Suellen Breakey, PhD. Distinguished Teaching Associate Professor; Associate Director, Center for Climate Change, Climate Justice, and Health; School of Nursing, MGH Institute of Health Professions, Boston, MA.
Kathryn Kieran, MSN, PMHNP-BC. Instructor, School of Nursing, MGH Institute of Health Professions.
Patrice K. Nicholas, DNSc, DHL (Hon).Distinguished Teaching Professor; Director, Center for Climate Change, Climate Justice, and Health; School of Nursing, MGH Institute of Health Professions, Boston, MA.
Dr. Breakey, Ms. Kieran, and Dr. Nicholas have no financial relationships with companies related to this material.
The impacts of climate change can be direct and immediate (eg, extreme heat), indirect in the short term (eg, floods, hurricanes, wildfires), or indirect in the long term (eg, prolonged drought, rising sea levels) (Cianconi P et al, Front Psychiatry 2020;11:74). Older adults more vulnerable to the effects of climate change include those with low socioeconomic status or who are experiencing homelessness, as well as racially and ethnically minoritized populations (Morello-Frosch R and Obasogie OK, N Engl J Med 2023;388(10):943–949). Clinicians working with older patients should be particularly aware of risks from high ambient temperature and air quality.
High ambient temperature Consider heat-related illnesses in older patients, particularly those living in elder care facilities without air conditioning, where high temperatures can affect mental health outcomes. Older adults with preexisting mental illness experience more emergency department visits during times of extreme temperatures (Liu J et al, Environ Int 2021;153:106533; Nori-Sarma A et al, JAMA Psychiatry 2022;79(4):341–349). Educate patients about the signs and symptoms of overheating, which can be fatal. Additionally, think about medications that can cause heat intolerance, including:
These medications can increase the risk of heat-related illnesses by impairing the body’s ability to sweat, regulate temperature, dissipate heat, or maintain hydration and electrolyte levels. If symptoms of heat intolerance align with the start of a new medication or a change in dosage, the medication could be contributing to the problem. In these cases, consider adjusting the dose, switching to an alternative with fewer thermoregulatory side effects, or discontinuing the medication if appropriate. Sometimes taking the medication at a different time (such as during the cooler part of the day) helps reduce the risk of heat-related symptoms.
Air quality Neurocognitive decline, including dementia, is linked to air pollution (Delgado-Saborit JM et al, Sci Total Environ 2021;757:143734). Poor air quality can worsen chronic pulmonary and cardiovascular diseases and increase a person’s risk for stroke, all of which can contribute to an older adult’s risk for mental illnesses. Older adults with long-term residential exposure to air pollution, especially those from socioeconomically disadvantaged groups, also have increased risk of late-onset depression (Qui X et al, JAMA Netw Open 2023;6(2):e2253668).
Carlat Take: Increasing global temperatures and worsening air pollution are just two reasons why climate change could cause distress for older adults. When climate change emerges as a source of anxiety, delve deeper. Beyond validating your patient’s concerns, try to understand how their anxiety affects their daily functioning. Your goal is to increase their agency and decrease their sense of hopelessness. Help them identify actionable steps, like assembling an emergency kit, staying inside when the air quality is poor, taking a break from the news, or becoming involved in environmental community efforts. Make sure patients and caregivers have at least two weeks of medications on hand in case of extreme weather events.
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