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Summer 2025
Summer 2025 Issue Home Therapy: Heating Up or Cooling Down How Temperatures Are Reshaping Older Adult Therapy Routines The bodies of older adults do not adjust to temperature variations as well as those of younger people. Changes that occur with aging—such as a reduced capacity to sweat, a decreased ability to feel hot, and a diminished blood flow to the skin—make even slight temperature increases uncomfortable. Neal K. Shah, CEO of CareYaya, notes temperature variations create a perfect storm for older adults’ already compromised physiological systems. “The aging body loses approximately 30% of its thermoregulatory efficiency by age 75, making even modest temperature shifts clinically significant,” he explains. “We’ve seen how a mere 7°F to 8°F increase can reduce therapy participation by up to 40% and decrease session duration by nearly 20 minutes. Winter cold similarly compromises circulation to extremities, making joint mobility exercises significantly less effective as tissues remain stiff and resistant.” These aren’t merely comfort issues; they also directly impact measurable clinical outcomes, rehabilitation timelines, and hospital readmission rates. “The temperature-related main risks we see include orthostatic hypotension during heat (when blood pressure drops suddenly upon standing), leading to dizziness and fall risks; dehydration that in turn affects medication efficacy and kidney function; cold-induced joint stiffness that increases injury risk during movement therapy; and cognitive impacts that involve the temperature discomfort itself reducing attention and instruction retention by as much as 35%,” Shah says. “The key is to monitor vital signs before and throughout sessions and adjust for any at-risk individuals identified by vital sign data.” Michelle Davis, PT, DPT, chief clinical officer of Attain, which specializes in physical therapy for older people, regularly works with older adults in home therapy settings, focusing on improving their mobility, strength, and well-being. “Seasonal changes can significantly impact seniors’ mobility, energy levels, and overall therapy outcomes,” she says. “Cold weather can cause joint stiffness, increased pain, and reduced circulation, making movement more difficult. On the other hand, hot weather can lead to dehydration, fatigue, and swelling, affecting endurance and balance. These temperature-related changes can influence motivation, participation, and progress in therapy, requiring tailored approaches to maintain effectiveness.” Additionally, inclement weather and increased time spent indoors can lead to social isolation and seasonal depression, which directly impact motivation for physical activity. “There is a strong correlation between mood, wellness activity, and health, so when seniors feel disengaged or isolated, they may be less inclined to participate in therapy,” Davis explains. “To counteract this, I encourage strategies such as increasing indoor lighting during darker months or conducting exercises near windows with natural light exposure, both of which can enhance mood and facilitate better participation. By addressing both the physical and emotional effects of seasonal changes, we can optimize therapy outcomes and overall well-being.” It’s Getting Hot in Here “Pneumatic compression devices and resistance bands lose effectiveness in high heat, as they exacerbate thermal discomfort, while underwater therapy tools and cooling weighted equipment show superior outcomes and participation rates,” Shah explains. Summer therapeutic activities involve less energy-consuming tasks to achieve the same goals as winter activities and still maintain range of motion. Chair yoga, seated tai chi, recumbent exercises, and strength workouts done in a horizontal position are good summer substitutes for therapies that occur in a standing position. “For the last two summers, I used simplified adaptive yoga class components to achieve these goals,” Shah shares. “Rebounding (jumping on a mini trampoline) and using a Bosu ball (a half stability ball) in the summer also provide cooling, refreshing effects and much-needed variety. Both are used for making horizontal movements, which are safer for the spine and nerve pathways.” Heat presents another challenge in the form of fatigue and dehydration. “As heat can make even minimal exercises demanding, our therapists adjust by shortening sessions, reminding clients more often to drink water, and having clients wear loose, breathable clothing,” Gamburd says. “Therapy sessions are also alternated during the cooler early morning summer hours.” Cold as Ice During extreme cold, Shar recommends the “Warm-Circuit Method,” which includes 10 to 15 minutes of pretherapy warming with infrared heating pads on target muscle