Education and Impact: Climate Change and Elderly Health

My patients all have one thing in common — they are above the age of 64. My partners and I cater our practice to our aging population, all—if not most—of them enrolled in Medicare. There are a few things that I appreciate my patients for, but chief among them are the stories of what was before. Recently, a patient mentioned a local sledding spot in nearby Kettering, OH.  There used to be enough snowfall to bring out my patient’s cross-country skis. Years later, the skis are lost in the garage, collecting dust. My patient’s lament touched on something increasingly undeniable: the climate is changing. While we as physicians are skilled in teaching our patients about their ailments, I fear that our patients know little about how the ills of our planet and the environment come back to affect them.  

Since graduating residency, my first encounter with climate-related illness as a physician came in the summer of 2023. Just as pictures of red skies over New York and blankets of haze covering the Northeastern U.S. came in through the TV, so did my patients come to the office—afflicted with COPD and asthma exacerbations. Between a past lifetime of smoking and the current Canadian wildfires, patients were filling my schedule, taking me back to the pulmonology rotation I’d had just a few years ago. Mucolytics, inhalers, and glucocorticoids were the orders of the day. There was not much else to do other than to counsel my patients to keep an eye on the air quality forecasts and stay indoors when it was poor, only venturing outside when necessary. If necessary, the N95 masks still ubiquitous from the waning days of a global pandemic could prove useful, as would taking care to change HVAC air filters regularly. This conversation repeated itself for weeks. Unfortunately, weeks like this may be more common as parts of the planet warm—since the 1980s, the acreage of area burned by wildfires each year has increased, with peaks in 2015 and 2020.  

All aspects of health are affected by climate change, from clean air to water and soil to food systems and livelihoods. It will have an impact on our health workforce and infrastructure, reducing capacity to provide universal health coverage; this is not unlike what we’ve seen with runs on our U.S. healthcare system during previous cold/flu/RSV seasons. Climate change is set to disproportionately affect the health of our elderly. With the population of adults aged 65 years and older in the United States expected to double from 2014 numbers by 2060, climate-related illness will be an increasing problem and burden on our health system.  

During Hurricanes Sandy and Katrina, about half of those who died were elderly. This should come as no surprise; the frail who rely on others for transportation are at the mercy of their caregivers for refuge. Those who are unfortunate enough to stay behind face power outages, flooding, and interruptions in utilities. Their misfortunes double if any medical equipment they rely on requires electricity while stranded without power. For the patients who return after the storms have passed, they may have difficulties with access to healthcare should emergencies or needs arise while local healthcare infrastructure is restored.  

Flooding from storms and longer, warmer seasons foster another common health threat: arthropod-borne disease. With warmer winters or standing storm water, breeding conditions are ideal for mosquitoes that can carry and transmit disease. West Nile virus, one of such arboviruses, recently gained national attention as Dr. Anthony Fauci was recently diagnosed with the disease. Severe forms of this disease correlate with compromised immune systems, and many of our elderly count themselves among the immunocompromised. There is evidence climate change has already contributed to an expanded range for ticks. This could put more people at risk of contracting Lyme disease, and adults aged 55–79 already have the highest incidence rates of confirmed and probable cases of Lyme disease in the United States. It is important to make patients aware of state health departments’ efforts in monitoring vector-borne illness, as well as standard precautions to take when outside.

We as physicians have a calling not only to care for our patients, but also to teach. What I have laid out before you is not exhaustive, nor is it necessarily universally applicable. Those in coastal areas, for example, may face different dangers due to their changing climate than those who are in arid or drought-stricken parts of the country. It is left to us, then, to prepare ourselves and our patients for our changing climate.

References:  

Carnes, B. A., Staats, D., & Willcox, B. J. (2013). Impact of climate change on elder health. The Journals of Gerontology Series A, 69(9), 1087–1091. https://doi.org/10.1093/gerona/glt159

Climate change and older adults: Planning ahead to protect your health. (2022, April 21). https://www.ncoa.org/article/climate-change-and-older-adults-planning-ahead-to-protect-your-health/

Climate change and the health of older adults | US EPA. (2024, July 22). US EPA. https://www.epa.gov/climateimpacts/climate-change-and-health-older-adults#:~:text=Climate%20change%20may%20increase%20outdoor,smoke%20and%20dust%20from%20droughts.&text=Air%20pollution%20can%20increase%20the,who%20are%20diabetic%20or%20obese.&text=It%20can%20worsen%20conditions%20like%20asthma%20and%20COPD.

Climate change indicators: Wildfires | US EPA. (2024, July 23). US EPA. https://www.epa.gov/climate-indicators/climate-change-indicators-wildfires#:~:text=The%20extent%20of%20area%20burned,and%202020%20(Figure%202).

WHITEHOUSE: CLIMATE CHANGE IS DRIVING UP HEALTH CARE COSTS, DRAGGING DOWN ECONOMIC GROWTH. (2023, April 24). https://www.budget.senate.gov/chairman/newsroom/press/whitehouse-climate-change-is-driving-up-health-care-costs-dragging-down-economic-growth

World Health Organization: WHO. (2023, October 12). Climate change. https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health