Hot and Cold in Old Age



Oxford Springs are slow and deceitful – tiny progress cancelled by returns to grey dank – but this April was wonderful. The Met Office says it has been the best ever recorded. I sat and read in the sun on the kitchen roof and saw my extremely eminent neighbour, 50 feet away, cautiously de-hibernate and open his bedroom window for the first time in 5 months. We waved, reaffirming for our 15th time the traditional British Neighbour Spring  Pact: “ Better weather means that our images may more frequently fall  on each other’s retinas but, notwithstanding this, no higher-level perceptual processing shall occur and, unless you or I begin to spontaneously combust, we shall never, ever, attempt conversation.”
Though kitchen-roof-tulips are out May is not yet wonderful. The tulips seem to like rain. I don’t. The Met Office thinks it will soon be warmer, drier and fit for roof-reading again. To prepare for the change I read what I can find about how altering seasons affect oldies like me.
Most Spring Poetry is unhelpful because it bangs on  about young yearnings. Basho is better tuned to geriatric inner weather: “Spring rain leaking through the roof dripping from the wasp’s nest” reminds me to do something about Mason bees excavating the bedroom wall but does not launch my spirit into Vernal Trajectories. “Spring Air, woven moon and plum scent”? A little better, but hardly in Oxford? “Sitting quietly, doing nothing, Spring comes and the grass grows by itself” catches the mood but also reminds me that the lawnmower is rusty. Paraphrased for those who are no longer at his imaginary perpetual “one-and –twenty” Houseman was a gloomy old toad, even in Spring:

“Of my three score years and ten,
Sixty will not come again,
To take from Seventy springs this score,
Only leaves a decade more”.

(OK, OK, Alfred. Just stop going on about it).

Do epidemiology and cognitive gerontology have anything  interesting to say about the way human spirits swing with the seasons?

The German Federal Bureau of Statistics publish data that most North-Northern Hemisphere residents will recognise. Between 1946 and 1995 deaths were most frequent between January and March, fewer during Springs and least in Summers [1]. The analysts speculate that greater mortality was related to lower temperature since it reduced with spread of domestic central heating. There is a well-documented Winter increase in incidence of cardiovascular problems, including myocardial infarctions and Strokes. This is followed by a fall in Spring to a Summer low which is more marked for old than for young [2]. An analysis of Japanese Vital Statistics between 1970 and 1999 sharpened this point by including simultaneous weather conditions. Deaths from infectious and parasitic diseases, tuberculosis; respiratory disease; pneumonia and influenza; heart and cerebrovascular diseases; diabetes;  digestive diseases and accidents all peaked with low temperatures in Winter but Suicides peaked with high temperatures in Spring and Autumn [3]. Italian suicides from 1984 to 1995, (31,771 males and 11984 females) also peaked in Spring and then dropped to an Autumn low for both sexes,- but this was true only for suicides by violent means. Non-violent suicides were evenly spread throughout the year. There were similar numbers of  violent and non-violent suicides but a wider literature suggests that their causes are not the same. Violent suicides seem to be passionate events related to disturbances in relationships at higher temperatures. Non-violent suicides are more often due to other chronic miseries. This story seems plausible but, if it is true, it is odd that the proportion of violent suicides should not decline with age and that seasonal differences in  numbers of violent and non-violent suicides were greater for the old [4].

Seasonal changes affect depression and mood. A small study found that 250 Boston women aged 43 to 72 were more Tense or Anxious, Depressed or Dejected, Angry and Hostile, Tired and Inert and Confused and Bewildered in the Autumn, but much better in the Spring and Summer [5] 400 mgm supplements of Vitamin D  (which we need sunlight to produce) did not help. Differences might also have been associated with opportunities for exercise which followed similar trends. This is important because in the N. Hemisphere winters keep elderly people indoors where they are not only bored and isolated but also inert. A British study found that older people were slightly more miserable in the Autumn and Winter than in the Spring and Summer [6] and cites other studies that have found parallel, but much greater, differences for young women of child bearing age. I am sure that a bleak winter’s day imprisoned at home with one or more infants is far more frustrating than quiet isolation in a warm room with a book or a lap-top. Increases in sadness with onset of Autumn and the progress of winter are common. In extreme Northern latitudes they are sometimes so severe as to qualify for a specific psychiatric diagnosis, “Seasonal Affective Disorder” (SAD). A Swedish review of published studies suggests that, in Sweden, it is common to be glum in Autumn and Winter and that the incidence of the most severe manifestation of glumness, SAD, varies from 0% to 9% and increases the further North you live [7].

