Addressing the Health Risks of Climate Change in Older Adults

Overview of Climate Science

In October 2018, the United Nation's Intergovernmental Panel on Climate Change (IPCC), comprised of the world's leading climate scientists, issued a sobering report. If greenhouse gas emissions continue at the current rate, Earth's surface temperatures could rise to 2.7°F (1.5°C) above preindus-trial levels by 2030 and this could have catastrophic impacts on human health (IPCC, 2018). Climate change is not something nurses typically think about, but it has the potential to influence the health of older adults in a significant way. As older adults experience changing weather patterns from climate change, gerontological nurses should be asking:

• How does climate change influence the health of older adults?
• How could gerontological nursing practices promote and maintain the health of older adults in relation to climate change?

To answer these questions, it is important for nurses to understand basic climate science and its impact on the older adult population.

There are naturally occurring and human (anthropogenic) factors that contribute to climate change. Naturally occurring factors include changes in the sun's warming energy on Earth (irradiance) and volcanic eruptions that eject sun-blocking particulates into the stratosphere (Mann & Kump, 2015; U.S. Global Change Research Program [USGCRP], 2018). Natural factors, however, cannot explain the recent warming that has been observed. Indeed, between 1951 and 2010, natural factors alone contributed to a slight cooling trend (between −0.18°F and 1.8°F and −0.1°C to 0.1°C) (USGCRP, 2018). The approximate mean 1°C (range = 0.8°C to 1.2°C) of global warming (i.e., the entire observed global warming trend) is attributed to human activity.

Anthropogenic greenhouse gas emissions are the dominant human-caused contribution to observed climate change. The dominant anthropogenic greenhouse gas is carbon dioxide (CO₂), whereas methane (CH₄) plays a secondary but important role, and ozone, nitrous oxide (N₂O), and halocarbons play a tertiary role (USGCRP, 2018). Burning fossil fuels (e.g., coal, gas, oil), agricultural practices, and deforestation are the greatest contributors of the two major greenhouse gases, CO₂ and CH₄. Greenhouse gases become part of Earth's atmosphere and they absorb heat. Atmospheric heat absorption by natural greenhouse gases is helpful to keep Earth habitable (i.e., in the absence of any greenhouse effect, Earth would be a frozen planet). However, when greenhouse gases reach high atmospheric levels, they act as if an extra blanket has been wrapped around Earth and too much heat is held on Earth's surface. Particulates known as aerosols produced by coal-burning and other industrial activities (particularly sulphate aerosols) have a regional cooling effect and have offset some of the greenhouse warming during the past century, but the aerosol cooling has decreased in recent decades, leading to an acceleration of global warming over that time frame.

Increases in atmospheric greenhouse gases have led to a sick Earth with myriad symptoms that affect human health. Unprecedented weather extremes have been seen in the United States in recent decades, including record-strength hurricanes and super storms, floods, droughts, heat waves, and wild-fires. These events are the result of a warmer atmosphere that can hold more moisture, which allows for more extreme precipitation events, including floods and winter blizzards, and stronger, more rainfall-producing hurricanes (Mann & Kump, 2015). The warming of the surface also leads to drying soil and worse drought in many regions. In addition, increasing atmospheric CO₂ has caused the oceans to absorb additional CO₂ and heat. In fact, the oceans have absorbed 55% of the industrial period CO₂ (Mann & Kump, 2015) and 93% of the excess heat energy (USGCRP, 2018), contributing along with the melting of glaciers and ice sheets to sea level rise. Rising sea levels along with more intense land-falling hurricanes have led to the inundation of coastlines. Increasing CO₂ levels have also led to acidification of oceans with decreased marine life and seafood (National Oceanic Atmospheric Administration, 2017). The latitudinal pattern of warming, and in particular Arctic amplification of warming due to melting ice and other feedbacks, may also be favoring stalled, extreme weather patterns. Thus, an extreme rain or snowstorm or heat wave may last many days (Mann, 2019; Mann et al., 2018) (Figure 1).

Figure 1. Human influence on the greenhouse effect. The left side depicts naturally occurring heat absorption that warms Earth by the sun and atmospheric greenhouse gases. The right side shows greater heat trapping that is occurring from increases in anthropogenic greenhouse gases in the atmosphere, thus leading to a warmer planet. From the Fourth National Climate Assessment (access https://nca2014.globalchange.gov/report/appendices/climate-science-supplement/graphics/human-influence-greenhouse-effect) (free to use with credit to original figure source).

What Makes Older Adults Vulnerable to Climate Change Health Threats?

Climate change is an environmental stressor. Vulnerability to climate change, like other health risks, is determined by three elements: exposure, the contact people have with the stressor; sensitivity, the degree to which people are affected by the stressor; and adaptive capacity, the ability of people to adjust to the stressor (Crimmins et al., 2016). Many factors span all three elements; for example, socioeconomic status can impact exposure (poor housing), sensitivity (poor health due to lack of access to health care), and adaptive capacity (inability to afford air conditioning). Vulnerability also operates at individual, community, and national levels, and these levels are inextricably interrelated.

Climate change has a differential impact on subgroups of the population depending on their vulnerability. Older adults have been designated a population of concern because of their heightened vulnerability (Balbus & Malina, 2009; Layva, Beaman, & Davidson, 2017).

Reducing the Health Risks of Climate Change in Older Adults

The climate change being experienced poses risks to older adults' health, but there are actions that nurses can take to mitigate vulnerability. Some actions are short-term interventions that reduce exposure and improve adaptive capacity, whereas others are long-term and focus on eliminating the source of the problem.

