A retrospective study on heat-related mortality in an elderly population during the 2003 heat wave in Modena, Italy: the Argento Project.
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.
Foroni
Micaela
M
University of Modena and Reggio Emilia, Nuovo Ospedale Civile S Agostino-Estense, Via Giardini 1135, Baggiovara di Modena, Italy.
Salvioli
Gianfranco
G
Rielli
Rita
R
Goldoni
Carlo Alberto
CA
Orlandi
Giuliano
G
Zauli Sajani
Stefano
S
Guerzoni
Andrea
A
Maccaferri
Cristina
C
Daya
Ghassan
G
Mussi
Chiara
C
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