The geriatric climate change imperative

Much has recently been written about the potential impact of climate change on Australia and the world, including the possible health effects. But climate change is not going to take place in a social vacuum and it seems clear that some groups of Australians are likely to be more at risk than others.

It is imperative that we view the expert comment about the impact of global warming on Australia in the context of current demographic, social and economic trends, with particular reference to those groups that are likely to be among the most vulnerable.

There would seem little doubt that the rapid ageing of Australia’s population, the related increase in chronic illness, disability and medication-dependence, and the continuing retirement migration to warmer parts of the continent, loom large and will help define vulnerability to climate change in the future.

Australia, like many countries in the world is growing older. The elderly are rapidly increasing both in absolute numbers and as a proportion of the total population. Within 40 years, almost 27 per cent of the population will be aged over 65 years (in some states it is likely to be over 30 per cent), and the numbers of “old old”, those aged over 85 years, will constitute at least 10 per cent of the total population.

At the same time as this happens there will be substantial increases in the level of chronic illness and disability as well as medication dependence. There is plenty of evidence to show that the old, the chronically ill, the medication dependant and the bed-bound, are more sensitive to temperature extremes and high humidity than many other groups.

In addition, those with impaired respiratory systems who remain highly susceptible to a wide range of irritants and allergens are certain to be affected by global warming.

The aged are also great consumers of medication and probably account for more than 60 per cent of all prescribed and non-prescribed medicines. In the case of the really old, well over 90 per cent remains dependant on a variety of drugs taken in tandem.

How will these groups fare under climate change? It is also clear that all the aged are not equal, and that those located at the disadvantaged end of the socio-economic continuum will be most vulnerable.

In such a context it is imperative that we produce policies that address ageing in the context of a changing climate. We need to appreciate that climate change will not affect all groups equally and that some will be more vulnerable than others. Prime among these will be Australia’s elderly population, the chronically ill, disabled and bed-ridden, and those living alone.

There are a number of things that we need to do. First, we need to appreciate the role of a changing climate on the aged, and we need to develop public education campaigns designed to draw attention to their increasing vulnerability.

Second, we need to develop long-term care and support structures designed to cope with an ageing population in a changing climate. Most of the 37,000 who perished during the European heat wave of 2003, for example, were elderly, either living alone or resident in severely short-staffed aged care facilities, most without air-conditioning. Would we do better in a protracted heat wave?

Third, we need to appreciate that under higher temperatures, the house and bed-bound, and those dependent on a cocktail of medications are more at risk. To this end we need to understand that when temperatures get hotter many of the drugs currently taken by the elderly for high blood pressure, hypertension, diabetes, heart and respiratory conditions often do not work as well as they previously did. Hence we probably need to place less emphasis on drug therapy among the aged, or at the very least, provide counsel about the potential effects of warmer temperatures.

Finally, we need to be aware that current retirement migration patterns are placing the elderly more at risk by moving them to hotter parts of Australia as well as areas noted for their mosquito population. To me this is the geriatric climate change imperative.