Heat Wave Safety Plan for an Elderly Parent (and Cold Weather)

A heat wave safety plan for an elderly parent has four parts: keep them somewhere cool (air conditioning, not just a fan), know which of their medicines make heat more dangerous, check on them at least twice a day while it lasts, and know the signs of heat stroke well enough to call 911 without second-guessing. Write it down before summer, with the name of the person who checks in and the cool place they can go. The cold weather version is at the end.

If the heat takes the power down too, see our power outage plan for medical equipment. This one is about the heat itself.

Why heat hits older parents harder

Your mother may insist she "doesn't feel the heat like she used to." That's part of the problem.

The CDC's page on heat and older adults gives three reasons people 65 and older are more prone to heat-related illness: they don't adjust as well to sudden temperature changes, they're more likely to have a chronic condition that changes how the body responds to heat, and they're more likely to take prescription medicines that affect temperature control or sweating. The National Institute on Aging's hot weather safety page adds heart, lung and kidney disease, normal skin changes with age, taking several prescriptions at once, alcohol, and living without air conditioning or fans.

Thirst is the sneaky one. The CDC tells older adults to drink more than usual and not to wait until they feel thirsty, and its clinician guidance lists reduced thirst as a side effect of several common blood pressure drugs. Cleveland Clinic adds that as you age, your body doesn't demand water the way it used to. So "I'll drink when I'm thirsty" isn't a plan.

For the sibling who thinks this is overblown: Ready.gov notes that extreme heat is responsible for the highest number of annual deaths among all weather-related hazards, and NIA says the temperature doesn't have to be high to put an older person at risk.

The medicines that change the math

Most heat articles stop at "ask your doctor about your medications." It helps to know what you're asking about.

The CDC's heat and medications guidance for clinicians names diuretics, anticholinergic drugs and some psychiatric medicines as commonly prescribed drugs that raise the risk from heat. Its table includes:

The CDC also flags a combination: an ACE inhibitor or ARB taken with a diuretic may significantly increase the risk of harm from heat. If your parent takes one of each, ask about it by name. Check the bathroom cabinet too, since diphenhydramine and doxylamine turn up in a lot of over-the-counter sleep aids and allergy pills.

What to do with this:

1. Pull out your parent's medication list and circle anything in these groups.
2. Before summer, ask the doctor or pharmacist: "Which of these matter in a heat wave, and should we do anything differently on very hot days?" The CDC tells clinicians they can consider adjusting doses or fluid limits on hot days, and to write the changes down.
3. Write the answer on the medication list itself, as a line like "Heat days: call Dr. Lee's office before changing anything."

The CDC is firm on one point: don't stop or change a medicine on your own because of the heat. That call belongs to the doctor, ideally in April, not to your parent at 4 p.m. on a 101 degree day.

Medicines that don't like heat either

The same CDC guidance notes that insulin can lose effectiveness if left in heat for a long time, inhalers can burst in hot places like a car trunk, and epinephrine auto-injectors may malfunction after heat exposure. If your parent keeps a rescue inhaler in the glove box, move it.

Heat exhaustion vs. heat stroke

Heat exhaustion is a warning. Heat stroke is a 911 call. With an older parent, the early signs can look like an ordinary bad afternoon, and confusion, one of the main signs of heat stroke, is easy to write off as tiredness.

Sources: the National Weather Service's heat cramps, exhaustion and stroke page, Ready.gov and NIA.

When to call 911

Call 911 for any sign of heat stroke: confusion, slurred speech, fainting, hot red skin, or a very high temperature. The NWS puts it bluntly: heat stroke is a severe medical emergency and delay can be fatal.

While you wait, Ready.gov says to move the person somewhere cool and shaded, remove outer clothing, put cold wet cloths or ice packs on the head, neck, armpits and groin (or soak their clothes with cool water), and raise their feet. The NWS adds the point people get wrong: do not give fluids to someone with heat stroke.

For heat exhaustion, get them cool and offer sips of water. The NWS says to seek immediate medical attention if the person vomits, or if symptoms get worse or last longer than an hour.

Paramedics will want the medication list, allergies and conditions in one place. That's what an emergency information sheet for paramedics is for.

Fans and air conditioning: where a fan stops helping

Lots of parents see air conditioning as a luxury and a box fan as plenty. Up to a point, it is.

