Dr. Michael Malone began to worry when his 90-year-old patient with cognitive impairments hadn’t called for their check-in. The patient lives alone in a trailer and, at a recent home visit, Malone noted the temperature in his kitchen was 98 degrees.
Malone is a medical director for senior services for Advocate Aurora and Aurora at Home in Kenosha. He’s up against a lot during heat waves, he said, because many of his senior patients have dementia, a disease exacerbated in some critical ways by the heat.
“Our job is to take care of people who are vulnerable. We’re worried about our patients,” Malone said. “It makes us have to think outside the box.”
Days of blistering heat can do a number on anyone’s mood, but the consequences are far more severe for people with mental and behavioral health conditions. That’s especially true for people with dementia, depression, generalized anxiety disorder, bipolar disorder and other cognitive impairments, specialists say.
It’s a concern with no end in sight.
June 2022 was the planet’s sixth-hottest month on record, according to the National Oceanic and Atmospheric Administration, a benchmark that conjures worry for geriatric doctors like Malone and clinical psychologist Dr. Shilagh Mirgain, who specializes in health psychology at UW Health.
According to the latest advisory from National Weather Service, a large area of the United States faces ongoing oppressive heat forecasted to last until the end of the week. While Wisconsin has been spared the daytime temperatures of over 100 degrees in the Southeast, potentially dangerous heat is expected to last through Saturday in the state.
Of those who have mental and behavioral health conditions, heat affects certain groups differently. People with these conditions who are low-income, have multiple medical issues, have mobility issues and those with dementia are the most vulnerable to the recent spate of heatwaves, Malone said.
And then social determinants of health can mean the difference between staying cool and languishing in summer heat, Mirgain said.
“We think of those people who do not have access to air conditioning, who might be living in crowded apartments where heat rises,” Mirgain said. “Those are the most vulnerable to really be impacted by this. It’s an extra layer on top of struggling with other challenging conditions or physical or mental health issues.”
In patients with mental health conditions, data suggest high temperatures and humidity can exacerbate symptoms including self-harm and panic attacks.
It is generally understood that crime rates rise in the summer months, Mirgain said, but perhaps less acknowledged are the increased rates of suicide and suicide attempts. Heat hinders our ability to sleep, process stress and problem-solve, she said, which is dangerous for people in crisis.
“We aren’t thinking as clearly and we’re not having access to those parts involved in solving complex cognitive tasks,” Mirgain said. “Those become impaired with heat stress.”
Heat further encumbers people with dementia, Malone said, which can impinge on their ability to get help.
“It’s harder to figure out, for example, if a patient should call their daughter or their neighbor if they need help,” Malone said. “Or if they should keep the window shut, or open it. Problem-solving may be compromised, hence the response to severe heat may not be sufficient.”
Heat also affects certain medications, usually prescribed for behavioral conditions, mood disorders, heart conditions and neurological disorders.
Selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitor, commonly used to treat anxiety disorders, major depression and other psychological conditions, don’t work as effectively depending on the person’s body temperature, Mirgain said.
“That’s something to be really aware of,” she said. “And a lot of this actually goes back to sleep.”
Mirgain explained that a drop in core body temperature is a part of sleep mechanics. It’s meant to be restorative, but if a person is sleeping in a very warm room and lacks air conditioning, fitful sleep and insomnia can lead to aggravated psychiatric conditions for those already vulnerable.
Medications critical for patients with dementia, Malone said, can affect how a person’s body sweats, or cools down, in response to severe heat.
But, he cautioned, those medications are necessary to continue taking as directed. It’s important to consult with a physician to address concerns if the medication is causing aggravated symptoms in the midst of a heatwave.
Recommendations to beat the heat
The Centers for Disease Control and Prevention breaks down tips for preventing heat-related illness into three categories: staying cool, hydrated and informed.
Mirgain said these tips are important for anybody contending with the heat, but additional steps should be taken for those who also have mounting stressors from their mental health conditions.
She and Malone suggested making a plan to stay cool. Important questions to ask yourself prior to a very hot day are: How can you get the support you need? Is there a public area with air conditioning you can go to? Are you making sure you’re hydrated?
Mirgain suggested finding a public library if your home doesn’t have air conditioning.
For friends and neighbors, Malone said, it’s important to engage those at risk. He suggested calling or knocking on the door of the person at risk for a check-in. If it’s clear their house is hot, he suggested helping them buy a box fan and also supplying bottles of water.
“If you check in with them Wednesday afternoon, see how they’re doing that evening or Thursday morning,” Malone said. “For people with dementia, one call is not going to cut it.”
The Wisconsin Department of Health Services recommends that people seek a cool area or find help if they’re experiencing dizziness, headache, muscle cramps, weakness, nausea or vomiting.
“We’ve never had temperatures this high and we also don’t have the infrastructure to support higher temperatures like that,” Mirgain said. “It’s going to take some courage work to address so much of what’s going on.”
MORE:The pandemic only worsened the quality of life for family caregivers. It’s an ongoing problem with no end in sight, experts say.
MORE:Schmitt Park sets the stage as the first ‘dementia-friendly’ neighborhood association in Green Bay. Here’s why it matters.
Natalie Eilbert covers mental health issues for USA TODAY NETWORK-CENTRAL WISCONSIN. She welcomes story tips and feedback. You can reach her at [email protected] or view her Twitter profile at @natalie_eilbert. If you or someone you know is dealing with suicidal thoughts, call the National Suicide Prevention Lifeline at 988 or text “Hopeline” to the National Crisis Text Line at 741-741.
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