Climate Change and the Elderly

Issue Summary
Recommendations for Local Governments
Federal Response
State Responses
Local & Tribal Responses
Resources

Issue Summary

Individuals over the age of 65 face unique health and social obstacles which may impact their ability to prepare for and recover from the hazardous impacts of climate change. As people age, they are more likely to develop a variety of chronic conditions–like congestive heart failure, chronic obstructive pulmonary disease (COPD), and diabetes–or be prescribed medications which can impair the body's natural ability to respond to environmental stressors, such as high temperatures. Many senior citizens taking medications are less capable of naturally regulating body temperature, leading to increased susceptibility to heat stroke and heart failure. 

Climate change is anticipated to exacerbate environmental factors already disproportionately impacting the elderly. The EPA reported that, should global temperatures rise an average of 2°C, there would be an estimated annual increase of approximately 2,100 premature deaths in U.S. adults over the age of 65. When the model is adjusted for a 4°C change, that figure increases to 5,800 deaths. Local governments can invest in adaptation strategies to reduce the risks their senior citizens face. 

Specific Climate Effects 

Extreme heat events: Local power grids are often disrupted as demand for electricity to power air conditioning units increases. This can leave mobility-impaired individuals who are vulnerable to high temperatures stuck indoors with no means of cooling off or powering necessary medical equipment. For physically handicapped or otherwise homebound seniors, heat related deaths can be partially attributed to poor social infrastructure. Immigrant seniors face increased social isolation due to language and cultural barriers, leading to increased risk of death or injury during extreme weather events.

Degraded air quality: Increased average temperatures and frequency of heatwaves increases wildfire frequency and ground-level ozone production. The resulting air pollutants–like fine particulate matter from forest fires or ozone–can exacerbate both cardiac and respiratory conditions in older Americans. For individuals with decreased respiratory capacity due to COPD, asthma, or emphysema, severe air quality events can prove fatal. This is especially true for elderly individuals who are also diabetic and/or obese. Low -income seniors who qualify for Medicaid are up to 34% more likely to be exposed to air pollutants and their associated health risks.

Severe weather events: Coastal communities have become increasingly popular retirement destinations, and present additional challenges for mobility impaired citizens during severe weather events. Elderly citizens in need of around the clock medical care, those who reside in long term care facilities and those without family are often forced to remain in place during severe storms due to the challenges posed by traveling with medical supplies and equipment. Older Americans face risks such as storm impact, home flooding or power outages which interrupt medical care and air conditioning. Rural elderly populations face challenges to evacuation efforts due to a lack of public transit systems.

Recommendations for Local Governments

Include senior citizens as well as representatives from nursing homes, senior centers and other service organizations in the development of local climate response plans.

• The U.S. Sustainability Directors Network's Guide to Equitable Community-Driven Climate Preparedness Planning provides planners with a framework and tools to develop local climate response plans that work for all communities. The guide encourages officials to engage seniors in climate preparedness planning "to support leadership development and for their unique perspectives."

• The C40 Knowledge Hub's Equity and Inclusivity in Climate Action Planning page contains implementation guides on various aspects of the planning process, including stakeholder engagement and drafting equitability into a climate action plan. Planners can also learn from case studies on ways other municipalities have addressed climate issues affecting specific populations. For example, the C40 page on extreme heat links to a case study detailing efforts in Buenos Aires' to protect senior citizens. 

• Provide cooling, heating or clean air stations during extreme weather events for seniors who are sensitive to extreme temperatures.

• Ensure relief centers are accessible to older residents by utilizing senior centers, and supplement public transit to these centers when in operation.

• Prioritize awareness by publishing maps of centers online as well as through physical post and text alert systems.  

• Consult Heat.gov for additional resources.

Establish social programs designed to address the isolation of elderly Americans prior to, during and subsequent to natural disasters. 

• Smartphone applications like EXTREMA Global and voluntary emergency text services can distribute information to seniors about extreme weather events and community resources available to help.

• Volunteer check-in services, such as New York City's Be a Buddy Program, encourage community members to regularly visit or contact elderly neighbors for wellness checks, especially during extreme weather events.

• Volunteer programs can engage seniors in climate preparedness planning and outreach by training them to be community ambassadors on the topic and present in local schools, libraries, etc. The AmeriCorps Retired and Senior Volunteer Program (RSVP) provides grants to groups which engage Americans aged 55 and older in volunteer services fulfilling critical needs.

