[Heatwaves and Resilience of Hospital Geriatric Care Pathways: Results of the Repeated National PUGG FLASH-HEATWAVE 2026 survey].

Abstract

Extreme heat disproportionately affects frail older adults and may simultaneously disrupt hospital capacity, working conditions, and geriatric care pathways. We aimed to describe thermal conditions, capacity strain, and organizational adaptations in acute geriatric units (AGUs) during a heatwave and one week later, and to describe conditions in medical rehabilitation units (MRUs). PUGG FLASH-HEATWAVE was a repeated national observational, non-interventional service-level survey. Phase 1 surveyed AGUs on 25-26 June 2026; phase 2 surveyed AGUs and MRUs on 2-3 July 2026. Data were aggregated at the service level. Because no stable unit identifier was available, AGU data from the two survey waves were compared as independent samples using chi-square or Fisher's exact tests. Exploratory Mann-Whitney tests assessed the association between room cooling and reported events in phase 1. One hundred and twelve AGUs, representing 4,268 usual beds, participated in phase 1; phase 2 included 30 AGUs (1,007 beds) and 26 MRUs (1,490 beds). In phase 1, 45.5% of AGUs considered patient-room temperatures to be intolerable, 71.4% reported excessive room temperatures as an operational difficulty, and 88.4% reported staff fatigue. Major or critical emergency-department strain affected 57.1% of units, while 64.3% reported capacity strain with consequences for admissions. Downstream rehabilitation and other care capacity was considered insufficient by 87.5% of AGUs. One week later, the proportion of AGUs reporting at least partly tolerable room temperatures had increased from 53.6% to 100.0% (p < 0.001), while at least moderate emergency-department strain decreased from 91.1% to 63.3% (p < 0.001), capacity strain with operational consequences from 64.3% to 40.0% (p = 0.016), and staff fatigue from 88.4% to 50.0% (p < 0.001). Downstream capacity insufficiency remained unchanged (87.5% versus 86.7%; p = 0.903). Among MRUs, 65.4% reported patient rooms that were intolerable or only partly tolerable, 73.1% had postponed or refused admissions, and 88.5% had adapted rehabilitation activities. In phase 1, units with at least partly cooled rooms reported fewer heat-related complications and heatstroke events in unadjusted exploratory analyses. The heatwave acted as a stress test for an already fragile system. Improvements in several indicators of acute strain did not resolve the persistent downstream bottleneck. A national multi-year policy should integrate thermal adaptation of healthcare facilities, protected seasonal capacity, adequate workforce resources, and regional coordination across geriatric care pathways.