These winter months often find our community unwell and suffering. It is important to be prepared for our cold, wet winters. In some cases people, particularly our vulnerable, frail elderly citizens may be severely affected by the cold, suffering cold stress.
Cold stress (Hypothermia)
Much like high blood pressure, hypothermia can be called a “silent killer” in the sense that many of its victims are not aware of the threat. In the case of hypothermia, elderly persons may not be aware they are becoming cold as readily as younger people, and their bodies may not adjust to changes in temperature.
Hypothermia (literally “low-heat”) is a condition marked by an abnormally low internal body temperature. It develops when body heat is lost to a cool or cold environment faster than it can be replaced. Temperatures do not have to be below freezing for hypothermia to occur, especially in vulnerable individuals. Many older adults can develop a low body temperature after exposure to conditions of mild cold, which would only produce discomfort in younger people.
What you can do?
To avoid being harmed by hypothermia, now that cold weather has come to South Gippsland, here is some practical advice:
- If you live alone, arrange for a daily check-in call with a friend, neighbour, relative, etc.
- Insulate your home properly.
- Wear warm clothing. Instead of tight clothing, wear several loose, warm layers. Wear a hat and scarf to avoid significant heat loss through your head and neck. Stay dry. Moisture from perspiration, rain, or melting snow can seriously reduce or destroy the insulating value of clothing because water conducts body heat over 25 times faster than air.
- Use extra blankets / doonas because hypothermia can develop during sleep.
- Eat nutritious foods and exercise moderately; proper diet and physical conditioning help protect you against abnormal heat and cold.
- Get proper rest; fatigue makes you more vulnerable to subnormal heat and cold.
- Drink adequate amounts of liquids, such as water. People forget to drink during the winter as they do not feel as thirsty as they do in summer, so they do not get the physiological prompting to drink.
- Limit your alcohol intake because alcohol speeds up body heat loss.
What to look for
Some people die of hypothermia because they, or those around them, do not recognize the symptoms. Here are some signs to watch for:
- Muscles: The muscles are often unusually stiff, particularly in the neck, arms, and legs. This stiffness may be accompanied by a fine trembling, perhaps limited to only one side of the body or one arm or leg.
- Shivering: Shivering is a sign that the body is having trouble keeping warm. The shivering response is frequently diminished or absent in older adults, and the fact that an older person is not shivering in a cool or cold environment does not GUARANTEE that the person is not cold.
- Face: The face is frequently puffy or swollen, and this can be an important sign, especially when found in combination with cold skin and signs of confusion.
- Coordination: The person often has difficulty walking and has problems with balance. Look for poor coordination and jerky movements.
- Breathing and Heart Rate: Both are slowed at low body temperatures, and may be very difficult to detect in severe hypothermia.
- Skin: The skin is cool or cold. Pay special attention to the stomach, lower back, arms, legs, hands, and feet. The skin colour is usually very pale, but it may also have large, irregular blue or pink spots.
- Consciousness: As the body cools, consciousness is depressed. Some hypothermia victims will still be conscious when their body temperatures are as low as 80 degrees. Remember, though, that “conscious” and “mental clarity” are two different things. A person can be “conscious and reactive” and yet still be in a confused, disoriented, and hypothermic state, so the level of consciousness is not always a reliable indicator of the victim’s condition.
- Confusion: One of the first changes brought on by hypothermia is a growing mental confusion, which becomes progressively worse as body temperature falls. Logical thinking becomes impossible and the person may become completely disoriented. Memory is affected and familiar things are often forgotten.
- Attitude: Apathy is common. Often the person doesn’t care what happens and will do nothing to help reduce the danger; he or she may behave strangely, or become irritable, hostile, mean, and aggressive.
Note: Keep in mind that these signs do not necessarily mean a person is suffering from hypothermia; they are listed to alert you to the possibility.
What to do
If you believe someone may be a victim of hypothermia, call an ambulance immediately. Hypothermia is a dangerous, complicated medical problem and the victim needs professional attention. However, until help arrives, here are some suggestions:
- Be very careful in handling the person. Failure to do so can cause sudden death because the heart is very weak when the body is cold.
- Insulate the victim with available covering such as blankets, towels, pillows, scarves or newspapers.
- Some steps can worsen a victim’s condition:
- Do not attempt to rewarm the victim at home. Hot baths, electric blankets, and hot water bottles can be dangerous.
- Do not give the victim any food or drink.
- If the victim is unconscious, do not raise the feet. This will cause blood from the legs to flow into the body “core” and further depress the body temperature.
It sounds very frightening because it is. It is important to ensure you do not become victims to hypothermia. The steps to prevent hypothermia noted above are simple and inexpensive.
Not only is it important to look after yourselves, it is important if you are unwell with flu or a cold, or any other infectious illness, that you do not spread it. You should isolate yourself until you are no longer contagious. In aged care, staff must be 48 hours symptom-free before returning to work if they have had flu, or gastro-enteritis or any other infectious disease. Do not go to work (or school) if you are unwell, and please, do not visit our vulnerable residents in our residential services, as the flu and colds spread quickly. You will help protect our residents’ wellbeing by ensuring you are 48 hours symptom-free before visiting.
Please do not hesitate to contact me should you require further discussion about any aspect of residential aged care. As I have said in previous columns, going into aged care residential services is not a death sentence; it is just a change of address. With the Eden Alternative Philosophy it is also a journey of change to resident focussed care, a journey of living and life.