Older adults and extreme weather events: recommendations from the Research Centers Collaborative Network workshop

Abstract

Extreme weather events are increasingly recognized as critical determinants of health and well-being in later life. To identify priorities for advancing research at the intersection of these events and aging, the Research Centers Collaborative Network convened a 1.5-day interdisciplinary workshop. This article synthesizes discussions across three domains: the effects of weather-related hazards on aging and health outcomes; the vulnerabilities and resilience of older adults; and interventions to mitigate risk. Key priorities include longitudinal studies that capture cumulative exposures and long-term outcomes across the life course, greater attention to heterogeneity within older populations, and the design of interventions responsive to social and environmental contexts.

Introduction

Population aging and extreme weather events are two major forces that pose unprecedented challenges to human health and longevity. In the United States, the number of adults aged 65 and older is projected to nearly double, from 49 million in 2016 to 95 million in 2060.¹ Simultaneously, extreme temperatures, wildfires and resultant pollution, flooding, and violent storms are increasing in intensity, frequency, and geographic reach.² Older adults face greater risks during these events due to age-associated declines in thermoregulatory, cardiovascular, respiratory, and cognitive function, immune response, and a high burden of chronic disease.³ These age-related vulnerabilities can be further understood through a geroscience perspective where aging is recognized as a progressive erosion of the biological processes that sustain resilience, repair, and adaptation. As these capacities diminish, functional deficits accumulate, and the ability to maintain health and independence under environmental or social stressors becomes increasingly limited.^4,5 From this perspective, extreme weather events can be understood not only as acute hazards associated with hospitalization and mortality, but also as stressors that trigger physiologic and psychosocial responses that may act on biological pathways implicated in the hallmarks of aging.^6,7 Repeated or cumulative exposure may therefore contribute to longer-term trajectories of frailty, multimorbidity, and loss of independence. This framing connects climate-related hazards to broader questions in aging biology and implications for healthy lifespan and underscores the need for research to define mechanisms, vulnerabilities, and opportunities for intervention.

In response, scholars have recently highlighted gaps in current knowledge and proposed research priorities to better understand how extreme weather exposures affect aging populations. For example, Malecki et al. called for greater integration of environmental health and aging biology, emphasizing the importance of exposomics, biomarkers, and cumulative risk frameworks to assess how lifelong exposures influence aging trajectories.⁸ Tipaldo et al. advanced a multidimensional vulnerability model incorporating biophysical, social, and contextual risks and stressed the need for interdisciplinary data and methods to study climate-related vulnerability.⁹ Prina et al. examined how climate hazards affect healthy aging through impacts on functional ability and resilience, and highlighted the importance of life course approaches and social determinants of health.¹⁰

Aligned with these efforts, the Research Centers Collaborative Network (RCCN) hosted a multidisciplinary workshop in November 2024 focused on climate-related hazards and aging. The workshop convened scholars across disciplines to identify barriers and opportunities for advancing high-impact, collaborative research. Discussions were organized around three key topic areas: the effects of climate-related hazards on aging and health outcomes; vulnerabilities and resilience of older adults that shape risk; and potential interventions to mitigate these risks. The agenda and recordings are archived at https://www.rccn-aging.org/climate-change-and-aging. Here, we synthesize key themes from the workshop, outline priority areas for future research, and highlight opportunities to integrate biological and medical sciences into the broader investigation of climate impacts on aging (Table 1).

Table 1.

Current gaps and overall recommendations from the research centers for collaborative network workshop on climate hazards and aging.

