You need to drink more. A geriatrician gives advice on how older people can survive the heat

07.07.2021

In July, many regions are expected to be hot again. How to protect your health?

Nadezhda Runikhina , tells AiF about this .

Pressure surges

– Nadezhda Konstantinovna, how does the well-being of an elderly person change in very hot weather, what are the most dangerous symptoms?

– Heat is a serious test for the body of an elderly person, who, as a rule, has several diseases. First of all, the load on the cardiovascular system increases, the heart rate increases. But blood pressure can behave differently: for some it increases, for others it decreases. You need to regularly measure your blood pressure and take medications on time.

Dehydration, i.e. dehydration, is very dangerous. In the heat, the evaporation of moisture from the skin and mucous membranes increases, a person loses not only water, but also electrolytes - sodium, potassium, calcium salts in the blood . And you need to replenish fluid on time. However, older people may have problems with this. As many people age, their thirst becomes worse. There are patients who, due to a geriatric syndrome such as urinary incontinence , specifically try to limit their water intake. Others try to drink less to avoid excessive sweating . And a decrease in fluid in the body leads to a whole cascade of adverse reactions. In particular, the risk of thrombosis increases, as blood . And this, in turn, can lead to heart attack , stroke, deep vein thrombosis of the lower extremities - depending on in which vessels the blood clots have formed.

– Some older people complain of weakness and dizziness in the heat...

– This may also be a consequence of the fact that they do not drink enough fluids. Due to dehydration, orthostatic reactions develop. When the body position changes, blood pressure does not increase (as is normal), but, on the contrary, decreases significantly. brain worsens . As a result, dizziness , darkening of the eyes , a person may lose consciousness and fall, and be seriously injured. Brain damage can be more serious when acute cognitive impairment develops due to dehydration and overheating, delusions and hallucinations (delirium) appear. Such disorders are possible in very elderly people. It starts with the fact that a person simply becomes very inattentive. It would seem not scary. But in reality, since the brain controls all functions, this affects all the activities of the body.

Depth of coma

A comatose state can develop gradually over several days, or occur suddenly in a matter of minutes. According to the degree of depth, the following stages of coma are distinguished:

Precoma with severe retardation or, on the contrary, psychomotor agitation. Reflexes are preserved, coordination of movements is impaired, thinking suffers.
The first degree, in which sleep or stupor occurs. Reactions to external stimuli are inhibited, but the person can take liquid food and make simple movements.
Second degree, the stage of deep sleep with a complete lack of contact, pathological forms of breathing, rare chaotic movements, weakened pupillary response to light, convulsive muscle twitching.
The third degree, in which there is no consciousness, there is no reaction to painful stimuli, reflexes are lost, the normal breathing rhythm is lost, blood pressure drops, and body temperature decreases.
The fourth degree or extreme coma, in which reflexes disappear, muscle tone is absent, and blood pressure and temperature drop sharply. Spontaneous breathing stops. It is supported by artificial ventilation, and nutrients are injected.

Death most often occurs in a state of extreme coma. However, if a person can be brought out of it, and further improvement occurs, then brain functions can be restored partially or completely.

Don't bring it to the emergency room

– Diabetes mellitus is a very common diagnosis in older people. What do they need to remember in hot weather?

– Yes, the most vulnerable among all patients are patients with metabolic syndrome. And diabetes mellitus is a prime example. Already initially, these patients have problems associated with the regulation of not only carbohydrate metabolism, but also protein and electrolyte metabolism. Sometimes they are overweight. Therefore, in hot conditions there may be higher blood , but what is even more dangerous are episodes of hypoglycemia in patients who are on insulin therapy. Hypoglycemic conditions can quickly lead to very serious complications. Therefore, it is more important than ever for such patients to more carefully monitor medications, insulin doses, and follow a diet with a reduced amount of simple carbohydrates.

– What could be the consequences of prolonged heat?

– Decreased functional status may occur. In hot weather, it is very difficult to maintain physical activity. Elderly people stay at home, sometimes in bed, and stop moving. This very quickly leads to the development of muscle weakness and functional deficits. You should definitely take a walk, for example, in the very early morning hours in a park, along the shore of a pond, or at least go out and just sit in the shade of trees or buildings.

Another danger is nutritional deficiency. Of course, in the heat, appetite decreases, but you can’t completely give up food. Juicy vegetables, fruits with a high liquid content, and fermented milk products (if there is no intolerance) are very useful.

Those who have very elderly relatives should pay closer attention to their hygiene and avoid diaper rash and abrasions on the skin of an elderly person. In the heat, infection of these tissues can occur very quickly.

– Is the number of visits to doctors from older patients increasing?

– In hot weather, the flow of elderly patients with heart attacks, strokes, and injuries increases (if a weakened elderly person falls, the injury may be incompatible with life). There are especially dangerous outcomes among people with many chronic diseases, diabetes mellitus .

