The Impact of Climate Change on Older Adults’ Mental Health: A Primer for Clinicians
Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
UCSF Weill Institute for Neurosciences, San Francisco, California, USA
Academic Editor: Calogero Caruso
Received: July 31, 2023 | Accepted: October 19, 2023 | Published: October 24, 2023
OBM Geriatrics 2023, Volume 7, Issue 4, doi:10.21926/obm.geriatr.2304254
Recommended citation: Seritan AL. The Impact of Climate Change on Older Adults’ Mental Health: A Primer for Clinicians. OBM Geriatrics 2023; 7(4): 254; doi:10.21926/obm.geriatr.2304254.
© 2023 by the authors. This is an open access article distributed under the conditions of the Creative Commons by Attribution License, which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is correctly cited.
Climate change is a major public health emergency, and health professionals are becoming more and more aware of its varied impacts on human health. The United Nations define climate change as “the long-term shifts in temperatures and weather patterns. Such shifts can be natural, due to changes in the sun’s activity or large volcanic eruptions. But since the 1800’s, human activities have been the main driver of climate change, primarily due to the burning of fossil fuels like coal, oil, and gas.”  Natural disasters (earthquakes, floods, hurricanes, tornadoes, tsunamis, landslides, wildfires, and volcanic eruptions) are severe life-threatening stressors [2,3]. In large part as a result of climate change, the number of weather-related disasters has increased fivefold in the past 50 years, with droughts, storms, floods, and extreme temperatures causing the largest human losses [2,4]. Extreme weather events can be associated with posttraumatic sequelae similar to human-caused disasters (e.g., mass shootings, terrorist attacks, wars) but may also have additional downstream effects: property destruction (homes, businesses - leading to income loss, and other infrastructure), population displacement, loss of community support, and disruption of health care services [5,6]. Additionally, extreme temperatures and slow-moving disasters, such as droughts, sea level rise, increases in water and soil salinity, and crop losses result in significant physical and mental health impacts . Children, pregnant women, older adults, Indigenous populations, land workers, marginalized communities, economically vulnerable families, first responders, people living on low-lying territories, immigrants, and refugees are more likely to be exposed and vulnerable to the health impacts of climate change [4,5,6,7,8,9]. Moreover, uninsured and underinsured people have limited access to health care services at baseline. Lack of access to medical services is amplified in the aftermath of disasters, exacerbating health inequities [5,6,9,10,11]. In turn, health inequities amplify the impact of natural disasters on communities [5,6,9,12].
The pathophysiological mechanisms through which climate change affects mental health are not yet fully understood, although there has been growing interest in this research area in the past two decades, particularly the last five years, as the national and global dialogue has intensified. This paper will focus on the mental health impacts of climate change (specifically, climate anxiety and symptoms associated with weather-related disasters) in older adults. Although highly vulnerable to the health impacts of climate change, the geriatric population is often overlooked. The purpose of this review is to increase clinician awareness regarding the age-specific risk factors, clinical presentations, and management of symptoms and syndromes linked to climate change in older adults and to provide suggestions for future work. Our aim was to provide practical information that clinicians can readily use when they are called upon to manage patients affected by these scenarios (in many cases, urgently) and to help improve their level of comfort and confidence, so patients have faster access to much needed mental health care. To our knowledge, no papers focusing on clinical presentations and management of climate-related mental health symptoms in older adults have been published to date.
2. Materials and Methods
A literature search was performed to identify studies focusing on the impact of climate change on older adults’ mental health. The database PubMed was searched for articles published in English. Search terms included older adult, aging adult, elderly, climate, climate anxiety, air pollution, natural disaster, wildfire, flooding, hurricane, mental health, anxiety, dementia, depression, posttraumatic stress, and sleep. For the treatment section, the search included the terms posttraumatic stress and psychotherapy as well as specific medications that have shown efficacy in late-life posttraumatic stress disorder (PTSD) in general, e.g., citalopram, mirtazapine, and prazosin . Case reports, case series, review articles, and grey papers presenting organizational position statements were included. There were also several randomized controlled trials (RCT) regarding management strategies. Additional articles were identified by examining the reference lists of the papers identified through the above search. Studies presenting adults of all ages were included, after reviewing the full text and/or tables and confirming that they included older individuals. Studies not listing participant ages or focusing on younger adults only were excluded, as were studies related to extreme temperatures, slow-moving disasters, and man-made disasters. Articles on these topics were retained if they illustrated broader points, such as vulnerability or resilience. Most sources defined older adults as people aged 60 or 65 and older. Several articles focusing on individuals aged 50 or older were included if they were particularly relevant or if they had been included in prior meta-analyses and it was not possible to disaggregate the data. Throughout this paper, the terms older adults, aging adults, elderly, late-life, and geriatric population were used interchangeably, as were weather-related disasters and climate disasters.
Figure 1 PRISMA flow chart of literature search and article selection.
We identified 60 sources through the search strategy described above. All were published in the last twenty years, reflecting the growing interest in this topic, as well as the higher number and impact of natural disasters. The results of the narrative review are presented below.
3.1 Older Adults’ Vulnerability to the Health Impacts of Climate Change
Older adults are more likely to be exposed to and highly vulnerable to the physical and mental health impacts of heat waves, extreme weather events, and air pollution [15,16,17]. A number of physiological and psychosocial factors contribute to this heightened vulnerability, namely chronic medical or neurological conditions (e.g., cardiac disease, respiratory problems, cerebrovascular accidents, Parkinson’s disease), sensory (e.g., vision, hearing) impairments, cognitive deficits, polypharmacy, and psychiatric illness. Additionally, linguistic isolation, living alone, having limited social support, and not having access to reliable transportation can all limit mobility and affect older people’s ability to receive or understand evacuation orders and get to safety during natural disasters.
In a U.K. registry-based study of 22,562 deaths, individuals with dementia, psychosis, and substance misuse (particularly alcohol) had a 4.9% higher risk of death for each additional 1°C above the 93rd percentile of the annual temperature average . Additionally, short-term exposure to air pollution and to higher ambient temperature has been linked to an increased number of psychiatric hospitalizations among older adults .
