Keeping a Bedridden Parent Cool in Indian Summers

Why heat is dangerous for older, bedridden people

• Reduced sweating and circulation. The body cools through sweating and sending blood to the skin. Both work less efficiently with age and with conditions such as diabetes, heart disease and neuropathy.
• Reduced thirst. Older adults may not feel thirsty until quite dehydrated; see hydration for older adults.
• Dependence on others for drinks, fans, clothing and bedding changes.
• Medicines. Diuretics, some heart and blood pressure tablets, antihistamines, antidepressants and others can reduce sweating or increase fluid loss; see medicine side effects families should watch.
• Heat and pressure sores. Sweat and warmth soften skin and raise the risk of breakdown; see preventing bedsores at home.
• Incontinence and fever. Make skin wetter and temperatures harder to read.
• Top-floor flats and tin roofs can reach very high indoor temperatures, particularly in the late afternoon and night.
• Heat waves. Hot nights prevent the body cooling down and increase risk; see heat stroke and dehydration in seniors.

Choose and prepare the room

• Pick the coolest room, usually one with fewer outside walls, on a lower floor, and away from the afternoon sun. See ground floor vs upper floor living.
• Block the sun. Use thick curtains, blinds or reflective film on windows facing the sun, keeping them closed in the afternoon, and open them in the early morning and at night when it is cooler outside. Light-coloured curtains reflect heat.
• Insulate the roof where possible. Roof coverings in light colours, or a layer of insulation, reduce heat from above; ask a builder if you can.
• Ventilate smartly. Open windows when the outside air is cooler than inside, especially at night and early morning, to let hot air out. Close windows and curtains when outside is hotter. Cross-ventilation through two openings helps. See temperature and ventilation at home.
• Reduce indoor heat. Switch off unneeded lights and devices, avoid cooking near the bedroom and keep hot appliances out. Incandescent bulbs and some chargers produce heat.
• Use a thermometer in the room, kept at the bedside, to know the temperature. A room above about 32 to 35 degrees Celsius is a concern for a frail person; ask your doctor for guidance.

Fans, coolers and air conditioners

• Fans. A ceiling or standing fan moves air and helps sweat evaporate, but in very high heat it can blow hot air and may dry the skin. Do not point a fan directly at the person all day and night; aim it to circulate air in the room, or use a gentle breeze from a distance. In extreme temperatures above the mid-30s Celsius, fans alone may not be enough.
• Evaporative (desert) coolers. They work well in dry heat, with water in the tank, but raise humidity; in humid coastal weather they are less effective and can add dampness. Keep the tank clean to avoid mould and mosquitoes; see pest, damp and mould at home.
• Air conditioners. A moderate setting, around 26 to 28 degrees Celsius, usually keeps a room comfortable without a shock to the body. Avoid very cold air blowing directly at the person. Keep filters clean. Do not let the room become so cold that the person shivers. Ask about the cost and the power supply.
• Wet cloth in front of a fan, a hanging damp sheet or a cool-water spray can help, but use carefully to avoid dampness and mould, and avoid wetting electrical items.
• Keep fans and cords safe, away from the bed, water and the person's reach, and keep wires out of the way of the bed's moving parts; see setting up a hospital bed at home.

Bedding and clothing

• Light, loose cotton clothing and sheets. Avoid nylon and polyester, which trap heat. See bed linen and fabrics for sensitive older skin.
• Thin cotton sheet instead of a blanket, or no top cover when it is hot.
• Smooth, dry sheets. Change often when damp with sweat.
• Avoid plastic sheeting directly under the person. Use breathable underpads and a mattress cover that lets air through; see mattress protector guide.
• Mattress choice. Thick foam and memory foam trap heat. Air mattresses with low air loss can help; see choosing an anti-bedsore mattress and air mattresses for pressure sores.
• Keep pillows covered in cotton, and change them often. Thin pillows and fewer layers reduce heat.
• Reposition regularly so that heat and moisture do not stay under the same skin; see positioning a bedridden parent.

