By now, many people understand that extreme weather – such as poor air quality caused by wildfire smoke or severe heat – affects people’s health as well as the environment, especially for vulnerable populations like the elderly.
But Sunnybrook’s Dr. Susan Deering wanted to learn more. The family physician, who specializes in elder care, set out to better understand the health impacts of climate change on older patients and what can be done to mitigate the risks.
“Since I work with seniors this was a really interesting place for me to dig in and explore the ideas being exchanged in this space,” says Dr. Deering, physician lead for Sunnybrook’s division of long term care.
Dr. Deering writes about some of those ideas in a recent article for the journal Canadian Family Physician. Given an aging population and global warming, she writes that doctors and health systems should “work together toward solutions that will help the most vulnerable among us adapt to climate change.”
How does climate change impact the elderly differently?
Our bodies go through many changes as we age, including the ability to sense and respond to shifts in temperature – what is known as thermoregulation.
“We all know seniors who always wear a sweater, even when it’s hot outside, because they constantly feel cold,” Dr. Deering says.
A decreased ability to thermoregulate makes it harder for seniors to adjust to even slightly warmer temperatures, let alone heat waves. Other changes that occur as part of the natural aging process add to the challenge.
“We don’t sweat as much as we get older and the blood flow to the skin decreases, so those cooling mechanisms that our bodies use when it’s hot are not there,” Dr. Deering explains.
In addition, older individuals are often on medication for conditions such as high blood pressure, congestive heart failure or dementia. Warmer temperatures can impact the potency or negative side effects of such medications unless the patient is increasing their fluid intake to compensate – something that seniors often find difficult to do.
Not drinking enough during warm temperatures can also lead to dehydration more quickly with older adults, Dr. Deering adds.
“They can compensate for a while but there’s a point beyond which things turn sour quickly, whether with confusion or disorientation or loss of consciousness.”
When it comes to dealing with poor air quality, older people’s lungs are at a disadvantage too.
“The cumulative effects of sickness like pneumonia or exposure to air pollution throughout our lives make our lungs less resilient as we age,” says Dr. Deering.
Lessons learned from experience
On top of being a clinician, Dr. Deering is an assistant professor at the University of Toronto’s Temerty Faculty of Medicine and is completing her Master of Public Health at U of T’s Dalla Lana School of Public Health.
She points to a growing body of evidence on the health impacts of climate change on older individuals – including Canada’s experience with the ‘heat dome’ in British Columbia in the summer of 2021. Analysis by the B.C. Coroner’s Service found that most of the 619 people who died following the extreme heat event were older adults with chronic diseases who lived alone. Dr. Deering describes those findings as “startling”.
Even without a heat wave outside, older adults can experience negative health effects when indoor temperatures rise. Research from the Netherlands and Germany found the elderly experienced symptoms like thirst, sleep disruption and slower physical function when indoor temperatures increased.
What can be done to help?
Ensuring older people have access to air conditioning and other ways to stay cool when it’s hot, and that they drink plenty of fluids, are crucial to avoiding heat-related illness.
Dr. Deering hopes to see other preventive measures adopted as well. She suggests primary healthcare providers take the time to educate their senior patients about the health impacts of heat before it becomes an issue in order to build up their resilience.
“Just beginning the conversation early with patients is a great place to start,” Dr. Deering says.
“When you have seniors come into your office in March or April, ask them if they have a plan to stay cool in case there is a summer heat wave, ask if they have social contacts who can check on them, and review their medications to see which ones might increase their risk of harm when it’s really hot.”
Public health campaigns and community programs to assist the elderly during extreme heat could also play an important role, Dr. Deering says. For people who are caring for at-risk seniors or responsible for checking in on them during hot temperatures, she says online tools like the one created by the National Collaborating Centre for Environmental Health are a useful guide for how to recognize and respond to heat-related illness.
Still, Dr. Deering believes primary care physicians are uniquely positioned to help seniors stay healthy amid climate change.
“People might ignore or miss a public health announcement, but they tend to trust and listen to their family doctor,” she says.
Whether it’s smoggy skies from raging wildfires or extreme heat events, Dr. Deering says acknowledging that climate change is also a health issue is essential.
“If we are going to get people moving on doing something about climate change, we have to recognize that the impact on our health is significant.”