3.2 Mental Health Impacts of Climate Change in Older Adults
Older adults can experience multiple mental health difficulties in response to fast- and slow-moving climate disasters. For purposes of this review, the search was narrowed to air pollution and natural disasters. Posttraumatic stress and depressive symptoms or disorders have been best studied. The sources reviewed also highlighted anxiety symptoms or disorders, adjustment disorders, cognitive deficits, and sleep disturbances. These mental health aspects will be detailed below, classified by climate-related variables.
3.2.1 Air Pollution
Accumulation of greenhouse (heat-trapping) gases in the atmosphere contributes to air pollution, as well as further global warming . Poor air quality can exacerbate or cause cognitive deficits, and social determinants of health intersect with and amplify this age-related susceptibility. A study of approximately 12,000 adults aged 50 years or older living in Metro Atlanta area revealed that low socioeconomic status neighborhoods were most vulnerable to air pollution . This finding has been replicated in many places, in the U.S. and abroad .
The French Tri-City cohort prospectively followed approximately 6,000 adults aged 65 or older (median age, 73.4 years) for up to 12 years. Exposure to particulate matter with diameter smaller than 2.5 μm (PM2.5) was significantly associated with global cognitive decline over time . Another French team conducted a cross-sectional examination of cognitive functioning in a large cohort of approximately 220,000 adults aged 18-69 . This study also revealed a significant association of exposure to black carbon, nitrogen dioxide (NO2), and PM2.5 with cognitive deficits among those aged 45 years or older . The evidence linking ambient air pollution to cognitive impairment has been so convincing that the Lancet Commission has recently included it among the modifiable risk factors for dementia . Neuroimaging studies have also revealed an association of long-term exposure to PM2.5, NO2, and ozone with increased risk for late-life depression [24,25], as well as a potential correlation of PM2.5 exposure with burden of amyloid-beta plaques in the brain .
3.2.2 Natural Disasters
A systematic review and meta-analysis found that aging adults were 2.11 times more likely to develop PTSD and 1.73 times more likely to experience adjustment disorders after being exposed to natural disasters compared to younger individuals, although this review included only six older studies, focused on earthquakes and tsunamis in Asia and Australia . Other studies found age to be protective against developing post-disaster PTSD [28,29]. About 6% of older individuals may experience delayed onset of posttraumatic symptoms and a slower recovery following natural disasters; this has been associated with a greater number of post-disaster stressors and traumas .
Aging individuals who escaped wildfires reported a high prevalence of anxiety, depression, insomnia, nightmares, and PTSD [31,32,33,34]. Older age, female sex, and having an imminent fear of death were independently associated with insomnia among survivors of wildfires in Greece . Proximity to and experience with the fires can mediate PTSD symptom severity, although this association has not been specifically found among older survivors .
Older adults affected by hurricanes and floods may experience clinically significant anxiety, depressive, and PTSD symptoms, as well as suicidal ideation or plans [11,12,36,37,38,39,40,41,42]. A rich body of research regarding the mental health impact of floods and hurricanes, including in aging adults, has emerged after Hurricane Katrina, which brought catastrophic floods to Louisiana, Mississippi, and Alabama in 2005, Hurricane Sandy, which struck the Eastern U.S. in 2012, causing widespread damage and human loss, and Hurricane Maria, which left behind widespread devastation in Puerto Rico in 2017. The relevant studies are summarized in Table 1. Several notable health inequities emerged in this regard. Hispanic ethnicity was significantly associated with higher PTSD symptom levels among survivors of 2004 Florida hurricanes, but only in younger, not older adults . Older adults with PTSD symptoms and hypertension had a higher risk of developing new cardiovascular events (cerebrovascular accidents, myocardial infarction, congestive heart failure exacerbation, or cardiovascular death) 1-2 years after Hurricane Katrina . This association was found among Blacks, but not Whites.
Table 1 summarizes details of the 21 primary sources identified on air pollution and climate disasters. Grey papers, review articles, perspectives, and other sources were discussed in text only.
There are few studies regarding the mental health impact of post-disaster relocation on aging adults, and even fewer focused on older climate refugees (people forced to leave their homes due to climate change). Post-disaster displacement has been associated with high rates of PTSD, anxiety, and depressive symptoms [29,44]. Forced relocation can also compound feelings of loss and grief, particularly among those with a strong sense of place attachment [7,45]. Moreover, patients with dementia relocated to unfamiliar environments can experience confusion and exacerbation of underlying cognitive deficits. A prospective study of elderly individuals temporarily relocated after the Great East Japan Earthquake and Tsunami of 2011 who were followed for up to 42 months found that the percentage of cognitively impaired people significantly increased over time . Aging adults who became socially isolated also had a significantly higher rate of depressive symptoms 6-8 years after the earthquake, compared to those who were not isolated .
3.3 Psychotropic Medication Effects with Extreme Temperatures
Older individuals are more susceptible to dehydration which, in turn, can lead to renal injury, hypovolemic shock, and seizures. Dehydration can also increase circulating levels of medications resulting in toxicity (for example, with lithium). Even though people of all ages can easily become dehydrated during heat waves, older adults are at higher risk, due to several physiological factors: decreased sweating, diminished thirst sensation, lower total body water and plasma volume, reduced glomerular filtration rate, and lower cardiac output, resulting in less blood flow to the skin and extremities . Additionally, older adults may restrict fluids to avoid frequent urination when taking diuretics. Chronic medical conditions and polypharmacy also play a role.
- Anticholinergics, antihistamines, tricyclic antidepressants and other agents with anticholinergic properties reduce sweating;
- Antipsychotics reduce sweating and affect thermoregulation;
- Amphetamines raise the base body temperature;
- Beta-blockers and sympathomimetic agents affect vasodilation of skin capillaries, not allowing heat to be released;
- Diuretics cause dehydration;
- Nonsteroidal antiinflamatory agents and angiotensin converting enzyme inhibitors can impair renal function;
- Laxatives may cause electrolyte imbalances;
- Thyroid hormones increase metabolic heat production.
These aspects should be kept in mind, and older adults counseled on the increased risk of heat stroke when prescribing the above agents.
