Published On June 13, 2019
WHEN HURRICANE SANDY HIT NEW YORK IN 2012, nearly half of the 52 people who died from the flooding and subsequent loss of services were at least 65 years old. Other weather-related disasters—severe heat waves, flooding and wildfires—also disproportionately affect older people, who may have health problems that make them less resilient than younger patients. As the planet warms, and extreme weather events become more common, the problem will only get worse.
Renee N. Salas, an emergency medicine physician at Massachusetts General Hospital and a researcher at the Harvard Global Health Institute, has begun to look at just how extreme weather events affect the health of older populations and how, in the aftermath, older patients use the health care system. Her research could help hospitals develop targeted interventions to use when disaster strikes.
Q: Why is it important to focus specifically on older patients?
A: For one thing, they are a growing percentage of the population. The number of people older than age 65 is expected to outnumber those under the age of 18, for example, in the near future. So we really need to understand how climate change, and the extreme weather events that come with it, affects their health.
Q: What do we already know about what happens to older patients during extreme weather events?
A: We know that they die more frequently than other populations. For example, during Hurricane Katrina almost half the fatalities were over the age of 75, despite the fact that those in that age group made up only 6% percent of the population.
Why does this happen? We know that older people often have decreased mobility and their social networks can be small, which means that they can be more isolated, which means that they are less likely to get help. These factors combine with other physical issues like decreased hearing or trouble with memory, which probably make them more at risk.
But although we can guess at some connections, the data hasn’t really been systematically analyzed or comprehensively understood. So our goal is to see how the health of older patients is directly affected by extreme weather events, and how these people are then utilizing health care services. We also want to understand the subsequent impacts on cost. So we’re combing through Medicare records in the wake of known disasters to try and tease out some answers.
Q: How do you hope that your research might be used?
A: I hope that it can allow us to develop ways to protect older patients, for example by informing the way we design hospital disaster preparedness plans. When we know where these patients seek care and what kind of injuries they have, we can put supplies and staff at the right time and location. Research like this has to be done so we can allocate scarce resources for the biggest impact.
But first and foremost, I hope that this work can add to the evidence that the climate crisis is truly a public health emergency. It carries costs, both in lives and medical care.
Q: So hospitals and physicians can do more to help older patients. Are there things they can do to help themselves?
A: It’s important for older patients to realize that they may be at higher risk for health harms, and every region has different climate risks. So, ideally, these patients and their families can work with their doctors in helping determine how they’re at greatest risk—whether it be from a wildfire or a hurricane—and how to take preventive steps to try to protect themselves.
If someone has lung disease and lives in a location where there are wildfires, then perhaps that person should minimize being outside, and make sure to have a mask or respirator handy. Others are on medications that can make them more at risk for heat illness or heat stroke, and may not know it. What happens when a power outage disables the air conditioners? They might look into asking their physicians and pharmacists these questions, and pre-emptively changing medications to one that doesn’t put them at that risk.
But they shouldn’t have to think of all of this themselves. Ultimately, it’s on the health care community to understand how a changing climate affects patients of different ages. We can do a better job of preparing and protecting them.
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