Topics	Opportunity
Effects of climate-related hazards on aging and health outcomes	Advance research on cumulative climate hazard exposures across the life course and their long-term effects on aging and health trajectories Improve personal-level exposure assessment by incorporating time-activity patterns, housing conditions, and mobility over time Investigate compounding effects of multiple climate stressors using advanced modeling techniques Integrate behavioral and social modifiers into exposure modeling frameworks to improve risk estimation Investigate how psychosocial stressors (e.g., depression, anxiety, and trauma) interact with or mediate the effects of climate-related exposures on health outcomes
Vulnerabilities and resilience of older adults	Disaggregate psychological, social, and material dimensions of resilience to inform more holistic disaster response strategies Account for heterogeneity within older populations by examining differences across age groups, race, gender, disability status, socioeconomic position, as well as structural and neighborhood-level conditions Incorporate lived experiences and community perspectives into vulnerability assessments and disaster planning Support the roles of multigenerational caregivers, particularly “sandwich generation” adults, in shaping household and community resilience
Interventions to cope with increasing climate-related hazards	Replace the “all-or-nothing” evacuation paradigm with tailored strategies for long-term care facilities that consider infrastructure, staffing, and individual risk profiles Evaluate the long-term feasibility, acceptability, and effectiveness of low-cost cooling strategies, particularly among socioeconomically vulnerable older adults Advance research on climate-induced migration among older adults, with a focus on identifying and supporting high-risk “trapped” populations Design integrated interventions addressing both physical and psychosocial impacts of climate hazards Develop communication strategies tailored to older adults’ concerns, cognitive styles, and information preferences Establish rapid-response funding mechanisms to enable timely engagement with affected communities and strengthen the linkage between disaster experiences and health outcomes

The effects of climate-related hazards on aging and health outcomes

Climate-related exposures are significant drivers of adverse health outcomes in older adults. Both heatwaves and cold spells, which are among the most well-documented climate hazards, are associated with increased all-cause mortality among older populations, and these burdens are expected to grow as temperature extremes become more common.¹¹ While warming trends may reduce the number of cold days in some regions, cold-related mortality is still projected to increase because of the disproportionate vulnerability of older adults.¹¹ Temperature extremes are also linked to higher hospitalization rates, particularly for cardiovascular and respiratory illnesses.¹² Additionally, infectious diseases are highly sensitive to climate factors. Shifts in temperature and precipitation affect the geographic range of vectors and pathogens, as well as patterns of human behavior and social contact,^13,14 facilitating the emergence or reemergence of infectious diseases in specific areas. Apart from the climate-related risk among the general population, age-related immune senescence and a high burden of comorbidities further increase susceptibility among older adults.^15,16 Climate hazards may accelerate underlying biological aging processes, as exposure to extreme heat has been linked to molecular and cellular stress responses, including maladaptive epigenetic changes and immunosenescence.^17–20 These findings point to a possible mechanism through which climate stressors could contribute not only to disease onset but also to subclinical deterioration in biological systems over time.

The health consequences of climate hazards often extend beyond their immediate impacts. These events generally unfold as cascading and chronic disruptions across a disaster continuum, rather than isolated incidents. Initial harms such as displacement, physical injury, or acute stress are frequently followed by prolonged secondary stressors, including loss of housing, financial insecurity, and impeded access to care. Over time, such cumulative exposures can erode resilience or lead to “resource exhaustion,” a declining capacity of individuals to sustain well-being under repeated or prolonged adversity.²¹ For example, a study of older adults after Hurricane Sandy found that stress during the disaster was associated with new diagnoses of diabetes, lung disease, and arthritis in the 4 years after the hurricane.²² In addition to these physical health consequences, the social and relational consequences of climate hazards also warrant attention. Disasters frequently disrupt the social structures and routines that many older adults rely on for emotional and practical support. Following hurricanes and heatwaves, prolonged isolation has been documented,^23,24 which itself is a significant risk factor for adverse health outcomes and may further compound the stress of environmental exposure.^24,25

Importantly, mental health is not only a consequence of climate hazards but also plays a central role in the pathways linking environmental exposures to long-term health deterioration. Climate hazards can amplify ongoing stressors, particularly for older adults who may already face challenges related to housing and economic stability. Displacement, insurance loss, and fear of future disasters can trigger chronic stress, anxiety, and depression, all of which are associated with poorer physical and cognitive health outcomes.²⁶ Recent studies show that joint exposure to air pollutants, depression, and anxiety symptoms significantly increased the risk of dementia among older adults, with mental health factors contributing most strongly to the risk.²⁶ Another study of flood survivors in China found that traumatic exposure was associated with sleep disturbances, with depression and fear serving as key mediators.²⁷ Together, these findings underscore how environmental exposures may contribute to chronic disease risk over time, through indirect pathways involving secondary stressors and psychosocial strain.

