Older adults, people with long-term conditions, and those on certain medications can be at higher risk in the heat if their bodies regulate temperature less effectively, and they may feel less thirsty even when dehydrated. These individuals can also deteriorate more quickly, and the signs of heat illness may be subtle or easy to miss in a care setting context.
People at higher risk of becoming unwell who you may support include:
- older people aged 65 years and over
- people with underlying health conditions particularly heart problems, breathing problems, dementia, diabetes, kidney disease, Parkinson’s disease, or mobility problems
- people on certain medications
- people with serious mental health problems
- people who are already ill and dehydrated (for example from diarrhoea and vomiting)
- people who experience alcohol or drug dependence
- people experiencing homelessness, including rough sleepers and those who are unable to make adaptations to their living accommodation such as sofa surfers or living in hostels.
- people who live alone and may be unable to care for themselves
We are asking you to:
- Keep the environment as cool as possible,
- watch for signs of heat illness in the people you care for, and
- look after your own staff who are working hard in conditions that carry their own risks.
Recognising early signs of health illness, and worsening signs of heat exhaustion and heatstroke – it’s worth knowing the difference, because heatstroke is a medical emergency.
Spotting heat illness – what to watch for
Early signs of heat illness can look different in older adults and people with long-term conditions. You may see:
- Confusion or unusual agitation – this can be the first sign in older adults
- Increased sleepiness or unusual fatigue
- Pale, clammy skin, or flushed, hot skin
- Fast or shallow breathing
- Nausea, headache or dizziness
- A temperature of 38°C or above
If you’re seeing these signs, act quickly. Move the person to a cool area, encourage fluids if they’re conscious and apply cool damp cloths – particularly around the neck and armpits. If symptoms don’t improve within 30 minutes, call NHS 111. If they deteriorate rapidly, lose consciousness, or have a temperature at or above 40°C, call 999. Heatstroke is a medical emergency.
For residents with heart or respiratory conditions: heat places additional strain on these systems. Be alert to worsening breathlessness, chest pain, or symptoms that feel different to their usual pattern. Contact their GP or NHS 111 promptly.
Recognising heat exhaustion and heatstroke and what to do
Heat exhaustion
Check Heat exhaustion symptoms:
- tiredness
- weakness
- feeling faint
- headache
- muscle cramps
- feeling or being sick
- heavy sweating
- intense thirst
What to do: move the person somewhere cool immediately, encourage them to drink cold water, cool them down with damp cloths, cold packs under the armpits and around the neck, or a cool wet sheet. If symptoms don’t improve within 30 minutes, or you’re worried, call NHS 111.
Heatstroke – call 999
Check Heat stroke symptoms:
- confusion
- lack of co-ordination
- fast heartbeat
- fast breathing or shortness of breath
- hot skin that is not sweating
- seizures
If you suspect heatstroke, call 999 immediately. While waiting for help, cool the person down as quickly as possible using whatever is available; water, ice packs, a fan, or a cool wet sheet. Do not give them anything to drink if they’re unconscious. If they lose consciousness, place them in the recovery position. This is a life-threatening emergency. Do not wait to see if they improve.
Keeping residents and clients safe – the environment
Check and record indoor temperatures regularly, particularly in rooms where residents spend the most time. Aim to keep living and sleeping spaces below 26°C where possible. Close curtains or blinds on windows that face the sun, particularly in the morning. Where you can, open windows in the cooler overnight hours to let stored heat escape – check your insurance conditions and security arrangements before doing so.
Turn off unnecessary lighting and equipment; both generate heat. Fans can be helpful but should not be pointed directly at individuals, and at temperatures above 35°C they become less effective and can worsen dehydration. Designate a cool room or area if one is available and make sure residents know they can use it.
Hydration
Make sure residents and clients have access to cold water at all times and actively encourage them to drink regularly – older adults in particular may not feel thirsty even when they are dehydrated. Cold foods such as salad, fruit and ice lollies are also helpful as they contain high water content. Limit caffeine and alcohol, both of which contribute to fluid loss.
Monitor for signs of dehydration: dark or strong-smelling urine, dry mouth, infrequent urination, or confusion. Where appropriate, consider weighing clients regularly – an unexplained drop in weight can be an early sign of dehydration. Alert a GP or NHS 111 if you’re concerned.
Medications
Certain medications increase the risk of heat-related illness. Diuretics increase fluid loss. Blood pressure medications can be affected by dehydration. Antipsychotics and some antidepressants can impair the body’s ability to regulate temperature. If a resident is on any of these, they need closer monitoring. If you’re unsure about a specific medication, contact the resident’s GP or a pharmacist – many are able to advise by phone.
Protecting your staff – PPE and heat stress
Wearing PPE in hot conditions significantly increases the risk of heat stress. PPE reduces the body’s ability to cool itself through sweat evaporation and limits the normal ways the body loses heat. Staff may not realise how quickly they are becoming overheated, especially when they’re focused on delivering care.
What managers need to do
- Assess the temperature in your workplace and put cooling measures in place — ventilation is the first priority
- Make sure all staff know the signs of heat stress and are not waiting until they feel very unwell before taking a break
- Increase the frequency of breaks during an amber alert — staff will need to change PPE more often as it becomes uncomfortable or damp from sweat; ensure you have sufficient PPE supplies to cover this increase in demand
- Consider whether additional staff may be needed per shift to maintain safe staffing levels
- Consider whether any staff members are themselves more vulnerable to heat — pregnant staff, those with health conditions, or those on certain medications — and make adjustments accordingly
What to tell your staff
- Staff should take regular breaks and find somewhere cool when they do.
- Remind them to check their own hydration – pale or straw-coloured urine is a good sign; dark or strong-smelling urine means drink more.
- Encourage a buddy system so colleagues are watching out for each other: confusion, pale or clammy appearance and fast breathing in a colleague are signs they need to stop and cool down immediately.
- Staff should also try to stay cool between shifts to allow their bodies to recover. Working in extreme heat is physically demanding, even without PPE.
When to escalate
Call NHS 111 if: a resident or staff member has signs of heat exhaustion that don’t improve within 30 minutes, symptoms are worsening, or you’re unsure.
Call 999 if: someone has a temperature at or above 40°C, is confused or uncoordinated, loses consciousness, or has a fit. This is heatstroke and it is a medical emergency.
Further guidance for care settings
The following national resources are available and should be shared with relevant staff today.
- UKHSA: Supporting vulnerable people before and during hot weather — social care managers, staff and carers — practical guidance on keeping people cool, monitoring health, and managing medications in hot weather
- Personal protective equipment and heat: risk of heat stress – GOV.UK
- Heat-Health Alert action card for health and social care providers – GOV.UK
- UKHSA: Beat the Heat — keep cool at home checklist – a simple checklist you can share with clients and their families.
Please also review the guidance here: Supporting vulnerable people before and during hot weather: social care managers – GOV.UK
If you would like further advice on managing heat in your care setting, contact Somerset Public Health via publichealth@somerset.gov.uk with ‘Heat management in care setting’ in the subject.
Briefing sources:
- Adverse Weather Health Plan
- Personal protective equipment and heat: risk of heat stress – GOV.UK
- Heat-Health Alert action card for health and social care providers – GOV.UK
