IN 2015, an estimated 8.5% ofthe world’s population was 65years and older; that number is expected to double by 2050and total 1.6 billion people.The World Health Assemblyhas named 2020-2030 as thedecade of healthy aging, andthe World Health Organizationis developing a framework forhelping people live long andhappy lives by focusing on in-dividuals’ functional abilitiesand their physical and socialenvironments.

The aging in population isoccurring as the effects of cli-mate change are increasing.(See Impact of climate changeon human health.) For exam-ple, heat waves have includeddeath tolls in the thousands(Europe, 2003, 71,310; Russia,2010, 55,736; Europe, 2006,3,418; India, 1998, 2,541 and2015, 1,826+) that dispropor-tionately affected older adults.Nurses must understand theconnection between global en-vironmental changes and older

Preparing older citizens for global climate change

Collaborate and advocate to meet patient needs andimplement policy change.

By Margarete L. Zalon, PhD, RN, ACNS-BC, FAAN

Environmental risks to health include weather (temperature extremes, storms, floods, wild-fires, tornadoes, cyclones), exacerbated vector-borne disease, compromised agriculture(poor soil and food quality, plant diseases), compromised water quality, and decreased hab-itability of population centers because of sea-level rise, air pollution, violence, and conflict.

Populations vulnerable to climate change include anyone living within or near areas:• where endemic disease is associated with weather conditions• with combined climate effects and limited food and water supply• with current environmental and socioeconomic stresses with little capacity to adapt.

Source: Centers for Disease Control and Prevention. Climate effects on health. 2014. cdc.gov/climateandhealth/effects

Impact of climate change on human health

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adults’ health. Current environmen-tal trends require vigilance and spe-cific strategies to protect the healthof this vulnerable population.

Aging and climate changeHealthcare systems aren’t preparedto address the coming impact ofclimate change and the needs ofolder citizens, who are at risk ofhigh rates of chronic disease, limit-ed access to healthcare and med-ication during a crisis, respiratorydistress during temperature increas-es, poor diet and nutrition, reducedaccess to water, and higher povertyrates in some settings. In addition,during a climate crisis, older adults(even those with limited access tofood and water distribution cen-ters) may give their meager sup-plies to family members.

A 2018 study by Kishore and col-leagues of Hurricane Maria’s after-

Adaptive strategies aim to reduce the impact of global climate change on health.

Category Implementation strategies

Built environment Home weatherization, district heating and cooling systems (centralized distribution of heating and cooling through an insulated pipe network), home energy assistance for low- income households, sidewalk plowing, coniferous tree planting, shade shelters

Community services Warming centers, emergency services, monitoring (water levels, temperature, fire, flooding, air quality), public health surveillance for disease outbreaks, registries for vulnerable elderly, early-warning systems, community evacuation plans, insect control

Protective policies Standards and policies for outdoor worker hours and clothing, preventive health services, water resource management, sanitation

Education Safe activity guidance during inclement weather, nutritional and hydration recommendations, disaster preparedness, community agency resources

Sources: Conlon et al. 2011; Patz et al. 2014.

Adaptive strategies for secondary prevention efforts

Raise awareness about older adults’ vulnerability to the effects of climate change by recommending these self-assessment tools.Print out the information for patients who don’t have access to the internet.

Organization Resource Website

American Association of Diabetes emergency preparedness diabeteseducator.org/living-with-diabetes/disaster-preparednessDiabetes Educators

American Red Cross Disaster preparedness for seniors redcross.org/images/MEDIA_CustomProductCatalog/m4640086_ by seniors Disaster_Preparedness_for_Srs-English.revised_7-09.pdf

Centers for Disease Emergency preparedness for cdc.gov/aging/emergencyControl and Prevention older adults

Environmental Protection Climate change and extreme heat: epa.gov/sites/production/files/2016-10/documents/Agency what you can do to prepare extreme-heat-guidebook.pdf

ReliefWeb Humanitarian inclusion standards https://reliefweb.int/report/world/humanitarian-inclusion- for older people and people with standards-older-people-and-people-disabilities disabilities

National Oceanic and U.S. climate resilience toolkit toolkit.climate.govAtmospheric Administration

United Nations Climate change toolkit unhabitat.org/books/climate-change-toolkit

United States Department Primary protection: enhancing toolkit.climate.gov/sites/default/files/SCRHCFI%20Best%20of Health and Human health care resilience for a Practices%20Report%20final2%202014%20Web.pdfServices changing climate

Resources for older adults

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math in Puerto Rico indicated thatthere were 4,645 more deaths thanwould ordinarily have been expect-ed during that time period and thatthis number was most likely under-estimated. The median age of thosewho left and didn’t return or weremissing was 25 years, compared to 50years for those who died or stayed;one-third of deaths were related todelayed or interrupted healthcare.Disruption to healthcare servicesincluded inaccessible medications(14.4%), loss of electrically poweredrespiratory services (9.5%), closedhealthcare facilities (8.6%), absentphysicians (6.1%), and inability toreach 911 services (8.8%).