Despite expanding evidence for these risks, several research gaps remain. First, most studies rely on short-term environmental measurements and rarely capture cumulative or life-course exposures. There is limited understanding of how early-life or mid-life environmental exposures influence aging processes or how cumulative climate stress contributes to long-term health trajectories. Second, existing exposure assessments depend on area-level environmental data, which may not accurately reflect individual exposures. Variations in mobility, housing conditions, and time-activity patterns are often overlooked. Third, compounding hazards also require further study. Increasingly, multiple events occur simultaneously or in rapid succession, such as heatwaves coinciding with wildfire smoke or flood events, whilst few studies assess these compound exposures.^28,29 Fourth, behavioral and social modifiers, such as housing stability, nutrition, and social support, are rarely integrated into modeling frameworks despite their likely important role in shaping risks. Finally, few studies consider psychosocial stressors as interacting determinants of health outcomes. To address these gaps, future research must adopt a life-course perspective and prioritize longitudinal designs, integrating personal disaster histories, biomarker and clinical data, and measures of cumulative stress to track how climate exposures shape health over time. Personal environmental monitoring technologies, such as wearable sensors or home-based air quality monitors, can improve the precision of individual-level exposure assessments. At the population level, systems modeling and machine learning approaches may help identify complex, multi-hazard risk profiles that reflect not only climatic exposures but also patterns of social vulnerability and behavioral response.

Vulnerabilities and resilience of older adults

Across all phases of climate-related disasters, from preparedness to impact and recovery, older adults have been reported to be the least prepared and face the greatest risks.³⁰ For example, older adults are particularly susceptible to extreme heat due to age-related impairments in thermoregulation,³¹ which can increase cardiovascular strain, dehydration, and the risk of heat-related illness or multi-organ dysfunction. Experimental studies show that exposure to extreme heat increased core temperatures, reduced skin blood flow and sweat rates, and elevated cardiovascular strain in this population.^32–36 In addition to physical vulnerability, many face unmet psychological needs³⁷ and heightened fear of injury or death during disasters.³⁸ Longitudinal studies show that disaster-related stress can have lasting health consequences, including functional decline and increased healthcare utilization in the years following disasters.^39,40 These health risks are often compounded by financial barriers that hinder recovery and stability in the aftermath. Findings from the Hurricane Ian Longitudinal Recovery Study suggest that rising homeowner insurance costs are an emerging barrier to aging in place in high-risk areas. Yet, many older adults choose to remain in their existing homes despite recognizing climate risks and economic challenges, motivated by a desire for independence and a strong sense of place-based identity.⁴¹

Recent evidence also highlights important sources of resilience in older adults. For instance, a post-Hurricane Sandy study found that individuals aged 75 and older were the most likely to report full recovery, suggesting greater resilience to disaster impacts compared to younger adults.⁴² Similarly, older survivors of Hurricane Katrina reported the best long-term mental health outcomes over ten years.⁴³ These findings support the “inoculation hypothesis,” which posits that older adults may be more psychologically resilient to disaster exposure due to accumulated life experiences and adaptive coping strategies.⁴⁴ Social support, particularly from adult children, has also been identified as a key facilitator of older adults’ recovery trajectories, especially when there is minimal post-disaster recovery programming.⁴¹

Despite shared characteristics, there is considerable heterogeneity in vulnerability and resilience within the older adult population. Sociodemographic factors such as sex, education, financial resources, and region of residence are all associated with vulnerability to extreme climate-related events.⁴⁵ A national analysis of projected risk from population aging and heat in the United States identified two types of hotspots: traditionally hot areas where population aging amplifies baseline risk (e.g., the Deep South, Florida, and parts of the rural Midwest) and newly warming regions (e.g., New England, the upper Midwest, and the Mountain West) where underprepared infrastructure and healthcare systems compound vulnerability.⁴⁶ These distinct risk profiles highlight the need for geographically tailored adaptation strategies, such as enhancing health and social service capacity in the South and investing in early warning systems and infrastructure upgrades in newer hotspots.

