Nursing homes and heat waves: air conditioning becomes a saving device for the elderly

Summer is approaching and concern about heat waves looms, a threat that lays bare the extreme fragility of our older population. Italia is going through an unprecedented demographic metamorphosis and is having to deal with a climate that grants no respite: after 2024 became the hottest year ever globally, data confirm that extreme heat is no longer a meteorological exception, but a structural challenge, especially for the health system. According to the joint report by the Ministry of Health and the Department of Epidemiology of the Lazio region, in 2022 the increase in summer mortality in Italia reached 15 per cent, a figure that rises dramatically among the 'very old' over the age of 80.

For an elderly person in a nursing home, heat is not just an inconvenience: it is a silent killer. With age, the capacity for thermoregulation diminishes, the sensation of thirst fades and many pharmacological therapies interfere with the body's response to high temperatures. In this scenario, facilities can no longer be mere retirement homes, but must evolve into environments capable of governing environmental and clinical risk.

Often downgraded to a matter of comfort or, worse, energy waste, air conditioning in nursing homes is actually a fundamental health care facility. This is confirmed by a recent rigorous study published in JAMA Internal Medicine, conducted in Ontario on over 73,000 deaths in 600 facilities. The research shows that in RSAs without air conditioning, mortality during extreme heat rises to 13.8%. In statistical terms, the risk of death only increases significantly where there is no cooling. But there is a crucial point: it is not enough to air-condition common areas. For bedridden or severely cognitively impaired residents, who cannot move independently to cooler rooms, the presence of air conditioning directly in the rooms is the only real bulwark against dehydration and cardiovascular decompensation. Investing in these technologies means, literally, adding years to residents' lives.

The future of residential care passes through what experts call 'RSA 4.0': facilities that are open, technological and integrated into the healthcare fabric. It is not just a matter of installing splits, but of implementing a cultural and organisational revolution that focuses on microbiological safety and constant monitoring. In Italia, where only 6% of long-term care beds are public (against an OECD average of 34%), the gap in organisation and equipment, between region and region, between facility and facility, makes a change of course urgent. Facilities must become vital nodes in a network that is not limited to receiving the elderly, but which knows how to prevent risks, from thermal to infectious, guaranteeing a dignity that goes beyond passive care.

The CCM Project entitled 'Health Protection in Social and Health Care Residential Facilities' is part of this journey towards global safety. It is a choral effort coordinated by Professor Silvio Brusaferro (University of Udine) that unites the Ministry of Health, ISS, Regions and Universities to create a common front against care-related infections. As emphasised by Professor Caterina Rizzo (University of Pisa), governing risk is an act of responsibility: fragility cannot be eliminated, but is managed through active surveillance and continuous training. The project, among its other declinations, aims to counter the insidious 'shuttle effect', i.e. the two-way exchange of germs between hospitals and RSAs that fuels antimicrobial resistance in both facilities. Through rigorous protocols and the use of data (based on the European HALT-4 study), the CCM aims to transform RSAs into transparent and safe places where technology and rigorous clinical prevention march together to protect our elderly.