Study probes heatwave risk to the elderly

23 December 2008 by Tom Marshall

More needs to be done to protect elderly people from the effects of heatwaves, according to new research.

Clouds and sky

The risk is real; the heatwave that hit Western Europe in the summer of 2003 is thought to have led to the premature deaths of some 35,000 people in Europe, including nearly 2000 in England and Wales, where temperatures were lower than on the continent.

Climate change is expected to make these extreme periods of hot, dry weather more common over the coming century. And the elderly are the fastest-growing part of the British population, so as time passes there will be more people who are vulnerable to heatwaves.

The government launched a Heatwave Plan in 2004, including an initiative to identify those at most risk and provide them with advice. The elderly and those with chronic or severe illnesses are among the most vulnerable; in southern England during the 2003 heatwave, 33 per cent more over-75s died than would be expected under normal conditions, compared to 13.5 per cent among under-75s.

A leaflet on dealing with heatwaves is available as part of the heatwave plan, but until this new study from researchers at University College London (UCL), the University of East Anglia and the London School of Hygiene and Tropical Medicine it wasn't known how well the message had got across to the elderly.

Researchers interviewed 73 people aged 75 and over, as well as a few of their carers. They found that although most interviewees had sensible ideas about how to deal with the threat of overheating and appreciated the theoretical risks to older people, few thought they personally were at risk.

In many cases this was because they didn't think of themselves as elderly or vulnerable, or because they felt that experience of hot weather in the past showed they could deal with the risks. Some interviewees didn't even consider themselves to be old, pointing out that age is a relative concept.

Part of the problem may be that there has been no heatwave since 2003, so the experience is not fresh in peoples' minds.

Getting the message across

The challenge, then, is how to get the message across most effectively. "Research suggests that just giving out information on its own isn't enough," says Vanessa Abrahamson, a research assistant in the department of epidemiology and public health at UCL and one of the paper's authors.

"Our study suggests that if the Department of Health just targets information at those who are at the most risk, it won't do much good if these people don't see themselves as being at risk, as they are unlikely to think the advice applies to them," she adds.

She explains that the research suggests that awareness-raising campaigns should be targeted at the general population, and not just at groups perceived to be vulnerable; people in these groups may not pay much attention if they don't think of themselves as vulnerable. Reaching neighbours, friends and those who care for elderly people may be just as important.

Another insight from the research was that using innovative communication channels might be more helpful than relying on leaflets, which are often ignored. Suggestions included storylines about the risks of hot weather in soap operas, or covering the subject on late-night talk radio stations.

If leaflets are used, they should be eye-catching and use large type. And the elderly may be more likely to take advice if it is presented positively, as a way to retain their independence, rather than emphasising their vulnerability.

She also notes that a possible flaw in the study was the method of recruiting older people: GP lists were used, but the GP was asked to screen out anyone they thought inappropriate to contact. Therefore 'those who replied are likely to have been among the more robust ones,' Abrahamson notes; this means the study may have missed interviewing the most vulnerable people.

The researchers are now writing up the second phase of the study which involved interviewing health and social care professionals as well as volunteer workers to ascertain their views about monitoring vulnerable adults during a heatwave.

The researchers are particularly interested in how professionals define and identify vulnerable individuals, how the Department of Health's recommendations are interpreted at a local level, and whether there are barriers to their implementation .

"It's true that over-75s are the most vulnerable, but this is a huge group," says Abrahamson. "There is a lot of variation within it; some may have live-in care, for example, so even if they are quite frail they may actually be at less risk in a heatwave than someone who is more capable of living independently but who has no regular support." The results of this research will be available in the spring.

The paper appears in the Journal of Public Health, and was funded by the Medical Research Council and by the Economic and Social Research Council, the Engineering and Physical Sciences Research Council and the Natural Environment Research Council.