There is an urgent need for public education to heighten awareness of the health risks associated with climate change and ways to avoid negative health outcomes (Gamble et al., 2013). Gerontological nurses can leverage their expertise to inform older adults and their families, other health care providers, health facility administrators, community-based organizations, and policy makers of the unique needs of an older adult population. For example, gerontological nurses can address the preparation for and response to extreme weather events within the context of the geographic region (e.g., heat, flooding, wildfires) and older adults' living setting. Ability to access emergency information and early warning systems (e.g., television, radio, phone, internet) should be assessed to determine if older adults are able to protect themselves during and after extreme weather events. Older adults with special needs, such as those with cognitive impairments, mobility issues, or mental health problems, should be identified to local emergency management agencies to ensure they receive necessary evacuation assistance (Balbus & Malina, 2009; Federal Emergency Management Agency, 2006).

Poor air quality from the changing climate and extreme weather events (Fiore, Naik, & Leibensperger, 2015) can negatively influence older adults who already have decreased lung capacity (Miller, 2019). In the past 20 years, pollen season in the United States is earlier and with higher concentrations (Poole et al., 2019). In addition, in higher temperatures, pollen has greater immunoglobulin E binding, thus creating a stronger allergic response (Ahlholm, Helander, & Savolainen, 1998). For this reason, older adults may display new allergy symptoms during pollen season. Nurses should monitor and teach older adults or their caregivers to monitor the air quality index (AQI), which can be found in the newspaper, news radio, Environmental Protection Agency (EPA) website (access https://airnow.gov), or the EPA app AirNow. In rural areas, the air monitoring systems may be further from an older adult's residence. In such cases, decisions for outdoor activities, including transport from care settings, should be made based on the weather conditions and AQI reading in the closest geographical area.

Indoor air quality may be compromised from poor outdoor air quality. Indoor air quality is also influenced by mold. Severe storms and sea level rise have led to floods with the risk of mold in homes and care facilities. Health impacts of mold spores can range from mild allergic response, such as irritation of the mucus membranes, to long-term impacts, such as cancer or bleeding disorders (Jezak et al., 2016). Older adults are at greater health risk from mold due to weakened immune systems from aging (Miller, 2019). Monitoring ambient (outdoor) air quality can also provide a guide for indoor activities and give an explanation for older adults' physiological response.

During extreme weather events, prevention is paramount. Knowing the risk factors for heat illnesses (e.g., older age, presence of comorbidities, use of certain medications, dehydration) will help nurses identify target populations during heat waves. Older adults should be instructed to increase their fluid intake to at least 2,000 cc even if they are not thirsty; eat smaller, more frequent meals; wear light cotton non-restrictive clothing; limit their physical activity during the hottest hours of the day; and use air conditioning or move to an area where air conditioning is available, such as malls or libraries (Worfolk, 2000). Nurses working in inpatient settings must participate in disaster planning and assure that older adults can transition to a cool environment when discharged or when transported to appointments during heat waves. In addition, assuring plans to manage extreme heat should be part of discharge planning and home care instructions.

Climate change can also cause extremely cold weather. Accidental hypothermia can occur even without severe cold exposure in older adults who have mobility problems, comorbidities that interfere with heat production or impair thermoregulation (e.g., hypothyroidism, diabetes, stroke, acute illnesses), or are using medications that interfere with thermoregulation (e.g., tranquilizers, sedative/hypnotics, antidepressants, vasodilators). During cold periods, older adults should be instructed to dress warmly, layer clothing with high insulation value (avoid polyester), wear a hat indoors to prevent heat loss, and take advantage of fuel assistance programs in the community (Worfolk, 2000).

Implications for Practice, Research, and Policy

There is a growing body of evidence on the impact of climate change on health and the health of older adults. The current article seeks to help nurses understand climate change and the need for specific interventions that support adaptation for the older adult population. Climate change is a direct threat to the health of older adults and there are interventions that can be implemented individually and collectively by nurses to lessen the burden for older adults. Older adults are particularly vulnerable to cardiovascular, respiratory, heat, and dehydration issues. Climate change requires a response that includes not just nursing but also government, communities, health care systems, society, and the world as a whole. There is much more work to be done; hence, the following research, practice, and policy agenda is proposed for nurses and health care leaders to consider in addressing climate change (Table 1).

Table 1: Research, Practice, and Policy Agenda for Climate Change

Recent studies have addressed the issue of nurses and climate change (Cook, Demorest, & Schenk, 2019); however, the current article is one of the first to identify practice, research, and policy issues for climate change in older adults. Nurses play an important role in policy and practice in being aware of and educating others on the threat of climate change on the health of older adults, taking steps to lessen the harm and burden to older adults, altering their own behavior to slow the trajectory of climate change, being active in societal efforts to address climate changes, and being aware of steps to take within their own practice or health care system to reduce their pollution and waste and conserve energy. Nurses can design and participate in research to better document and measure the harm and impact of climate change on older adults and can advocate for policies that support older adults in disasters or extreme weather events. Nurses can also join or learn more about organizations that are resources for education about climate change, address best practices for health care organizations, and share sustainable practices within their own communities and with older adults (Table 2).

Table 2: Resources and Websites to Learn More About Climate Change and Health

Conclusion

It is everyone's responsibility to learn about climate change and participate in slowing the trajectory of climate change. Gerontological nurses are in an important position to lessen the harm of climate change in older adults in practice, research, and policy.