Climate, Vulnerability, and Older People
Climate change refers to a range of global phenomena created predominantly by burning fossil fuels. These add heat-trapping gases to the Earth’s atmosphere (NASA 2019). These phenomena include the increased global temperature trends referred to as global warming that can lead to changes in rainfall, wind patterns, and the frequency of extreme weather events such as tropical cyclones, heatwaves, flooding, and drought, which impact both human health and environment (IPCC 2018; Padhy et al. 2015; Trombley et al. 2017; UNFCC 1994). In contrast to susceptibility, which is a state or fact of being likely or liable to be influenced or harmed by a stimulus (M-W 2019a; Oxford 2019a), vulnerability is a propensity or predisposition to be either physically or emotionally adversely affected (M-W 2019b; Oxford 2019b). This is determined by the characteristics of a person or group that influences their capacity to anticipate, cope with, resist, and recover from the adverse effects of physical events (Wisner et al. 2004; Lavell et al. 2012). Older people are particularly vulnerable to the effects of a changing climate (Kottow 2003).
The earth’s climate system is approaching a threshold, beyond which there will be major and irreversible threats to human physical and mental health (BMA 2018). Rising temperatures, changing sea levels, and more frequent and extreme weather patterns will lead to impacts on human health, environment (See “Health Aging”), and society.
Heatwaves (with the greatest impact on older adults, babies and young children, and people with ill-health)
Flooding and tropical cyclones (including drowning, chemical hazards, contamination of drinking water, and mental stress)
Increased spread of infections only seen in other parts of the world (such as tick-borne encephalitis, Lyme disease, malaria, and dengue),
Reduced food safety associated with warmer temperatures greater exposure to ultraviolet radiation with increased risk of sunburn, sunstroke, and skin cancers
Reduced air quality and increased pollens
Climate change presents the single biggest threat to sustainable development. Urgent action to halt climate change and deal with its impacts is integral to the successful implementation of the UN Sustainable Development Goals (SDGs). In particular, climate change is expected to lead to a widening of health and social inequalities between and within countries, with the effects most severe in developing countries and among the poorest people. The older population is at greater risk (See “Global Action on Aging”) due to a combination of exposure and increased psychosocial susceptibility or social vulnerability. Older people are more susceptible to disease (See “Healthy Aging”) and the effects of stresses on the food and water supply, and reduced ability to mobilize (See “Geographical Gerontology”) themselves in an extreme weather event (ASA 2019).
Key Research Findings
The adverse health effects of climate change on the health and well-being of older people are due to their greater physiological susceptibility and social vulnerability. The effects of climate change depend on pre-exposure health status, psychological well-being, and social factors associated with aging and less on the fact of turning 60 or older (Geller and Zenick 2005). People aged 85 and over suffer from physical decline, multiple preexisting chronic disorders that limit mobility, intake of susceptibility-increasing medications, social isolation, possible poverty, and frailty and are, therefore, more likely to develop adverse health impacts from climate change (McGeehin and Mirabelli 2001; Geller and Zenick 2005; Haq et al. 2008).
Accumulated exposure over the life course to air pollution, pesticides, and other neurotoxins can produce greater susceptibility to health threats in older people by heightening inflammatory responses associated with cardiovascular disease, diabetes, dementia, and Parkinson’s disease (Cohn and MacPhail 1996; Stein et al. 2008). In the United States, older adults live in areas that will experience higher temperatures, tropical storms, or extended droughts in the future (USGCRP 2014). Poor older people have limited financial resources to cope with heat, relocate or evacuate (See “Geographical Gerontology”), or respond to increases in the cost of food (USGCRP 2016).
Climate change-related events such tropical cyclones or heatwaves can cause and intensify stress and anxiety, adversely affecting mental health and leading to depression, anger, and even violence. Although everyone is at risk, older people (See “Geographical Gerontology”), including those with existing mental illness and those with close ties to the land, are especially vulnerable to mental health impacts (APHA 2019).
People and communities differ in their exposure, inherent vulnerability, and adaptive capacity to respond to and cope with climate-related health impacts, which vary across time, location, communities, and among individuals and groups (USGCRP 2016). Factors contributing to exposure of older people include the time spent in risk-prone locations, displacement by weather extremes, economic status, condition of infrastructure, compromised mobility (See “Geographical Gerontology”), cognitive function, and other behavioral and mental factors.
Psychosocial susceptibility or social vulnerability, and adaptive capacity are tied to many of the same factors, which change across an old person’s lifetime and life stage. Locations that experience greater risks include urban heat islands, where cities are significantly warmer than its surrounding rural areas. Exposed older populations in such situations are likely to have limited adaptive capacity due to poor housing conditions, living in rooftop apartments, and are unable to use or to afford air conditioning.