Fluids and food

Dehydration is the main threat. Take the lead, because your parent may not ask.

• Offer a drink every one to two hours during the day, and whenever you attend them, unless a doctor has told you to limit fluids, as in some heart or kidney conditions. Ask your doctor how much is right; see heart failure at home guide and nutrition for kidney disease.
• Variety. Water, buttermilk, coconut water, thin dal water, diluted fruit juice, light tea, oral rehydration solution if advised, soups. Avoid very sweet, very salty or very caffeinated drinks in large amounts. For people with diabetes, take care with sugar content; see diabetes at home after 60.
• Sit the person up for drinking, as upright as possible, and watch for coughing; see swallowing problems and dysphagia. A straw, a lidded cup or a spoon may help. For people with swallowing problems, follow a speech therapist's advice on thickened fluids.
• Watery foods. Cucumber, melon, curd, fruit, thin khichdi, soups and light meals. Avoid heavy, oily, spicy meals in the heat. See soft and pureed diets.
• Check urine colour and amount. Dark, strong-smelling or very little urine suggests dehydration. See diarrhoea and dehydration in seniors.
• Keep a drink chart of times and amounts.

Skin care in the heat

• Wash with lukewarm water once or twice a day, with a soft cloth, and pat dry, in particular skin folds, groin, under breasts, armpits and behind the knees. See bed bath step by step.
• Dust with a light, medicated or plain powder only if a doctor or nurse recommends, and keep it from caking.
• Prickly heat (heat rash). Keep skin dry and cool, wear loose cotton, and ask a pharmacist about a suitable lotion; see skin conditions in older adults.
• Fungal rashes in folds, red, itchy and moist, need medical advice.
• Barrier cream where skin is wet with urine or sweat, as the nurse advises; see barrier cream and skin care.
• Check pressure areas often, as heat makes breakdown faster.
• Moisturise dry skin lightly after washing.

Cooling safely

• Lukewarm sponge baths help a person feel cooler. Use cool-to-lukewarm, not ice water, which can cause shivering and shock.
• Damp cloths on the forehead, neck, underarms and groin, changed when they warm.
• Cool, not cold. Avoid ice packs directly on the skin.
• Keep the person covered lightly so that they do not chill.
• Avoid long exposure to hot rooms, such as the late afternoon on a west-facing wall.
• Do not use heating devices such as hot water bottles or heating pads in summer.

Warning signs of heat illness

Seek medical help quickly if your parent has:

• hot, flushed or very dry skin, or unusually heavy sweating with cold, clammy skin;
• temperature above 39 degrees Celsius, or feeling very hot to touch;
• confusion, unusual drowsiness, agitation or fainting;
• fast pulse, rapid breathing, headache, nausea or vomiting;
• very little or dark urine, dry mouth, sunken eyes;
• muscle cramps or weakness.

A fever may also signal infection. Take the temperature with a digital thermometer; see digital thermometer guide and fever in older adults. In suspected heat stroke, move the person to a cooler place, begin cooling with damp cloths and fanning and call emergency services; see ambulance and emergency numbers in India.

Power cuts in the heat

Power cuts turn a hot room into a dangerous one.

• Plan a backup. An inverter or battery for a fan, and a plan for the air mattress and bed; see hospital beds and power cuts.
• Open windows at night, and use hand fans, damp cloths and fluids.
• Move the person to the coolest room or the ground floor, if safe and possible, with help.
• Keep a cool box with water and ice, if available.
• Check the person more often during an outage.
• Know who to call if the person worsens.

When to ask a professional

Ask a doctor about fluid limits, medicines that raise heat risk, and signs to watch. A nurse can advise on skin care, hydration and what to do in a heat wave. A pharmacist can review medicines. An occupational therapist can help with room set-up and equipment. Call emergency services immediately for heat stroke signs: confusion, collapse, very high temperature or unresponsiveness.