https://orcid.org/0000-0002-6788-001X
Figures
Abstract
Extreme heat events are increasing in frequency, duration, and intensity owing to climate change. In light of older adults’ heightened risks of heat-related morbidity and mortality, this rapid review examines and updates current knowledge about their preparedness and coping behaviors for extreme heat. We searched six databases focused on aging, social sciences, and the environment for empirical studies published between 2010 and 2024 focused on extreme heat preparedness and coping strategies among older adults. After screening, we retained 41 articles for data extraction and quality assessment. We organized results according to the social-ecological model across individual actions and structural strategies (e.g., service delivery, residential care, and heat-related policy). Studies were primarily conducted in Australia, Canada, the United Kingdom, and the United States, with fewer studies in low-and-middle-income countries. Most studies focused on individual coping methods, including hydration and cooling, environmental adjustments, and relocation. Seven studies examined social service delivery contexts, highlighting the importance of formalized health response plans to enhance service coordination, resource allocation, and information dissemination. The fewest number of studies examined heat-related policies, such as heat wave response plans, heat action plans, heat warning systems, and national heat plans. Findings from the rapid review suggest that community-engaged researchers and practitioners can effectively implement participatory planning with older adults and service providers to enhance risk awareness and improve communication among older adults and their support networks. Older adults, especially those who are socially isolated or resource-constrained, require special considerations in heat preparedness planning. Future research with older adults, particularly in low-and-middle-income countries, should be prioritized. Findings from this study inform practice and policy interventions, centering perspectives of older adults and their caregivers within the context of their living environments.
Citation: Doherty FC, Rao S, Traver A, Dabelko-Schoeny H (2025) Extreme heat preparedness and coping among older adults: A rapid review. PLOS Clim 4(8): e0000689. https://doi.org/10.1371/journal.pclm.0000689
Editor: Teodoro Georgiadis, Institute for BioEconomy CNR, ITALY
Received: March 31, 2025; Accepted: July 16, 2025; Published: August 20, 2025
Copyright: © 2025 Doherty et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All data are in the manuscript and/or supplemental information files.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Global demographic projections suggest that older adults are one of the fastest-growing age groups, and people ages 65 or older will outnumber children under the age of five by 2050 [1]. A 2013 narrative review outlined multiple factors, including physiological, social, and economic factors, that exacerbate climate change impacts on older adults, especially in relation to extreme heat [2]. Since then, the rising impacts of the climate crisis have been felt and confirmed through advances in attribution studies. Extreme heat is one of the most palpable effects of human-driven climate change, and the frequency and intensity of heat waves have risen globally [3,4]. Countries worldwide experienced record-breaking heat in 2023 and 2024, with temperatures predicted to surge over the next few years [5]. In the context of climate change, “extreme heat” refers to prolonged periods of excessively high temperatures [6] that can significantly and adversely impact human health, the environment, and the infrastructure upon which we depend. As with all climate impacts, some population groups are more burdened than others due to differences in exposure, sensitivity, and capacity to adjust to changes during increased heat events [7]. This inequity at the heart of climate injustice underscores the need to focus on populations facing the worst of the climate impacts to guide alleviating measures and policy solutions.
Owing to a combination of physiological, psychological, and social vulnerabilities, older adults are more likely to suffer from heat-related illness and death [8–10]. Aging can make bodies less responsive to temperature changes, causing overheating and dehydration in extremely hot temperatures [8,11]. Inadequate awareness and literacy, or underestimating risks among older adults, [12] can cause increased and unexpected exposure to extreme heat. Older adults, especially those socially isolated, economically marginalized, or with disabilities or limited mobility [13], might lack access to efficient and affordable cooling solutions. Several scholars have recognized older adults’ vulnerability to climate impacts, including extreme heat, emphasizing the need for increased preparedness and improved systems to aid coping [7,14–16]. While some attention has been given to maintaining heat during winters, particularly for older adults [17], the need for extreme heat-related coping and preparedness among this population has come into heightened focus, given the rising incidence of extreme heat events in recent times.
