Introduction
Climate change refers to persistent shifts in the Earth’s typical weather patterns, including long-term changes in temperature, precipitation, and other climatic variables occurring over extended periods [
1]. It is widely recognized as a major global challenge that poses significant threats to public health. Over the past 4 decades, global warming has emerged as a principal driver of climate change [
2]. The World Health Organization estimates that between 2030 and 2050, climate change may contribute to approximately 250,000 additional deaths annually, primarily due to undernutrition, malaria, diarrheal diseases, and heat-related stress [
3].
Climate change affects not only the general population but also disproportionately impacts older adults [
4]. By 2050, approximately 16% of the global population will be aged 65 years or older, with Europe and North America projected to have nearly 1 in 4 individuals in this age group [
5]. Older adults are particularly vulnerable to climate-related hazards because of reduced physiological reserve, functional limitations, social disadvantage, and environmental constraints [
6]. Previous research has examined how aging, quality of life, and coping strategies influence older adults’ well-being in the context of climate change [
7].
The association between climate change and infectious diseases is becoming increasingly evident, as rising temperatures and altered rainfall patterns create favorable conditions for pathogens and vectors to proliferate [
8]. Heat waves and extreme weather events are also associated with increased cardiovascular risk, particularly among older adults [
9]. Recent evidence indicates a 53.7% increase in heat-related deaths among adults aged 65 years and older over the past decade [
10]. However, relatively few studies have examined these risks in tropical countries such as India, where summer heat tends to be more intense and prolonged than in temperate regions [
11].
Both heat waves and sustained high temperatures are becoming more frequent and severe [
11–
15]. Many older adults live with chronic conditions—including cardiovascular, pulmonary, and renal diseases, as well as diabetes—that may be exacerbated by heat exposure, making these conditions particularly concerning in the context of climate-related health risks [
16–
18].
Extreme cold also poses significant health risks. Cold waves may contribute to seasonal influenza outbreaks [
19]. Despite the heightened vulnerability of older adults in tropical countries such as India, region-specific research remains limited. In these settings, prolonged and intense summer heat further increases exposure risks compared with temperate climates. The growing severity of both chronic heat exposure and acute heat waves underscores the need for context-specific research and targeted interventions [
20].
Multidisciplinary strategies that integrate weather-related health risk information into comprehensive health warning systems may improve preparedness and response, enhance public awareness, and support coordinated local and national measures to mitigate temperature-related morbidity and mortality [
21]. Although attention to climate-related health impacts has increased, consolidated evidence focusing specifically on older adults remains limited. Their vulnerability is compounded by comorbidities, limited mobility, social isolation, and reduced adaptive capacity. In this scoping review, we aimed to examine the health impacts of climate change on older adults and to map existing interventions and coping strategies used to address these challenges.
Research Questions
(1) What are the documented health impacts of climate change on older adults?; (2) What intervention strategies and coping mechanisms are currently employed by older adults to mitigate or adapt to these impacts?; (3) What gaps remain in the literature regarding climate change and geriatric health?
Materials and Methods
Eligibility Criteria
We included studies focusing on adults aged 60 years and older. The concept of interest was the impact of climate change on the physical and mental health of older adults. All global contexts were eligible, regardless of geographic region or healthcare setting. We excluded studies that did not focus on older adults (younger than 60 years) or did not provide age-stratified data for this population. We also excluded publications not written in English and studies lacking sufficient methodological detail or full-text availability.
Eligible sources included original quantitative and qualitative studies, gray literature, policy documents, and organizational reports addressing climate change, health, and aging. Only publications from the past 15 years (2010–2025) were considered. (1) Population: adults aged 60 years and older. (2) Exposure: climate change and related environmental stressors affecting physical and mental health. (3) Outcomes: health outcomes and intervention strategies associated with climate-related effects.
All global contexts and study designs were eligible. The review followed Arksey and O’Malley’s scoping framework and adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting guidelines. Two independent reviewers conducted study selection and data extraction to ensure methodological transparency and reproducibility.
Information Sources
A comprehensive search was conducted across PubMed, Scopus, Google Scholar, and other relevant databases and resources. Both qualitative and quantitative studies reporting the effects of climate change on older adults were included. Gray literature and reports from organizations addressing climate change and aging were also reviewed.
