The rising frequency and intensity of extreme heat events are exacerbating the health and safety concerns of America's older population — an already vulnerable community, and one that's growing fast.
"We're seeing increasing heat and increasing extremes of heat," said Ian Neel, a geriatrician and an associate professor at the University of California San Diego School of Medicine, at a recent webinar.
"But we're also seeing increasing frequency of older adults, and older adults are one of the more at-risk populations for heat related injuries," he added.
The population of Americans 65 or older ballooned from roughly 40 million to 56 million between 2010 and 2020, and it is projected to grow by another 17 million by the end of this decade. At the same time, temperatures are swelling around the world, shattering heat records and contributing to an increase in wildfires.
Tarik Benmarhnia, an associate professor in climate change epidemiology at UC San Diego's Scripps Institution of Oceanography, described extreme heat as "a huge, silent and sneaky killer."
While prevailing estimates today directly link between 6,000 and 7,000 American deaths to heat each year, Benmarhnia challenged that figure as "only the tip of the iceberg." When considering how extreme heat can also trigger complications in an aging population living with chronic diseases, he said that this number could be as high as 12,000 to 20,000 annual deaths.
Neel, who works predominantly with older adults experiencing advanced dementia, characterized heat as "one of the major things that we see as a huge detriment on patients' health."
"Invariably, what we see every summer, more and more frequently, is an increasing incidence of older adults coming in with falls," Neel said.
Those falls are often "related to dehydration, related to heat exhaustion, heat stroke, as well as serious sequelae of heat stroke," he added, using the medical term for a condition that results from a previous injury or disease.
Zooming in on his own region, Neel discussed the wide range of communities throughout San Diego County — noting that further east in the high desert, there is typically a smaller incidence of central air conditioning in homes.
As such, he explained that "having access to community centers that may have central air if you can't get it, ways to try to mitigate cooling," is an essential step toward alleviating the threats extreme heat poses on older Americans.
"It's easy to say, 'Oh, buy central air,' but people are struggling financially everywhere, so it's just not an easy fix," Neel acknowledged.
"One of the biggest and most important things is to make sure that you have access and that you are drinking water and staying hydrated," he said.
Another unique issue challenging geriatricians like Neel is the fact that they can "try to educate a patient with dementia on how to keep safe in the heat, but they're not going to remember," the physician added.
Neel therefore called for increased awareness on a societal level — encouraging relatives and neighbors to look out for older loved ones who could be prone to heat stroke.
For example, he recommended that friends and family schedule check-ins with these individuals to ensure that they aren't wandering around in the backyard. Neel recalled a recent instance in which he saw a dementia patient with third degree burns all over her body.
For those people who lack air conditioning and who tend to be alone during daylight hours, insurance often funds visits to adult day centers equipped with cooling facilities, he added.
Carson De Fries, a PhD candidate in social work at Denver University, echoed many of these sentiments — stressing the need to provide older adults with places they can cool off during the day — and the transportation to get there.
"Heat is incredibly dangerous to anyone, but especially older adults," she told The Hill in an interview this week.
De Fries, who last summer co-authored a review focused on wildfires and older adults, likewise urged local-level action on the part of other community members. She encouraged neighbors and relatives to speak with older adults in the area, assess what their needs are and perhaps consult with caregivers and other experts about what actions could be most beneficial.
In last year’s review, published in the International Journal of Environmental Research and Public Health, De Fries and her colleagues analyzed 75 studies that mainly focused on the health effects of wildfires — such as smoke exposure and poor air quality — on older adults worldwide.
"Significant numbers of people delay evacuation during a wildfire event, often leading to increased evacuation danger," the authors observed.
When contending with natural disasters, older adults are more prone to "mobility limitations, decreased social supports, difficulty maintaining necessary health regimens and limited access to information about disaster preparedness," according to the analysis.
Chronic conditions, which are more common among older adults, may require specific diets and medicines — needs that can be challenging to fulfill during such events, the authors noted.
"As a result of these age-related risks, older adults are disproportionately negatively impacted by natural disasters when compared to other age groups," they added.
The authors cited Hurricane Katrina as an example — finding that about 71 percent of those who perished were older than 65, even though such individuals made up just 15 percent of the New Orleans population.
Unlike hurricanes, which usually occur with some warning, De Fries noted that "wildfires can start quickly and spread quickly." At that point, older adults may either not be aware of the blaze in the first place or may not have the means to evacuate, she stressed.
Amid the increasing threat of weather conditions so extreme that they warrant evacuation, the American Heart Association recently published a disaster-planning guide for older Americans. During Hurricane Ian in Florida in 2022, many of the 150 individuals who died were older adults who had heart-related issues, power outages, medical device failures or lack of access to care.
Without a heads-up that evacuation may be imminent, affected individuals might not have time "to put a package together with medications and all the things they need on a daily basis,” 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 this. I'm just going to hope for the best,'" she said.
Chief among the document’s recommendations was the creation of an evacuation plan that includes these additional needs. Such a plan could involve going to a friend or relative's home or reaching out to local emergency agencies to learn what public resources might be in place.
The guidelines also suggested copying all personal identification, medical records and insurance documents, as well as setting aside cash and extra medications in case a longer-term evacuation becomes necessary.
During situations in which evacuation isn't critical but lengthy power outages are possible, the guidelines also urged older Americans to acquire a generator — and sufficient fuel — to keep medical devices functioning.
Going forward, De Fries, from Denver University, said she believes it will also be critical for researchers to start speaking with members of this unique population themselves.
"There's a lot of space for working with older adults more and hearing directly from them about what they need and what would be helpful for them during these times," she added.