3.4 Climate Anxiety in Older Adults
Even people who have not experienced natural disasters may develop anxiety when witnessing the ecological devastation and anticipated threats posed by climate change (eco-anxiety) [8,10]. Climate anxiety is a facet of the wider phenomenon of eco-anxiety and refers to anxiety specifically linked to anthropogenic (human-caused) climate change and its impact on the environment [10,50,51]. The American Psychological Association defines climate anxiety as “the chronic fear of environmental cataclysm that comes from observing the seemingly irrevocable impact of climate change and the associated concern for one's future and that of next generations” . Although more prevalent among youth, climate anxiety can also occur in older individuals [10,52]. It is important to note that climate anxiety and eco-anxiety are not considered psychiatric disorders and are therefore not included in current diagnostic classifications, although symptoms can become severe enough as to cause functional impairment [8,51].
3.5 Older Adults’ Resilience Regarding Climate Change
Despite all the challenges outlined, aging adults are quite resilient. They help maintain a coherent sense of identity for their families and are often leaders in rebuilding destroyed communities. Their psychological strength and resourcefulness can help guide younger generations. Research exploring older adults’ post-traumatic growth and resilience in the aftermath of natural disasters is scarce. Many studies have focused on risk factors for post-disaster PTSD instead, defining resilience as the absence of PTSD symptoms [38,42,53,54]. These risk factors were reviewed in detail by Kellis et al. . Moreover, although measures of older adult resilience when facing health challenges and life stressors have been developed [56,57,58], evidence-based indicators for post-disaster resilience have not yet been clearly established . Approaches to quantifying potential contributory factors such as social capital and social cohesion also vary. These research gaps make it difficult to characterize the climate disaster-related resilience construct .
Individual and community factors that contribute to older adult post-disaster resilience include:
- life experience (including prior exposure to natural or human-caused disasters, such as the World Trade Center attacks preceding Hurricane Sandy; this has been termed “inoculation hypothesis”) [29,60,61]; more specifically, prior disaster exposure was protective against PTSD, but increased risk for depression following climate disasters 
- social cohesion and social capital [29,34,39,53,60,62,63,64]
- positive emotion and optimism [60,65]
- history of mastering challenges 
- positive religious coping skills 
- perceived quality of the neighborhood green space .
Social cohesion (reflecting the trust and connections among community members) mediated the association between disaster exposure and PTSD symptom severity among New Jersey residents exposed to Hurricane Sandy . Social capital (the ability to mobilize resources based on one’s relationships and position within the social group) was cited as an important resilience contributor by ten older adults (age range 67-83) displaced by two successive floods in Brisbane, Australia . Having a high structural social capital (participation in organized activities) reduced the odds of developing PTSD after flooding in a Japanese sample of older women, although the opposite was true for older men . In a survey of 272 adults aged 18-98 who were living in Houston in areas affected by Hurricane Harvey, a greater perceived quality of the neighborhood green space was significantly associated with lower risk of developing PTSD and hurricane-related distress 2 years later . Higher emotional resilience levels mediated the effects of perceived green space quality on hurricane-related distress measures.
3.6 Management of Climate Change-Related Psychiatric Symptoms in Older Adults
There are no studies specifically focusing on the management of climate anxiety or natural disaster-related symptoms in older adults, although several reports have included adults of all ages. This section draws on the general adult literature, extrapolating recommendations. There is limited evidence for the effectiveness of specific therapeutic approaches for eco-anxiety. Hasbach  recommended expanding the initial therapeutic interview to include the patient’s relationship with nature and incorporating strategies to reconnect with nature, such as assigning between-session nature-based homework or holding therapy sessions outdoors. Feder and colleagues  suggested a four-step approach: normalizing climate-related feelings and providing a safe space to process these; cognitive restructuring (trying to shift away from catastrophic thinking) and understanding that, although the future is uncertain, small actions taken in the present can have profound effects in complex systems (“the butterfly effect”); building or enhancing emotional resilience; and taking individual or collective purposeful action to mitigate and adapt to climate change. The ability to live with ambivalence and accept one’s ethical responsibility, while keeping things in perspective, is an important psychological task when dealing with climate change . Baudon and Jachens  conducted a scoping review of treatment interventions for eco-anxiety. Cognitive-behavioral therapy, mindfulness-based cognitive therapy, psychodynamic psychotherapy, and motivational interviewing were among the approaches studied, although the strength of the evidence varied . As mentioned above, climate anxiety may be less prevalent in older adults; as such, this area requires further exploration.
With regard to the management of post-climate disaster symptoms, appropriate triage of older adult survivors and prompt linkage to resources and services are crucial [12,71,72]. Screening for psychiatric symptoms, including for the survivors who were exposed, but not directly affected by the disaster, is recommended, coupled with a risk stratification approach that can guide prioritization and resource utilization. Psychological first aid has been shown to be beneficial and well-received by disaster survivors and to increase provider confidence, although it has not been specifically studied in connection to older adults . In the study conducted by Sirey et al. , Hurricane Sandy survivors were offered up to 6 free sessions of Engage, a supportive therapy modality coupled with behavioral activation. The intervention effectiveness was not reported.
Cognitive-behavioral therapy (CBT) has best evidence in the treatment of mental health symptoms following natural disasters, including for aging adults [74,75,76,77]. A modified intervention called CBT for post-disaster distress (CBT-PD) was effective for individuals with moderate-to-severe PTSD symptoms in the aftermath of Hurricane Sandy, and benefits were maintained at 2 years .
Based on the evidence available to date, pharmacological management of late-life climate-related PTSD does not appear to differ from that of other posttraumatic stress syndromes. First-line agents are selective serotonin reuptake inhibitors or serotonin–norepinephrine reuptake inhibitors . Mirtazapine as monotherapy, titrated up to 45 mg/day, was not significantly better than placebo in a 16-week (8-week double blind phase, followed by 8-week open label) randomized trial of veterans with PTSD . Prazosin, an a1-adrenergic blocker, is used for patients with PTSD-associated nightmares, although evidence has been mixed and is not age-specific [80,81].
There is a paucity of research addressing the specific mental health needs of older adults in the context of climate change, although the number of published studies has increased in recent years. Studies performed in the wake of natural disasters predominate, with very few explorations of climate anxiety in aging individuals. There is also insufficient evidence regarding management strategies for post-disaster mental health symptoms. This narrative review summarized age-specific risk factors, clinical presentations (including anxiety, cognitive, depressive, and posttraumatic stress symptoms, and sleep disturbances), and management of psychiatric symptoms linked to climate change in the geriatric population, based on the evidence available to date.
