Health Disparities and Maladaptive Behavior in Response to Extreme Heat

Population aging, escalating global temperatures, and health disparities are not just pressing but urgent issues in public health of the current century (Deivanayagam et al., 2023). The World Health Organization (WHO; 2022) has identified mental health as a priority for action on climate change, and the risk of death and illness from heatwaves is one of the eight significant risks related to climate change, especially in vulnerable minority populations (McCarthy, 2001), including older adults (Rony & Alamgir, 2023). Heat significantly increases the frequency of psychiatric emergencies, morbidity, and mortality attributable to mental illness (Walinski et al., 2023). The potential increase in heat-related mental illnesses in older adults is a cause for immediate concern, as even their mental performance and memory, leading to weakness, dizziness, and increased risk of falls, is adversely affected by mild dehydration (Liu et al., 2021).

HEALTH DISPARITIES IN EXTREME HEAT AND MENTAL HEALTH PROBLEMS AMONG OLDER ADULTS

Disparities in heat-related illnesses by race, socioeconomic status, and the built environment have been documented in the United States (Eisenman et al., 2016; Medina-Ramón et al., 2006; Zanobetti et al., 2013). Being non-White and female was associated with an elevated risk of mortality on extremely hot days and increases in warm-month temperatures (Zanobetti et al., 2013). Older adults, people with diabetes, and Black individuals were more susceptible to extreme heat (Medina-Ramón et al., 2006; O’Neill et al., 2003). Zip code level and personal characteristics have been associated with increased susceptibility to temperature (Zanobetti et al., 2013). Areas with more significant proportions of Black, Hispanic, and Asian residents are hotter on average than areas with more White residents (Deivanayagam et al., 2023), and Black and Hispanic residents had the highest heat vulnerability index (Manware et al., 2022). As temperatures rise, mortality from heat-related illness decreases in census tracts that contain more publicly accessible cooled spaces, and social vulnerability was associated with mortality after adjusting for infrastructure variables (Eisenman et al., 2016). Therefore, disparities in heat vulnerability by individual- and community-level characteristics must be considered to promote equitable climate change adaptation policies (Manware et al., 2022).

MALADAPTIVE BEHAVIOR TO EXTREME HEAT IN OLDER ADULTS

Maladaptation is an inappropriate response to a situation (in this case, extreme heat) that creates a vulnerability that is difficult and costly to change and has long-term health consequences, including mental health. Maladaptive behavior may minimize stress or anxiety in the short term, but constant use of the behavior can cause more significant problems in the long term, such as substance use and poor social relationships. It is projected that heat-related mortality rates will continue to rise when considering current trends and the rapidly growing aging population (Åström et al., 2017; Lee & Kim, 2016), whereas the influence of temperature is often underestimated (Rony & Alamgir, 2023). As older adults also tend to be more skeptical about climate change, they may not perceive extreme heat as a threat because they are already accustomed to the changing weather patterns (Abrahamson et al., 2009), and often they see themselves as less affected than the average population (Bittner & Stößel, 2012). Older adults unaware of their susceptibility to hot weather generally demonstrate many of the recommended preventive measures during heatwaves (Vu et al., 2019). Enhancing risk awareness and promoting individuals’ shift from maladaptive to adaptive behavioral patterns in response to extreme heat is essential.

MINIMIZING MALADAPTIVE BEHAVIOR AND ENHANCING ADAPTIVE STRATEGIES FOR OLDER ADULTS

Four factors affect the vulnerability of older adults in heatwaves, including physiology and age-related health decline, socioeconomic factors, psychological issues (e.g., anxiety), and adaptive strategies (which can be identified as enablers and barriers) (Hansen et al., 2011). Depending on older adults’ selections of strategies and behaviors to adapt to heatwaves, risks of heatwaves on their mental health may be mitigated or exacerbated (Hansen et al., 2011). Understanding how adaptive behaviors and levels of accessibility to care and daily services interact with extreme heat can enhance public health and safety (Eisenman et al., 2016). There are two dimensions of adaptive capacity: (a) subjective (how people perceive the resources at their disposal; people often perceive they have little control over environmental problems), and (b) objective (environmental and social resources available) (Gardner & Stern, 1996). Individuals’ capacity to adapt to climate change is primarily a function of their access to resources, and social determinants substantially influence behaviors conducive to health (Eady et al., 2020). Further, we need to help older adults and communities build resilience during heatwaves and associated power failures with non–energy-intensive heat adaptive behaviors (soft adaptation) rather than relying solely on air conditioning (hard adaptation) (Hansen et al., 2011).

Several strategies can help minimize the risk of maladaptive behavior in older adults (Intergovernmental Panel on Climate Change, 2022). These strategies include: (a) using an interdisciplinary team and systematic thinking and planning approach; (b) promoting collaboration and communication between individuals and institutions; (c) involving local communities in the preparation phase to help target each intervention and tailor it specific to each group/area; and (d) focusing on the impacts and long-term goals and using strategies that have built-in flexibility (i.e., to reduce the risk of lack of data or incorrect forecasts and expectations) to enhance autonomous adaptation in individuals and institutions.

CONCLUSION

Implementing preventive strategies is an essential step in the promotion of mental wellness in high temperatures (Rony & Alamgir, 2023), and long-term therapeutic relationships through assessment, preventive education, and care extending beyond the immediate consequences of climate change could enhance mental health care (White et al., 2023). The new WHO (2022) policy recommends approaches for governments to address the mental health impacts of climate change by: (a) integrating climate change within mental health programs; (b) providing mental health support within climate action; (c) developing community-based approaches to reduce vulnerabilities; (d) closing large funding gaps between mental health and psychosocial support; and (e) building upon global communities. In addition, community involvement and awareness of those most at risk, including older adults, has become integral to extreme heat communications plans (Hansen et al., 2011). Furthermore, community health worker–led interventions and outreach in low-income communities have documented increased access to health care and health education, and this innovative approach can bridge the gap among transportation, socioeconomic status, and connection (Deo & Singh, 2021; Hand et al., 2021; Rajaa et al., 2022; Woldie et al., 2018). Finally, it is important to support older individuals shifting from maladaptive to adaptive behaviors in response to extreme heat and promote adaptation strategies that enhance their mental health outcomes.