ST. LOUIS • Marvin Flanigan wouldn't leave his longtime south St. Louis home. Not when the air conditioner broke down and temperatures soared above 100 degrees in early July. And not to join his wife, Diane, who escaped the suffocating heat to stay with relatives.
The retired Marine had survived much worse than another summer heat wave. Despite the pleas of family members, he stayed in his home.
On July 8, he became the 18th person to die from heat-related illnesses in the St. Louis area this summer.
"He was very set in his ways," Diane Flanigan said as she gathered his belongings at their home Thursday, on what would have been her husband's 73rd birthday. "He wasn't going anywhere."
Since his death, an additional five people have died from heat-related illnesses, bringing to the total so far to 23. Most were 70 or older.
Health experts say a combination of factors are at work: a stubborn clinging to habit, fear of high utility bills, isolated residents with little or no family and even mental health issues. The problem is especially dangerous in the city, where aging brick homes easily trap heat.
"This is a generation where many of them grew up without air conditioning, and they have this attitude that it's almost a badge of honor that I can handle the heat," said Linda Rhodes, former secretary of the Pennsylvania Department of Aging and author of "The Essential Guide to Caring for Aging Parents."
People whose family members or neighbors refuse to turn on the air conditioning or get to a cool place should not give up, said Rhodes, who led a task force on heat deaths in Pennsylvania in the early 1990s.
"Treat this how you'd respond if there was a tornado warning," she said. "This can be just as deadly."
The 23 deaths so far this year are the most since 1995 — with the heat likely to last for several more weeks. Temperatures have reached 100 degrees on 13 days, and forecasts call for more triple-digit heat through Thursday.
The prolonged heat wave is catching up to the most miserable summer on record — 1936 — when there were two long stretches of above 90-degree weather. In those days before air conditioning, 479 people died.
The youngest and oldest residents are most vulnerable to heat illnesses, such as heatstroke or hyperthermia, because they can't regulate their body temperatures as well.
For older people, health issues like heart disease, dementia and prescription drug use can contribute to the problem. The typical Missourian who succumbs to heat is older and lives alone.
Many of the people who died have also had dementia, Alzheimer's disease or some other cognitive disability, said Pamela Rice Walker, director of the St. Louis Department of Health.
Many older residents might not even consider themselves at risk, she said.
"We have to stop talking about them in the third person and we have to start talking to them," Walker said. "I'm struggling with how to get that message through. Maybe that will work, (to say) it's not fair to your grandchildren for you to die because you won't turn on your air conditioner."
The city and several groups mobilize at the start of each summer, urging residents to check on elderly neighbors and providing window air-conditioning units.
The St. Louis chapter of the Alzheimer's Association calls people in the area who are known to live alone.
"Those individuals are at the greatest risk," said Stephanie Rohlfs-Young, the local outreach director. "With Alzheimer's or dementia comes not only memory loss but confusion and impaired judgment, which might make them unable to use the thermostat."
Rohlfs-Young encourages families to install a lock box system, available at hardware stores, over the thermostat of a relative with dementia.
At least eight people who died this summer had working air conditioners that were not turned on. One woman had the thermostat set at 95 degrees. Another had the unit set to "heat."
Health officials also want to alleviate concerns about the cost of running air conditioners. By state law, electric customers cannot be disconnected for nonpayment if the forecast calls for 95 degrees or 105 on the heat index.
And just calling to check up on older relatives and neighbors isn't enough, experts say. Relatives and neighbors should stop by in person at different times of the day, try to get in the house, and shake hands or offer a hug to gauge body temperature.
More than 1,400 people around the region have called the United Way's 211 hotline this summer to request fans or air conditioners. An additional 629 have called looking for cooling centers. Cool Down St. Louis (314-241-7668) can provide air conditioners to seniors and people with disabilities.
Marvin Flanigan's son, Jasen Wells, 33, said he tried several times to get his dad out of the house to cool down. His father seemed in good spirits the day before he died, Wells said.
The family says it could not afford to repair the broken air conditioning unit, which has not been fixed. Diane Flanigan is still in the home on Nebraska Avenue but finds ways to cool off, such as visiting her sister or even riding the bus.
Marvin Flanigan loved to hang out on the front porch, where he waved at neighbors, chatted with the mail carrier and passed out sodas and Milky Way bars to neighborhood kids who showed him good report cards.
"He was a very good man. He loved his kids unconditionally. He loved people in his community," Wells said. "Now my focus is checking in on my mom every day."
View Summer 2012 heat deaths in St. Louis area in a larger map