A systematic review of body temperature variations in older people.

AIM The purpose of this systematic review was to determine the extent to which the research literature indicates body temperature norms in the geriatric population. OBJECTIVES The specific questions addressed were to examine normal body temperature values in persons 60 years of age and older; determine differences in temperature values depending on non-invasive measurement site and measurement device used; and, examine the degree and extent of temperature variability according to time of day and time of year. BACKGROUND The traditional 'normal' temperature of 98.6 degrees F/37 degrees C may in fact be lower in older people due to the ageing process. Age-associated changes in vasomotor sweating function, skeletal muscle response, temperature perception and physical behaviours may influence the ability to maintain optimum temperature. DESIGN A systematic literature review. METHODS A search of multiple databases yielded 22 papers which met inclusion criteria. Studies were included which focused on temperature measurement, sampled persons 60 years of age and older, collected data from non-invasive temperature measurement sites and which used a prospective study design. Studies were independently appraised using a structured appraisal format. RESULTS Temperature normal values by site were rectal 98.8 degrees F/37.1 degrees C, ear-based 98.3 degrees F/36.8 degrees C, urine 97.6 degrees F/36.5 degrees C, oral 97.4 degrees F/36.3 degrees C and axillary 97.1 degrees F/36.2 degrees C. Temperature exhibited a 0.7 degrees F/0.4 degrees C diurnal and 0.2 degrees F/0.1 degrees C circannual variation. CONCLUSIONS Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C, ear-based 0.3 degrees F/0.2 degrees C, oral 1.2 degrees F/0.7 degrees C, axillary 0.6 degrees F/0.3 degrees C lower than adults' acceptable value from those traditionally found in nursing textbooks. RELEVANCE TO CLINICAL PRACTICE Given the fact that normal body temperature values were consistently lower than values reported in the literature, clinicians may need to re-evaluate the point at which interventions for abnormal temperatures are initiated.

[1]  Dan Loyd,et al.  Errors in body temperature assessment related to individual variation, measuring technique and equipment. , 2004, International journal of nursing practice.

[2]  Y. Motohashi,et al.  Oral temperatures of the elderly in nursing homes in summer and winter in relation to activities of daily living , 1997, International journal of biometeorology.

[3]  P. Higgins.  Can 98.6° be a fever in disguise? , 1983 .

[4]  A. Ferro-Luzzi.  The conceptual framework for estimating food energy requirement. , 2005, Public health nutrition.

[5]  Märtha Sund-Levander,et al.  Normal oral, rectal, tympanic and axillary body temperature in adult men and women: a systematic literature review. , 2002, Scandinavian journal of caring sciences.

[6]  M. Giuffre,et al.  Postoperative Temperature Measurement , 1990, Nursing research.

[7]  R. Erickson,et al.  Accuracy of infrared ear thermometry and other temperature methods in adults. , 1994, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[8]  N. Sugarek.  Temperature Lowering After Iced Water: Enhanced Effects in the Elderly , 1986, Journal of the American Geriatrics Society.

[9]  Michael Yeh,et al.  Fever Response in Elderly Nursing Home Residents: Are the Older Truly Colder? , 1991, Journal of the American Geriatrics Society.

[10]  P. Mackowiak,et al.  Carl Reinhold August Wunderlich and the evolution of clinical thermometry. , 1994, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[11]  Lacy A. Holowatz,et al.  Altered Mechanisms of Thermoregulatory Vasoconstriction in Aged Human Skin , 2008, Exercise and sport sciences reviews.

[12]  R. Erickson,et al.  Effect of cerumen on infrared ear temperature measurement. , 1995, Journal of Gerontological Nursing.

[13]  J. A. Wise.  A procedure for the effective recalibration of liquid-in-glass thermometers , 1991 .

[14]  B. Cunha.  Fever of unknown origin in the elderly. , 1982, Geriatrics.

[15]  G. Boysen,et al.  ACCEPTABLE AGREEMENT BETWEEN TYMPANIC AND RECTAL TEMPERATURE IN ACUTE STROKE PATIENTS , 2002, International journal of clinical practice.

[16]  Märtha Sund-Levander,et al.  The impact of ADL status, dementia and body mass index on normal body temperature in elderly nursing home residents. , 2002, Archives of gerontology and geriatrics.

[17]  G. Kelly,et al.  Body temperature variability (Part 1): a review of the history of body temperature and its variability due to site selection, biological rhythms, fitness, and aging. , 2006, Alternative medicine review : a journal of clinical therapeutic.

[18]  R. Abrams,et al.  Reliability of urine temperature as a measurement of basal body temperature. , 1984, JOGN nursing; journal of obstetric, gynecologic, and neonatal nursing.

[19]  R. Thatcher.  98.6 degrees F: what is normal? , 1983, Journal of gerontological nursing.

[20]  R. H. Fox,et al.  Problem of the Old and the Cold* , 1973, British medical journal.

[21]  Simcha Pollack,et al.  Older is colder: observations on body temperature among nursing home subjects. , 2007, Journal of the American Medical Directors Association.

[22]  P. Carney-Gersten,et al.  The relationship between axillary and core body temperature measurements. , 1990, Applied nursing research : ANR.