On hot days , as a rule, there are not many calls the clinic It is often difficult for an elderly person to get organized, come and see a doctor in the heat. And that's the problem. As a result, there are emergency calls - heart attack , stroke, falls, trauma, hypertensive crisis. For example, in Germany it was calculated that in hot weather, every third reason for hospitalization in geriatric patients is associated with dehydration (the first two are cardiovascular diseases and injuries). It is dehydration that causes emergency hospitalization. While the problem can be solved very simply: control the amount of water you drink. It is no coincidence that in medical institutions, especially in geriatric departments, medical staff walk through the rooms with water an additional 2-3 times a day and ask patients to drink more. Therefore, in the family, relatives should pay more attention not only to what pills the elderly person has taken, but also to whether he drinks enough water.

Communicating with a person in a coma

Those who managed to come out of a coma say that they felt as if they were in an extremely deep sleep. Some report that very near-death tunnel, at the end of which a bright light was visible. Almost everyone remembers nothing about the events that led to the coma, and, moreover, about what happened to them in this state.

However, although comatose patients have no reaction to external stimuli, there is reason to believe that some forms of subconscious perception still remain. Therefore, the British Department of Health has made the following recommendations for those visiting a relative, loved one or friend who is in a coma:

Introduce yourself and share the news in a positive way.
Talk about your current life as if the person in a coma were an ordinary interlocutor, or rather, a listener.
Show your support. To do this, just sit next to him and hold the person’s hand.
Let him listen to his favorite music using headphones.

Advice from Dr. Runikhina

Carefully monitor how much fluid you drink. For those who live alone and are not confident in their memory, you can use the same principle as with medicines that are put in a pill box for the day: in the morning, pour water into a 1.5-2 liter bottle or carafe, put it on the table and drink during the day. It is important to drink not only water - fruit drinks, compotes, mineral water, tea are suitable.
The best diet in the heat is a light dairy-vegetable diet. Vegetables, fruits, all kinds of smoothies, dairy products, low-fat kefir or kefir diluted with water, low-fat cottage cheese. This will provide the body with vitamins, minerals, fiber and protein. It is better to eat little by little and have small snacks more often.
Reduce physical activity. Don't even try to work in the garden. However, you cannot lie down all day. You need to get up and walk. You can go outside and sit or take a walk in the shade, in a park, next to a fountain or pond.
You should not swim in open water in hot weather. Due to the large difference in air and water temperatures, there is a risk of developing vasospasm and , as a result, a heart attack.
Elderly people should be careful in the open sun - only wear a hat, be sure to use sunglasses, and cover exposed skin with light-colored clothing. The risk of skin damage and the development of cancer under the influence of ultraviolet radiation in older people is very high.
Take water treatments at home as often as possible. This will refresh and prevent skin diseases.

When to see a doctor immediately

In case of a fall, even if there is no visible damage or injury.
If there is chest pain, shortness of breath.
If there is asymmetrical weakness in the arms and legs , it is difficult for you to speak, speech has become slurred and unintelligible.
If a person behaves differently than usual: he becomes very sleepy, starts talking, repeats the same thing (possible symptoms of brain ).
Nausea and vomiting do not go away

How long does it take for a person to die and how painful is it?

Renowned Professor Ken Hillman, who practices at the University of New South Wales Hospital, has seen many dying people in his time. He notes that every person has reserves that he does not know about, and the body turns on them in order to live another day, week and even month. Relatives of a dying person often wonder how long it takes for a person to die if the first signs have already appeared. Hillman explains that natural death is painless, the person simply loses consciousness or falls asleep, passes out, and disappears.

If at the moment of death the patient feels severe pain, his suffering is alleviated by special potent drugs.

Scientists identify 4 stages of human dying:

Preagonia - blood pressure is greatly reduced, consciousness and breathing are impaired, a terminal pause in breathing occurs, the pupil does not respond to light.
Agony has signs in the form of weak short breaths, which are replaced by convulsive breathing breaths.
Clinical death is manifested by loss of consciousness, lack of breathing, and cessation of pulse. At this moment, there is still a chance to save the person with the help of resuscitation devices.
Biological death is irreversible in all human organs and systems. Manifestations: breathing, no pulse, pupils are maximally dilated, body temperature drops, numbness of the limbs occurs.

As for the psychological perception of death by a dying person, there are not many answers. Some scientists claim that a person experiences fear and panic, while others say that before death a person becomes better, he goes into oblivion, and feels ready to let go of life.

Consequences and complications of coma

In fact, it is not the coma itself that leaves the consequences, but the painful state of the body that resulted from it. The severity of the consequences depends on the degree of coma. They can be so serious that a person simply loses the ability to exist without medical equipment and outside help. There may be another situation when the patient successfully recovers, restoring all body functions to the maximum extent possible. One of the most common consequences of coma is impairment of memory (to the point of amnesia), attention, and everyday skills (inability to eat independently, carry out usual hygiene procedures, etc.). In addition, prolonged lying down causes the development of bedsores. If you have suffered a coma, rehabilitation can greatly help the body cope with its consequences.