The wisdom and coolness of many of our older friends and family members astonishes. But staying cool through the heat of summer and early fall is a challenge.

In the summer of 2003 a heatwave hit Europe. France recorded more than 70,000 heat-related deaths. Those aged 65 and older died at a rate two to three times that of those under 65. The 35-year-olds were unlikely to be affected at all by the record-breaking extreme heat.

The event caught the attention of many who care for older folks and those studying aging. Over the 20 years since, we have often witnessed similar incidents associated with climate change and an aging population here and in many other countries. Leaving the complexity of climate change aside, a key question is “How does aging change our response to heat stress?”

Think of a time earlier in life when you weathered an infection or a major health crisis. For me what comes to mind is flying over the handlebars of my Huffy and sliding down the next block on my chest. Recovery was not solely determined by proper treatment and care (Dad was an M.D. and Mom an R.N.), but also by my ability to get back to a “normal” level of activity. 

Resilience in early life can be taken for granted from childhood onward, but it declines as we age. Minor accidents and infections, for example, are likely to require more time and attention from others. 

The science of thermoregulation is fascinating and continues to provide a clearer view of age-related changes affecting our ability to maintain a normal temperature. Most people over 65 have two or more chronic conditions—commonly cardiovascular disease, hypertension, diabetes, lung disease or kidney disease—each frequently requiring several medications. In addition to the good the drugs provide, some might blunt the response to heat stress.

The skin (our largest organ) is essential to a normal response to heat stress through increased blood flow to the skin surface and sweating; each function is impaired with healthy aging. The reduced capacity to control blood flow can also affect cardiac and kidney function, creating a vicious circle and making the heat-related medical emergencies of heat exhaustion and heat stroke more likely. 

The most effective “thermoregulators” are behavioral, namely going to a cooler place and/or using air conditioning. Change in function and cognition among heat-vulnerable adults can leave an individual unable to understand the risks of heat exposure. 

In many communities the risk of even opening a window could add noise, pollution and—in the case of air conditioning—cost to the equation.

The CDC website provides a clear and useful list of measures to employ to avoid heat vulnerability* that includes advice in developing a care plan to provide guidance for multiple caregivers. It describes the signs and symptoms of the early and late effects of extreme heat exposure. Many of the suggestions are self-evident, but difficult for many of advanced age to accomplish alone. 

The bottom line? A strategy to prevent heat vulnerability requires a community response.

*www.cdc.gov/climate-health/php/resources/protect-yourself-from-the-dangers-of-extreme-heat.html.