This rapid review examines empirical evidence on extreme heat preparedness and coping behaviors among older adults, published from 2010 to 2024. The research question motivating our review is: What is the current state of knowledge on extreme heat preparedness and coping behaviors among older adults? The project, research question, and methods were determined with input from gerontological scholars and practitioners. The social-ecological model is a holistic framework that considers intersecting factors across individual, relational, community, and societal domains [18]. This model has seen application in health promotion studies to understand the relationship between older adults and their social and built environments [19,20], and provides the structure to organize the findings of this rapid review. We summarized, evaluated, and synthesized current knowledge on the extreme heat preparedness and coping strategies of older adults to inform effective and tailored interventions designed to protect older adults from the harms of extreme heat. The study approach and findings have the potential to motivate future examinations of heat and other extreme weather preparedness and response among marginalized populations facing higher risks. Findings can be used to update and inform evidence-based strategies aimed at mitigating the harms caused by extreme heat.
Methods
We conducted a rapid review following guidance from the Cochrane Rapid Review Methods Group [21]. Compared to systematic reviews, rapid reviews employ a streamlined knowledge synthesis approach to provide timely and resource-efficient results in response to urgent challenges [21–24], such as climate change and extreme heat. With this approach, we limited the number of databases searched, excluded gray literature, used a flexible team approach for article screening and data extraction, and conducted a narrative synthesis of results [22]. We registered the review with PROSPERO [ID#: CRD42022353044] and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting and transparency [25].
Search strategy and eligibility criteria
We searched six databases (Ageline, Environment Complete, Social Sciences Abstracts, SocIndex, PubMed, and Web of Science) and Google Scholar in August 2024 to identify relevant scholarship using keyword searches for “older adults,” “extreme heat,” “planning,” “readiness,” and “coping” (See supplementary files, Table A in S1 Text, for a detailed search strategy and Table B in S1 Text for field codes used for each database). The selection of databases and search terms was guided by a review of relevant literature and in consultation with two librarians at The Ohio State University.
Studies were included if they were 1) empirical, including quantitative, qualitative, mixed methods, or systematic reviews; 2) published since 2010; 3) available in English (due to language limitations among the research team); 4) explicitly focused on older adults; and 5) focused on extreme heat preparedness or coping in the climate change context. We included articles published from 2010 to 2024 to capture the most recent research and retained a broad definition of “older adults” to encompass all potential conceptualizations, including people ages 60 and older [26,27] and those ages 65 and older [28,29].
Study selection
We used Veritas Health Innovation’s Covidence systematic review software (www.covidence.org) to manage the review process. Upon import of the articles from the databases, Covidence automatically removed duplicates. Two reviewers initially screened 30 titles and abstracts to pilot test and discuss the screening process. The reviewers then independently screened the remaining 1,228 titles and abstracts with a reliable Cohen’s kappa of 0.62 [30]. Discrepancies during the review were discussed and resolved through team consensus. For full-text screening (111 articles), two reviewers independently screened five articles and compared the results, achieving 100% agreement. The remaining 106 articles were divided between two team members for full-text screening. Ambiguities regarding inclusion were resolved after team discussions; 20 of 106 full-text articles were discussed. Please see supplementary files, Table C in S1 Text for a list of 70 articles excluded following full-text review.
Eleven closely considered studies were excluded from the final analysis. Of these, three articles focused on thermal comfort but were not situated in extreme heat or climate change contexts [31–33], two used building simulations to test how energy efficiency influenced care-home thermal resilience [34,35] and one employed weather modeling to assess the impact of neighborhood albedo (surface solar reflection) and tree cover on heat exposures [36], and therefore were not within the scope of the study. Five other studies were not empirical [37–39] or did not focus on older adults [40,41].
Data extraction, quality assessment, and data synthesis
Two team members, in consultation with the research team, developed a data extraction template in Microsoft Excel. The template was piloted with three articles, and then a single team member extracted data using the piloted form (See supplementary files, Table D in S1 Text, for data extraction categories). When articles missed any of the data items, “not applicable” was noted. Areas of uncertainty were discussed in weekly team meetings. Two team members evaluated the methodological quality of included articles using the Critical Appraisal Skills Programme (CASP) [42] checklist for qualitative studies, the Mixed Methods Appraisal Tool (MMAT) [43] for mixed methods studies, and National Institutes of Health National Heart, Lung, and Blood Institute (NIH NHLBI) tools for quantitative studies and systematic reviews [44]: the NIH NHLBI tool for Observational Cohort and Cross-Sectional Studies, the NIH NHLBI Tool for Controlled Intervention Studies, and the NIH NHLBI Tool for Systematic Reviews. Studies assessed with the NIH NHLBI tools were ranked as low, medium, or high quality, while CASP and MMAT-evaluated studies received no overall rating, per Cochrane recommendation [45]. Again, areas of uncertainty were discussed and resolved with the larger team. Owing to the heterogeneity of the included article types and the evidence-informed guidance for rapid reviews, we used narrative synthesis to explore patterns within the study characteristics and findings [22,23,46]. The research team used the data extraction template to organize the data into groups based on the social-ecological model, representing the levels at which individuals and systems operate in relation to older adults, and to understand multilevel heat preparedness and coping among older adults.
