title: A retrospective study on heat-related mortality in an elderly population during the 2003 heat wave in Modena, Italy: the Argento Project.
abstract: BACKGROUND
  Summer 2003 witnessed an excess in heat-related mortality in the elderly population. The Argento Project was planned to define risk factors for heat-related death in Modena, Italy, during the hottest month of 2003 (August).
  
  
  METHODS
  We performed a retrospective, case-control study of a cohort of 394 older persons living in Modena, 197 dead (cases) and 197 survivors (controls). A questionnaire to collect information about demographic, social, environmental, and clinical characteristics and about causes of death was completed.
  
  
  RESULTS
  Cases were more likely to be living in a nursing home and needing assistance (p =.024, and p <.001, respectively). Survivors were living on higher level floors (p =.046). Spending the summer in Modena was significantly related to poor outcomes (p <.01). A higher number of cases were using public health services (p <.001). Individuals who died had a greater degree of comorbidity and dependence (p <.001); they were cognitively impaired (p <.001), took a larger number of drugs (p <.001), and had a greater number of hospital admissions (p <.001). Multivariate analysis showed that patients who spent the summer in Modena had a higher mortality. Other predictors of death were the use of home public-integrated assistance, a higher comorbidity and a higher degree of disability; the loss of at least 1 Activity of Daily Living (ADL) represents the strongest risk factor of heat-related death.
  
  
  CONCLUSIONS
  Our study identifies the major risk factors of heat-related death in the elderly population. With the creation of an up-to-date database, when a new heat wave will come, it will be possible to identify frail persons for preventive targeted strategies.
authors.affiliation: University of Modena and Reggio Emilia, Nuovo Ospedale Civile S Agostino-Estense, Via Giardini 1135, Baggiovara di Modena, Italy.
authors.forename: Micaela
authors.initials: M
authors.lastname: Foroni
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Salvioli
authors.forename: Rita
authors.initials: R
authors.lastname: Rielli
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Goldoni
authors.forename: Giuliano
authors.initials: G
authors.lastname: Orlandi
authors.forename: Stefano
authors.initials: S
authors.lastname: Zauli Sajani
authors.forename: Andrea
authors.initials: A
authors.lastname: Guerzoni
authors.forename: Cristina
authors.initials: C
authors.lastname: Maccaferri
authors.forename: Ghassan
authors.initials: G
authors.lastname: Daya
authors.forename: Chiara
authors.initials: C
authors.lastname: Mussi
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002908:Chronic Disease; D003072:Cognition Disorders / Q000453:epidemiology; D015331:Cohort Studies; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data; D006299:Health Services for the Aged; D018882:Heat Stress Disorders / Q000401:mortality*; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009735:Nursing Homes; D010343:Patient Admission / Q000706:statistics & numerical data; D019338:Polypharmacy; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons; D017741:Survivors; D014887:Weather