Older people experience different inherent psychosocial susceptibilities or social vulnerabilities to climate-related impacts, especially exposure to extreme ambient temperatures which have been associated with increased hospital admissions for cardiovascular, respiratory, and metabolic disorders. Extreme weather events that compromise the availability and safety of food and water supplies and that interrupt communications, utilities, and emergency services affect older adults (USGCRP 2016). Functional and mobility impairments of older people (See “Geographical Gerontology”) make them less able to evacuate in an extreme weather event. Social and economic factors affect disparities in the prevalence of chronic medical conditions and the incidence of mental health conditions (APHA 2019).
If global temperatures continue to rise, present day changes in heatwaves, vector-borne disease, and food security, compounded and overwhelming impacts on public health are to be expected: “Trends in climate change impacts, exposures, and vulnerabilities show an unacceptably high level of risk for the current and future health of populations across the world.”
Increasing greenhouse gas emissions and shortcomings in building adaptive capacity threaten both human lives and the viability of the national public health services.
The nature and scale of the response to climate change will be the determining factor in shaping the health of nations for centuries to come.
Understanding climate change “as a central public health issue will be crucial in delivering an accelerated response.”
Reducing the Climate Vulnerability of Older People
Registries of and surveillance data on older adults and geographic information systems for identifying them.
Communities can develop early warning and response systems.
Community nurses and home health workers could reduce the adverse effects of extreme weather events by educating older people about their vulnerability.
Vulnerability indices, based on socioeconomic and demographic data, and vulnerability mapping can help planners, emergency managers, and technical support agencies locate vulnerable older individuals
Educational materials and disaster checklists can be developed and distributed to older people.
Resilience building in populations and infrastructure requires responsibility and joint action at local, national, and international levels, by all stakeholders including the public, private sectors, communities, and nongovernmental organizations.
Governments should develop and resource resilience-supporting strategies and tactical measures involving all stakeholders, long-term and system thinking, and including the reconciliation of national and local priorities.
International policy frameworks on disasters, climate change and its impacts, sustainable development and conservation of the environment should be coherent, mutually reinforcing, and complementary.
More national and international funds should be directed to resilience-building measures.
Resilience should be integrated into the global financial system to inform valuations and investment decisions. Organizations should be required to consistently report their financial expenditures for extreme weather events.
Examples of Application
Case Study: Mental Health and Hurricane Katrina
Considerable destruction, devastation, displacement, and death followed in the aftermath of Hurricane Katrina. Over a million people were displaced, thousands were traumatized, 2,000 died, survivors were unable to access basic resources such as shelters, emergency services, and retirement homes, and had to cope with profound loss, disrupted social ties, and resulting surges in violence (APHA 2019). A survey of a random sample of 1043 hurricane Katrina affected residents revealed that the 30-day prevalence rate was 49% for anxiety-mood disorders and 26% for post-traumatic stress disorders (PTSD). The prevalence of PTSD and attempts at self-harm showed an actual increase, over time, in a long-term mental health impact study of Katrina on a representative sample of 815 pre-hurricane residents. Even 2 years after the hurricane, high mental morbidity was observed (Kessler et al. 2008). Older people may have been more affected, in particular those who already suffer from a mental disorder (approximately 15% of adults aged 60 and over) (WHO 2017).
Case Study: Fatalities in the United States Associated with Tropical Cyclones
In a study of 59 Atlantic tropical cyclones over the period from 1963 to 2012 cyclone-induced direct and indirect fatalities were analyzed as well as cardiovascular failures (Rappaport and Blanchard 2016). Direct fatalities resulted mostly from excessive stormwater, storm surge incidents, and flood events. Indirect fatalities were related to heart attacks, trauma, vehicle accidents, carbon monoxide poisoning, fires, and electrocutions. Hurricane Katrina in 2005 resulted in 520 direct deaths and 565 indirect deaths of which 318 deaths were due to heart attacks and other cardiovascular failures. The number of indirect fatalities increased with age. There were about eight times as many victims who were more than 70 years old as there were victims under the age of 21. For the most part, this disparity comes from the large number of senior citizens who died from heart-related ailments. USEPA (2016) reported that almost half of the Hurricane Katrina deaths were among people aged over 75 and nearly half of the deaths from Hurricane Sandy in 2012 were among people aged 65 and older.
Case Studies: Heat-Related Fatalities During Heatwaves
During a heatwave, most of the additional death and disease are not directly heat related, but are cardiovascular in origin, brought about by the increased cardiovascular challenge associated with thermoregulatory responses to heat stress (Vandentorren et al. 2006). Older individuals are the most vulnerable population during prolonged environmental heat exposure, experiencing worse health outcomes than any other age cohort.
During the New York City heatwaves in July 1972 and August/September 1973, the majority of those who died were 65 years and older (Ellis et al. 1975). Of the 1686 excess deaths in the 1995 Chicago heatwave, 473 or 28% had excessive heat as a contributing cause of death and almost 94% of these excess deaths were found to be related to an underlying cardiovascular cause (Kaiser et al. 2007). The risk of heat-related death was increased for older human beings with known medical problems such as being confined to bed, or being unable to care for themselves, or living alone with no or little social contacts (Semenza et al. 1996).