Expand energy assistance and resilience programs for senior citizens.

• Establish community energy programs to improve local resiliency and more easily prioritize vulnerable communities when demand for electricity is high. The Department of Energy Guide to Community Energy Strategic Planning offers tools and tips for successful planning efforts.

• Adjust Low Income Home Energy Assistance Program  (LIHEAP) and local energy assistance programs to better assist seniors with medical conditions in paying for cooling costs.

• Provide medically disabled seniors with alternative power supplies, such as traditional or solar generators.

Federal Response

The federal government has not enacted legislation specifically to protect elderly individuals from the harmful effects of climate change, but recent executive action has spurred development of policies and programs prioritizing senior citizens in climate planning.

• Executive Order on Tackling the Climate Crisis at Home and Abroad (Executive Order 14008) takes a government-wide approach to reduce greenhouse gas emissions and increase resilience while addressing equity, conservation and promotion of economic growth.  (Section 222  directs the Secretary of Health and Human Services to lead an interagency task force under the newly formed Office of Climate Change and Health Equity (OCCHE) aimed at exploring ways to decrease the risk that climate change poses to the elderly, alongside children, people with disabilities and other vulnerable groups. 

• Department of Health and Human Services 2021 Climate Adaptation and Resilience Plan (CARP). HHS is developing a climate change and health equity working group, which will update the plan and include representatives from multiple HHS departments, such as the Administration for Community Living, who will, in part, focus on the needs of the elderly. CARP is to be reviewed and updated annually.

• U.S. Department of Housing and Urban Development (HUD) 2021 Climate Action Plan. The Section 202 Supportive Housing for the Elderly program requires above-code building standards with regard to energy efficiency and green building design. 

• 2021 Long Term Care (LTC) Requirements CMS Emergency Preparedness Final Rule. The Center for Medicare and Medicaid Services (CMS) now requires that LTC facilities have a process to engage in collaborative planning with state and local emergency planning authorities, which must be included in its emergency plan. Finalized emergency plans need not receive approval from those local officials, but the plan must be present upon annual inspection. The Final Rule also provides facilities with guidance on what to include in these documents, including plans for evacuation during storm events and alternate power sources to fuel air conditioning and medical devices during extreme heat. 

• FEMA's Public Assistance Program. FEMA provides supplemental federal grant assistance for debris removal, emergency protective measures, and the restoration of disaster-damaged, publicly owned facilities and certain nonprofit facilities. In the event of a major disaster or emergency, hospices, nursing homes, hospitals and related facilities and nonprofit senior centers are considered essential social services and may be eligible for program financing. 

• The National Integrated Heat Health Information System (NIHHIS). Created by NOAA and the CDC, Heat.gov is the web portal for NIHHIS federal partners – the Centers for Disease Control and Prevention, Assistant Secretary for Preparedness and Response, Environmental Protection Agency, Federal Emergency Management Agency, National Institute for Occupational Safety and Health, Department of Veterans Affairs, Forest Service, National Park Service, Department of Health and Human Services, National Institute of Environmental Health Sciences, Occupational Safety and Health Administration, and Substance Abuse and Mental Health Services Administration.

State Responses

Louisiana addresses the needs of mobility-impaired seniors during evacuation and sheltering efforts. The Louisiana Department of Health presentation entitled "Support Coordination and Provider Responsibilities for Emergency Preparedness" outlines health care providers' responsibilities in the case of an emergency or natural disaster, including the specific needs of Adult Day Health Care services. The Department of Health establishes training regimens for health care providers, outlines emergency plan components and provides for agency coordination. Louisiana Admin. Code 48: I.5063.

Florida established Emergency Power Plan Rules to address the threat that storm-related power outages pose to senior care facilities. State regulations were implemented in response to multiple deaths at senior facilities following Hurricane Irma in 2017. The regulations set alternative power supply requirements for assisted living facilities and nursing homes, respectively, during environmental emergencies like hurricanes and floods. Facilities must maintain generators onsite with enough fuel for three days of electricity (two days for small facilities) to power air conditioning and medical equipment.  Local emergency management agencies must approve written plans for keeping ambient temperatures below 81 degrees Fahrenheit for three days using alternate power sources; approved plans are submitted to the state's Agency for Health Care Administration (AHCA), which tracks facilities' compliance through State Fire Marshal inspections and posts statistics on an interactive state map.