The strength of the evidence and study designs varied widely. The study design was most often cross-sectional, performed at different intervals after the traumatic event, ranging from one month  to 16 years . There were only five longitudinal prospective studies [30,32,36,38,39]. Sample sizes varied widely as well, ranging from ten to hundreds or thousands of individuals. Several epidemiological studies were included [18,19,20,21,22]. In particular, the two French investigations linking air pollution to cognitive impairment drew their findings from large population-based cohorts [21,22], and one followed participants for up to 12 years . The sources reviewed were international, originating from the U.S. [4,11,12,19,20,25,29,30,32,35,36,37,38,39,42,44,53,61,64,65,66,67,71,73], Puerto Rico [5,40,41,72], Canada [7,31], Australia [16,34,45,60], Europe [8,18,21,22,33], and Asia [46,47,62,63,75]. Several articles were specifically focused on older adults, including the oldest-old [11,12,29,30,31,32,33,34,36,37,38,39,41,42], four of which also surveyed people over 90 years of age [12,30,34,37]. The majority recruited adults of all ages, with a smaller representation of the higher age segments, while some did not present the age breakdown, so it was difficult to draw age-specific conclusions. Most studies did not have control groups. Several authors stratified participant samples by age (although subgroup sizes were not always comparable, which limited statistical power for comparing mental health outcomes), and one study compared 44 older adults with PTSD to 44 without .
This review focused on air pollution and its impact on cognitive functioning, given the emerging research and relevance of this association, and post-disaster psychopathology, due to its salience and prevalence. PTSD and depression have been best studied among post-disaster mental health syndromes. One advantage of PTSD research is that most authors used the standardized, validated Posttraumatic Stress Disorder Checklist (PCL)  or Diagnostic and Statistical Manual of Mental Disorders (DSM), although PTSD criteria were revised in the latest DSM edition . Twelve-month PTSD prevalence for adults 60 years of age and older in the general population is 1%, and it tends to decrease over time [84,85]. There is no clear estimate of late-life post-disaster PTSD rates, although a recent systematic review indicated an all-age prevalence of up to 52% of survivors . In this review, past-month PTSD prevalence was 7.6% , while point prevalence shortly after hurricane exposure was 20.9% (age-aggregated data) . In contrast, anxiety and depressive symptoms were measured with various instruments, so results were more heterogenous and difficult to summarize.
As Table 1 shows, investigations of hurricane survivors from the U.S. mainland (Katrina and Sandy) were better represented, whereas the literature on Hurricane Maria in Puerto Rico and disasters in other parts of the world was less robust. The 2022 devastating floods in Pakistan, which affected an estimated 33 million people, left 89,000 displaced, and led to an increase in suicides  were a tremendous tragedy. Yet, few related reports were identified in PubMed, and none regarding older adults specifically. This may reflect more limited research resources, the broad infrastructure destruction, hindering access to affected communities, or publishing in non-English language journals. Another observation about the Katrina-focused studies is that multiple teams used the same dataset, reporting various aspects of the data collected.
Half of the primary sources reviewed reported the participant race/ethnicity breakdown [11,12,29,30,31,36,37,38,39,40,41,53], of which three only showed the White/Caucasian and non-White/Caucasian subsamples. Minoritized populations are more vulnerable to the mental health impacts of climate change [4,5,6,7,8,9,10] as well as other types of disasters  and more likely to live in areas with the highest projected levels of climate change impacts with 2°C of global warming or 50 cm of global sea level rise . Only three of the studies we reviewed identified racial differences, which is an extremely low number, considering the widespread societal and health inequities present in the U.S. Other authors found higher rates of depressive  and PTSD  symptoms in Blacks compared to Whites following Hurricane Katrina. However, the racial difference in depressive symptoms was no longer significant after controlling for other socio-demographic factors . The association of race with post-disaster mental health outcomes has not yet been fully elucidated; structural racism is most likely an important mediator [59,90,91]. Moreover, only three of the studies explored the Indigenous perspectives: one focused on the Inuit in Nunantsiavut, Canada , another included First Nations members , and the third surveyed members of Aboriginal communities in New South Wales, Australia . Several additional studies included Native American/Alaskan people, but no specific results were shown, most likely due to small sample sizes. An extensive exploration of the intersection of social determinants of health with age-related climate change impacts was beyond the scope of this paper, although this area clearly deserves attention and has been the focus of recent research and presentations at professional meetings [9,91,92]. Given the health inequities discussed above, having a cadre of culturally proficient trauma recovery providers would be ideal [75,93]. However, there are few climate-aware clinicians available currently, let alone culturally proficient, trauma-informed ones. As such, it is imperative to develop international curricula and training programs for mental health professionals interested in supporting climate disaster survivors from all backgrounds and countries .
Most of the primary sources were quantitative (typically surveys), although several teams conducted qualitative, in-depth interviews with individuals affected by climate anxiety or weather-related disasters [7,45,60]. High-quality qualitative studies exist, but only a few met criteria for inclusion, since these typically refer to individual or group perspectives regarding climate change, not so much to mental health presentations. Qualitative studies, which often require a great deal of effort, planning, and community involvement, are important contributions and should be targeted for inclusion in future reviews. This approach could also bring to light the minoritized groups’ perspectives, which may be diluted in larger samples.
While the impact of natural disasters on older adults’ health has been relatively well studied, there is a dearth of research regarding the management of associated psychiatric symptoms, as well as explorations of climate anxiety in aging individuals. In particular, pharmacological management of late-life post-disaster psychiatric symptoms is woefully under-researched. There are complex pharmacokinetic and pharmacodynamic considerations with the geriatric population, and additional aspects (such as dehydration, electrolyte imbalances, or displacement leading to partial medication adherence) need to be considered in the aftermath of natural disasters. There are also insufficient attempts to characterize climate and health-related inequities; these aspects are very important and should be prioritized on future research agendas.