The CDC's heat prevention page says to use fans only if indoor temperatures are below 90°F, because above 90°F a fan can increase body temperature. Ready.gov says fans create a false sense of comfort but don't reduce body temperature or prevent heat-related illness. The NWS frames its cutoff around a heat index in the high 90s, so humidity matters too.

The practical rule: put a simple indoor thermometer in the room where your parent actually sits, not the hallway by the thermostat. If it reads 90°F, the fan is no longer the plan. Your parent needs air conditioning, at home or somewhere else.

Other things that help, from the CDC and NIA:

• Keep shades or curtains closed during the hottest part of the day, and open windows at night.
• Skip the oven and stove. A cold supper is fine.
• Cool showers or baths.
• Loose, lightweight, light-colored clothes. NIA notes cotton may feel cooler than synthetics.

If the AC never runs because of the electric bill, Ready.gov points families to the Low Income Home Energy Assistance Program, and NIA lists the National Energy Assistance Referral line at 866-674-6327. If the issue is pride or habit, our piece on an elderly parent who refuses help has ways into that conversation.

Cooling centers: how to find one and what to ask

A cooling center is an air-conditioned public space, often a library or senior center, open during extreme heat. The CDC suggests three ways to find one: dial 2-1-1, check the National Center for Healthy Housing's cooling centers by state page, or contact the local health department or emergency management agency. NCHH also suggests watching local news, since that's where some centers announce their openings.

It needn't be official. NIA suggests spending midday at a mall, movie theater, library, senior center or a friend's home, and the CDC notes that even a few hours in air conditioning can help.

Before the first heat wave, make one call and write down the answers:

• Where is the nearest cooling site, and what are its hours?
• Is it accessible for a walker or wheelchair, with seating and restrooms?
• Can your parent plug in an oxygen concentrator? Bring medicines that need to stay cool?
• Does it only open when a heat warning is issued, and how will you hear about it?
• Who drives your parent there and back?

That last one gets skipped. NIA says not to stand outside in the heat waiting for a bus, and notes that some senior centers, religious groups and Area Agencies on Aging help with rides. The Eldercare Locator (800-677-1116) can point you to local services.

A daily check-in plan for heat days

The CDC's caretaker checklist says to visit an older person in your care at least twice a day during hot weather and ask four questions: Are they drinking enough water? Do they have access to air conditioning? Do they know how to keep cool? Do they show signs of heat stress?

Twice a day is a lot from two states away, so split it up:

On the phone you can't see clammy skin, but you can hear confusion. Ask something with a real answer ("What did you have for lunch?") instead of "Are you okay?", which always gets "Fine."

Decide ahead of time what happens if nobody answers. One reasonable rule: no answer, and none on a second try fifteen minutes later, means the nearest person with a key goes over, and if no one can get there quickly, you call for a welfare check. Put that rule and the key holder's number on your parent's emergency contact list.

The CDC also tells doctors to have patients on heat-sensitive medicines name a point of contact who will check on them. Make sure that's you, and that the office has your number.

Watch their forecast, not yours

The CDC's HeatRisk dashboard gives a heat forecast by zip code, with recommended actions. Bookmark it with your parent's zip code, not yours. NIA also suggests watching the heat index, which accounts for humidity.

Hydration when the doctor limits fluids

"Drink plenty of water" is standard heat advice. For a parent with heart failure or kidney disease on a fluid restriction, it can be the wrong advice.

The CDC and NIA agree: if the doctor limits fluids or your parent takes water pills, ask how much to drink in hot weather. Ask in spring, not mid-heat-wave.

For everyone else, the CDC suggests:

• Drink more than usual, and don't wait for thirst.
• Keep a water bottle within reach and refill it through the day.
• Go easy on drinks high in sugar or sodium, caffeine and alcohol.
• Check urine color: light yellow or clear usually means enough water.

NIA adds fruit or vegetable juices and electrolyte drinks as options. One trick: fill a pitcher in the morning with the day's amount (whatever the doctor said), so your parent can see what's left.

The cold weather version

Winter runs on the same plan. NIA's cold weather safety page explains that aging can make it harder to notice the body getting too cold, and that some medicines, including some over-the-counter cold remedies, affect body heat.

Keep the house at 68°F or warmer

NIA recommends setting the heat to at least 68°F and warns that even mildly cool homes of 60 to 65°F can lead to hypothermia in older adults. If your thrifty parent keeps it at 62, that's the conversation to have. For heating bills, NIA points to the National Energy Assistance Referral line, the Weatherization Assistance Program and the local Area Agency on Aging.

