HYPOTHERMIA HYPED TO DEATH

Dr Gerard Bulger on the

fatal results of giving old people the wrong help

LABOUR MPs have been telling us that privatisation of the electricity industry will lead to more deaths from hypothermia. But they are wrong if they believe the Government can prevent hypothermia deaths by reducing fuel prices or by giving extra heating allowances.

The term hypothermia has been hijack- ed by those that Auberon Waugh has defined for us as pilgerists. The very word hypothermia gives that certain medico- scientific authenticity to patronising hum- bug. Such hype only diverts resources and attention from areas where beneficial help for the elderly can be given. Money spent on heating allowances often goes up. in smoke, as is often perfectly well under-, stood by the elderly themselves, who have been through more frugal times. In my east London practice and at hospital I meet many cold, lonely old people living in poverty. Solutions to their plight will not be found by harping on about hypother- mia.

Hypothermia refers to a core body temperature of 35° centigrade or lower. If it goes below 28° the chances of survival are low. Hypothermia is not the room temperature at which a centrally heated social worker or guilt-ridden relative feels uncomfortable.

Anyone can become hypothermic through over-exposure, such as is caused by being out on Dartmoor without proper equipment, falling down drunk in the snow or by falling into the North Sea. These are extreme situations. A reasonably mobile person in a cold house does not become hypothermic.

Britain's yearly record of mortality rates is no worse, and sometimes better, than those of our trading partners. There is a bunching of deaths in winter, an effect first scientifically noted in 1841, a little before Mrs Thatcher's time. Hypothermia accounts for about 400 out of the 40,000 winter 'excess' deaths. The season seems to bring on other conditions like heart attacks. There are some well understood physiological reasons to explain how cold weather can do this, although the size of difference between summer and winter mortality rates has decreased in the last few decades, including Mrs Thatcher's years.

Yet the winter excess mortality rates do not seem dependent on room temperature. Studies have shown that elderly people succumb to the winter cull no matter how warm their housing is.

It is rare for people to die of hypother- mia alone, without other reasons. My neighbour, `Pop' Richardson, an 80-year- old man from Antigua, did not become hypothermic last winter although he was living in a house that had no back wall. His only heating was to leave his oven door open. Pop had no hot water and he had to walk to an exposed chemical toilet. It was the coldest winter for decades. The Gov- ernment was forced to introduce new heating allowance regulations because of the pilgerist media hype involving heart- rending stories of grannies apparently freezing to death, for no other reason than lack of money.

Thanks to the local-government ombudsman, Pop has just been rehoused, and he is much more comfortable. He did not die of hypothermia last year because he was not ill and was reasonably mobile. He dressed himself up to keep warm. Extra heating allowance would not have helped him one jot, and would certainly not have got him rehoused. The key to his survival that winter was that his arthritic hip had been replaced a few years before. Without a hip operation he would have been less mobile and in pain. He would have been given anti- arthritis pain-killers. These together with his immobility would have made his feet swell. He would have then been given water tablets. These would have made him a little giddy when he stood, so that he would then have sat more. The pain killers may well have made him slightly anaemic.

A social worker may well have called and organised his mobility allowance, advised on extra heating allowance and put in a home help and meals-on-wheels. Pop may have been able to afford a little Antiguan rum which would have given him some relief and his only comfort.

He would now be sitting in his chair most of the day, falling asleep and not getting about. He would then have been given a commode and a wheelchair. The effect of all this care would be to reduce what exercise he took, limiting his mobility one further notch. He would then be sleeping during the day so that he couldn't sleep at night, and would 'need' sleeping tablets.

One morning his cold would have be- come a chest infection. The doctor might have been able to fit him in with an appointment next week, or if he was lucky, he might have been promised a home visit in the next few days.

While creeping over from his chair to his commode he misses his grip, due to a side effect of the sleeping tablet; his blood pressure falls, because of the water tablets and his chest infection. He faints and falls. He would be weak and stuck fast to the floor with a fractured hip, his body bearing the effects of sleeping tablets, water tab- lets, painkillers and a little rum. He would be anaemic, injured, with a chest infection. His temperature would soon fall. He would quickly become hypothermic, even if the fire was left on. (Immobile people become hypothermic in heated hospital wards, let alone at home.) The response to our next epidemic of hypothermia hype must be to reduce the suffering of the elderly all year round. That is to offer fast and prompt service and treatment of the problems of the elderly as soon as they arise and not to respond by simply wishing to turn up the heating.

We may prevent 'hypothermia' deaths and reduce the winter cull by ensuring that the elderly are kept independent and mobile. If something must be done it should be the funding of neighbourhood occupational therapists since they are now the experts on keeping the elderly mobile.

This could be funded by the savings follow- ing a campaign to stop us doctors from poisoning our elderly patients by over- prescribing. Polypharmacy is one of the main causes of hypothermia.

And if Labour MPs want to prevent true hypothermia deaths by a collectivist approach it would be more effective to subsidise the milkman on his rounds rather than spend money on heating allowances.

Dr Bulger is a member of Hackney Com- munity Health Council.