Recognizing and Mitigating the Effects of Medication on Heat-Related Illness in Older Adults: A Scoping Review

Heat waves have intensified since the 1960s, leaving older adults uniquely susceptible to heat-related illnesses, including hyperthermia and fluid-electrolyte imbalances. While clinicians recognize that certain medications increase heat vulnerability, the specific interplay between drug use and patient characteristics remains unclear. This scoping review, following the Joanna Briggs Institute framework for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, investigated the risk of heat-related illness associated with medication use in older adults to identify research gaps. Investigators queried four databases for English-language primary literature (2000-2025) based on predefined Population, Concept, and Context criteria. Additionally, a grey literature search mapped existing United States (U.S.) mitigation strategies. Two reviewers independently screened studies via Covidence, and one extracted data. Results included 61 primary studies and 41 grey literature sources. While epidemiological data confirm higher heat-related morbidity and mortality in older populations, few experimental studies evaluate medication's specific role. Despite many public health efforts, specific, evidence-based guidance on managing drug-heat interactions is limited. Diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), anticholinergics, and antipsychotics were the medication classes most frequently associated with heat-related illness. This review underscores a critical need for research into the confluence of age, multimorbidity, and polypharmacy to inform future clinical mitigation and protect vulnerable populations.