NIA also suggests dressing warmly indoors, extra covers and a head covering at night, and limiting alcohol, which makes you lose body heat.

Hypothermia signs in older adults

NIA defines hypothermia as a core body temperature below 95°F. Its early warning signs:

• Cold feet and hands
• Puffy or swollen face
• Pale skin
• Shivering or shaking
• Slowed or slurred speech
• Feeling sleepy, angry or confused

Later signs include stiff, jerky movements, slow heartbeat or breathing, and passing out. NIA says to call 911 right away if someone shows signs of hypothermia, then move them somewhere warmer, offer a warm drink, and wrap them in dry blankets. The CDC's hypothermia page adds: no alcohol, and don't try to give a drink to someone who is unconscious.

Hypothermia clouds thinking, NIA notes, so your parent may not realize what's happening. Keep the daily check-in going through cold snaps.

Space heaters and carbon monoxide

NIA warns that some space heaters are fire hazards or can raise the risk of carbon monoxide poisoning. The Consumer Product Safety Commission's portable heater safety habits are worth printing and taping next to it:

1. Keep all sides of the heater at least 3 feet from beds, clothes, curtains, papers, sofas and anything else that can catch fire.
2. Never run the cord under rugs or carpeting, and never plug the heater into an extension cord or power strip.
3. Keep it away from water, and never touch it if you're wet.
4. Put it on a stable, level surface where it won't get knocked over.
5. Never leave it running unattended or while sleeping.
6. If the cord or plug is hot, unplug it and get it repaired. If the outlet is hot, call an electrician.
7. Check SaferProducts.gov for recalls.

Number 5 is the hard one for a parent who likes the heater by the bed. Per the National Fire Protection Association's heating safety page, space heaters and heating stoves accounted for nearly a third of home heating fires but over seven out of ten of the deaths, based on 2020 to 2024 averages.

The CDC's carbon monoxide basics say older adults are more likely to get sick from CO, its symptoms (headache, dizziness, weakness, upset stomach, confusion) are often called flu-like, and people who are asleep can die before they have symptoms. From the same page:

• Battery-operated or battery-backup CO detectors near every sleeping area
• Detector batteries checked when the clocks change in spring and fall
• Detectors replaced per the manufacturer's instructions, or every 5 years
• Furnace, water heater and other gas or oil appliances serviced by a qualified technician every year
• Chimney checked or cleaned every year
• Never heat the house with a gas oven
• Never use a portable gas camp stove or burn charcoal indoors

If a winter storm knocks out the heat, NIA suggests staying with a relative or friend. For generators and the rest of the outage plan, see our emergency plan for a parent living alone.

Frequently asked questions

What indoor temperature is too hot for an elderly person?

There's no single safe number, since medicines and health conditions change the risk. The CDC's practical cutoff: above 90°F indoors, a fan can raise body temperature, so your parent needs air conditioning.

What are the signs of heat stroke in elderly people?

Confusion or acting strangely, slurred speech, fainting, hot red skin that may be dry, a strong rapid pulse, and a very high body temperature. Sudden confusion on a hot day is reason enough to call 911.

How often should you check on an elderly parent during a heat wave?

At least twice a day, the CDC says, checking whether they're drinking enough, have air conditioning, know how to keep cool, and show any signs of heat stress.

How much water should an elderly person drink in hot weather?

More than usual, without waiting for thirst, unless a doctor has limited their fluids. On a fluid restriction or water pills, ask the doctor.

What temperature should an elderly person keep their house in winter?

NIA recommends at least 68°F, and warns that homes of 60 to 65°F can lead to hypothermia in older adults.

Putting the plan where people can find it

The whole plan fits on one page: the medicines to watch and what the doctor said, the check-in schedule and no-answer rule, the cooling site and driver, and the winter thermostat number. Tape a copy inside a kitchen cabinet and send one to everyone with a role. You can build it yourself from this guide and a couple of phone calls. Or Emergency Binder Now can do the organizing from about 25 minutes of guided questions, producing a printable binder with your parent's medicines, doctors and contacts, a one-page sheet for paramedics and the ER, and a list of what's still missing. If you'd like to look first, see a sample binder.

This article is general information, not medical advice. Don't change a medicine, dose or fluid limit without talking to your parent's doctor or pharmacist. In an emergency, call 911.