Why Heat Waves Raise Fall Risk for Older Adults in Belgium

Last verified: August 3, 2026. This article is for caregiver education and fall-prevention planning, not a substitute for medical advice. If an older adult has heart failure, kidney disease, fluid restrictions, complex medications, or sudden symptoms during heat, contact their clinician, pharmacist, home-care nurse, or emergency services as appropriate.

Belgium’s June 2026 heatwave deserves attention not because it was dramatic weather, but because it exposed a very ordinary danger inside homes: an older person gets up from a chair, feels lightheaded, reaches too late for the armrest, and falls before anyone has used the words “heat stroke.”

Sciensano’s Be-MOMO monitoring initially reported 1,747 excess deaths during the 18 June to 1 July 2026 heatwave, an excess mortality estimate reported around 47.8% to 48%, with 498 excess deaths in residential care homes and a peak day on 27 June when 641 deaths were recorded, or 146.5% above expected mortality.[1] Later reporting described the estimate as moving toward roughly 2,000 excess deaths, with large regional differences: Wallonia at 76% excess mortality, Brussels at 60.9%, and Flanders at 31.4%.[2] Belgian and international reports described it as the country’s deadliest heatwave since mortality tracking began in 2000.[1][3]

For a daughter calling Brussels from Chicago, a neighbor checking a flat in Liège, or a spouse in an older Antwerp apartment without good cooling, the practical question is smaller than the headline: what should be checked today so heat does not turn into dizziness, a collapse, or a fall?

Heat can raise fall risk before it looks like heat stroke

The fall pathway is not mysterious, but it is often skipped in public heat advice. Heat increases sweating and fluid loss. If the older adult does not replace enough fluid, circulating blood volume can fall. With less volume available, blood pressure may drop when the person stands. The result can be dizziness, faintness, slowed reaction time, or a fall.

That pathway matters because falls are not a side issue. In a retrospective cohort study of 30,634 adults aged 65 and older, 37.9% were classified as dehydrated, and dehydration was positively associated with falls, with an odds ratio of 1.13 and a P value of .002.[4] The study does not prove that every dehydrated older adult will fall, or that dehydration is the only reason falls happen. It does support the caregiver’s working assumption during a heat alert: hydration status belongs in a fall-risk check.

Older bodies also have less reserve. A Dutch geriatrician interviewed by Radboudumc explained that body water is roughly 65% in younger adults and about 50% in older adults, so the same amount of fluid loss has a stronger effect.[5] Thirst may be less reliable, appetite may drop, and a person who normally manages well may become unsteady after one hot afternoon, one missed drink, or one extra trip to the bathroom.

This is why “drink more water” is too blunt. Some older adults do need more planned fluid during heat. Others have clinician-set limits because of heart failure, kidney disease, low sodium, or other conditions. The useful caregiver task is not to force a number of glasses; it is to know the person’s safe range, watch for dehydration and overhydration concerns, and ask the clinician or pharmacist in advance how heat days should change the routine.

Medications can turn a hot day into a standing-balance problem

Many older adults in Belgium take medications at breakfast and dinner that are sensible on ordinary days but less forgiving during heat. The CDC’s clinician guidance on heat and medications names several drug groups that can increase heat-related risk through volume depletion, hypotension, reduced cardiac output, sedation, cognitive impairment, or increased risk of fainting and falls.[6] This is a medication-review issue, not a reason to stop prescriptions suddenly.

AARP’s consumer medication guidance similarly highlights medication types that may increase heat intolerance, including diuretics, blood-pressure medicines, antihistamines, antidepressants, antipsychotics, stimulants, thyroid medication, and some diabetes medicines.[7] The lists are not identical because they are written for different audiences, but the caregiver implication is the same: a heat alert is a reason to ask for a medication safety review, especially when dizziness, confusion, fainting, or poor intake appears.

For a deeper medication-focused discussion, use Preventing Heat Stroke in Seniors Starts With Medications as the companion piece. Here, the point is narrower: medication effects can sit inside the dehydration–dizziness–fall chain, so the first visible harm may be a fall rather than a classic heat-stroke presentation.

Use Belgium’s heat alert as a fall-prevention trigger

Belgium’s ozone and heat plan uses vigilance, warning, and alarm phases, with regional communication through public authorities.[8] For caregivers, the label matters less than the routine it should trigger. When a heat warning is active, the fall-prevention routine should become more deliberate: fewer unassisted transfers, slower standing, planned fluids if allowed, cooler rooms, and a twice-daily check that asks about balance rather than only comfort.

The CDC advises caregivers to check on older adults at least twice a day during heat.[9] In Belgium, that can mean one morning contact before the hottest part of the day and one evening contact when fatigue, dehydration, and medication effects may have accumulated. If you are calling from another country, arrange a local backup person who can physically enter the home if the older adult does not answer.

Morning check: set up the day before dizziness starts

• Ask whether the person felt dizzy getting out of bed, walking to the toilet, or standing after breakfast.
• Confirm what they have actually drunk and eaten, not what they intend to drink later.
• Check whether urine is much reduced or unusually dark, while remembering that some medicines and conditions change urine patterns.
• Review the day’s medication timing and ask whether any new medicine, extra diuretic dose, sleep aid, alcohol, or over-the-counter product has been added.
• Move water, phone, walking aid, glasses, and a light snack within reach of the main chair so standing trips are fewer and safer.
• Plan cooler hours for washing, dressing, errands, or stairs; postpone nonessential tasks during the hottest part of the day.

