Keep frail elders warm!

It is not uncommon to see an elderly person wearing a sweater on a hot summer day. We know that with advancing age, the efficiency of mechanisms that regulate heat production and loss declines, placing many older people at high risk for cold discomfort and hypothermia, even in warm environments. Whereas healthy elders compensate by turning up the thermostat and adding extra clothing, the frail elders with impaired environmental awareness, physical abilities, and communication may be dependent on caregivers to provide the extra warmth they require. Unfortunately, the thermoregulatory problems of the aged have received insufficient attention in the education of caregivers. As a consequence, some routine procedures in the care of frail elders may inadvertently cause cold discomfort and increase the risk that core temperature will fall. This article provides a brief review of the thermoregulatory system, age-related changes that impair its efficiency, and additional stressors that make it difficult for frail elders to maintain their core temperature at comfortable and safe levels. Nursing interventions to prevent cold discomfort and decrease the risk of hypothermia are emphasized, and changes in some current practices are suggested. Guidelines for assessment and emergency care of elders with hypothermia are provided.