Results
We first provide an overview and quality assessment of the included articles, followed by a synthesis of the findings. The findings are presented utilizing the social-ecological model, and results are further categorized into themes.
Study characteristics
Table 1 includes detailed study characteristics, and Fig 1 shows the PRISMA flow diagram for the 41 included studies on heat preparedness and coping strategies focused on older adults, published between 2010 and 2024 (See supplementary files, Table E in S1 Text for PRISMA checklist for Rapid Review). Nineteen studies were quantitative, 13 were qualitative, seven used mixed methods, and two were systematic reviews. Studies had a wide geographic spread: Australia (10 studies), the United Kingdom (6), Canada (4), the United States (4), Austria (2), China (2), Hong Kong (2), Sweden (2), and one each in Germany, India, Iran, Italy, Netherlands, Portugal, and Spain. Two studies—a systematic review [47] and a study that performed a content analysis of heat wave response plans [48]—utilized a global and a multicountry scope, respectively. Ten studies included specific theories or guiding frameworks, such as the Ottawa Charter for Health Promotion framework, the Theory of Planned Behavior, the Health Belief Model, social capital, and age-friendly design. Older adults were most commonly defined as those ages 65 and older, though some studies focused on ages 75 and older or ages 55 and above.
Quality assessment
Seventeen quantitative articles were assessed using the NIH NHLBI Tool for Observational Cohort and Cross-Sectional Studies, a 14-item checklist. The average number of criteria met was 5.53, while the average number of inapplicable criteria was 4.29. Commonly unmet criteria included participation rate (13 studies) and sample size justification (16). Criteria commonly deemed not applicable included exposure measured prior to outcome (14), different levels of exposure (12), and follow-up loss (13). Two randomized controlled trials, assessed with the NIH NHLBI Tool for Controlled Intervention Studies, lacked key details such as sample size justification, differential dropout rates, and whether blinding or masking was used. Nine quantitative articles were rated low quality, seven were rated medium, three were rated high, and one, [49], was considered not assessable given their use of dynamic building simulation or spatial analysis methodologies.
Thirteen qualitative articles were assessed using the CASP [42], a 10-item checklist that does not include a scoring system. None of the articles included met the criteria for consideration of researcher–participant relationships. Six mixed methods articles, ranging in design type, were assessed for quality using MMAT [43]. The quantitative components of all articles were descriptive, and only one included inferential data analysis. Lack of rigorous sampling was a limitation across the mixed methods studies. Qualitative components were descriptive, using either focus groups or semistructured interviews to collect data. Integration of components and outputs was adequate, but divergence between findings produced by different methods was inadequately addressed in all mixed methods studies.
The two systematic reviews were assessed using the NIH NHLBI Tool for Systematic Reviews; their overall quality was considered medium. The primary limitations of [47] were the lack of a second reviewer for inclusion, absence of quality assessment, and a lack of explicit discussion or assessment of publication bias. The main limitation of [50] was the omission of gray literature. Research questions, search specificity and comprehension, and presentation of results were of high quality in both reviews. (See supplementary files, Table F in S1 Text for details on quality assessment of all included studies).
Article synthesis
We used the social-ecological model to organize and synthesize current literature to identify extreme heat preparedness and coping strategies among older adults. Findings are arranged into individual-level actions, structural strategies, and heat-related policy. Structural strategies included community service delivery, housing, and residential care settings. Social-ecological levels often overlap [18]; therefore, many studies span individual, community, and policy levels. Fig 2 depicts the various key findings across the social-ecological levels.
Older Adults’ Individual-Adaptation Actions.