This study has several limitations. First, we conducted a narrative review. While systematic reviews provide a higher level of evidence, they are not always the best approach for multifaceted, clinically oriented questions. Recent approaches have suggested using systematic reviews as lenses through which evidence is appraised and summarized to use in clinical practice . The field of climate psychiatry, and climate health in general, is just emerging, and the literature focused on older adults is limited and heterogenous. Table 1 shows there were only 15 non-duplicate primary sources focusing on mental health clinical presentations related to natural disasters in older adults. The remainder were studies pertaining to vulnerability, resilience or management strategies, gray papers, reviews, perspectives, or duplicates investigating the same samples which did not bring any additional information. Of note, several excellent scoping or systematic reviews on mental health aspects related to climate disasters exist [54,86,96], although no recent ones focusing on older adults and all the clinical aspects we sought to cover here. The extant reviews informed the outline of this paper, which was followed by branching literature searches for each sub question identified. Second, we excluded most studies that pertained to slow-moving disasters (extreme temperatures, drought). These phenomena cause food insecurity and economic downstream effects, which tend to affect women, children, and older adults disproportionately [4,10,91]. Future reviews can shed light on mental health aspects related to slow-moving disasters, as well as earthquakes, which were only briefly covered here. Another limitation is that only English-language publications were included; this is a common weakness of similar reviews . Climate change has global impacts; hence, non-English language literature provides important perspectives and should be included in future work. Lastly, this is a single-author paper, which could have led to bias in source selection.
In summary, older adults are highly vulnerable and can experience multiple psychiatric symptoms as a result (or in anticipation) of climate change. As extreme weather events become more frequent and severe, we can expect that every healthcare professional who cares for older adults will encounter such clinical scenarios. All clinicians should be aware and educated regarding these mental health presentations, so they can best support their patients. Here we aimed to provide a primer for clinicians who need to care for such patients immediately. This review can also serve as a starting point for future research, which will in turn inform best practices.
The first author designed the study, conducted the literature review, and wrote the manuscript.
The author has declared that no competing interests exist.
- United Nations. What Is Climate Change? [Internet]. New York, NY, US: United Nations. Available from: https://www.un.org/en/climatechange/what-is-climate-change.
- World Meteorological Organization. Weather-related disasters increase over past 50 years, causing more damage but fewer deaths [Internet]. Geneva, Switzerland: World Meteorological Organization; 2021. Available from: https://public.wmo.int/en/media/press-release/weather-related-disasters-increase-over-past-50-years-causing-more-damage-fewer.
- Ahmed SK, Dhama K, Abdulqadir SO, Omar RM, Ahmed DR, Chakraborty C, et al. The mental health of people in Turkey-Syria earthquake-affected areas needs urgent attention. Asian J Psychiatr. 2023; 84: 103573. [CrossRef]
- Intergovernmental Panel on Climate Change. Synthesis Report of the IPCC Sixth Assessment Report (AR6) [Internet]. Geneva, Switzerland: Intergovernmental Panel on Climate Change; 2023. Available from: https://report.ipcc.ch/ar6syr/pdf/IPCC_AR6_SYR_SPM.pdf.
- Berggren RE, Curiel TJ. After the storm-health care infrastructure in post-Katrina New Orleans. N Engl J Med. 2006; 354: 1549-1552. [CrossRef]
- Ferré IM, Negrón S, Shultz JM, Schwartz SJ, Kossin JP, Pantin H. Hurricane Maria’s impact on Punta Santiago, Puerto Rico: Community needs and mental health assessment six months postimpact. Disaster Med Public Health Prep. 2019; 13: 18-23. [CrossRef]
- Cunsolo Willox A, Harper SL, Ford JD, Landman K, Houle K, Edge VL. “From this place and of this place:” Climate change, sense of place, and health in Nunatsiavut, Canada. Social Sci Med. 2012; 75: 538-547. [CrossRef]
- Pihkala P. Climate Anxiety. Helsinki: MIELI Mental Health Finland [Internet]. Copenhagen, Denmark: Climate-ADAPT; 2019. Available from: https://climate-adapt.eea.europa.eu/en/metadata/publications/climate-anxiety-mieli-mental-health-finland.
- Morello Frosch R, Obasogie OK. The climate gap and the color line-racial health inequities and climate change. N Engl J Med. 2023; 388: 943-949. [CrossRef]
- Clayton S, Manning CM, Speiser M, Hill AN. Mental health and our changing climate: Impacts, inequities, responses. Washington, DC: American Psychological Association, and ecoAmerica; 2021. [CrossRef]
- Corley SS, Ornstein KA, Rasul R, Lieberman Cribbin W, Maisel H, Taioli E, et al. Mental health effects of hurricane Sandy on older adults. J Appl Gerontol. 2022; 41: 1131-1142. [CrossRef]
- Sirey JA, Berman J, Halkett A, Giunta N, Kerrigan J, Raeifar E, et al. Storm impact and depression among older adults living in Hurricane Sandy-affected areas. Disaster Med Public Health Prep. 2017; 11: 97-109. [CrossRef]
- Conroy ML, Maruca Sullivan P, Lane CE, Cook JM. Anxiety, obsessive-compulsive, and trauma-related disorders. In: The American Psychiatric Association Publishing Textbook of Geriatric Psychiatry, 6th Ed. Washington, DC: American Psychiatric Association Publishing; 2023. pp. 343-382. [CrossRef]
- Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group*. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Ann Intern Med. 2009. Doi: 10.7326/0003-4819-151-4-200908180-00135. [CrossRef]
- Gamble JL, Hurley BJ, Schultz PA, Jaglom WS, Krishnan N, Harris M. Climate change and older Americans: State of the science. Environ Health Perspect. 2013; 121: 15-22. [CrossRef]
- Nitschke M, Hansen A, Bi P, Pisaniello D, Newbury J, Kitson A, et al. Risk factors, health effects and behaviour in older people during extreme heat: A survey in South Australia. Int J Environ Res Public Health. 2013; 10: 6721-6733. [CrossRef]
- Carnes BA, Staats D, Willcox BJ. Impact of climate change on elder health. J Gerontol Ser A. 2014; 69: 1087-1091. [CrossRef]
- Page LA, Hajat S, Kovats RS, Howard LM. Temperature-related deaths in people with psychosis, dementia and substance misuse. Br J Psychiatry. 2012; 200: 485-490. [CrossRef]
- Qiu X, Danesh Yazdi M, Wei Y, Di Q, Just A, Zanobetti A, et al. Associations of short-term exposure to air pollution and increased ambient temperature with psychiatric hospital admissions in older adults in the USA: A case-crossover study. Lancet Planet Health. 2022; 6: e331-e341. [CrossRef]
- Li Z, Christensen GM, Lah JJ, Marcus M, Russell AG, Ebelt S, et al. Neighborhood characteristics as confounders and effect modifiers for the association between air pollution exposure and subjective cognitive functioning. Environ Res. 2022; 212: 113221. [CrossRef]
- Duchesne J, Gutierrez LA, Carrière I, Mura T, Chen J, Vienneau D, et al. Exposure to ambient air pollution and cognitive decline: Results of the prospective Three-City cohort study. Environ Int. 2022; 161: 107118. [CrossRef]
- Sakhvidi MJ, Yang J, Lequy E, Chen J, de Hoogh K, Letellier N, et al. Outdoor air pollution exposure and cognitive performance: Findings from the enrolment phase of the CONSTANCES cohort. Lancet Planet Health. 2022; 6: e219-e229. [CrossRef]
- Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020; 396: 413-446. [CrossRef]
- Petkus AJ, Resnick SM, Wang X, Beavers DP, Espeland MA, Gatz M, et al. Ambient air pollution exposure and increasing depressive symptoms in older women: The mediating role of the prefrontal cortex and insula. Sci Total Environ. 2022; 823: 153642. [CrossRef]
- Qiu X, Shi L, Kubzansky LD, Wei Y, Castro E, Li H, et al. Association of long-term exposure to air pollution with late-life depression in older adults in the US. J Am Med Assoc Netw Open. 2023; 6: e2253668. [CrossRef]
- Iaccarino L, La Joie R, Lesman Segev OH, Lee E, Hanna L, Allen IE, et al. Association between ambient air pollution and amyloid positron emission tomography positivity in older adults with cognitive impairment. J Am Med Assoc Neurol. 2021; 78: 197-207. [CrossRef]
- Parker G, Lie D, Siskind DJ, Martin Khan M, Raphael B, Crompton D, et al. Mental health implications for older adults after natural disasters-a systematic review and meta-analysis. Int Psychogeriatr. 2016; 28: 11-20. [CrossRef]
- Norris FH, Friedman MJ, Watson PJ, Byrne CM, Diaz E, Kaniasty K. 60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981-2001. Psychiatry. 2002; 65: 207-239. [CrossRef]
- Acierno R, Ruggiero KJ, Kilpatrick DG, Resnick HS, Galea S. Risk and protective factors for psychopathology among older versus younger adults after the 2004 Florida hurricanes. Am J Geriatr Psychiatry. 2006; 14: 1051-1059. [CrossRef]
- Pietrzak RH, Van Ness PH, Fried TR, Galea S, Norris FH. Trajectories of posttraumatic stress symptomatology in older persons affected by a large-magnitude disaster. J Psychiatr Res. 2013; 47: 520-526. [CrossRef]
- Binet É, Ouellet MC, Lebel J, Békés V, Morin CM, Bergeron N, et al. A portrait of mental health services utilization and perceived barriers to care in men and women evacuated during the 2016 Fort McMurray Wildfires. Adm Policy Ment Health Ment Health Serv Res. 2021; 48: 1006-1018. [CrossRef]
- North CS, Hong BA, Suris A, Spitznagel EL. Distinguishing distress and psychopathology among survivors of the Oakland/Berkeley firestorm. Psychiatry. 2008; 71: 35-45. [CrossRef]
- Psarros C, Theleritis C, Economou M, Tzavara C, Kioulos KT, Mantonakis L, et al. Insomnia and PTSD one month after wildfires: Evidence for an independent role of the “fear of imminent death”. Int J Psychiatry Clin Pract. 2017; 21: 137-141. [CrossRef]
- Halcomb E, Thompson C, Morris D, James S, Dilworth T, Haynes K, et al. Impacts of the 2019/20 bushfires and COVID-19 pandemic on the physical and mental health of older Australians: A cross-sectional survey. Fam Pract. 2023; 40: 449-457. [CrossRef]
- Silveira S, Kornbluh M, Withers MC, Grennan G, Ramanathan V, Mishra J. Chronic mental health sequelae of climate change extremes: A case study of the deadliest Californian wildfire. Int J Environ Res Public Health. 2021; 18: 1487. [CrossRef]
- Kessler RC, Galea S, Gruber MJ, Sampson NA, Ursano RJ, Wessely S. Trends in mental illness and suicidality after Hurricane Katrina. Mol Psychiatry. 2008; 13: 374-384. [CrossRef]
- Pietrzak RH, Southwick SM, Tracy M, Galea S, Norris FH. Posttraumatic stress disorder, depression, and perceived needs for psychological care in older persons affected by Hurricane Ike. J Affective Disord. 2012; 138: 96-103. [CrossRef]
- Pietrzak RH, Tracy M, Galea S, Kilpatrick DG, Ruggiero KJ, Hamblen JL, et al. Resilience in the face of disaster: Prevalence and longitudinal course of mental disorders following hurricane Ike. PLoS One. 2012; 7: e38964. [CrossRef]
- Heid AR, Pruchno R, Cartwright FP, Wilson Genderson M. Exposure to Hurricane Sandy, neighborhood collective efficacy, and post-traumatic stress symptoms in older adults. Aging Ment Health. 2017; 21: 742-750. [CrossRef]
- Stukova M, Cardona G, Tormos A, Vega A, Burgos G, Inostroza Nieves Y, et al. Mental health and associated risk factors of Puerto Rico Post-Hurricane María. Soc Psychiatry Psychiatr Epidemiol. 2023; 58: 1055-1063. [CrossRef]
