s best, especially if your loved one’s taking a diuretic medicine.

CGMW: What kinds of clothing should an older adult wear in the summer? Are some materials better suited or more “breathable” than others? Does loose fitting or light colored clothing really help?
Boyko: Loose clothing made of natural fibers (think cotton), rather than synthetic, is ideal. Cotton is breathable and can help keep someone cooler in the summer’s heat. Johns Hopkins Medicine does, in fact, say that “lightweight, tightly woven, loose-fitting clothing in light colors” can help prevent heat stroke.

CGMW: Protecting skin and eyes from the harmful effects of the sun is always important, but it’s especially imperative during the longer, hotter days of summer. What strength of sunscreen should older adults use? How often should it be applied or reapplied? What other protections should be used?
Boyko: Experts agree that a broad spectrum sunscreen can offer protection from UVA and UVB rays, both of which are harmful. An SPF (sun protection factor) of at least 30 is recommended. In order for the skin to reap the benefits of sunscreen, it should be applied liberally (about a shot glass’ worth) half an hour prior to sun exposure and every two hours thereafter.

According to the Skin Cancer Foundation, older adults have likely experienced damage to their skin from the sun. But they remain susceptible to further damage, and “unprotected sun exposure increases the risk of developing new skin cancers and pre-cancers…”

In addition to sunscreen, older adults should consider wearing UV-blocking sunglasses, a wide-brimmed hat and clothing that contains SFP protection. The Skin Cancer Foundation is a great resource for information about sunscreen.

Finally, the sun’s peak hours are between 10 a.m. and 4 p.m.; if you really want your loved one to avoid the sun, be sure they stay indoors during that period.

CGMW: How long is it safe for an older adult to stay outside in the summer, even if wearing sunscreen, hats, etc.?
Boyko: While there’s not a “one size fits all” approach to safely be outdoors in the heat, encourage your loved one not to go outside when the sun is at its peak (between 10am and 4pm, as a refresher). But when your loved one is outdoors, they should drink plenty of fluids, try to stay in shaded areas and avoid strenuous activity.

CGMW: What is heat stroke? What are the warning signs? How can you prevent it? And what should you do if your loved one is showing symptoms of heat stroke?
Boyko: Heat stroke is usually accompanied by a fever no higher than 104 degrees Fahrenheit. Some of the same symptoms as in heat exhaustion will remain and become worse: excessive thirst, nausea, fainting, cool and clammy skin, weakness, muscle aches, heavy sweating, slow heartbeat and dizziness. However, some victims of heatstroke will no longer sweat; their skin will be dry and red.

Heatstroke can kill. Remember that heat emergencies are more common in very hot and humid weather, as one’s ability to cool through perspiring is diminished; perspiration is less effectively evaporated from our skin.

Prevent heat stroke with the following guidelines:
•    Wear lightweight, loose-fitting clothing
•    Drink lots of fluids
•    Wear sunscreen
•    Stay out of the sun during peak hours
•    Discuss photosensitivity with your loved one’s doctors if she’s on any medications

If you suspect that someone has heat stroke, call 911 immediately. Of course, get them in the shade and have them lie down. Don’t administer any fever medications; they won’t work, because the brain’s thermo-regulator can’t respond to them. If they’re available, put cold packs at the groin, the neck and under the arms.

CGMW: If you are not living with the older loved one you are caring for, how often should you check on them? Should you be checking in more often during the summer because of the dangers of the heat? What should you be looking out for when you check in?
Boyko: Make a list of important phone numbers and post on the fridge, where they are easily seen. Identify a few neighbors who are willing to stop by your loved one’s house regularly – twice per day is ideal – in your absence. Consider hiring a professional caregiver to help your loved one minimize their vulnerability to heat-related illnesses.

Some tips for home safety in the heat:
•    Install an air conditioner.
•    Purchase a few handheld fans for your loved one.
•    Put together an emergency kit in the event that your loved one’s power goes out. The American Red Cross suggests the kit contain the following items:
– One gallon of water for each person in the home per day
– Non-perishable foods
– A flashlight and extra batteries
– A seven day supply of her medications
– Emergency contact information
– Personal documents like medication list, insurance cards, passports and birth certificates

For a comprehensive list of suggested items, visit American Red Cross.

CGMW: Are there other summer-related issues caregivers should be aware of?
Boyko: Heat emergencies are another condition about which seniors and their family members should know. Heat emergencies are progressive, and heat exhaustion can become heatstroke if it’s not managed. Heat exhaustion is characterized by dark-colored urine, signaling dehydration, confusion, dizziness, fatigue, headache and muscle or abdominal cramps. It can be managed by getting the patient out of the sun and having him drink small amounts (1/2 cup) of cool (not ice cold) water every half hour. Ice packs can be applied under arms and at the neck to help with cooling.

If your loved one is on any medications (as many seniors are), be cautious about photosensitivity. Ask your loved one’s physicians if any of the medications put her at risk for this condition, which causes an increased sensitivity to the sun.

If an individual’s home doesn’t have air conditioning, encourage her to go somewhere that does. Some ideas: the local senior or community center, a library, the theater or even the mall. But be sure your loved one doesn’t walk if it’s hot out; identify a few friends or neighbors who can be available if your loved one needs a ride. Or identify local transportation services, like the MetroWest Regional Transit Authority, which offers paratransit services within and throughout several MetroWest communities.

Other tips for making a home more comfortable in high temperatures include:
•    Keeping shades closed during the day
•    Opening windows at night to let cooler air circulate
•    Avoiding strenuous activities
•    Avoiding alcohol and caffeine, which can further the loss of important fluids that keep our bodies hydrated

Many of us associate summer with barbeques, the beach and lots of time enjoying the outdoors. But we also must make sure that our older loved ones are safe from the dangers that the warmth of the season can pose.