Common physiologic changesassociated with aging make olderadults particularly vulnerable tothe effects of global climate change.These changes include reducedability to regulate body tempera-ture, changes in sweating, reducedsense of thirst and awareness ofdehydration, decreased cardiac re-serve, decreased respiratory mus-cle strength and vital capacity, decreased immune response, re-duced mobility, and cognitivechanges. The potential for a rangeof climate effects on older adultsis broad and complex and includestemperature extremes, vector-borneillnesses, storms, financial loss, ex-tended allergy seasons, pollution,and disasters. For example, ex-treme heat may result in heatstrokeand extreme cold may lead to hy-pothermia.

Older adults’ vulnerabilities toclimate change are exacerbated bypoverty, polypharmacy (or extend-ed lack of access to medication),and limited social networks.

Social impact of climate changeOlder adults also face social risksassociated with aging, includingisolation, lack of family or socialsupport, and poverty. Women livingalone are most at risk. Older adultsmay be left behind in war zonesand face the risk for violence and

injuries. Social inequalities are exac-erbated in the presence of environ-mental stressors. Various environ-mental, behavioral, lifestyle, andsocioeconomic effects interact.

Mitigation and adaptivestrategies Addressing older citizens’ needs re-quires an approach that includes mit-igation and adaptation.

Share these adaptive strategies to help patients reduce the effects of extremetemperatures.

Strategies to prevent heatstroke Strategies to prevent hypothermia

Stay out of the sun. Set heat at 68° F to 70° F. Close off rooms not in use.

Remain in a cool place; air-conditioned Keep blinds and curtains closed. Use caulkis preferable. or weather stripping around windows.

Drink fluids but avoid caffeine and Dress warmly even if staying home; wear alcohol. a cap or hat.

Shower, bathe, or sponge with cool water. Put blanket over legs and wear socks and slippers.

Lie down or rest in a cool place. Wear long underwear under pajamas.

Keep blinds and shades drawn during Limit or eliminate alcohol.hot times of the day.

Spend time during mid-day in a place Ask family or friends to check in.with air-conditioning (movie theater, mall, senior center).

Avoid crowds. Dress warmly when going out.

Limit outdoor exercise during hot Change clothes if they become damp or weather. wet.

Sources: Adapted from National Institute on Aging. Hot weather safety for older adults. 2016.nia.nih.gov/health/hot-weather-safety-older-adults; National Institute on Aging. Cold weather safety for olderadults. 2018. nia.nih.gov/health/cold-weather-safety-older-adults

Adaptive strategies for extreme temperatures

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Mitigation strategies focus onreducing the underlying causes ofglobal challenges to health by re-ducing human contributions to thegreenhouse effect. Because thehealthcare sector also contributesto greenhouse emissions, effortsshould be extended to decreasinghealthcare facilities’ carbon foot-print, decreasing the amount oftravel needed to obtain healthcareservices or medication, reducingmedical waste, and expandinggreen space in cities where moreheat is generated. Several groupsprovide tools and guidance in ad-vocating for mitigation strategies.Health Care Without Harm (no-harm.org) has a global focus, andHelpAge (helpage.org) focuses onstrategies to ensure that older peo-ple’s rights are addressed.

Adaptive strategies focus on sec-ondary prevention to reduce the im-pact of global climate change onhealth. They address built environ-ment, community services, protec-tive policies, and education for oldercitizens and their caregivers. Olderadults may have limited ability toadapt to global climate changes, sothey may need additional services toassist with implementing adaptivestrategies. (See Adaptive strategiesfor secondary prevention efforts.)

Nursing actionsNurses have a long history of fo-cusing on the environment when

implementing health-promotionstrategies. You can play an integralrole at several levels: in your ownfamily, through direct patient care,and in your communities and be-yond to prevent health marginaliza-tion and deterioration in vulnerableolder citizens.