- Swiatek JL, JP CI, Ramsey FV, Gentile NT. Six months after Maria: A post-hurricane examination of mental health and associated risk factors in older Puerto Ricans. J Emerg Manage. 2022; 19: 177-187. [CrossRef]
- Heid AR, Christman Z, Pruchno R, Cartwright FP, Wilson Genderson M. Vulnerable, but why? Post-traumatic stress symptoms in older adults exposed to Hurricane Sandy. Disaster Med Public Health Prep. 2016; 10: 362-370. [CrossRef]
- Lenane Z, Peacock E, Joyce C, Frohlich ED, Re RN, Muntner P, et al. Association of post-traumatic stress disorder symptoms following Hurricane Katrina with incident cardiovascular disease events among older adults with hypertension. Am J Geriatr Psychiatry. 2019; 27: 310-321. [CrossRef]
- Schwartz RM, Rasul R, Kerath SM, Watson AR, Lieberman Cribbin W, Liu B, et al. Displacement during Hurricane Sandy: The impact on mental health. J Emerg Manage. 2018; 16: 17-27. [CrossRef]
- Rigby CW, Rosen A, Berry HL, Hart CR. If the land's sick, we're sick:* The impact of prolonged drought on the social and emotional well‐being of Aboriginal communities in rural New South Wales. Aust J Rural Health. 2011; 19: 249-254. [CrossRef]
- Ishiki A, Okinaga S, Tomita N, Kawahara R, Tsuji I, Nagatomi R, et al. Changes in cognitive functions in the elderly living in temporary housing after the Great East Japan Earthquake. PloS One. 2016; 11: e0147025. [CrossRef]
- Kotozaki Y, Tanno K, Otsuka K, Sasaki R, Sasaki M. Longitudinal changes in depressive symptoms associated with social isolation after the Great East Japan Earthquake in Iwate Prefecture: Findings from the TMM CommCohort study. BMC Public Health. 2023; 23: 1154. [CrossRef]
- Westaway K, Frank O, Husband A, McClure A, Shute R, Edwards S, et al. Medicines can affect thermoregulation and accentuate the risk of dehydration and heat-related illness during hot weather. J Clin Pharm Ther. 2015; 40: 363-367. [CrossRef]
- Hajat S, O'Connor M, Kosatsky T. Health effects of hot weather: From awareness of risk factors to effective health protection. Lancet. 2010; 375: 856-863. [CrossRef]
- Clayton S. Climate anxiety: Psychological responses to climate change. J Anxiety Disord. 2020; 74: 102263. [CrossRef]
- Clayton S, Karazsia BT. Development and validation of a measure of climate change anxiety. J Environ Psychol. 2020; 69: 101434. [CrossRef]
- Hajek A, König HH. Climate anxiety, loneliness and perceived social isolation. Int J Environ Res Public Health. 2022; 19: 14991. [CrossRef]
- Tracy M, Norris FH, Galea S. Differences in the determinants of posttraumatic stress disorder and depression after a mass traumatic event. Depress Anxiety. 2011; 28: 666-675. [CrossRef]
- Chen S, Bagrodia R, Pfeffer CC, Meli L, Bonanno GA. Anxiety and resilience in the face of natural disasters associated with climate change: A review and methodological critique. J Anxiety Disord. 2020; 76: 102297. [CrossRef]
- Kellis D, Killilea D, Joyce L, Seritan AL. Post-traumatic stress disorder [Internet]. Climate Resources for Health Education; 2022. Available from: https://climatehealthed.org/course/post-traumatic-stress-disorder/.
- Martin AV, Distelberg B, Palmer BW, Jeste DV. Development of a new multidimensional individual and interpersonal resilience measure for older adults. Aging Ment Health. 2015; 19: 32-45. [CrossRef]
- Georgescu MF, Fischer IC, Lowe S, Pietrzak RH. Psychological resilience in US military veterans: Results from the 2019-2020 national health and resilience in veterans study. Psychiatr Q. 2023; 94: 449-466. [CrossRef]
- Akatsuka E, Tadaka E. Development of a resilience scale for oldest-old age (RSO). BMC Geriatr. 2021; 21: 174. [CrossRef]
- Rodriguez Llanes JM, Vos F, Guha Sapir D. Measuring psychological resilience to disasters: Are evidence-based indicators an achievable goal? Environ Health. 2013; 12: 115. [CrossRef]
- Brockie L, Miller E. Understanding older adults’ resilience during the Brisbane floods: Social capital, life experience, and optimism. Disaster Med Public Health Prep. 2017; 11: 72-79. [CrossRef]
- Shrira A, Palgi Y, Hamama Raz Y, Goodwin R, Ben Ezra M. Previous exposure to the World Trade Center terrorist attack and posttraumatic symptoms among older adults following Hurricane Sandy. Psychiatry. 2014; 77: 374-385. [CrossRef]
- Miyaji C, Takao S, Noguchi M, Okazaki T, Sato S, Yorifuji T. Social capital and post-traumatic stress disorder among heavy rainfall and flood victims in Japan. Acta Med Okayama. 2022; 76: 439-446.
- Dai W, Chen L, Tan H, Wang J, Lai Z, Kaminga AC, et al. Association between social support and recovery from post-traumatic stress disorder after flood: A 13-14 year follow-up study in Hunan, China. BMC Public Health. 2016; 16: 194. [CrossRef]
- Wolters B, Kok A, Huisman M, Cartwright F, Pruchno R. Long-term impact of Hurricane Sandy exposure on positive and negative affect: The role of perceived social support. J Gerontol Ser B. 2022; 77: 1892-1903. [CrossRef]
- Southwick SM, Charney DS. The science of resilience: Implications for the prevention and treatment of depression. Science. 2012; 338: 79-82. [CrossRef]
- Henslee AM, Coffey SF, Schumacher JA, Tracy M, Norris FH, Galea S. Religious coping and psychological and behavioral adjustment after Hurricane Katrina. J Psychol. 2015; 149: 630-642. [CrossRef]
- Li D, Newman G, Zhang T, Zhu R, Horney J. Coping with post-hurricane mental distress: The role of neighborhood green space. Soc Sci Med. 2021; 281: 114084. [CrossRef]
- Hasbach PH. Therapy in the face of climate change. Ecopsychology. 2015; 7: 205-210. [CrossRef]
- Feder R, Behavioral Health Work Group, New Hampshire Healthcare Workers for Climate Action. A Brief Guide to Individual Therapy for Climate-Related Mental Distress [Internet]. Manchester, NH: New Hampshire Healthcare Workers for Climate Action; 2022. Available from: https://www.nhclimatehealth.org/behavioral-health.
