Spring is a welcome time of year for many people, especially after a harsh winter. It’s important to adjust to the season in a healthy manner, however, as it may pose certain challenges, particularly for older adults. While your patients have faced the seasonal onset of daylight savings, increased sun exposure, stormy weather, and possible allergies for decades, these changes may be more difficult to cope with due to the effects of chronic disease or other senior health issues. The risk for falls increases as seniors spend more time outdoors, too.
Watching for seasonal challenges and offering advice or referrals is one way healthcare professionals can ease the transition for seniors. But don’t forget about the family caregivers who provide direct patient care or about yourself, either. It’s important to stay healthy and able to enjoy the outdoors with the seniors in your care.
Daylight Savings Time
Anyone who has taken a trip by air and crossed time zones has probably experienced jet lag. This results from a disruption to the body’s circadian rhythms, which regulate sleep. Daylight Savings Time (DST) is closely related to jet lag. Just as it can take several days or more to adjust to a new time zone, it can take days to adjust to DST after clocks “spring” forward.
Advancing age can cause circadian rhythms to become less effective, putting older adults at greater risk for interrupted sleep. Sleep is an essential component of overall health, and sleep deprivation can lead to a variety of symptoms that healthcare professionals should learn to recognize. Some of these include daytime fatigue, sleep disturbances, loss of concentration, nausea, changes in appetite, upset stomach, and mood disturbances. More serious health issues can result from loss of sleep, too. One recent study published in Open Heart, for example, associated breaks in the circadian rhythm from DST with the timing (but not the cause) of acute myocardial infarction (AMI); an increase in the daily number of AMI counts was shown on the Monday following DST.
Seniors who are already suffering from fatigue may become more lethargic following DST, which could increase their risk for falls. This could in turn increase the risk of injury for caregivers and medical staff who might quickly act to prevent a fall or lift a senior back up after.
DST-induced sleep deprivation may be mistakenly attributed to other diagnoses. Conversely, symptoms from other senior health issues might be attributed to DST, so it’s important to distinguish the two. DST can affect other conditions connected to sleep, such as sundown syndrome occurring later or earlier in the night. Seniors may also be at risk of over- or under-medicating themselves when adjusting medication times.
Help your patients ward off senior care issues related to DST by teaching them and their caregivers sleep hygiene techniques. This includes blocking out sound and/or light (as long as this doesn’t compromise safety); engaging in a relaxing activity before bedtime (avoiding television or the computer); using the bed for sleep only; avoiding alcohol, caffeine, and food several hours before bedtime; and quickly reestablishing a bedtime routine. You can also suggest using curtains and lighting to artificially adjust for that single extra hour.
The sun bathes our planet in warmth, energy, and light. In the spring, stronger sunlight can bleach away the winter blues, drawing seniors to spend more time outside. This can be great for improving mood, socializing, and helping the body manufacture vitamin D. There are costs associated with too much sun exposure however.
Older adults are at a higher risk for dehydration, which warmer temperatures and increased activity levels can exacerbate. According to the National Institutes of Health, the signs of mild to moderate dehydration to watch for include thirst, headaches, muscle cramps, low urine output, and cool, dry skin. A severe instance of dehydration is a medical emergency. If your patient has stopped urinating or excretes small amounts of deep amber urine; is irritable, listless, dizzy, or confused; or has a rapid heartbeat, excessively dry skin, or sunken eyes, encourage or assist her to seek urgent medical attention. If left ignored, severe dehydration can lead to fainting, delirium, or shock.
Skin damage from the sun can be as mild as a minor sunburn or as serious as melanoma. It can also weaken the immune system. People taking certain medications, such as tetracycline, should avoid unprotected sun exposure.
Skin cancer and most benign, noncancerous skin tumors, which are linked to sun exposure, are an increasing problem among all adults. According to the Skin Cancer Foundation, five million people are treated for skin cancer every year, and there are more new diagnosis of skin cancer than lung, colon, breast, and prostate combined. There are three main types of skin cancer: basal cell, squamous cell, and melanoma. Basal and squamous cell cancers are more common but are typically not life-threatening, whereas melanoma is. If you recognize any possible skin cancers among your patients, urge them to seek medical attention.
