Why are older adults at higher risk during a heat wave without air conditioning?

The CDC identifies adults aged 65 and older as a high-risk group during extreme heat for several reasons: the body does not adjust as well to sudden temperature changes with age, older adults are more likely to have chronic conditions that change normal body responses to heat, and many common medications including diuretics, beta blockers, anticholinergics, and certain psychiatric medications can reduce the body's ability to sweat, sense thirst, or regulate its core temperature. During a power outage, when air conditioning is unavailable, these factors combine to create a dangerous situation.

When should a senior leave home during a heat-related power outage?

Leave before you feel sick, not after. If you take medications that affect heat tolerance, live alone, or do not have a way to cool your home below 80 degrees Fahrenheit, plan to leave when a prolonged outage begins in hot weather rather than waiting to see if you can endure it. Go to a cooling center, a family member's home, or any air-conditioned public building. The CDC recommends that older adults stay in air-conditioned buildings as much as possible during extreme heat and that fans alone should not be relied upon as the main cooling source when temperatures are very high.

Staying Cool During an Outage — New World Survival

Why this is different for seniors

Your body cools itself less efficiently now.

The CDC identifies adults 65 and older as a high-risk group during extreme heat. The body does not adjust as well to sudden temperature changes with age. The ability to sense thirst declines. Chronic conditions like heart disease, diabetes, and kidney disease change the body's normal response to heat. And many of the medications prescribed for those conditions further reduce the body's ability to regulate its temperature.

The National Institute on Aging notes that older adults are more likely to have heat exhaustion progress to heat stroke because the warning signs can be subtle and easy to dismiss. Dizziness gets attributed to standing up too fast. Confusion gets attributed to a bad night's sleep. Nausea gets attributed to something eaten. By the time someone recognizes that heat is the cause, the situation may already be serious.

During a power outage, the air conditioning stops and the house begins warming. For a younger, healthy person, this is uncomfortable. For an older adult on multiple medications, it can become dangerous within hours.

Medications and heat

Your prescriptions may be working against you.

The CDC's clinical guidance on heat and medications identifies several common drug classes that increase heat-related risk. If you take any of these, your threshold for leaving during a heat-related outage should be lower than someone who does not.

Medications that reduce cooling

Diuretics (water pills like furosemide, hydrochlorothiazide) increase fluid loss and can cause dehydration and electrolyte imbalances
Beta blockers (metoprolol, atenolol) reduce the heart's ability to increase blood flow to the skin for cooling
Anticholinergics (oxybutynin, tolterodine, some bladder and Parkinson's medications) reduce the body's ability to sweat
Certain psychiatric medications (antipsychotics, some antidepressants) can disrupt the brain's temperature regulation center

What to do about it

Do not stop taking your medications because of heat. The risks of stopping most prescribed medications are greater than the risks from heat. Instead, take the heat risk more seriously than a person not on these medications would.

Talk to your doctor or pharmacist before summer begins. Ask specifically: "Do any of my medications affect my heat tolerance?" Ask what to watch for and whether any dosing adjustments are appropriate during extreme heat.

The CDC notes that the combination of an ACE inhibitor or ARB with a diuretic may significantly increase the risk of heat-related harm. If you take this combination, your leave-early threshold during a heat-related outage is lower than most.

Cooling without power

What works and what does not.

The CDC is direct: do not rely on a fan as your main cooling source when it is very hot outside. When the air temperature exceeds body temperature (around 95 to 98 degrees Fahrenheit), fans move hot air across the body but do not actually cool it. Below that threshold, fans help. Above it, they can create a false sense of comfort while the body continues to overheat.

Wet towels and cool water

A cool, damp towel on the back of the neck, wrists, and forehead provides real cooling through evaporation. A cool (not cold) bath or sponge bath lowers core body temperature. The NIA recommends cool showers or baths as an active cooling strategy.

Drink before you are thirsty

The ability to sense thirst declines with age. The CDC recommends drinking more water than usual during hot weather and not waiting until you feel thirsty. If your doctor limits your fluid intake or you take water pills, ask how much you should drink during heat events.

Use the coolest part of the day

Open windows in the early morning and evening when outside air is cooler than inside air. Close windows and draw curtains during the hottest hours (typically 10:00 AM to 6:00 PM) to keep heat out. The lowest level of a multi-story home is usually the coolest.

Loose, light clothing

Wear loose-fitting, lightweight, light-colored clothing. Dark colors absorb heat. Tight clothing traps it. Cotton breathes better than synthetic fabrics in still air.

Do not use the stove or oven

Cooking generates heat that raises the indoor temperature. During a heat-related outage, eat foods that need no cooking: crackers, peanut butter, canned fruit, applesauce, nutritional supplement drinks. See Food Storage for Dietary Needs.

Battery-powered fans

A rechargeable battery fan ($15 to $30) provides airflow when grid power is out. Useful below 95 degrees Fahrenheit. Combine with a damp towel for evaporative cooling. Keep the battery charged. A portable power bank can recharge it if the outage extends.

Warning signs

Know the signs. Act early.

Heat-related illness progresses through stages. The earlier you recognize it, the easier it is to reverse. The NIA and CDC describe two critical stages:

Heat exhaustion

A warning that the body can no longer keep itself cool. Act immediately.

Heavy sweating
Weakness and fatigue
Dizziness or faintness
Nausea
Cold, clammy skin despite the heat
Rapid pulse

Response: Move to a cool place. Drink cool water. Apply cool, wet cloths. Rest. If symptoms do not improve within an hour, seek medical care.

Heat stroke: call 911

A medical emergency. Body temperature rises above 103 to 104 degrees Fahrenheit. Can cause brain damage, organ failure, and death.

Hot, dry skin (no sweating despite the heat)
Confusion or disorientation
Slurred speech
Loss of consciousness or fainting
Strong, rapid pulse or slow, weak pulse

Response: Call 911 immediately. Move the person to a cooler place. Cool them with wet cloths or a cool bath. Do not give fluids if unconscious.

For older adults living alone, the danger is that confusion is itself a symptom. A person with heat stroke may not recognize that they are confused, which is why the check-in system described in Who Will Check on You? matters more during heat events.

When to leave

Leave before you feel sick, not after.

The CDC recommends that older adults stay in air-conditioned buildings as much as possible during extreme heat. If your air conditioning fails and you cannot cool your home below a safe temperature, leaving is the correct decision, not a last resort.

Leave-early triggers for heat

1
Indoor temperature above 80 degrees Fahrenheit and rising. If your home reaches 85 degrees Fahrenheit without air conditioning, leave. Do not wait to see if it stabilizes.
2
You take medications that affect heat tolerance. Your threshold is lower. Leave earlier than someone not on those medications would.
3
You live alone. If there is no one in the home to notice heat illness symptoms, the margin for error is smaller. See Preparing When You Live Alone.
4
The outage is expected to last more than a few hours during a heat advisory. Utilities often provide estimated restoration times. If the estimate extends through the hottest part of the day, leave in the morning rather than waiting.

Where to go

A family member's or friend's air-conditioned home is the best option. Second: a designated cooling center (your local government opens these during heat events; call 211 or check your county's website). Third: any air-conditioned public building such as a library, mall, or community center.

If you do not drive, arrange transportation before the emergency. Tell your check-in contacts that "too hot to stay home" is a trigger for them to come get you. The Low Income Home Energy Assistance Program (LIHEAP) may help with cooling costs: call the National Energy Assistance Referral hotline at 866-674-6327.

See When to Stay, When to Evacuate for the full decision framework.

Connected guides

Heat does not wait for you to notice.