groups, layered clothing that’s removed progressively during exertion, and circulation-focused warm-up routines that start with proximal muscles and work outward toward the extremities. “In cold conditions, paraffin therapy for hands and feet prior to fine motor activities improves performance by 27%, and equipment with built-in heating elements (like certain massage tools) delivers significantly better outcomes than traditional passive devices,” Shah notes. After working for decades in senior care, Moti Gamburd, CEO of CARE Homecare, has seen firsthand how changes in temperature can subtly affect how older adults can move around, their level of pain, and how effectively their therapy works. “In colder months, elderly patients who have arthritis also notice increased joint stiffness, posing more difficulties in stretching or range-of-motion exercises,” he says. “Our therapists accommodate by employing longer warm-up processes, prewarming with warm wraps prior to treatment, and conducting therapy in warmer areas of the home. A client with a diagnosis of rheumatoid arthritis noticed a significant difference when we started sessions following a warm bath instead of first thing in the morning when it was cold.” Gamburd has also seen a problem with the effect of temperature on sensation, explaining that older people with neuropathy tend to be even more numb in the cold, which distorts balance and coordination. “We’ve had a client who abruptly had problems with standing exercises during the winter, not due to weakness, but due to cold-caused numbness distorting how their feet perceived pressure,” he recalls. “Solutions such as heated floors, thick socks, or even foot massage before a session allowed them to regain confidence and mobility.” When Davis works with clients during the winter, most activities are completed indoors during extreme weather conditions, and for any outdoor obstacles or challenges required for daily tasks, she simulates them inside. “This allows us to maintain a safe and controlled environment while still preparing clients for real-life scenarios,” she says. “We optimize climate control and aim to keep the indoor temperature around 72 degrees, which is ideal for safe exercise and fitness.” In severe cold, if her clients experience increased joint achiness or stiffness, she spends extra time “warming up” the joints through gentle, repeated movements and/or stretching exercises to improve circulation and reduce discomfort. Monitoring Matters “We use a multilayered approach to monitoring, starting with a standardized assessment before each session,” Shah says. “This includes taking the temperature of the room, recording resting vitals, and having the client rate their comfort level. Throughout the session, our staff observes for subtle changes that might indicate the person is moving out of the safe zone. If energy starts to drop, if speech starts to slur, or if coordination begins to fall apart, we’re trained to notice and to call a timeout. And we do this not for our convenience but because the simple act of checking in allows us to recalibrate.” Davis monitors vital signs, hydration levels, and overall energy before, during, and after sessions, paying close attention to changes in mobility, fatigue, breathing patterns, and skin temperature as indicators of potential discomfort. “Mentally, I check for mood shifts or signs of disinterest, as temperature extremes can sometimes lead to seasonal depression or frustration,” she says. “Adjustments are made as needed to keep sessions engaging and safe.” Psychological Impact Elvis Rosales, LCSW, clinical director at Align Recovery Centers, notes that for sustaining cognitive health, the optimal indoor temperatures for older adults should be between 68°F and 75°F, and deviations of just 7°F can double the risk of attention problems for older adults because the physical discomfort can easily distract from their focus. “Beyond the obvious effects like mood disturbances, therapy outcomes can also be affected by temperatures,” he says. “Increased agitation that gets in the way of cognitive performance has been recorded for seniors who were exposed to a heatwave. The elderly who are exposed to cold temperatures risk the worsening of isolation and sadness.” That’s why home therapies should include temperature assessments in their care protocols and adjust session timing to coincide with optimal indoor conditions when possible. “Teaching seniors specific mindfulness techniques for managing temperature-related discomfort improves their resilience and also helps their therapeutic progress,” Rosales says. By staying flexible and responsive to seasonal challenges, therapy remains effective, safe, and enjoyable for older adults in any kind of weather. — Keith Loria is a freelance writer based in Oakton, Virginia. |