The eyes can take a beating from unprotected exposure to sunlight. Ultraviolet rays have been linked to cataracts, macular degeneration, and keratitis (sunburn of the cornea). Sun exposure has also been linked to eyelid skin cancer as well as eye cancer. Eyelid cancer, if detected early, often responds well to treatment, but intraocular melanoma can be difficult to detect.
Heat stress is more likely to affect older adults, according to the US Centers for Disease Control and Prevention, because they are more likely to have a chronic disease or be taking medications or treatments that interfere with their ability to regulate body temperature. During the warmer months, seniors may be at risk for two types of heat stress: heat exhaustion and heat stroke. These can be avoided by staying well hydrated, taking frequent rests, taking cool showers, and wearing lightweight clothing.
The onset of heat exhaustion usually follows a period of dehydration, excessive exposure to heat, or both. Signs of heat exhaustion mimic other senior health issues and can include nausea, heavy sweating, fast and shallow breathing, headache, and dizziness. Heat stroke occurs when the body has lost the ability to cool itself; internal temperatures can increase to 106 degrees Fahrenheit in a matter of minutes. Intense headaches, skin that’s hot to the touch, dizziness, and nausea are all indicators of this serious condition.
Nurses, nursing assistants, and caregivers need to be extra vigilant to protect against sun-related conditions. For example, you might situate your senior patient in a cool, shady spot, but as the shade follows the movement of the sun, you’ll need to move your patient so that he doesn’t later end up sitting in direct sunlight. Take simple measures to protect not only the senior in your care but yourself as well. A full-spectrum UV sun-blocking agent with an SPF rating of at least 30 is just one measure; loose-fitting clothes and long-sleeve shirts also block the sun, as do hats and dark glasses with UVA and UVB protection (keeping in mind that this might impair vision). Ensure that your patients stay adequately hydrated to help protect against heat exhaustion and dehydration, and keep medications out of the sun, too.
A discussion of spring health issues would not be complete without touching on allergies. It’s even possible be allergic to sunlight! Like other body systems, the immune system can weaken with age, and this immunosenescence can lower an older adult’s ability to fight off infections and allergies. Something as simple as age-related changes in the structure of the nose could exacerbate allergic reactions to pollen, for example, and thinning skin can make seniors more prone to contact dermatitis.
Asthma is often over- or underdiagnosed among seniors, as well as over- or undertreated, but it occurs in up to 10 percent of adults over the age of 60, according to a paper published in the Journal of Allergy. Since asthma can be confused with COPD or other respiratory issues, physicians are advised to employ a combination of diagnostics to differentiate the two, including lung function tests, bronchial hyperresponsiveness and atopy status, and HRCT scans.
Allergic rhinitis (AR) affects from 5.4 to 10.7 percent of adults over 65, according to a Clinical and Translational Allergy paper. Patients with AR present with symptoms similar to the common cold: nasal congestion, sneezing, and pruritus (itching). The most important factor for healthcare professionals is to distinguish AR from other health issues.
Cutaneous allergic conditions involve a number of skin reactions. The most common skin complaint among seniors is pruritus (itching). Since pruritus can indicate such other senior health issues as blood, kidney, or liver diseases; drug reactions; or neurological and psychological responses, a careful work-up is critical. Both topical and systemic medications are used to treat skin allergies.
Caregivers and direct care practitioners need to be aware of methods to reduce the threat of allergens and to have the means available to address acute allergic reactions, as well as insect bites and bee stings. Masks and closed windows reduce pollen exposure, for instance, while long sleeves and repellents help ward off insects.
Severe weather in the form of thunderstorms, tornadoes, and flooding is a hallmark of spring. Talk to your patients about emergency preparedness and urge them to develop a plan that ensures their safety during a natural disaster. Here are a few points for your senior patients or their caregivers to keep in mind:
- Pay attention to weather alerts.
- Be prepared for power outages. Have candles and flashlights in ready reach.
- Water can become tainted, so always have several gallons of clean drinking water on hand.
- Watch for slippery grass, downed power lines, flooding, and leaky roofs. Spoiled food is another issue if the power goes out.
- Have a battery-operated radio and a means to communicate help both charged and at the ready.
Spring is a time of renewed life. Help your senior patients take measures to prevent health issues and promote safety so that they can fully enjoy this season of revitalization.