New York developed a technology-based approach to addressing social isolation and emergency response for seniors. The New York State Office for the Aging developed a smartphone application called NYS Aging, which connects senior citizens to community emergency response resources, including handbooks and tips for disaster preparedness, provides a map of local cooling centers to use during extreme heat events and connects users to public transit services to aid mobility. The state agency  committed to distributing ten thousand free tablets preloaded with useful apps for seniors living in New York City. The plan prioritizes those living alone without internet-enabled devices to decrease social isolation and provide emergency preparedness resources.

Vermont assists senior care facilities with developing disaster and emergency planning strategies. The Vermont Department of Disabilities, Aging and Independent Living's 2017 report on Emergency Preparedness Planning for Nursing Homes and Residential Care Settings in Vermont informs facilities of best practices and local resources for responding to natural disasters. The plan encourages facilities to (1) incorporate staff members' families and local volunteers into shelter-in-place and evacuation protocol, so as to avoid staffing shortages; (2) develop communication networks with facilities providing similar care to residents outside their region to ensure that senior care facilities have a back-up location(s) where they can transport residents for short-term housing; and (3) make agreements–on top of established transit contracts–with other care facilities and faith-based organizations to ensure a sufficient number of vehicles are available for evacuation efforts.

Missouri's Department of Health & Senior Services (DHSS) operates a Hyperthermia Hotline which allows citizens to call and report an elderly resident who they believe may be at risk due to neglect or isolation during severe weather events.  Agents from the DHSS investigate the claims and reach out to these vulnerable individuals regarding available community resources. The Missouri DHSS also maintains a map of cooling and warming centers on their website for reference during extreme heat/cold events. The state created the Ready in 3 Toolkit to help seniors prepare for disasters by providing them with resources on: (1) creating multiple plans for different situations (e.g., evacuation vs. staying home); (2) preparing an emergency kit; and (3) listening for information from city, county, and state officials.

Local & Tribal Responses

Oakland, California piloted several initiatives aimed at including seniors in climate planning.  The Senior Companion Program prioritizes the inclusion of aging residents into urban social networks, countering isolation for mobility-impaired seniors and providing services such as wellness checks during extreme heat events and transit coordination, which may prove useful for evacuation efforts. The city adopted two climate action plans which emphasize equity and included input from relevant stakeholder groups. The 2020 Equitable Climate Action Plan (ECAP) aims to supplement existing central transit routes with shuttles that service neighborhoods housing increased concentrations of elderly individuals and commits to cooperation with East Bay Community Energy (EBCE) to enhance community energy resilience by installing renewable energy projects with onsite energy storage and islanding capabilities; seniors are a targeted service population due to their heightened sensitivity to extreme weather events. The 2021 Hazard Mitigation Plan (HMP) solicited input from the Oakland Aging and Adult Services Manager and the Mayor's Commission on Aging; the HMP includes the protection of senior citizens as one of its key objectives.

Karuk Tribe – Northern California addresses the unique challenges faced by rural elders during extreme weather events, such as extreme heat, wildfires, and road closures due to storms. The 2019 Climate Adaptation Plan emphasizes the need to modernize home cooling systems by expanding energy assistance programs, notes that the Tribal government has provided all elders in the village of Orleans with backup generators to power air purifiers/conditioners and medical equipment and states that the Tribe will continue to maintain air purifiers in all tribal housing units. The 2015 Hazard Mitigation Plan commits the tribal government to providing elders with air purifiers during periods of decreased air quality, reports that the Tribe purchased Emergency Preparedness Kits for elders using state grant funds and outlines a program managed by the Karuk Department of Emergency Management which provided clean air and evacuation centers for vulnerable individuals (discontinued). Both documents outline plans to use the Karuk Senior Nutrition Centers as heating, cooling and clean air centers. Placing these emergency resources in locations which already prioritize senior accessibility will facilitate and encourage participation.

New York City, New York released the "Cool Neighborhoods NYC" report in 2017 outlining a new program aimed at minimizing the threat extreme heat poses to vulnerable communities by increasing social cohesion through two strategies. The first is utilizing existing relationships between elderly citizens and state certified home health aides. The city partnered with local home healthcare agencies to develop modules on heat-health to be included in the standard training curriculum. The second is investing $930,000 to launch the two-year pilot Be a Buddy NYC program. Volunteer "buddies" establish relationships with senior neighbors, provide resources related to climate and community preparedness, and provide welfare checks during severe weather. Training is provided to existing community-based organizations on the basics of heat-health and how to form their own buddy systems. This project continues as The Hunts Point – Longwood Be A Buddy (BaB) program, led by THE POINT CDC, in partnership with the Mayor's Office of Resiliency, NYC Department of Health and Mental Hygiene (DOHMH) and the Fund for Public Health NY (FDPNY).

