MEDICAL MATTERS:The winter, so far, has been milder than last year. In our part of the world, we have yet to experience our first frost, and while it has been wet and windy in the past week or so, there has certainly been no extreme cold of the bone- chilling variety.
Hypothermia is a particular risk for older people during a cold snap. It occurs when the body’s temperature falls below 36 degrees. Older adults can develop hypothermia in temperatures that produce only discomfort in younger people.
The cause of hypothermia is often environmental in younger patients, whereas in older people the cause is often a combination of poverty, poor housing and immobility. And the risk of hypothermia is increased by drugs, alcohol and illness.
When someone becomes immersed in cold water during the winter months, the resultant hypothermia is labelled primary; secondary hypothermia, on the other hand, results from reduced metabolic and vascular responses in the body when it is exposed to a cold environment such as an inadequately heated house.
If you are concerned about an older neighbour or relative over the coming months, what should you watch out for if you are worried they may have hypothermia?
Look for shivering, problems with walking, confusion and unusual apathy or lack of interest. Other signs and symptoms include slow speech, forgetfulness, a blue colour around the lips and reduced respiratory effort.
If you come across someone with these symptoms, the first thing to do is to make sure their clothing is dry. If not, take off wet clothing and dry the skin. Next wrap them in blankets, towels and scarves. Never give alcohol to someone with signs of hypothermia as it will exacerbate the physiological effects of the cold.
Once the person reaches hospital, treatment depends on whether or not he or she is conscious. For patients who are responsive and have a reasonable cardiac output, active rewarming, using forced air and full body blankets designed to allow warm air to flow directly onto the patient’s skin, is the treatment of choice.
However, for those with more severe hypothermia, invasive rewarming is the treatment choice. Essentially, doctors attempt to restore a normal body temperature by warming it from the inside. Options include replacing body fluid with warm intravenous solutions; using warm humidified oxygen; and introducing warm fluid into the body via the stomach or bladder.
But perhaps the most effective method involves putting the patient on cardiopulmonary bypass, which has the advantage of providing adequate circulation and ventilation while the core body temperature is increased.
Unlike usual resuscitation, which is stopped relatively quickly if there is no response, in the case of someone with a very low body temperature, prolonged efforts can save the patient.
This has led to a rather odd medical aphorism when dealing with someone with hypothermia: “Remember the patient is not dead until they are warm and dead.”
Older people are especially vulnerable to bitterly cold weather conditions. People aged over 65 are seven times more likely to be admitted to hospital as a result of low temperatures compared with those aged 18 to 44.
Stays in hospital in poorer communities due to cold weather are 2½ times more common than in the wealthiest neighbourhoods. In part, this can be attributed to fuel poverty, which occurs when a household needs to spend more than 10 per cent of its income on energy to maintain an acceptable level of heat in the home.
In a 2009 report, the Institute of Public Health said it was concerned that a recent trend of rapidly rising fuel poverty in the Republic and Northern Ireland could lead to a rise in excess winter deaths – defined as the number of deaths occurring in the winter months (December to March) compared to the rest of the year.
While we earnestly hope to avoid the prolonged cold spells of the last two winters, we are likely to experience at least a couple of hypothermic snaps in the months ahead.