From deadly heat waves to smothering wildfire smoke. How nurses need to prepare to help vulnerable older adults.
Dr. Ann Kriebel-Gasparro, is a nursing faculty member at Walden University and president of the Gerontological Advanced Practice Nurses Association. She is dually credentialed as a family and gerontological nurse practitioner and sees elderly home health patients in her clinical practice.
Climate change is not an equal opportunity environmental health crisis.
For older adults, extreme weather and its impact—heat waves, floods, fires, hurricanes, droughts, and cold spells—can put them at significant risk for respiratory, cardiovascular, and psychological harm due to factors like compromised immune systems, dementia, limited mobility, and health conditions.
The warming of the Earth coincides with another trend. By 2030, one-fifth of the country’s population will be over age 65, with the fastest growing segment being ethnic minorities.
The combination of these factors demands an urgent call for nurses to integrate the health effects of climate change into nursing education, policy, and research. It also calls for advocating in favor of policies and practices that prioritize health and safety in a changing climate.
Health Threats Faced by the Elderly
Nurses, other caregivers, and policymakers need to be aware of the effects of extreme weather events and climate-change-related disasters on the elderly.
- Heat Stress and Exhaustion:
- Heatwaves, heat domes, and droughts can lead to poor air quality, which worsens lung conditions in elderly patients with asthma, COPD, and allergies.
- The cardiovascular and renal effects of hotter climates include dehydration, which can lead to kidney failure.
- Older people tend to have decreased thirst and are prone to dehydration on normal temperature days; this is exacerbated on high heat days.
- Certain medications also can put older adults at risk for dehydration and heat-related illnesses.
- Heat stroke is considered a medical emergency and is characterized by a temperature of 104° F, nausea/vomiting, dizziness, confusion, blurry vision, and falling.
- Wildfires:
- Older adults in low-income areas are at a disadvantage during wildfires because of their limited resources to evacuate or relocate to new housing.
- Smoke contributes to respiratory challenges.
- Wildfire ash, which contains hydrocarbons and heavy metals, can pollute the water and land after wildfires.
- Mold: Another harmful effect of climate change is caused by longer rainy seasons and increases in flooding. This can cause overgrowth of indoor and outdoor molds and fungi in buildings. These exacerbate allergies, asthma, emphysema, and COPD, resulting in increased emergency services and hospitalizations.
How to Treat Elderly Patients
Nurses must be knowledgeable about the health effects of climate change events when caring for vulnerable older adults. It is essential for practice that APRNs have the knowledge to evaluate this age group for presentations of heat stress, heat stroke, dehydration, acute kidney injury, and cardiorespiratory illness brought on by extreme temperatures.
Practical steps nurses can take for treating elderly patients in the face of health threats caused by climate change include:
- Learn about infectious diseases that result from exposure to natural disasters.
- Review medications for ones that compound the impact of temperature extremes.
- Assess the living situation of patients. Those on fixed incomes may experience food insecurity and be unable to stock up in case of a disaster. Or their home may be unprepared for a climate-change event.
- Consider telehealth for evaluating older adults so that they don’t need to endure environmental factors to get to appointments.
- Educate elderly patients on the critical need to drink water, even when they are not thirsty. Dehydration is already common in the elderly and can be critical during high temperatures, increasing the risk of urinary tract infections, renal damage, and heat stroke.
Climate Change in Nursing Education
Traditionally, there has been little content in nursing curricula about the health impacts of climate change on the elderly. Now, more than ever, it is essential to weave climate change and its dangerous impact on the health of the elderly into nursing education.
At Walden University, we are already working toward this. My colleagues and I are adding readings from the Alliance of Nurses for Healthy Environments into our gerontology course. Students will share their reflections via the online discussion board and do a grand-rounds style presentation on a climate-change topic of their choice like air quality or water pollution.
There are also opportunities for PhD in Nursing students to develop original research on these topics for their dissertation and for Doctor of Nursing Practice students to create applied projects for their doctoral study.
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