Assess and recommendMuch of the data and publicityabout the risks of climate changeand the elderly are focused on mor-tality, but weather extremes have animpact on older adults’ day-to-daylives. You can help older adults pre-pare for and manage mobility re-strictions and social isolation thatmay occur. Think about the specificeffects that older adults are likely toexperience in your own community(winter storms, heat waves, hurri-canes, tornadoes, flooding, air pol-lution, wildfires) and consider howthey might restrict normal daily ac-

tivities. Start with a needs assess-ment of vulnerable adults withinyour own family and use the resultsto develop recommendations forthose in your practice. Focus on in-dividual capacity; relationships withfamily, friends, and the community;and the community’s infrastructure.

Encourage older adults to con-duct a self-assessment with one ofthe many available online toolkits.(See Resources for older adults.)Completing an assessment can con-tribute to raising risk awareness forolder adults who don’t considerthemselves to be susceptible to theeffects of climate change. Some ofthe most vulnerable older adultsmay not have access to or the abili-ty to use internet resources, so down -load these toolkits and review keyfeatures of preparedness with them.

Advocate and volunteerBe an advocate within your health-care organization and communityfor policy changes that include im-plementing climate change mitiga-tion and adaptation strategies. Takemeasures to ensure that older pa-tients are well-informed about cli-mate risks to health, and workwith your organization’s leadershipto include pertinent questions onhealth histories, post visible sig-nage about climate change healthrisks, and share written literature.(See Adaptive strategies for extremetemperatures.)

Serve as a champion to addressneeded changes in the built envi-ronment, planning for communityservices, and advocating for theimplementation of policies that pro-tect workers, including older adults.And serve as an early-warning sys-tem by alerting public health offi-cials when you see unusual changesin patterns of illness that might beattributed to climate (for example,increased respiratory illnesses in thesummer months). From a broaderpolicy perspective, you’re ideallypositioned to examine the socialservice infrastructure available in

Find out how you can advocate for policies and strategies that reduce the im-pact of climate change on older citizens’ health.

Organization Website

Alliance of Nurses for Healthy envirn.orgEnvironments

American Nurses Association nursingworld.org/practice-policy/advocacy/

Elders Climate Action eldersclimateaction.org

Health Care Without Harm noharm.org

World Health Organization: Climate who.int/globalchange/resources/toolkit/en/Change and Human Health

Advocacy resources

Weather extremes

have an impact on

older adults’ day-to-

day lives because of

mobility restrictions

and social isolation.

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your community. For example, doescommunity have a heat wave re-sponse plan? Learn about the param-eters for its activation, the mediacommunication plan, daily checksfor at-risk older adults, transportationto climate-controlled community cen-ters, and the preparation of emer-gency and urgent care center staff.

Volunteer with local social serv-ice or government agencies toserve as a responder during a dis-aster. At a more macro level, youcan participate in efforts to addresspolicy implications of global cli-mate change (for example, advo-cating for a national smoke healthwarning system and emergencyservices for at-risk older adults).You also can work to implementpolicies to lift restrictions on pre-scription refills in the face of animpending emergency or partici-pate in developing a plan to ad-dress extreme heat or cold events.Identifying the potential stumbling

blocks that older adults may facein an emergency will facilitate pre-paredness and enhance safety.

Partner with older adults and oth-ers by joining advocacy groups toadopt climate mitigation strategies inyour community. Advocacy groupscan include diverse stakeholderssuch as nurses’ organizations (e.g.,state nurses associations, special in-terest groups), healthcare profession-al groups, elder advocacy groups,single-issue groups, and local andnational environmental organizations.(See Advocacy resources.)

Deliberate effort, meaningfulchangeAccording to the 2015 LancetCommission report on Health andClimate Change, responding to cli-mate change could be the “great-est global health opportunity ofthe 21st century.” That response,when caring for older adults, re-quires a concerted collaborativeeffort that begins with addressingindividual patients’ needs. Advo-cate for thoughtful planning andimplementation of mitigation andadaptive strategies to meet theneeds of this vulnerable popula-tion. And engage in deliberate ef-forts to institute meaningful policychanges to ensure a sustained re-sponse.

Margarete L. Zalon is professor of nursing and direc-tor of the online MS in health informatics program atthe University of Scranton in Scranton, Pennsylvania.

Visit americannursetoday.com/?p=55348 for alist of selected references.

Encourage older

adults to conduct a

self-assessmentwith one of the many

available online

toolkits.