Search Strategy
The following keywords and combinations were used: “climatic changes,” “older adults,” “interventions,” “natural disaster,” “vulnerable older population,” “health impact,” “coping strategies,” “mortality,” “morbidity,” “global warming,” “disaster preparedness,” and “policy response.” Boolean operators were applied as appropriate. Duplicate records were removed using Zotero ver. 7.0 (Corporation for Digital Scholarship).
Selection Process
Two reviewers independently screened titles, abstracts, and full-text articles for eligibility according to the predefined inclusion criteria. Disagreements were resolved through discussion and consensus. The review followed Arksey and O’Malley’s scoping framework and adhered to PRISMA-ScR reporting standards (
Figure 1).
Data Collection Process
Two reviewers independently extracted data from each eligible study. Extracted variables included study characteristics (e.g., country, design, population, and setting), outcomes, and key findings. Discrepancies were resolved through discussion and consensus. The Rayyan ver. 1.6.1 (Rayyan Systems Inc.) platform was used to facilitate study management and screening.
A predominantly inductive thematic content analysis approach was employed (
Table 1). Two researchers first familiarized themselves with the data through repeated review. Initial codes were generated manually to capture meaningful segments relevant to the research questions. These codes were subsequently organized into potential themes through iterative discussion. Themes were refined by comparing coded extracts to ensure internal consistency and conceptual distinctiveness. Disagreements were resolved by consensus, enhancing methodological rigor and reliability. Rayyan software supported data management; however, coding and theme development were conducted manually and collaboratively.
Data Items
Data extracted included (1) physical health outcomes: heat-related illness, cardiovascular events, respiratory diseases, and infectious disease burden; (2) mental health outcomes: anxiety, depression, insomnia, and related psychological effects; (3) additional variables: population characteristics, geographic context, type of intervention or coping strategy, and policy-related factors. When data were unclear or incomplete, contextual assumptions were made based on reported information and explicitly documented.
Study Risk of Bias Assessment
Because the primary objective of this scoping review was to map the breadth of existing literature rather than evaluate causal relationships, a formal risk of bias assessment was not conducted, consistent with scoping review methodology.
Effect Measures
Effect measures were not calculated because this review did not include a meta-analysis. Findings were synthesized narratively and descriptively.
Synthesis Methods
Data were analyzed using descriptive methods to summarize study characteristics (e.g., design, location, and population) (
Table 2) and thematic content analysis to synthesize findings across studies [
21–
36]. Results were tabulated and grouped under major domains, including physical health impacts, mental health impacts, interventions, coping strategies, and policy responses. This approach facilitated the identification of recurring patterns, knowledge gaps, and areas requiring further research.
Reporting Bias Assessment
Given the scoping nature of this review, no formal assessment of reporting bias (e.g., funnel plots or Egger’s test) was performed.
Results
Overview
This scoping review included 16 peer-reviewed articles and 5 grey literature sources, most of which were published in the past 15 years.
Influence of Climate Change on Older Adults’ Health
Analysis of the included studies identified several key themes related to the health impacts of climate change on older adults (
Figure 2). Findings were categorized according to major domains, highlighting the detrimental effects of climate-related exposures on both physical and mental health.
Infectious Diseases Associated with Climate Change
Climate-sensitive infectious diseases are conditions whose transmission and distribution are influenced by environmental factors such as temperature, rainfall, and humidity [
37]. Population aging has resulted in a growing proportion of older adults, particularly in high-income countries, thereby increasing the number of individuals vulnerable to climate-sensitive infections. Age-related reductions in physiological reserve, slower metabolic processes, and diminished immune responsiveness contribute to increased susceptibility in this population [
38]. The reviewed studies identified several infectious diseases influenced by climate variability and described their transmission pathways and public health implications [
39]. Air pollution and atopic conditions may increase susceptibility to infections, while poor water quality elevates the risk of exposure to waterborne pathogens. Vector-borne diseases, particularly those transmitted by mosquitoes and ticks, also pose substantial risks to older adults [
40,
41]. Policy responses addressing climate-sensitive infectious diseases should prioritize enhanced surveillance systems that integrate climate and epidemiological data to enable early detection and rapid response [
42]. Additional preventive measures include improving drainage systems to reduce mosquito breeding sites, increasing community awareness of infection risks, and implementing targeted prevention strategies [
43].
