The increasing frequency and intensity of heatwaves exacerbates health and safety concerns for an already vulnerable community, older Americans, whose numbers are growing rapidly.
“We’re seeing more heat and more extreme heat,” Ian Neal, a geriatrician and associate professor of medicine at the University of California, San Diego, said during a recent webinar.
“However, accidents among the elderly are also increasing, and the elderly are one of the groups at high risk of heatstroke,” he added.
The U.S. population over the age of 65 soared from about 40 million to 56 million between 2010 and 2020 and is projected to grow by another 17 million by the end of the century. At the same time, temperatures are rising around the world, breaking heat records and leading to an increase in wildfires.
Tarik Benmarnia, an associate professor of climate change epidemiology at the Scripps Institution of Oceanography at the University of California, San Diego, described the heatwaves as a “giant, silent, stealthy killer.”
Currently, it’s estimated that 6,000 to 7,000 people die from heat-related illnesses in the U.S. each year, but Benmalnia said that figure is “just the tip of the iceberg.” Given that extreme heat can cause complications for older adults with chronic illnesses, the figure could be as high as 12,000 to 20,000 people a year, he said.
Neal, who primarily works with older people with severe dementia, said fever was “one of the main factors that we think has a major negative impact on patients’ health”.
“One thing we see every summer is an increase in older adults coming into the hospital with falls,” Neal said.
He added that these falls are “often associated with dehydration, heat exhaustion, heat stroke and even the severe after-effects of heat stroke,” a medical term that describes symptoms resulting from a previous injury or illness.
Focusing on his own region, Neal discussed various communities throughout San Diego County, noting that the eastern high desert generally has a lower percentage of homes with central air conditioning.
That’s why, he explained, “if central air conditioning isn’t available, visiting a community center and knowing how to provide cooling relief” is a key step in mitigating the threat that extreme heat poses to older Americans.
“It’s easy to say, ‘Buy central air conditioning,’ but people everywhere are struggling financially so it’s not a quick fix,” Neal acknowledged.
“One of the biggest and most important things is having access to water and drinking water and staying hydrated,” he said.
Another unique challenge geriatricians like Neale face is the fact that “if you try to teach patients with dementia how to protect themselves from the heat, they’re not going to remember,” he added.
Neal therefore called for awareness at the community level, urging relatives and neighbours to look out for elderly family members who are more susceptible to heatstroke.
For example, he suggested that friends and family check regularly to make sure such individuals are not wandering around their backyards. Neal recalled a recent visit to a dementia patient who had suffered third-degree burns all over his body.
For people who don’t have air conditioning and are often alone during the day, insurance often covers the cost of going to an adult day center that has air conditioning, he added.
Carson de Vries, a doctoral student in social work at the University of Denver, agreed, emphasizing the need to give seniors places to cool off during the day and transportation to get there.
“Heat is very dangerous for everyone, but especially for older people,” she told The Hill in an interview this week.
De Vries, who co-authored a research report last summer that focused on wildfires and older people, urged other local residents to act at a local level as well. She encouraged neighbors and relatives to talk to older people in their community, assess their needs, and consult with caregivers and other experts to consider what actions would be most effective.
In a review published last year in the International Journal of Environmental Research and Public Health, de Vries and his colleagues analyzed 75 studies that focused primarily on the health effects of wildfires, including exposure to smoke and poor air quality, on older adults around the world.
“During wildfires, many people often delay evacuating, increasing the risk of evacuation,” the authors noted.
The analysis found that older adults exposed to natural disasters are more likely to experience “restricted mobility, reduced social support, difficulty maintaining essential health care, and limited access to disaster preparedness information.”
Chronic diseases common among older adults may require special diets or medications that may be difficult to meet in these circumstances, the authors note.
“As a result of these age-related risks, older people are disproportionately affected by natural disasters compared to other age groups,” the researchers added.
Using Hurricane Katrina as an example, the authors found that around 71% of those who died in New Orleans were over the age of 65, even though that age group made up just 15% of the city’s population.
Unlike hurricanes, which usually occur with some warning, “wildfires can start quickly and spread quickly,” de Vries said, at which point seniors may not even notice the fire in the first place or have the means to evacuate, he stressed.
With the growing threat of extreme weather conditions that could require evacuation, the American Heart Association recently published a disaster preparedness guide for seniors. Of the 150 people who died during Hurricane Ian, which struck Florida in 2022, many were seniors who suffered from heart-related issues, power outages, medical equipment failures, or lack of access to care.
Without advance notice that an evacuation may be imminent, disaster victims may not have time to “prepare a package with all of your medicines and daily necessities,” Lindsay Peterson of the University of South Florida said in a statement included in the guidelines.
“A lot of people say, ‘I can’t do it. I’ll just hope for the best,'” she says.
The document’s most important recommendation is to create an evacuation plan that accounts for these additional needs, which could include going to the home of a friend or relative or contacting local emergency agencies to find out what public resources are available.
The guidelines also suggest making copies of all identification, medical records and insurance documents, as well as keeping cash and extra medicines in case an extended evacuation is necessary.
The guidelines urge older Americans to make sure they have generators and enough fuel to keep medical equipment functioning in situations where evacuation is not an emergency but an extended power outage is possible.
The University of Denver’s de Vries said he thinks it will be important for researchers to also start talking to members of this unique population themselves.
“There’s a lot of room to engage more with older people and hear directly from them what they need and what would be helpful for them during this time,” she added.