- Baudon P, Jachens L. A scoping review of interventions for the treatment of eco-anxiety. Int J Environ Res Public Health. 2021; 18: 9636. [CrossRef]
- Dyer CB, Regev M, Burnett J, Festa N, Cloyd B. SWiFT: A rapid triage tool for vulnerable older adults in disaster situations. Disaster Med Public Health Prep. 2008; 2: S45-S50. [CrossRef]
- Alto ME, Nicasio AV, Stewart R, Rodríguez Sanfiorenzo TD, González Elías G, Orengo Aguayo R. Provision of mental health services immediately following a natural disaster: Experiences after Hurricane Maria in Puerto Rico. J Emerg Manag. 2021; 19: 167-175. [CrossRef]
- Allen B, Brymer MJ, Steinberg AM, Vernberg EM, Jacobs A, Speier AH, et al. Perceptions of psychological first aid among providers responding to Hurricanes Gustav and Ike. J Trauma Stress. 2010; 23: 509-513. [CrossRef]
- Lopes AP, Macedo TF, Coutinho ES, Figueira I, Ventura PR. Systematic review of the efficacy of cognitive-behavior therapy related treatments for victims of natural disasters: A worldwide problem. PLoS One. 2014; 9: e109013. [CrossRef]
- Udomratn P. Mental health and the psychosocial consequences of natural disasters in Asia. Int Rev Psychiatry. 2008; 20: 441-444. [CrossRef]
- Hamblen JL, Norris FH, Pietruszkiewicz S, Gibson LE, Naturale A, Louis C. Cognitive behavioral therapy for postdisaster distress: A community based treatment program for survivors of Hurricane Katrina. Adm Policy Ment Health Ment Health Serv Res. 2009; 36: 206-214. [CrossRef]
- Hamblen JL, Norris FH, Symon KA, Bow TE. Cognitive behavioral therapy for postdisaster distress: A promising transdiagnostic approach to treating disaster survivors. Psychol Trauma. 2017; 9: 130-136. [CrossRef]
- Department of Veterans Affairs, Department of Defense. VA/DoD Clinical Practice Guideline. Management of Post-Traumatic Stress. Guideline Summary [Internet]. Washington, DC: The Office of Quality and Safety, Department of Veterans Affairs; 2010. Available from: https://www.healthquality.va.gov/guidelines/MH/ptsd/CPGSummaryFINALMgmtofPTSDfinal021413.pdf.
- Davis LL, Pilkinton P, Lin C, Parker P, Estes S, Bartolucci A. A randomized, placebo-controlled trial of mirtazapine for the treatment of posttraumatic stress disorder in veterans. J Clin Psychiatry. 2020; 81: 20m13267. [CrossRef]
- Raskind MA, Peskind ER, Chow B, Harris C, Davis Karim A, Holmes HA, et al. Trial of prazosin for post-traumatic stress disorder in military veterans. N Engl J Med. 2018; 378: 507-517. [CrossRef]
- Singh B, Hughes AJ, Mehta G, Erwin PJ, Parsaik AK. Efficacy of prazosin in posttraumatic stress disorder: A systematic review and meta-analysis. Prim Care Comp CNS Disord. 2016; 18. Doi: 10.4088/PCC.16r01943 [CrossRef]
- Weathers F, Litz B, Herman DS, Huska JA, Keane TM. The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Berlin, Germany: ResearchGate GmbH; 1993.
- American Psychiatric Association. Diagnostic and Statistical Manual for Mental Disorders: DSM-5™, 5th ed. Washington, DC: American Psychiatric Association; 2013. [CrossRef]
- Byers AL, Yaffe K, Covinsky KE, Friedman MB, Bruce ML. High occurrence of mood and anxiety disorders among older adults: The national comorbidity survey replication. Arch Gen Psychiatry. 2010; 67: 489-496. [CrossRef]
- Kessler RC, Berglund P, Chiu WT, Demler O, Heeringa S, Hiripi E, et al. The US national comorbidity survey replication (NCS‐R): Design and field procedures. Int J Methods Psychiatr Res. 2004; 13: 69-92. [CrossRef]
- Keya TA, Leela A, Habib N, Rashid M, Bakthavatchalam P, HABIB N. Mental health disorders due to disaster exposure: A systematic review and meta-analysis. Cureus. 2023; 15: e37031. [CrossRef]
- Mahesar RA, Khalil H, Shaikh S, Kalhoro A, Rajar AB, Memon MA, et al. Exploring suicidality in the aftermath of the 2022 flood in Pakistan: Insights from newspaper reports. CNS Spectr. 2023. Doi: 10.1017/S1092852923002419. [CrossRef]
- United States Environmental Protection Agency. Social Vulnerability Report [Internet]. Washington, DC, US: United States Environmental Protection Agency; 2023. Available from: https://www.epa.gov/cira/social-vulnerability-report.
- Ali JS, Farrell AS, Alexander AC, Forde DR, Stockton M, Ward KD. Race differences in depression vulnerability following Hurricane Katrina. Psychol Trauma. 2017; 9: 317-324. [CrossRef]
- Alexander AC, Ali J, McDevitt Murphy ME, Forde DR, Stockton M, Read M, et al. Racial differences in posttraumatic stress disorder vulnerability following Hurricane Katrina among a sample of adult cigarette smokers from New Orleans. J Racial Ethn Health Disparities. 2017; 4: 94-103. [CrossRef]
- Nogueira L, White KE, Bell B, Alegria KE, Bennett G, Edmondson D, et al. The role of behavioral medicine in addressing climate change-related health inequities. Transl Behav Med. 2022; 12: 526-534. [CrossRef]
- Seritan A, Asghar Ali AA, Cooper R, Hatcher A. The time is now: Climate change and aging adults’ mental health. Am J Geriatr Psychiatry. 2023; 31: S21. [CrossRef]
- Hargrow ME. Creating conditions for survivors’ recovery from natural and man-made disasters. J Black Psychol. 2013; 39: 248-251. [CrossRef]
- Seritan AL, Coverdale J, Brenner AM. Climate change and mental health curricula: Addressing barriers to teaching. Acad Psychiatry. 2022; 46: 551-555. [CrossRef]
- Murad MH, Asi N, Alsawas M, Alahdab F. New evidence pyramid. BMJ Evid Based Med. 2016; 21: 125-127. [CrossRef]
- Sharpe I, Davison CM. Climate change, climate-related disasters and mental disorder in low-and middle-income countries: A scoping review. BMJ Open. 2021; 11: e051908. [CrossRef]