Evening check: look for accumulation

• Ask the person to describe transfers: chair to standing, toilet to standing, bed preparation, and any near-fall.
• Listen for new confusion, slower speech, unusual irritability, or not following the conversation.
• Ask whether they feel weak, faint, nauseated, cramped, very tired, or newly short of breath.
• Check whether the home cooled down. If one room is cooler and safer, set up sleeping or resting there.
• Confirm the route to the toilet is lit and clear; night-time urgency plus heat-related dizziness is a common fall setup.
• If the person lives alone, confirm who will answer if they call during the night.

For a fuller day-by-day heat routine, pair this article with the Heat Wave Safety Checklist for Elderly Parents. If heat is one part of a wider emergency plan for a parent who lives alone, the broader framework in A Severe Weather Plan for Elderly Parents Is a Fall Plan can help assign who checks, who has keys, and who escalates.

Hydration planning has to respect heart and kidney limits

A useful heat-day hydration plan has three parts: what the older adult is allowed to drink, how the drinks will be spaced, and what signs mean the plan is not working. The first part is the one families most often miss. If a clinician has limited fluids because of heart failure, kidney disease, low sodium, or another condition, do not override that limit because of a heat article. Ask the clinician or pharmacist what the heat-alert version of the plan should be.

Where fluids are not restricted, small regular drinks are often more realistic than expecting a frail person to make up a large deficit late in the day. Food matters too: soups, fruit, yogurt, and other tolerated foods may contribute fluid and salt, but diabetes, swallowing problems, kidney diets, and appetite changes can all alter what is safe. The caregiver’s job is to make the safe option visible, reachable, and repeated.

Dutch care guidance from Vilans lists dehydration warning signs to watch for during heat, including thirst, dry mouth, headache, dizziness, confusion, reduced urination, dark urine, rapid heart rate, and drowsiness.[10] Those signs do not diagnose dehydration by themselves, but during a Belgian heat alert they are enough to slow the day down and seek advice if they persist, worsen, or appear with medication concerns.

Cooling the body also prevents falls

Cooling advice can sound like comfort advice, but it belongs in fall prevention. A cooler room reduces sweating and fluid loss. A cool shower or washcloth may reduce heat strain. Resting during peak heat reduces trips across the room when the person is most likely to be weak or lightheaded.

WHO guidance advises people to spend 2 to 3 hours a day in a cool place during extreme heat when possible, and cautions that fans should be used only when indoor temperatures are below 40°C.[11] In an older Belgian flat, that might mean moving the day’s main chair to the coolest room, using shutters or curtains early, avoiding unnecessary cooking heat, or arranging time in an air-conditioned public place if transport itself can be made safe.

Do not make cooling depend on extra walking. If the safest cool place requires stairs, a long bus trip, or carrying bags, the plan may need a neighbor, taxi, family member, or home aide. During heat, the “safe” option is the one that lowers body strain without adding a new fall hazard.

When to escalate in Belgium

Belgium’s emergency number for urgent medical help is 112, and safe.brussels identifies 112 and 101 as the two main emergency numbers, with 112 used for ambulance and fire services.[12] For heatwave fall prevention, the important decision is not whether the situation has already become textbook heat stroke; it is whether the older adult is unsafe to remain unassessed.

Call 112 for emergency signs such as collapse, loss of consciousness, severe confusion, seizure, suspected stroke symptoms, chest pain, serious breathing difficulty, a fall with injury or inability to get up, or heat-stroke signs. The American Geriatrics Society’s Health in Aging guidance describes heat stroke as a medical emergency and includes signs such as a core body temperature around 104°F or 40°C, hot dry skin, confusion, fainting, or coma.[13]

Seek same-day medical advice, a pharmacist call, or a home-care nurse check for new dizziness on standing, repeated near-falls, reduced urination, vomiting, worsening weakness, medication mistakes, or confusion that is mild but new. If the person lives alone and cannot reliably answer the phone, remote reassurance is not enough; someone local needs to check in person.

A practical heat-alert fall plan

Europe’s wider heat burden is large: the European Environment Agency has reported that heat was linked to 95% of climate-related fatalities in Europe between 1980 and 2023, with tens of thousands of heat-related deaths estimated in the summers of 2022 and 2023.[14] That context matters, but the caregiver’s next action remains local and concrete. During a Belgian heat alert, treat dizziness prevention, medication review, safe hydration, cooling, and twice-daily contact as fall prevention.

References

1. 1,747 additional deaths during the last heatwave: highest excess mortality during heatwave since measurements began, VRT NWS, July 8, 2026, link
2. Heatwave sets excess mortality records in Belgium, The Bulletin, link
3. Belgium records deadliest heatwave since 2000 with 1,747 excess deaths, Anadolu Agency, link
4. Is Dehydration a Risk Factor for Falls in Older Adults?, Mayo Clinic Proceedings, 2020, link
5. Vijf vragen over de invloed van hoge temperaturen op ouderen, Radboudumc, 2025, link
6. Heat and Medications – Guidance for Clinicians, CDC, link
7. 8 Types of Medications That Don’t Mix With Heat, AARP, link
8. What is the ozone and heat plan in Belgium and what are the different phases?, IRCEL-CELINE, link
9. Heat and Older Adults (Aged 65+), CDC, link
10. Hittegolf en ouderen: waar moet u op letten?, Vilans, link
11. Climate change: Heat and health, WHO, link
12. Emergency numbers, safe.brussels, link
13. Tip Sheet: Hot Weather Safety Tips for Older Adults, HealthInAging.org, link
14. The impacts of heat on health: surveillance and preparedness in Europe, European Environment Agency, link