More than 70,000 additional deaths occurred in Europe during the heat wave in August 2003 of which more than 15,000, 19,000, and 20,000 were estimated for Spain, France, and Italy, respectively (Robine et al. 2007, 2008). Excess mortality varied considerably with age and rose as age increased. Older people confined to bed, with a cardiovascular or neurological disease or mental disorder, living in old buildings without insulation or in the areas with the greatest heat island effects, and with a bedroom located directly under the roof had a higher risk of death (Vandentorren et al. 2006). Another analysis of the heatwave in France concluded that excess mortality in retirement institutions was greater than that in hospitals and that the geographic variations in mortality showed a clear age-dependent relationship with the number of very hot days (Fouillet et al. 2006; Perčič et al. 2018).
Numerous studies have been reviewed investigating the relationship between high ambient temperatures and mortality in Australia (Bi et al. 2011; Climate Council 2016; Wang et al. 2012). Hot and dry and warm and humid synoptic categories were associated with higher all-cause, circulatory, and cerebrovascular mortality in Sydney and Brisbane, especially for the 65 years and older age group and women. For the week spanning the 2009 heat wave in Melbourne, the greatest number of deaths occurred in those 75 years or older, a 46% increase in deaths occurred in the group of 64–75 years of age but also an unexplained 55% increase in deaths was in the 5–64 age groups.
For Beijing, the heat-related mortality risk for adults aged over 65 in the 21st century was projected from various climate models to rise up to more than 250 percent as compared to the 1980s (Li et al. 2016).
Individuals older than 65 years comprise a majority of the extra emergency room visits and deaths during heatwaves (Semenza et al. 1999). A key factor for enhanced excess mortality of older persons during heatwaves is that evacuation scenarios are difficult for older people with disabilities who may be physically unable or prepared to leave their homes (Kenney et al. 2014).
Case Study: Extreme Weather Events and Mental Health
Extreme weather events can lead to psychological and mental health impacts associated with loss, disruption and displacement as well as cumulative mental health outcomes from repeated exposure to natural and/or manmade disasters (Fritze et al. 2008). The vulnerability of individuals and communities, the appropriateness and swiftness of emergency responses, and the resources available to provide support and rebuild compound the mental health impacts of disasters. Extreme weather events such as Hurricane Katrina shows high rates of depression, trauma, chronic stress, anxiety, co-morbidity with existing psychopathology or medical illness, or dysregulated defenses (Shukla 2013). Such effects are felt most by vulnerable people and those with preexisting serious mental illness, who currently make up for 15% of adults aged 60 and over (Doherty and Clayton 2011; WHO 2017).
A study in Adelaide, South Australia, reported a positive relationship between ambient temperature and hospital admissions for mental and behavioral disorders from 1993 to 2006, The higher the temperature, the higher the admissions for organic mental illnesses such as “dementia; mood (affective) disorders; neurotic, stress-related, and somatoform disorders; disorders of psychological development; and senility.” Mortalities due to these disorders also increased during heatwaves in the age group of 65 to 74 years (Hansen et al. 2008).
Future Directions for Research
The vulnerability of older people to extreme weather events such as heatwaves and tropical cyclones has been widely reported. However, more information is needed on the vulnerability of older adults to river flooding, coastal flooding from sea level rise, droughts, wildfires, deterioration of air quality, and contaminated food and water supplies. In addition, strategies are needed for reducing the vulnerability of older people and increasing their ability for adaptation, preparation, and response to emerging climate-related changes.
Indicators for older peoples’ overall vulnerability to the effects of climate change – such as personal wealth, gender, age, ethnicity, race, rural or urban residence, property owning or tenancy, education, family and friendship structure, available health and social services, and infrastructure dependence – should be developed to help identify populations and locations that could be targeted for capacity enhancement and communication strategies for reducing vulnerability (Cutter et al. 2003).
Research is needed to better understand the risks posed by climate change to older adults and the appropriate ways to communicate those risks to decision makers, public health and safety officials, and other stakeholders concerned with aging populations (Gamble et al. 2013).
The earth’s climate is warming (IPCC 2018). The adverse consequences of a changing climate include increased weather-related damage to infrastructure, more frequent and severe heatwaves, loss of land to rising sea levels, increased frequency and severity of heatwaves, spatially expanding insect infestation, more wildfires, more droughts and scarcity of water, increase of disease pathogens and invasive pests, a degradation of water quality, and an increase in air pollution and airborne allergens such as pollen and mold (Carnes et al. 2014). At the same time, the number of older people is rapidly increasing from approximately 12% in 2015 to 22% in 2050 (WHO 2017). Growing old in the twenty-first century will bring with it the unique challenge of adapting to changing weather patterns caused by a warmer climate. An interdisciplinary approach is needed to better understand the intersection between population aging and climate change and to reduce the vulnerability of older people, ensuring they reach later life with greater resilience (Haq 2017).
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