The American Public Health Association (APHA) has outlined four major effects of climate change impacting health: 1) extreme weather events (i.e., floods, storms resulting in electric outages, fires); 2) air quality; 3) rising temperatures; and 4) vector-borne illnesses (i.e., diseases transmitted to humans or other animals through bites or feeding such as mosquitoes, ticks, flies).  These climate change effects pose major threats to both healthy and vulnerable older adults.

Key Threats to Older Adults:

1. Extreme weather events: Older adults are at risk due to limited mobility, chronic conditions, and compromised immune systems.

• Floods: compromised immune systems can lead to higher risk of diseases, particularly gastrointestinal illnesses from untreated and contaminated water; or respiratory illnesses due to mold or bacteria from water damage.
• Fires: limited mobility results in increased mortality during house fires. Fires can also lead to an increased risk of exacerbation of chronic respiratory diseases due to smoke particles. Alzheimer’s disease and other forms of dementia may result in challenging behaviors or inability to recognize risk and increasing mortality.
• Severe storms with electrical outages:  may lead to increased falls and loss of food in those struggling with food insecurity, inability to cool homes or to run critical health devices (e.g., CPAP, home oxygen, nebulizers, refrigeration for some medications).

Mitigation strategies include:

• Fostering strong social connections
• Installing automatic sprinklers in homes
• Drinking filtered or bottled water
• Preparing an emergency kit and “to go” bag
• Locating food pantries
• Developing safety plans (people who will check-in, knowing safe locations in an emergency)

2. Air quality: Older adults are at increased risk due to prevalent pulmonary and cardiac conditions.

• Poor air quality, especially due to particulate matter from fires and smoke, leads to increased COPD exacerbations, asthma attacks, and chronic bronchitis.
• Small air particles (particulate matter with a diameter of 2.5 micrometers or less - PM2.5) result in deposition and “hardening” of blood vessels, increasing cardiac and cerebrovascular disease.
• PM2.5 is also associated with the development of dementia, which is thought to be due to these particles entering the circulatory system and weakening the blood-brain barrier.

Mitigation strategies include:

• Stay informed about air quality - avoid exertion outside when Air Quality Index (AQI) is 101-150; avoid being outside entirely when AQI is > 201
• Check AQI for your zip code https://www.airnow.gov/  
• Wear a mask if needing to go outside when AQI is poor
• Purchase (or build your own using a box fan and air filters) and use an in-home air filter

3. Rising Temperatures: Older adults are at risk due to decreased ability to thermoregulate, increased chronic health conditions, and high-risk medication use.

• Heat stroke and heat exhaustion are risks from exposure to higher temperatures and can be deadly if not treated. Heat exhaustion can also result in delirium which may delay treatment due to inability to self-manage the condition.
• Heat can aggravate chronic conditions (e.g., diabetes, kidney disease, heart disease).
• High Risk medications include:
  • Anti-hypertensive medications (e.g., diuretics, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers) may cause volume depletion and hypotension.
  • Mental health medications (e.g., selective serotonergic reuptake inhibitors, tricyclic antidepressants, antipsychotics) may impair sweating and central thermoregulation, causing orthostatic hypotension, sedation, and cognitive impairment.
  • Parkinson’s disease medications (e.g., anticholinergic medications) may impair sweating and central thermoregulation.
  • Cardiac medications (e.g., aspirin, clopidogrel, nitrates, calcium channel blockers, beta blockers) may reduce cardiac output and cause blood vessel dilation with a subsequent inability to dissipate heat; or cause hypotension and electrolyte imbalances.
  • Antiseizure medications (e.g., topiramate, carbamazepine, oxcarbazepine) may decrease sweating and increase urination.

Mitigation strategies include:

• Education and awareness of heat index
• Increased hydration
• Locate and promote cooling centers
• Foster strong social connections
• Safety planning

4. Vector-borne illness: Older adults are at risk due to compromised immune systems and decreased mobility.

• Compromised immune systems in older adults lead to increased risk for severe infections
• Lower flexibility or decreased vision while checking for ticks or insect bites

Mitigation strategies:

• Awareness of public health department warnings when increased vector activity
• Daily skin examination during warm weather or high tick activity
• Application of insect spray to prevent bites
• Wearing protective clothing (e.g., long sleeve shirts, long pants)