Climate change found to have variable impacts on older adults

Leyva E, Beaman A, Davidson P. Health impact of climate change in older people: An integrative review and implications for nursing Journal of Nursing Scholarship. 2017; 49(6): 670-678.

Review question

•      What are the health impacts of climate change on older adults?

Background

•      According to the World Health Organization, climate change has both direct and indirect effects. Direct effects can encompass extreme weather events such as heat waves, cold waves, and natural disasters, while indirect effects include ecosystem effects, environmental effects, and socio-economic effects.

•      These direct and indirect effects can contribute to morbidity and mortality related to cardiovascular diseases, other noncommunicable diseases, infectious and waterborne diseases, malnutrition, and mental-health problems.

•      Although older adults are disproportionally affected by the adverse health outcomes associated with climate change, little research has focused on the effect of climate change on this vulnerable group.

•      The aim of this review is to synthesize the available research on the health impacts of climate change on older adults.

How the review was done

•      Review authors conducted a detailed search of three research databases for eligible studies published in English from 2007 to 2017.

•      A manual search of additional research was conducted in consultation with a librarian.

•      The following keywords were used in the search: climate change, global warming, health, vulnerability, resilience, coping, quality of life, older person, senior citizen, and elderly.

•      A total of 278 articles were retrieved from the initial search, of which 30 were included in this review.

•      No specific funding was declared for this review.

What the researchers found

•      Of the included studies, 13 were from North America and Europe, another 13 were from Asia, and the remaining four were from Australia. Almost all of the studies were from high-income countries.

•      The findings from these studies were organized into six categories, including 1) climate stressors, 2) perceptions on climate change and health, 3) health impacts of climate change, 4) resilience and quality of life in climate-affected communities, 5) determinants of resilient capacity, and 6) measuring health impacts of climate change.

•      The review found that while many older adults recognize the health impacts of climate change, others are more skeptical, believing climate change to be a “hoax.” These individuals do not perceive extreme heat as a threat due to available protective measures such as air conditioning equipment. In addition, they are already accustomed to the changing weather patterns.

•      In terms of its health impacts, extreme heat events were found to be associated with increasing risk of hospitalization. For ischemic heart diseases, one study found that colder temperatures pose a greater risk for hospitalization compared to warmer summer temperatures. For various diseases, hospital admissions are projected to increase by 4.5% for every 1-degree Celsius increase in temperature.

•      Morbidity and mortality related to typhoons and flooding are predominantly related to injuries, drowning, and mental health problems such as depression, post-traumatic stress disorder (PTSD), and anxiety. It was found that older adults are at a higher risk for drowning compared to their younger counterparts.

•      Despite the stereotypes of frailty, older adults (between 61 and 75 years of age) were reported to be more resilient after a flooding experience compared to the general population. This is partially due to the fact that older adults tend to perceive themselves as survivors rather than victims of floods. They were also found to be 4.49 times more likely to have an emergency evacuation plan and have a three-day supply of medications compared to their younger counterparts.

•      Protective behaviours to combat rising temperatures were reported in a few papers. The most frequently cited strategies included taking showers, wearing light clothing, drinking more liquids, and using air conditioning equipment.

•      Many studies emphasized the concept of vulnerability. In terms of risk factors, some studies reported that impairments in cardiovascular function can result in increased mortality from cardiovascular disease. Increasing age, low income, sex, disability, comorbidities, and living alone were identified as contributors to vulnerability. One study reported that older adults from racialized communities are at greater risk for heat-related mortality. Males are at a greater risk to die from typhoons and hospitalized for ischemic heart disease, while females are at a higher risk for heat-related deaths.

Conclusion

•      Older adults are facing a multitude of unique challenges related to climate change.

•      Nurse researchers can play an important role in building resilience and averting adverse health outcomes in this population through practice and policy.