Geographic patterns of vulnerability are compounded by longstanding structural disparities. Marginalized communities often face higher baseline exposures, fewer adaptive resources, and slower recovery. Disasters such as Hurricane Katrina have illustrated how racial and economic inequalities translate into disproportionate impacts.^{43,  47} Thus, to understand health risks in this context and overall vulnerability, it is essential to consider concurrent environmental exposures and existing social disadvantage. The cumulative risk assessment framework provides a theoretical foundation for analyzing how these multiple, interacting exposures contribute to health outcomes.⁴⁸ In many socioeconomically disadvantaged areas, which often become “sacrifice zones” burdened by unwanted land use activities such as waste dumping and heavy industry, residents confront multiple environmental stressors simultaneously, such as houses with lead-based paints and contaminated water pipes, alongside ambient pollutants at the community level, while also facing psychosocial burdens including economic adversity and chronic anxiety. Empirical evidence supports these interactions. A recent study found that dementia risk linked to air pollutants was higher in socioeconomically deprived communities.⁴⁹ However, supportive social environments can buffer these risks. Higher levels of neighborhood social cohesion have been shown to attenuate the association between pollution exposure and dementia, suggesting its role in shaping community-level resilience.⁵⁰

Several critical research gaps remain. First, much of the current literature focuses on psychological resilience, such as emotional coping or mental health outcomes, while paying less attention to other dimensions of resilience, including social, financial, and structural conditions. An individual may report psychological stability after a disaster yet face worsening material circumstances, such as housing insecurity or diminished access to care. Teasing apart these different dimensions of resilience is essential for developing targeted interventions. Second, older adults are often treated as a homogenous group in disaster planning and public health programming. This obscures critical differences between, for example, those in their late 60 s and those in their 90 s, as well as among older adults who differ by disability status, cultural background, or caregiving responsibilities. A more nuanced, intersectional understanding of this heterogeneity is necessary to tailor support systems effectively. Third, there is often a failure to incorporate the lived experiences and voices of those most affected. Population-level data alone cannot fully capture the challenges of aging in high-risk environments. Incorporating qualitative insights, such as perceptions of risk, coping behaviors, and emotional attachments to place, can improve both the design and acceptability of interventions. In addition, future work must better account for the ways in which social and structural conditions shape vulnerability and resilience. Neighborhood infrastructure, access to green space, and reliability of essential services all influence older adults’ exposure and recovery potential. Finally, more attention needs to be given to the burden experienced by “sandwich generation” adults supporting both children and aging parents during climate-related events. These dual responsibilities are often intensified during disasters and central to family-level adaptation, yet are often overlooked in current planning frameworks.

Interventions to cope with climate hazards

Several interventions have been implemented to protect older adults from climate hazards. One of the most studied areas is evacuation and disaster preparedness in long-term care facilities. Experiences from Hurricanes Katrina and Irma highlight substantial difficulties in safely evacuating residents, including logistical challenges with transportation, staffing, and coordination of evacuation plans. Nursing home administrators described evacuation during Hurricane Katrina as profoundly distressing, requiring extensive physical exertion from staff, and often causing significant harm to residents themselves.⁵¹ They also faced ethical dilemmas, balancing the dangers of evacuating frail residents against the risks of sheltering in place with limited resources. Subsequent studies showed that evacuation itself can pose independent risks of increased morbidity and mortality,⁵² particularly among residents with dementia or functional impairments.⁵³ Moreover, research after Hurricane Irma revealed underreporting of disaster-related health outcomes. Many residents who died from exacerbations of chronic illnesses within weeks after displacement were not classified directly as storm-related casualties, highlighting surveillance gaps following disasters.⁵⁴ Recent work advocates structural improvements (“facility hardening”), flexible disaster-response models, and enhanced care models that include “marshaling staff and support” as an essential preparedness component.⁵⁵ Effective strategies must therefore combine proactive structural measures (e.g., constructing disaster-resistant facilities) with contingency plans addressing inevitable population relocation scenarios. Some facilities have partnered with transportation providers outside disaster-prone areas to improve evacuation reliability. Nonetheless, challenges remain, particularly regarding staffing shortages during emergencies, when professional responsibilities conflict with employees’ personal or family obligations.