So, with the Spring Equinox now well behind us, Northern oldies swing from SAD land into glad warm Summer. We shall read in the warm sun, get out and walk about much more and take the cheering exercise that we have avoided throughout a long dull winter. If we commit suicide there are greater odds that we will go out violently with a bang or a squelch rather than  just a plaintive whimper. With global warming now evident the likelihood of heat waves and other extreme events will surely increase. Will this be a good or bad thing for our survival and morale ?

Blazing Sun

Recent studies anticipate problems for older people. The problems of harsh winter weather are obvious but a Japanese study covering summers of 1968 through 1994  found significant rises in deaths of children and elderly during temperature peaks of 38 deg C or more. I feel that I am more comfortable at high temperatures than most of my friends are, and that a reptilian ability to happily bask has strengthened in old age. I am probably wrong. A small but useful study found that both older and younger people feel most comfortable at temperatures between 20 deg C and 22 deg C but also that the old have problems because their perception of temperature changes is so coarse and sluggish that they may not notice as they gradually chill down – or heat up – outside this range [8]. Analysis of records of elderly patients admitted to a French Hospital emergency department during the 2003 French heatwave found that 42 out of 246 had heat – related illnesses not diagnosed by their physicians and that living in institutional care and taking psychotropic medications were risk factors [9]. A study of heat-stroke deaths in Japan between 1968 and 1994 found that numbers rose sharply when temperatures rose to 38 or above and half were people aged under 4 or over 70.[10] I had been looking forward to The Great Warming, especially in North Oxford, but these numbers, and increases in counts of exotic pollens now wither my hopes.

So, back again to poetry in the hope of some relief from the realisation that when we all begin to freeze or fry we old, and the very young, will suffer before the rest. Robert Frost is not particularly cheerful, but at least is poised and balanced:

Some say our world will end in fire,
Some say in ice.
From what I’ve tasted of desire
I hold with those who favour fire.
But if we have to perish twice,
I think I know enough of hate
To say that for destruction ice
Is also great
And would suffice.

1. Lerchl, A. (1998). Changes in the seasonality of mortality in Germany from 1946 to 1995: the role of temperature. International journal of biometeorology, 42(2), 84-88.
2. Sheth, T., Nair, C., Muller, J., & Yusuf, S. (1999). Increased winter mortality from acute myocardial infarction and stroke: the effect of age. Journal of the American College of Cardiology, 33(7), 1916-1919.
3. Nakaji, Shigeyuki, et al. “Seasonal changes in mortality rates from main causes of death in Japan.” European journal of epidemiology 19.10 (2004): 905-913
4. .Preti, A., & Miotto, P. (1998) Seasonality in suicides: the influence of suicide method, gender and age on suicide distribution in Italy Psychiatry Research, 81, 219-231.
5. Harris, S., & Dawson-Hughes, B. (1993). Seasonal mood changes in 250 normal women. Psychiatry research, 49(1), 77-87.
6. Eagles, J. M., McLeod, I. H., & Douglas, A. S. (1997). Seasonal changes in psychological well-being in an elderly population. The British Journal of Psychiatry, 171(1), 53-55.
7. Magnusson, A. (2000). An overview of epidemiological studies on seasonal affective disorder. Acta Psychiatrica Scandinavica, 101(3), 176-184.
8. Collins, K. J., Dore, C., Exton-Smith, A. N., Fox, R. H., MacDonald, I. C., & Woodward, P. M. (1977). Accidental hypothermia and impaired temperature homoeostasis in the elderly. BMJ, 1(6057), 353-356.
9. Fish, P. D., Bennett, G. C., & Millard, P. H. (1985). Heatwave morbidity and mortality in old age. Age and ageing, 14(4), 243-245.
10. Nakai, S., Itoh, T., & Morimoto, T. (1999). Deaths from heat-stroke in Japan: 1968–1994. International journal of biometeorology, 43(3), 124-127.

About Gray Rabbitt

Grumpy gerontologist
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