Intended for healthcare professionals


Heat waves and dehydration in the elderly

BMJ 2009; 339 doi: (Published 02 July 2009) Cite this as: BMJ 2009;339:b2663
  1. Marcel G M Olde Rikkert, professor in geriatric medicine,
  2. René J F Melis, senior researcher, epidemiologist,
  3. Jurgen A H R Claassen, senior researcher, geriatrician
  1. 1Department of Geriatrics, Radboud University Nijmegen Medical Centre, 925 Department of Geriatric Medicine, PO Box 9101, 6500 HB, Nijmegen, Netherlands
  1. M.Olde-Rikkert{at}

    Recognising the early warning signs can save lives

    The heat wave of 2003 caused an excess mortality of 150% across all age groups, with the largest increase (160-200%) in older people.1 Excess mortality was high across the whole of western Europe (>50 000 deaths) but highest in big cities such as Paris (1854 deaths).1 The death rate was particularly high in cities that were unaccustomed to high temperatures, and cities with warmer climates, such as those in southern France, were spared. This death toll was not followed by a subsequent decline in death rate, which can occur when serious environmental stress causes premature mortality in the frailest people.

    No universally accepted definition of a heat wave exists. An alarm signal should be given for frail older people when the outdoor temperature exceeds 90°F (32°C) for three days or more, which is the most universally accepted definition of a heat wave. Meteorologists predict that global warming will dramatically increase the number of such periods.

    The main causes …

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