Elderly, Isolated Are Heat’s Quiet Victims

The heat wave that gripped California this week is emerging as the state’s deadliest act of nature in years and is prompting calls for the government to overhaul the way it deals with the elderly during periods of extreme temperatures.

The suspected death toll from the heat rose to about 130 on Friday -- including the first confirmed case in Los Angeles County -- far surpassing the number of deaths caused by the Loma Prieta and Northridge earthquakes, as well as the 2003 wildfires.

Officials said the vast majority of the victims were “hidden” members of society -- often transients and elderly people who lived alone and in isolated areas. Most of the deaths occurred in the Central Valley, Inland Empire and desert regions, where the usually broiling summer temperatures jumped 10 to 12 degrees.

Poor seniors were particularly hard hit, including four men who died in hotel rooms a few blocks from the state Capitol and several elderly women found dead in their tiny apartments in Fresno.

“This is a natural disaster,” said Mark Beach, an AARP official in Sacramento. “People live alone with no friends or family. A tiny minority of these places have air conditioning. People are being cooked in these little boxes of rooms.”

By midweek, state and county officials began checking on elderly people they knew lived alone and might be at risk. But it was too late in some cases.

There is growing support for California to create a disaster plan dealing with extreme heat, based partly on ones implemented by Chicago and other cities that experience a significant number of heat-related deaths.

After a 1995 heat wave killed more than 700 people in Chicago, most of them elderly, the city established a registry in which officials would check during periods of hotter weather on elderly people living alone. Kansas City, St. Louis and Philadelphia adopted similar systems.

“There’s more Americans living alone, aging alone and dying alone than before,” said Eric Klinenberg, a professor of sociology at New York University and author of “Heat Wave: A Social Autopsy of Disaster in Chicago.”

Chicago uses a network of police officers, social workers and volunteers to keep tabs on thousands of its most vulnerable citizens. When a heat wave strikes, an automated phone system calls more than 60,000 seniors and frail people. For those who cannot be reached, the teams make direct visits.

“Sick people can survive dangerous heat waves and live many years,” Klinenberg said. “And so there’s no reason not to treat heat-related deaths as premature and unnecessary when the victims are old people.”

AARP’s Beach supports creating a similar system for California and said his organization would be interested in offering its huge volunteer corps.

In the wake of California’s deaths, state emergency management officials said Friday that they probably would move to create a system that classifies extreme heat with other natural disasters.

“This was an act of nature, like an earthquake or a fire,” said Roni Java, a spokeswoman for the Governor’s Office of Emergency Services.

The Central Valley has seen unusually high temperatures for several weeks, but they really surged the last six days. Between Saturday and Wednesday, Fresno’s high was 112 or greater -- a good 10 to 12 degrees above normal for the period (the high dropped to 106 on Thursday, and low temperatures rarely dropped below the 80s this week).

County medical examiners say they have not seen anything like the recent spate of deaths.

In Stanislaus County, there typically is no more than one heat-related death during the summer. This year there have been 29 suspected heat deaths.

David Jones, of Stanislaus County’s office of emergency services, said that when the death toll began to climb earlier this week, officials tried to contact seniors they knew about. But they realized it would be impossible to reach all of them.

“Of the people who tragically died during this heat wave, the majority of them lived alone and were scattered through different places throughout the county,” Jones said. “The question for those people who have fallen under the radar, how do you find them?”

Health experts and others said the elderly are especially at risk because they cannot sense extreme heat the way younger people can. Elderly individuals are also more likely to take medication that impairs the body’s ability to regulate temperature.

Hal Fielding, a field supervisor at Fresno’s American Ambulances, said many elderly people seemed desensitized to the heat. “It can be 80 degrees in their house, and they’ll feel cold,” he said. “I’ve walked into the house of an elderly person, and she was just baking in there.”

Valentine Villa, a professor of social work and associate director of the Applied Gerontology Institute at Cal State Los Angeles, said psychological issues often are at work. Some elderly people grew up in a time before air conditioning and believe they can brave hot weather without it, she said.

Los Angeles has seen far fewer heat deaths than other areas. On Friday, the coroner’s office confirmed that a 51-year-old Lancaster man died of heat-related illness. The man spent hours either outdoors or in a vehicle without air conditioning. Officials said they have seven other cases in which the weather appears to have been a factor but have not yet classified them as heat deaths.

Several California officials said the heat wave underscored the vulnerability of the elderly in much the same way Hurricane Katrina did.

Katrina disproportionally affected the poor and the elderly, because they were the least likely to get out of the storm’s path. The situation sparked debate about whether authorities need to plan better for aiding the elderly and disabled when a disaster strikes.

“This is a perfect example of the Katrina lesson, where the government cannot check on every citizen,” said Dr. Howard Backer, a medical consultant for the state Department of Health Services. “There are so many people with chronic illnesses, and to tell the point where they’re considered a risk, there’s no clear definition of that.”

But this week’s heat shows that even the most extensive planning won’t reach everyone.

In Kern County, most of the eight people who died because of the heat seemed to be recluses, said Deputy Coroner Kelly Cowen. Many probably were on tight budgets and may have felt they could not afford air conditioning, she said.

But others apparently made choices that mystified investigators.

One elderly victim kept meticulous records of his finances and had more than $30,000 stashed around the house, Cowen said.

“He had all this money,” Cowen said. “But he chose not to use air conditioning.”

In another case, family members stopped by the home of an elderly man to deliver relief from the heat. “The family brought an air conditioner the morning before he was found and he wouldn’t let them in the house,” Cowen said. “They had to leave it on his porch. I guess he just didn’t want people in his house.”

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(Begin Text of Infobox)

Heat deaths

In some Southern California counties, deaths attributed to the current heat wave have approached or exceeded previous annual record highs.

Heat deaths by county

*--* Current Avg. Most heat per year per year County wave** ‘89-’04 Year of max. deaths Imperial 8 3.5 8 1995, 1996,2000 Los Angeles 9 3.9 10 1990, 2000 Orange 0 1.1 3 2003 Riverside 3 2.4 5 1990, 1994 San Bernardino 9 1.8 4 1989,1990,2001, 2003 San Diego 3 2.6 7 2001, 2004 Ventura 0 0.6 4 2001

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Although the elderly are especially vulnerable to extreme heat, people of all ages die during heat waves. The figures below are not adjusted for the size of the population in each age group.

Deaths from extreme heat in California, 1989-2004*

*--* Age group Deaths Birth to 14 21 15 to 34 62 35 to 54 106 55 to 74 79 75 and over 57

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*Most recent year available **Since July 16

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Sources: California Department of Health Services, the Associated Press

Data analysis by Doug Smith

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Q&A;

‘Invisible’ Citizens Hit Hard

Question: Why did so many elderly people die in the heat?

Answer: Officials said many were “invisible” citizens, poor seniors who lived alone, sometimes in isolated areas, with limited daily contact with friends or family. Some died in single-room hotels that didn’t have air conditioning.

Q: What can be done to prevent the heavy loss of life in future heat waves?

A: In Chicago and other cities, a network of police officers, social workers and volunteers keeps tabs on thousands of the most vulnerable citizens. When heat strikes Chicago, an automated phone system calls more than 60,000 seniors and frail people. For those who cannot be reached, teams make personal visits.

Q: Would that system work in California?

A: Some officials said they would like to try some variation. But they say such a roster would be incomplete because officials doubt they could account for all the seniors who need oversight.

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Times staff writers Lynn Doan in Fresno and P.J. Huffstutter in Chicago contributed to this report.