Another critical area of intervention involves strengthening climate-resilient physical and social infrastructure. Strengthening the power grid is critical given many older adults’ reliance on medical technologies and climate control. California’s program to bury electrical lines and weatherize existing power infrastructure can serve as an example to other states, and might have mitigated the devastating effects of Winter Storm Uri in Texas in 2021.⁵⁶ Rapid post-disaster restoration of essential services should also be prioritized. For example, after Hurricane Beryl in Southeast Texas, prolonged power outages were likely responsible not only for excess mortality among older adults but also for disruptions in home-based care and medical services that many depend on.^57,58 Expanding green spaces and tree canopy coverage is another promising adaptation strategy. Trees can reduce urban heat island effects through shade and evapotranspiration, which substantially lowers heat-related illness and mortality risks among older adults.⁵⁹ However, challenges include the cost of tree maintenance, the time required for benefits to manifest, lack of public awareness regarding health benefits, and uncertainty about species’ future climate compatibility.

Cooling strategies are a critical protective measure against heat-related illness and death. Air conditioning (AC) remains the most effective intervention. For example, studies of incarcerated populations show significantly fewer heat-related deaths in air-conditioned facilities than those without cooling systems.⁶⁰ However, AC is not universally accessible. As of 2020, nearly 12% of United States households did not have AC, with rates as high as 27% in the West Census Region.⁶¹ Even among households with AC, high energy costs and unreliable power during periods of peak demand can limit its use. Many older adults, especially in low-income households, face the “heat-or-eat” dilemma, unable to afford both the costs of cooling and food.^62,63 These challenges underscore the need for low-cost, low-energy-burden cooling alternatives. One study assessed simple strategies, including water spray, fans and the combination of both and found that water spray alone was highly effective in reducing the heat-related physiological stress in older adults.⁶⁴ In addition, weatherization interventions, such as retrofitting homes to improve insulation, sealing, and ventilation, offer cost-effective means to regulate indoor temperature and enhance energy efficiency. Such retrofits have been shown to improve air quality, reduce respiratory symptoms, and support mental well-being by alleviating thermal discomfort and reducing energy insecurity.⁶⁵ However, more investment is needed to scale these programs to reach underserved communities.

Climate-induced migration and displacement represent emerging and understudied areas of research. Climate projections suggest that within the next 50 years, over 30% of the world’s population could reside in areas with mean annual temperatures above 29 °C, thresholds historically incompatible with dense human habitation.⁶⁶ These climatic shifts are expected to drive global migration, but older adults often lack the mobility, financial resources, or social support necessary to relocate, and many may become part of “trapped populations.” For those forced to migrate, disruptions to care networks and psychosocial stressors can lead to worsened health outcomes. However, many climate assessments do not adequately capture the specific vulnerabilities and adaptive needs of aging populations. Current migration models often overlook key socio-environmental feedback loops, including governance quality and social determinants of health, potentially underestimating future displacement risks and migration flows.⁶⁷

Finally, communication about climate risk plays a pivotal role in shaping how older adults perceive, prepare for, and respond to environmental threats. Many people perceive climate-related hazards as temporally and spatially distant, a phenomenon known as psychological distancing.⁶⁸ This perception can limit concern and delay protective action. Communication research offers promising tools for overcoming this barrier. Studies show that reframing climate issues as more immediate and personally relevant was effective in fostering greater public urgency.⁶⁹ Prior research identifies six core messages that resonate widely: that climate change is real, human-caused, and recognized by experts, and its impacts are serious but solvable, and a majority care about addressing it.⁷⁰

Several gaps in research and policy remain. First, many long-term care facilities still lack the structural resilience and staffing capacity needed to withstand severe natural hazards. The prevailing “all-or-nothing” evacuation paradigm must be replaced with more tailored strategies that account for facility infrastructure, individual risk profiles, and the feasibility of sheltering in place. Second, while low-cost cooling interventions show promise, evidence on their long-term feasibility, acceptability, and effectiveness across different populations and settings is limited. Further studies are needed to evaluate their sustained use and real-world impact, particularly among socioeconomically vulnerable older adults. Third, climate-induced migration among older populations remains underexplored, and future research should include identifying and supporting high-risk “trapped” communities. Fourth, beyond physical harms, there is a need to address immediate (first-order) trauma and longer-term (second-order) psychosocial stressors that climate hazards impose on older adults. More post-disaster interventions are needed to restore services that address older adults’ social needs and facilitate relationship-building. Finally, public communication strategies targeting older adults remain underdeveloped. Although climate-related health messages are increasingly being designed for the general public, few are tailored to the specific concerns, cognitive styles, or trusted information sources of older populations. Delivering concise messages through trusted sources may be particularly effective. Physicians consistently rank among the most trusted messengers on climate-related health risks, more so than environmental scientists or government agencies.⁷¹ Thus, empowering health professionals to serve as climate communicators, particularly to older patients, may be a highly effective strategy for increasing engagement.

