Sudden Confusion in Hot Weather? Don’t Miss Heatstroke
An amber heat-health alert is currently in place across every region of England, with the UK Health Security Agency warning that high temperatures are likely to affect health and social care services.
For people providing care, one warning sign deserves particular attention: a sudden change in someone’s thinking, behaviour or coordination.
An older person may be described as “not quite themselves”, unusually restless, less responsive or more confused than normal. It can be tempting to attribute this to age, dementia, tiredness or simply the discomfort of a hot day. But sudden confusion in hot weather can be a sign of heatstroke — and heatstroke is a medical emergency.
The important word is sudden
Some people already live with confusion or cognitive impairment. This makes it especially important for staff and relatives to know what is usual for that individual.
A noticeable change from the person’s normal presentation should never be dismissed. Look for changes in alertness, speech, behaviour, balance, coordination and ability to follow a conversation or simple instruction.
Heat may be one possible cause, but it is not the only one. Sudden confusion can also accompany other serious conditions. The person therefore needs prompt action and appropriate medical assessment rather than an assumption about the cause.
Heat exhaustion and heatstroke are not the same
Heat exhaustion happens when the body becomes too hot and struggles to cope. NHS warning signs include tiredness, dizziness, headache, nausea or vomiting, excessive sweating, pale or clammy skin, cramps, thirst, irritability and a high temperature.
Someone showing signs of heat exhaustion should be moved to a cool place. Remove unnecessary clothing, offer cool fluids if the person is alert and can swallow safely, and cool the skin with cool water and a fan. Wrapped cold packs can be placed around the neck or under the armpits.
Stay with the person and continue to observe them. They should begin to cool down and feel better within 30 minutes. Seek help from NHS 111 if symptoms are difficult to manage or advice is needed.
Heatstroke is different. It means the body can no longer control its temperature effectively and emergency help is required.
Call 999 immediately if the person has signs of heatstroke, including:
- confusion or loss of coordination
- a very high temperature
- hot skin that is not sweating
- fast breathing or shortness of breath
- a fast heartbeat
- a seizure
- loss of consciousness
- continuing to be unwell after 30 minutes of cooling and fluids for suspected heat exhaustion
Do not wait 30 minutes if emergency signs such as confusion, a seizure or loss of consciousness are already present. Call 999 and begin cooling the person while waiting for help.
What to do while waiting for an ambulance
Move the person to a cooler place if it is safe to do so. Remove unnecessary outer clothing and cool them using a cool wet sheet, cool water, sponging or a fan. Follow the instructions given by the ambulance service.
If the person becomes unconscious but is breathing normally, place them in the recovery position and tell the ambulance service. Continue to monitor their breathing. If they are not breathing normally, begin cardiopulmonary resuscitation and follow the call handler’s instructions.
Do not give drinks to someone who is unconscious or cannot swallow safely.
Why people receiving care may be at greater risk
Anyone can become unwell in hot weather, but the risks are greater for some people. This includes older adults, babies and young children, and people with conditions such as dementia, diabetes, heart disease, kidney disease, breathing problems, Parkinson’s disease or reduced mobility.
Some medicines can also affect hydration, sweating, thirst or the body’s ability to regulate temperature. Staff should follow the person’s care plan and seek advice from the appropriate clinician or pharmacist where needed. Prescribed medicines should never be stopped or changed without professional advice.
What good care looks like during hot weather
Preventing heat-related illness is not simply a matter of offering an occasional drink.
Care providers should know who is most at risk, adapt individual care plans where necessary and help people keep both themselves and their surroundings cool. Staff should monitor for meaningful changes in hydration and wellbeing, plan activities for cooler parts of the day and understand what action to take when someone deteriorates.
Records should describe what was actually observed. “Resident seemed confused” is less useful than documenting how the person differed from their usual presentation, when the change began, other symptoms, observations taken, cooling measures started and who was contacted.
Know the person. Notice the change. Act promptly.
In health and social care, deterioration does not always arrive with a dramatic collapse. It may begin with a small change noticed by someone who understands what is normal for that individual.
During hot weather, sudden confusion must not be written off. Recognising the change, responding within your role and escalating promptly could save a life.
Safe Skills Training provides practical, clinically informed training that helps health and social care staff recognise risk, respond confidently and provide safer individualised care.
To discuss training for your organisation, contact Safe Skills Training at https://www.safeskillstraining.com
SOURCES FOR THE PUBLISHED ARTICLE
UKHSA Heat-Health Alerts:
https://ukhsa-dashboard.data.gov.uk/weather-health-alerts/heat
NHS heat exhaustion and heatstroke guidance:
https://www.nhs.uk/conditions/heat-exhaustion-heatstroke/
UKHSA guidance for social care managers:
https://www.gov.uk/guidance/supporting-vulnerable-people-before-and-during-hot-weather-social-care-managers