Air conditioners have been around for more than 100 years, and they are a necessity -- not a luxury -- for the elderly and those with heart conditions. So you'd think they'd be easy enough to install.

Not. 

And it's the problem of installation -- and air-conditioner design -- that keep many from having reliable access to this life-saving device. 

Many caregivers, especially those taking care of parents who are in a frail condition, are short on time and money and try to survive from day to day -- from health crisis to health crisis -- so anything out of the ordinary like an appliance breakdown or repair can seem like an insurmountable hurdle. Considering window air conditioners are a health necessity, is it asking too much to have a small window unit designed for easy installation? 

At the very least, could an outline of installation instructions be included on the box so you can at least buy the tools and materials needed at the same time as buying the air conditioner? Could the installation instructions be less than 40 pages long? Could the instructions include directions for something besides a wooden double hung window? 

Air-conditioning is rooted in health. The Royal Victoria Hospital, in Belfast, Northern Ireland, built in 1906, is a landmark building that claims to being the first "air conditioned building in the world." 

Dr. W. Larry Kenney, professor of physiology and kinesiology at Pennsylvania State University's Noll Physiological Research Center, who has studied the effects of chronological age, fitness and gender on cardiovascular responses to heat stress for more than 15 years, says the research has shown that when older people have serious problems associated with the heat, it's usually a cardiovascular problem. 

"People die because heat puts a greater strain on their hearts to pump blood," says Kenney. 

In fact, heat waves kill more people each year than hurricanes, tornadoes or volcanoes, and people over the age of 65 are 10 to 12 times more likely to die during extended periods of hot weather, according to Kenney. 

Kenney and colleagues studied the heat stress sedentary older people experience during serious heat waves like the one in Chicago in 1995, which resulted in 733 people dying from the heat. 

The lack of air conditioning in homes, nursing homes and medical facilities in France was one of the main factors resulting in the estimated 35,000 deaths of the 2003 heat wave in Europe. 

"When older people die during a heat wave, they usually are not exercising," said Kenney. "They are typically sitting in a very hot room without air conditioning -- and they seldom die of heat stroke; rather, there is almost always an underlying cardiovascular cause." 

Kenney and Christopher T. Minson, a doctoral candidate, monitored young and old men in special body suits that rapidly raised their skin temperature to about 108 F. 

Although the older men's outward appearance wasn't different from the younger ones, the younger men experienced increased skin blood flow 2.5 times greater than that observed in the older men. 
"The hearts of the older men were just not doing the job that the younger ones' were doing," said Minson. 

Since the Chicago heat wave in 1995, Chicago has chosen a labor-intensive approach of having city workers knock on the doors of the elderly to check on them and urge those without air conditioning to spend some time in an air-conditioning environment such as a community center -- even though some may not have the mobility to leave their homes. 

Just as effective would be help getting an air conditioner in their home. Researchers say, and I can verify this, that many of the greatest generation and the Depression era are no fans of air conditioning in their home. Some don't like spending the money for the extra electricity, some feel that they've survived decade after decade of not having air conditioning in their home, and some have arthritis and like the warmer temperatures. 

For many, the problem was that even a small window air conditioner used to be costly, from about $300 to $500; in recent years the cost has dropped to less than $100. But there is still the barrier of installation. 

My 93-year-old father doesn't like air conditioning for all of the reasons cited, but the big problem was getting an air conditioner that would fit the wooden casement window in his bedroom. A vertical air conditioner that fit casement windows used to exist in the 1980s, but the $500-plus cost was too much for my father, and later I could no longer find them. 

However, a couple of years ago the doctor told me that my father absolutely must have air conditioning. By this time my father had moved to a downstairs bedroom so he could have a regular window air conditioner. The trouble is he just turned it off. But the little black kitty my father adopted a couple of years ago saved the day. She likes to spend a big chunk of daylight hours napping sprawled on his bed not far from my father's air conditioner. 

So we pointed out to my father that the kitty likes air conditioning because, after all, she wears fur. Now he's relented to keep the air conditioner on -- for her.