It is timely to remind you of the impact that warmer weather may have on the older people in your care and the extra precautions and interventions that may be needed. The Bureau of Meteorology (BOM) summer outlook already notes that it is likely that the average October to December maximum temperatures will exceed the long-term median maximum temperatures over large parts of Australia. The next issue of the seasonal outlook, expected toward the end of October, will give a better indication for the rest of the summer. However, as we all know, hotter summer weather means we need to be alert to the possibility of heatwaves.

Community Care providers have recently been sent a reminder to review risk management plans to ensure that they are prepared for all types of emergency events. Heatwaves kill more people than any other natural hazard experienced in Australia. Bureau of Meteorology – Heatwaves: www.bom.gov.au/wa/sevwx/perth/heatwaves.shtml [Link was active at time of publication]

Older people are among those most at risk of heat-related illness. Due to normal age-related changes to the body, older people do not always recognise that they are over-heated. In addition, older people are more likely to have a chronic medical condition and to be taking medication that may interfere with the body’s ability to regulate fluid.

Older people living in the community therefore may suffer from heat stress and those who live alone without regular contact from others may be particularly at risk. Many service providers will have protocols in place to meet these circumstances. However, to assist the comfort of older people receiving community care, and for you to meet the requirements of the Community Care Common Standards, particularly Standard 2 (Identifying Care Needs), the following activities need to be undertaken as appropriate:

Care Provider

Review and check on clients at risk, particularly those who live alone and/or have limited capacity to keep cool;
be aware that clients are particularly at risk when there are high night-time temperatures;
check cooling systems are working effectively; suggest or make arrangements for a portable air conditioner, cooler or fan if the client’s home is not air-conditioned (remembering that the use of fans in an overheated environment can make dehydration worse);
raise awareness with relatives and friends to ensure that your client is cool and comfortable and appropriately dressed on hot days;
offer to provide extra support where family is not available to assist. Consider the possibilities of food spoilage as well as advice about how to keep cool.

Care Staff

Check that the temperature in a client’s home is kept comfortable, keeping curtains and blinds closed to reduce excess heat;
ensure small amounts of fluids are readily available, rather than large amounts of fluids less frequently;
suggest alternative forms of fluid, such as jelly, ice-cream or fruit juice blocks and discourage alcoholic or caffeinated beverages;
encourage your clients to eat frequent small meals;
encourage clients to wear loose fitting clothing, use sunscreen and keep skin covered when exposed to direct sunlight;
encourage clients to seek some shade when outside, and to avoid going outside between 11am and 3pm;
offer additional tepid showers or sponging; and
observe for signs of heat stress, such as nausea, and changes in appearance including red/pale or severely dry skin.

A clinical assessment will be required if your client shows any signs of deterioration.

The effects of heat-related illnesses can range from mild conditions such as a rash or cramps to very serious conditions such as severe confusion or heat stroke. Heat may also worsen the condition of someone who already has a medical condition such as heart disease.

A special note about medicines

Some medicines increase the risk of heat-associated illness in susceptible
people. These include:

medicines that cause dehydration or electrolyte imbalance;
medicines likely to reduce renal function; and
medicines that interfere with the production or regulation of heat.

If your client shows signs of heat-associated illness, report these symptoms to the Care Provider to arrange a review of medication with a pharmacist or general practitioner. A medication review should assess the risks and benefits of any changes to a medication regimen.

If you are concerned about a client’s wellbeing, his or her medical practitioner should be immediately contacted.

You may find it useful to display the attached checklist as a reminder for your staff over the coming summer months.

Further information is available from state and territory health department websites.

Susan Hunt, RN, PhD, FRCNA
Senior Nurse Advisor
Office of Aged Care Quality and Compliance
November 2012

Attachment: - Heatwave Check List – Community Care

Heatwave Checklist

Before a heatwave occurs

Assess which clients are at risk - who has limited capacity to keep cool; or which homes are prone to being hot;
check cooling systems in clients homes are adequate and working effectively;
ask relatives and friends to ensure clients are cool and comfortable and appropriately dressed on hot days;
offer extra support to clients where family and friends are not available to assist; and
provide contact details of your clients to the local emergency services.

During a heatwave

Continue to deliver care – source additional staff or volunteers if required;
be aware clients may be at particular risk following high overnight temperatures;
keep curtains and blinds closed in clients homes to reduce excess heat;
make small amounts of fluids readily available to clients;
provide alternative forms of fluid, and discourage alcoholic or caffeinated beverages;
encourage clients to eat frequent small meals;
encourage clients to wear loose fitting clothing, use sunscreen and keep skin covered when exposed to direct sunlight;
encourage clients to seek shade when outside, and to avoid going out between 11am and 3pm;
offer additional tepid showers or sponging;
observe for signs of heat stress, such as nausea, and changes in appearance including red/pale or severely dry skin; and
request a clinical assessment if your client shows any signs of deterioration.

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Important Reminder for Aged Care Providers in Warmer Weather (FYI - Com Care)

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