Extreme Temperatures and Health Effects
Exposure to extreme heat has been associated with reduced kidney function among older adults receiving antihypertensive medications, leading to increased rates of prolonged hospitalization [
22]. Rising indoor temperatures have also been correlated with decreases in blood pressure among older adults [
23]. Individuals with pre-existing myocardial dysfunction appear to face elevated risks of cardiac ischemia and cardiogenic shock during heat waves, rendering older adults particularly vulnerable to heat-related cardiovascular events [
24,
44]. Heat stroke further exacerbates morbidity among older adults, especially those with severe disabilities [
4]. Overall, increased ambient temperatures are associated with higher mortality rates in this population [
40].
Older women are more likely to report heat-related symptoms during periods of elevated temperatures, and individuals with comorbid conditions tend to experience more severe and numerous symptoms [
25]. Heat waves are also associated with worsening respiratory conditions [
26]. Projections of heatwave-related mortality underscore the urgent need for effective adaptation and mitigation strategies [
37]. Long-term exposure to temperature variability has been associated with increased prevalence of chronic diseases in older adults [
17]. Additionally, older adults demonstrate increased vulnerability to diurnal temperature range, which has been linked to elevated rates of emergency admissions for cardiovascular conditions [
27].
Enhancing general practitioners’ understanding of heat-related health impacts and climate change is essential. Social support and nursing care have been identified as key factors influencing vulnerability to heat exposure among older adults [
28]. Coping strategies reported by older adults include body-related measures (e.g., hydration, clothing adjustment), home-protection practices, and activity modification. Socioeconomic status and culturally influenced decision-making processes also shape adaptive behaviors. Comprehensive and targeted awareness campaigns for high-risk populations are strongly recommended [
25,
29].
Cold waves likewise pose significant health risks. Older adults are more susceptible to cold-related morbidity and mortality than younger populations. Notably, countries with milder winters may experience higher rates of cold-related deaths than those with more severe winters, possibly reflecting differences in adaptation and infrastructure. Among individuals with a history of congestive heart failure, the risk of hospitalization or death is significantly higher during winter months compared with summer, independent of air pollution levels [
30].
Air and Water Quality
Changes in climatic conditions also affect air quality. More than half of air pollution–related deaths occur among older adults, with approximately half attributable to cardiorespiratory conditions. Ozone depletion and increased ultraviolet radiation exposure have been associated with rising incidence of skin cancers, including melanoma and basal cell carcinoma [
45]. Climate-related environmental stressors may also accelerate the progression of geriatric syndromes, particularly frailty and cognitive decline [
44]. Alterations in rainfall patterns and temperature can increase contamination of water sources and modify their chemical composition, thereby affecting water quality and facilitating the proliferation of microbial pathogens [
46]. These changes contribute to elevated risks of infection among vulnerable older adults.
Older Adults’ Vulnerability During Disasters
Older adults often face financial constraints that limit their ability to repair homes or recover following climate-related disasters [
31]. Limited income and reduced access to resources restrict adaptive capacity and delay recovery [
47]. Women frequently assume caregiving responsibilities for older adults during disasters, further compounding vulnerability [
47]. Inadequate social support and limited assistance during emergencies have been associated with increased mortality among older individuals. Pre-existing poor health status further increases disaster-related mortality risk. In one setting, residents anticipated flooding of the Chietanga River by observing changes in wildlife behavior, including the movement of hippopotamuses. In response, community members constructed mud barriers to protect agricultural land and stored food and essential supplies in preparation for the flood [
32]. These examples illustrate the importance of local knowledge and anticipatory coping mechanisms in disaster response.
Mental Health and Climate Change
Elevated night-time temperatures can disrupt sleep, as discomfort may prevent individuals from maintaining regular sleep patterns. One study reported significant seasonal variation in sleep–wake cycles among an older rural cohort in France [
33]. Such disturbances are associated with increased rates of insomnia among older adults [
23]. Older adults who survived wildfires reported high prevalence of anxiety, depression, insomnia, nightmares, and post-traumatic stress disorder [
34]. Climate-related disasters may therefore have lasting psychological consequences in this population. Addressing climate-associated mental health outcomes in older adults is increasingly important, given their heightened vulnerability to environmental stressors. Healthcare professionals should receive training on the mental health implications of climate change to provide appropriate assessment, support, and intervention [
20].