Nome Eskimo Community (NEC) – Nome, Alaska. The Nome Tribal Climate Adaptation Plan (2017) prioritizes community-based solutions to climate related issues, including food insecurity, and emphasizes the need to include elders and their traditional knowledge into the framework of adaptation. The Plan calls upon elders to conduct workshops at local schools on traditional knowledge of local weather patterns and the changes which elders have observed over time. This provides youth with knowledge of changing weather patterns will facilitate necessary adaptations to traditional hunting and food preservation practices. Elders also provide community workshops on traditional food preservation practices–like drying, canning, seal oil, and salting–that are less energy intensive than electric freezers. Such programs weave elders into the social network while also decreasing local energy usage and promoting long term food security.

Austin, Texas. The citizen steering committee which oversaw development of Austin's 2020-2021 Climate Equity Plan  met with the Commission on Seniors to address specific needs the elderly face due to climate change's immediate and long-term effects. This includes expanding access to public transit systems for communities protected by the Americans with Disabilities Act (ADA) to aid mobility to cooling centers and during evacuation events. The Plan aims to accomplish this by creating new transit stops and walkways near senior facilities and updating existing infrastructure to be more accessible for disabled pedestrians. The Plan also includes expansion of current repair programs for affordable housing and multi-family units serving residents most in need, including elderly individuals. This program would help repair buildings damaged by climate change related events, like heavy storms, and make structures more resilient to events such as flooding and extreme heat.

San Francisco, California convened an Age and Disability Friendly Workgroup to provide feedback on how the draft Hazards and Climate Resilience Plan (HCR) (2020) could better incorporate their respective communities' needs into response plans. The Department of Aging and Adult Services (DAAS) was tasked with developing evacuation plans for people with access and functional needs, including the elderly, in cooperation with bodies like the Age and Disability Friendly San Francisco Workgroup. The DAAS "2018-2021 Action Plan for an Age and Disability Friendly San Francisco" commits to developing additional outreach and training programs for seniors, people with disabilities, and their caregivers to learn about disaster preparedness. The HCR also highlights the successful implementation of San Francisco's ongoing Climate and Health Program which sends volunteers on outreach visits to discuss senior heat health. 

Resources

Organizations

AARP. National advocacy group supporting older Americans. Partnered with the World Health Organization to adapt their "Global Age Friendly Cities and Communities" framework and develop the U.S. Network of Age Friendly Communities. 

The National Indian Council on Aging, Inc. (NICOA). A nonprofit organization founded by members of the National Tribal Chairmen's Association to represent the needs of American Indian and Native Alaskan elders. Advocate for improved healthcare, social services and economic opportunity for elders. 

National Institute of Environmental Health Sciences. A division of the National Institute of Health aimed at researching climate change's impacts on human health, including the specific needs of vulnerable communities. 

Antioch University New England Center for Climate Preparedness and Community Resilience. Conducts research on climate change's impacts on public health, including specific vulnerable groups. 

Reports and Articles

Climate Change and Social Vulnerability in the United States (EPA 2021). Report assessing the health impacts four vulnerable communities face as a result of climate change

Nine Populations of Concern (2016). Interagency and university collaboration to assess climate change's impacts on the health of 9 vulnerable populations. Contributors included representatives from the EPA, USGS, CDC, University of Arizona, Michigan State University, University of Oregon, and the University of California, Berkely

Climate Change and the Health of Older Adults (EPA 2016). Policy brief providing an overview of the health and safety disparities seniors face as a result of climate change

Air Pollution and Mortality in the Medicare Population (Harvard T.H. Chan School of Public Health 2017). Article analyzing data collected from Medicare Current Beneficiary Surveys (MCBS) to provide insight on health disparities sub-demographics of elderly citizens (race, income level, etc.) face due to air pollution

Aging in Flood-Prone Coastal Areas: Discerning the Health and Well-Being Risk for Older Residents (2018). National Center for Biotechnology Information (NCBI) article which analyzes the unique challenges faced by seniors living in coastal communities and how to better include them in emergency preparedness planning

WHO Global Age-Friendly Cities Guide. Framework for city development which identifies and addresses barriers to the well-being and participation of older people