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Surviving summer

By RAJIV M
The Hindu Times, May 20, 2002

HOME ALONE: Ventilation is important to avoid heat-strokes. - Photo: K. Ramesh Babu

THE HOT summer months herald a sharp increase in the number of people being hospitalised for dehydration and heat-related illnesses, and a significant proportion of these people are the elderly.

Lakshmi vividly remembers the hot summer day, a decade ago, when she came home from work to find her septuagenarian father sitting in a chair, looking disorientated and mumbling incoherently.

He slipped into a coma soon afterwards and spent the next four days on a hospital bed, hovering between life and death, before finally pulling through.

"I remember he had had a mild bout of diarrhoea that morning. He seemed all right when I left for work. Back then I did not know these things could manifest like this or turn serious so quickly," says Lakshmi. "I still feel guilty about leaving him alone at home that day."

Why do so many of the elderly succumb to heat stress and dehydration in summer?

Prof. Sudha Ramana, Superintendent of the Sir Ronald Ross Institute of Tropical and Communicable Diseases feels that a combination of socio-economic, behavioural and age-related physiological and pathological factors is to blame.

Nuclear families increasingly tend to shut out the elderly and they lead forgotten lives alone, on dwindling incomes, in small, poorly ventilated houses that are hot as ovens in summer. They have little access to clean water or domestic help and there is usually no one to raise the alarm when something goes seriously wrong.

Sudha feels that the behaviour of the elderly people raises the risk of their succumbing, unnoticed, to these conditions.

"They suffer from so many chronic diseases, that it is possible they would be alarmed about their own health and they are less likely to seek medical help promptly. This attitude rubs off on their family members as well and they become less alert to signs of deterioration in the health of the aged. Consequently, the elderly seek the help of doctors at a later stage in the illness."

The elderly are also indifferent about taking care of themselves. Depression, common in them, reduces their motivation to strive for good health.

Some drink less water than they need to because of prostate, renal, or bladder ailments and it is their way of avoiding urination, which may be involuntary, painful, or difficult. Arthritics are less likely to fetch potable water from afar and sometimes they would rather go thirsty than get up to drink a glass of water.

The fact that the elderly are physiologically ill equipped to deal with dehydration and heat stress makes this behaviour all the more hazardous. Their bodies naturally hold less water; their sweat glands pump less sweat and their kidneys conserve water inefficiently.

Besides, there is also the complex role of diseases that are common in the elderly and the effect of some of the drugs used to treat them. Hypertension, diabetes, artereo-sclerosis, respiratory and renal ailments, are common.

"Dehydration may trigger a heart attack or a stroke. Because their fluid reserves are usually precariously low, it may not take much fluid loss to trigger a heart attack or the failure of an organ system.

It may also complicate the search for a cause and make it time consuming. Vomiting may be a sign of a heart attack and this is something physicians have to take into account while weighing different diagnoses." Some hypertensives are on diuretics, which draw fluid away from the body; some are on a low salt diet, and some on anti-hypertensive drugs, sedatives and hypnotics that interfere with the process of sweating.

However, Sudha stresses that the elderly should not make arbitrary changes to their recommended diet or treatment regimen. She stresses on and makes a fervent appeal for prevention of these illnesses in the elderly. "Because of their frail constitution, mortality rates are higher in this age group. Dehydration can be hard to read in the loose wrinkled skin of the aged and diagnosis can be tricky and time consuming, especially when the patient has been living alone and has been brought to the hospital in an unconscious state. Prevention is always better than cure."