Importantly, we should acknowledge that there is no one-size-fits-all solution, as the effectiveness of interventions heavily depends on the local context. Some adaptation strategies may carry unintended consequences; for example, urban greening efforts like tree planting can increase property values and contribute to housing displacement in vulnerable neighborhoods. These tradeoffs must be carefully weighed in planning and policy decisions. Given the unpredictable and localized nature of extreme weather events, there is also a need for flexible, rapid-response funding mechanisms that allow researchers and practitioners to engage quickly with affected communities. Such mechanisms would help capture the immediate impacts of disasters, link lived experiences to health outcomes, and support timely, context-specific recovery efforts.

Conclusion

Climate hazards are reshaping the aging experience, interacting with biological, social, and structural factors to produce complex risks that unfold across the life course. Figure 1 summarizes the conceptual framework emerging from this RCCN workshop: extreme weather events create exposure-related risks through immediate injury, direct physiologic strain, and indirect psychosocial and lifestyle disruption. These risks influence processes of aging biology, including chronic inflammation, mitochondrial dysfunction, and epigenetic alterations, and ultimately contribute to downstream aging outcomes such as frailty, chronic disease, functional decline, disability, and mortality risk. Biological and social factors further amplify or attenuate vulnerability, helping to explain why older adults do not experience climate-related hazards uniformly. Preexisting chronic conditions, social isolation, inadequate housing, and limited access to care shape not only exposure risk, but also susceptibility and recovery following extreme events. At the same time, the framework identifies actionable targets for intervention, including low-cost cooling, emergency preparedness, effective risk communication, and improvements in physical and social infrastructure. This workshop also highlighted the need for multidisciplinary research to advance our understanding of impacts, vulnerabilities, and interventions. Future research should incorporate longitudinal designs to capture cumulative exposures, while addressing the structural factors that shape both vulnerability and resilience. Adaptation strategies must be tailored to local contexts and rigorously evaluated for effectiveness and unintended consequences. Equally important is the translation of research into timely action. Rapid-cycle funding, cross-sector partnerships, and community-engaged approaches are critical to building climate resilience. Older adults must be recognized not only as at-risk individuals but also as active contributors to advancing climate-aging research and promoting strategies that ensure the health and well-being of all.

Figure 1.

Conceptual framework linking extreme weather events to aging biology and downstream aging outcomes through multiple interacting pathways. Extreme weather events may affect health span through multiple interacting pathways. These pathways include direct physiologic strain, immediate injury and hospitalization, and indirect effects through psychosocial stress and disruption of daily routines and health-supporting behaviors. These risks are shaped by biological and social factors that may amplify or attenuate vulnerability and may act on core processes of aging biology. In turn, these processes may contribute to downstream outcomes including multimorbidity, functional decline, frailty, disability, and mortality risk. Biological, social, and structural factors may amplify or attenuate these effects. The framework also highlights potential points for intervention, including low-cost cooling strategies, emergency preparedness, effective risk communication, and improvements in physical and social infrastructure.

Funding

This work was supported by funding from the National Institute on Aging Research Centers Collaborative Network (grant number U24AG058556 to Stephen B. Kritchevsky), the American Federation for Aging Research, the National Institutes of Health National Institute on Aging (grant number T32AG000037 and K99AG090817 to Eun Young Choi; grant number T32AG000270 to Alexandra B. Holland), and the Alzheimer’s Association (grant number AARF251473227 to Eun Young Choi).

Conflicts of interest

None declared.

Author contributions

The authors’ responsibilities were as follows—Stephen B. Kritchevsky: participated in workshop organization; Eun Young Choi, Lingzhi Chu, Alexandra B. Holland, Arun Balachandran, Sara C. Zapico, Sadaf Arefi Milani, and Roger Wong: contributed to conceptualization and writing of the original draft; Tina E. Brinkley and Stephen B. Kritchevsky reviewed and edited the manuscript; Eun Young Choi: had primary responsibility for content; and all authors: read and approved the final manuscript.

Data availability statement

No new data were generated or analysed in support of this research.