Interventions and Climate Change
In Italy, participation in the Long Live the Elderly intervention program was associated with reduced mortality during summer heat waves, particularly among individuals aged 80 years and older. Programs designed to reduce social isolation were linked to smaller increases in mortality during periods of extreme heat [
46]. In Egypt, a community-based awareness program significantly improved knowledge, attitudes, and practices related to climate change and health among older adults [
47]. Financial strategies to subsidize electricity costs for cooling devices during heat waves have also been proposed as essential measures to protect heat-vulnerable populations [
23].
Best practice recommendations emphasize that adaptation plans should be grounded in local epidemiological data and aligned with available emergency management resources. Strengthening monitoring and alert systems, including clearly defined temperature exposure thresholds, may enhance the effectiveness of cold weather and heatwave action plans [
21]. Effective adaptation requires coordinated improvements in early warning systems, healthcare infrastructure, urban planning, social support networks, and community engagement [
48]. Increasing general practitioners’ awareness of heat-related health risks may promote greater involvement in preventive strategies. Social support and nursing care remain central determinants of vulnerability among older adults during extreme temperature events [
28].
Discussion
Climate change poses a substantial public health threat to older adults, who are disproportionately affected due to age-related physiological vulnerability and social determinants of health. Consistent with prior reviews, this scoping review identified increased morbidity and mortality associated with extreme temperatures, air pollution, and other climate-related hazards in this population. Beyond acute morbidity and mortality, broader determinants—including functional decline, quality of life, healthcare access, and social isolation—play significant roles in shaping overall vulnerability and warrant further investigation [
20,
49,
50].
The current evidence base remains limited regarding the effects of climate-related hazards beyond heat waves, such as floods, droughts, cold spells, and vector-borne diseases, on older populations. This limitation constrains the development of comprehensive, tailored interventions. Mental health consequences—including anxiety, depression, and trauma-related disorders—have historically received less attention but are increasingly recognized as integral components of climate-related health risk in older adults [
20,
51,
52].
Healthcare providers play a central role in recognizing and managing both the physical and psychological consequences of climate-related events in older adults. However, targeted education and training are needed to equip clinicians and caregivers with the competencies required to address these complex challenges effectively. Age-appropriate mental health support strategies should be integrated into routine clinical practice and disaster response frameworks [
20,
48].
Despite the existence of policies and educational resources addressing climate change and health, implementation remains inconsistent. There is a notable lack of older adult–specific programs focused on climate-related health risks. Public health authorities should prioritize targeted education and outreach initiatives for older adults, particularly those with lower socioeconomic status, emphasizing adaptive behaviors such as protection from temperature extremes and mitigation of social isolation. Financial support for infrastructural adaptations—including access to adequate cooling and heating systems—is essential to reduce vulnerability and promote healthy aging in the context of climate change [
44,
48,
49].
Theoretical models, including resilience theory, offer valuable frameworks for conceptualizing adaptive capacity among older adults. The findings of this review align with resilience-based approaches that emphasize the importance of social networks, community engagement, and institutional support in strengthening adaptive responses to climate stressors [
53].
Strengths and Limitations of the Study
This scoping review synthesizes evidence from multiple countries, providing a broad overview of the health impacts of climate change on older adults and the range of interventions implemented internationally. By integrating findings across diverse geographic and socioeconomic contexts, the review highlights common patterns while underscoring the need for localized, context-specific research to inform tailored interventions at national and regional levels.
However, this review is limited by its reliance exclusively on previously published literature. Consequently, the findings reflect only the available evidence base and may be subject to publication bias. Confounding factors—such as comorbidities and socioeconomic status—were not systematically evaluated because formal risk of bias assessment was not conducted. Additionally, given the global scope of included studies, the review does not provide detailed analysis of country-specific interventions, which may vary substantially depending on geographic, climatic, and socioeconomic conditions.
