Older adults are more susceptible to hypothermia

Q: Is it true it's dangerous for older adults to spend time outside in cold weather? Why would that be? I'm 73 years old and have enjoyed cross-country skiing this winter. It does get cold, but I'm careful. My daughter wants me to stop because she's worried about hypothermia.

A: Cold weather can be hazardous for anyone. However, it does pose additional risks to older adults. This is because of some of the physical changes associated with aging, which can make it more difficult to generate and retain body heat than when a person was younger.

One factor is that the layer of fat just beneath the skin, which helps to conserve body heat, becomes thinner in older adults. Another is less-efficient blood flow, which occurs due to the decline in elasticity in the veins and arteries as we age. Blood absorbs and distributes heat as it circulates through the body, and less-efficient circulation makes it harder to stay warm. Certain health conditions —- such as cardiovascular disease, kidney disease, thyroid problems and diabetes — can increase someone's sensitivity to cold. So can some medications, such as beta blockers and calcium channel blockers. These meds, which are used to manage blood pressure, can reduce blood flow to the extremities.

At the same time, it can be more difficult for older adults to recognize the body's signals that it is becoming too cold. The result is hypothermia, which is when the body loses heat at a faster rate than it can generate it, becomes a real possibility. Hypothermia affects not only the body, but also the brain. The muddled or disordered thinking that occurs during hypothermia can not only affect decision-making, it can also prevent the person from even realizing they are in danger.

Symptoms of hypothermia in adults include uncontrollable shivering, slow or shallow breathing, weak pulse, loss of precise motion when using hands and fingers, exhaustion, drowsiness, slurred speech and confusion. This drop in body temperature adversely affects the heart, nervous system and organs, and it can lead to death.

Hypothermia is a medical emergency and requires immediate medical attention. While waiting for help to arrive, get the person into a warm room, remove wet clothing and wrap them in a dry blanket. Some people with hypothermia need help with rewarming. This can include the use of warm nonalcoholic drinks, a heating blanket or heating pad on a moderate setting wrapped around the torso and warm packs wrapped in fabric. Never apply these directly to the skin. If nothing else is available, use your own body heat.

Avoid hypothermia by dressing for the weather. Wear an inner layer that wicks away sweat from the body, a middle layer to insulate and an outer layer that repels moisture. Avoid cotton, which traps moisture and leads to becoming chilled. Have a hat, scarf and gloves, and wear warm, weatherproof footwear. Remove layers as you warm up with exercise, and add them back as soon as you feel cold.

Ease your daughter's mind by always bringing along a cellphone, sticking to a set path and keeping your outings short.

Q: I had the omicron variant of COVID-19, and even though it was mild, I'm not back to normal. I am tired all the time, my joints ache and my sense of smell is still gone. I've been told this could be long COVID-19. I thought that only happened if you got really sick. Why did I get long COVID-19? When will we see a cure?

A: We are receiving letters from a number of readers who, after dealing with COVID-19, find themselves facing a new health concern. Technically known as post-acute sequelae of SARS-CoV-2 infection, or PASC, it's more commonly referred to as long-haul COVID-19, or long COVID-19. This refers to the symptoms that persist for weeks, and even months, after an initial coronavirus infection has passed.

These symptoms include the exhaustion, joint pain and loss of taste and smell that you are experiencing. Additional symptoms can include fever, headache, dizziness, racing heartbeat, poor concentration, chronic cough, shortness of breath, insomnia, changes to mood, stomach pain, gastroenteritis and changes to menstrual cycle.

At the start of the pandemic, it did appear that long COVID-19 occurred most often in those who had been gravely ill. However, it has since become evident that anyone who has been infected with SARS-CoV-2, which is the coronavirus that causes COVID-19, is at risk of experiencing ongoing symptoms. A study published last fall by researchers at the University of Michigan estimated that more than 40% of COVID-19 survivors experience long-term effects.

As for why it occurs, the answer remains unclear. One line of inquiry has tied long COVID-19 to something known as “viral load.” That is the amount of virus that is found in an infected person's blood. When someone has a high viral load at the start of their infection with SARS-CoV-2, even if they go on to have only a mild illness, they may be at increased risk of developing long COVID-19. There continues to be evidence that fragments of the virus may persist in organs and other parts of the body, and thus drive an ongoing immune response. Some studies are uncovering genetic factors that may play a role in long COVID-19, while others are targeting the gut microbiome. There is also initial evidence that being fully vaccinated may lower the risk of developing long COVID-19 after a breakthrough infection.

At this time, treatment for long COVID-19 continues to be a multidisciplinary approach to manage each person's specific set of symptoms. This includes the use of medications, as well as physical and occupational therapy. However, research into a cure is ongoing. In a new study published in the Journal for Nurse Practitioners, two women with long COVID-19 symptoms got significant relief with the use of over-the-counter antihistamines. This echoes previous findings that showed antihistamines played a beneficial role in the treatment of severe COVID-19.

This may all sound like slow progress, but it's important to put things into perspective. During the first two years of the pandemic, much of the focus was on halting the spread of the virus. Now, with infection rates dropping, attention can shift to decoding and curing long COVID-19.

• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.