[23]  J. Moreland,et al.  A comparison of infrared ear thermometry with electronic predictive thermometry in a geriatric setting. , 1999, Geriatric nursing.

[24]  Linda S. Smith.  Using low-tech thermometers to measure body temperatures in older adults. A pilot study. , 2003, Journal of gerontological nursing.

[25]  J. Waterhouse,et al.  The Circadian Body Temperature Rhythm in the Elderly: Effect of Single Daily Melatonin Dosing , 2006, Chronobiology international.

[26]  P. Payne,et al.  Environmental Conditions and Body Temperatures of Elderly Women Living Alone or in Local Authority Home , 1971, British medical journal.

[27]  J. A. Cohen,et al.  The Effect of Oxygen Administration on Oral Temperature Assessment , 1982, Nursing research.

[28]  S. Schoenbaum,et al.  Practice guideline for evaluation of fever and infection in long-term care facilities. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[29]  P. Fulbrook.  Core temperature measurement in adults: a literature review. , 1993, Journal of advanced nursing.

[30]  T. Howell.  Axillary temperatures in aged women. , 1972, Age and ageing.

[31]  S. Hanneman,et al.  Design, Analysis, and Interpretation of Method‐Comparison Studies , 2008, AACN advanced critical care.

[32]  G. Mancia,et al.  Impairment of Thermoregulatory Control of Skin Sympathetic Nerve Traffic in the Elderly , 2003, Circulation.

[33]  T. Terndrup,et al.  Impact of operator technique and device on infrared emission detection tympanic thermometry. , 1992, The Journal of emergency medicine.

[34]  Linda S. Smith.  Reexamining age, race, site, and thermometer type as variables affecting temperature measurement in adults – A comparison study , 2003, BMC nursing.

[35]  S. Campbell,et al.  Relationships Between Sleep and Body Temperature in Middle‐Aged and Older Subjects , 1998, Journal of the American Geriatrics Society.

[36]  C J Henry,et al.  Mechanisms of changes in basal metabolism during ageing , 2000, European journal of clinical nutrition.

[37]  A. Goldstein,et al.  Measurement of urine temperature as an alternative to observed urination in a narcotic treatment program. , 1979, The American journal of drug and alcohol abuse.

[38]  G. Marion,et al.  Core body temperature in the elderly and factors which influence its measurement. , 1991, Gerontology.

[39]  A. Guz,et al.  Normal rectal, auditory canal, sublingual and axillary temperatures in elderly afebrile patients in a warm environment. , 1991, Age and ageing.

[40]  R H Fox,et al.  Body Temperatures in the Elderly: A National Study of Physiological, Social, and Environmental Conditions , 1973, British medical journal.

[41]  Ulkü Yapucu Güneş,et al.  Does the body temperature change in older people? , 2008, Journal of clinical nursing.

[42]  J. K. Lilly,et al.  Urinary bladder temperature monitoring: a new index of body core temperature. , 1980, Critical care medicine.

[43]  G. Sergi,et al.  Reliability of body temperature measurements in hospitalised older patients. , 2008, Journal of clinical nursing.

[44]  J. Chamberlain,et al.  Determination of normal ear temperature with an infrared emission detection thermometer. , 1995, Annals of emergency medicine.

[45]  G. Wolf-Klein,et al.  Older Is Colder: Temperature Range and Variation in Older People , 2005, Journal of The American Geriatrics Society.

[46]  L. Keilson,et al.  Screening for hypothermia in the ambulatory elderly. The Maine experience. , 1985, JAMA.

[47]  P. Mcgeer,et al.  Increase in Core Body Temperature of Alzheimer’s Disease Patients as a Possible Indicator of Chronic Neuroinflammation: A Meta-Analysis , 2006, Gerontology.

[48]  R. Erickson,et al.  Comparison of Tympanic and Oral Temperatures In Surgical Patients , 1991, Nursing research.

[49]  J. Spangler,et al.  The influence of gender and race on mean body temperature in a population of healthy older adults. , 1993, Archives of family medicine.

[50]  K. Culp,et al.  Nutritional status and delirium in long-term care elderly individuals. , 2008, Applied nursing research : ANR.

[51]  M. Cereda,et al.  Intraoperative Temperature Monitoring , 2004, International anesthesiology clinics.

[52]  M. Petersen,et al.  Can training improve the results with infrared tympanic thermometers? , 1997, Acta anaesthesiologica Scandinavica.

[53]  D. Altman,et al.  Comparing methods of measurement: why plotting difference against standard method is misleading , 1995, The Lancet.

[54]  A N Exton-Smith,et al.  Urban hypothermia: preferred temperature and thermal perception in old age. , 1981, British medical journal.

[55]  M. Conaway,et al.  The effect of respiratory rate and ingestion of hot and cold beverages on the accuracy of oral temperatures measured by electronic thermometers. , 2007, Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses.

[56]  T. Howell.  Oral temperature range in old age. , 1975, Gerontologia clinica.

[57]  R. H. Fox,et al.  Evaluation of a method for measuring urine temperature. , 1973, The Journal of physiology.

[58]  D. Manthey,et al.  A comparison of oral, tympanic, and rectal temperature measurement in the elderly. , 2002, The Journal of emergency medicine.