Twenty-nine studies focused on older adults’ individual preparedness and coping behaviors during extreme heat events. Most older adults were living independently in houses or apartments, although one study [51] included older adults in nursing homes. Most studies focused on heat-coping behaviors or risk perception, with one study exploring heat preparedness actions [52]. Heat-coping behaviors noted by older adult participants were often described as “commonsense” behaviors [47,53,54,55,56–59], such as hydration and cooling, environmental adjustment, and relocation (Table 2).
Frequent hydration and cooling strategies included drinking more fluids, changing diets to lighter food, decreasing physical activity, staying out of the sun, choosing thinner clothing or bedding, and showering more often [58,60]. Less frequently used cooling strategies were sleeping, using wet cloths, or placing water in front of fans or windows. Environmental adjustment strategies included opening or closing windows; adjusting routines and schedules to avoid the hottest part of the day; using blinds, curtains, or awnings; staying in cooler parts of gardens or making cooling modifications in the garden (e.g., adding shady plants or pergolas); and using fans and air conditioners (AC). Evidence also indicated that adjusting routines to stay cool or indoors during heat events resulted in older adults missing errands, medical treatments, food procurement, or social engagements. Others relocated to cooler locations such as supermarkets/shops, community centers, malls, churches, or green spaces [61]. When relocating outdoors, older adults preferred green spaces with vegetative shade, seating, water features, and ease of walkability and accessibility [62,63].
Coping behaviors differed across groups, contexts, and housing characteristics. Those in high-rise apartments used more heat-adaptive strategies than those in single-family homes or two-family dwellings (i.e., two units with separate entrances) [64]. Housing in urban slums or rural villages often lacked windows or reliable electricity, limiting the cooling capacity in some communities [65]. Apartment dwellers were more likely to cope by going outside during a heat event [66,64], and renters found it more difficult than homeowners to maintain comfortable indoor temperatures [66]. Older homes were warmer [67] and had poor insulation and ventilation [68]. Women [69], those with higher perceived heat strain [70,71], and those living in areas with high surface imperviousness (e.g., paved roads and parking lots) were more likely to use heat-adaptive strategies [64]. With increasing age, older adults were less likely to change their diet or take frequent showers [70], use fans, open windows, or drink cool fluids [53]. Households with more than one member were more likely to have AC, while those with lower income were more likely to cool their arms with water [70].
Structural and community-level strategies.
Service Delivery for Older Adults. Seven studies examined social service delivery in the context of extreme heat events. Community-based health professionals supporting older adults endorsed the value of formalized health response plans that could improve service coordination, resource allocation, and information dissemination [72]. In one study, service providers identified fewer services geared toward minimizing harm to older adults in hot weather than in cold weather [73], underscoring the need for enhanced heat-related public health communication. Studies found that education increased heat risk perception and protective actions, while subsidies increased AC use among older adults [74,75].
Liotta et al. [76] compared mortality rates between urban areas in Rome that were or were not served by the Long Live the Elderly program, a community-based social support program, during the summer of 2015. Targeted program activities such as needs assessments, care plans, periodic phone calls, home visits, health promotion campaigns, and hyperlocal volunteer networks increased in frequency as risk of negative events (e.g., extreme heat events) rose. Their analysis provides evidence for the supportive capacity of proactive and coordinated engagement strategies during heat events. However, in another study [77], service providers in Sweden reported feeling negatively impacted by the extra workload of providing fans and wet clothing to older adults amid the 2018 heat wave, underscoring the reality of additional burden on workers in the absence of commensurate support.
Older Adults’ Housing and Residential Care Settings. Housing-related themes included building design factors, strategies for maintaining indoor thermal comfort, and methods for mitigating heat. Seven studies focused on residential care settings. Using meteorological data and behavioral records, two studies assessed how older adults interacted with their environment during high heat. Tsoulou et al. [68] compared temperature, building thermal performance, and adaptive responses in three public housing units in New Jersey. The authors found that internal temperatures were most influenced by modifying ventilation and circulation through air conditioning, use of fans, and opening windows. Peng & Maing [62] used net radiometers and cameras to analyze the relationships among temperature, exterior design features, and the use of open-air courtyards situated in high-density and high-rise housing in Hong Kong. Age-friendly building design features, such as including immediate and peripheral green spaces, awareness of thermal conditions, and increased numbers of adaptive (shaded) seating options, informed the degree to which older adults were exposed to high ambient heat and the adaptive behaviors they undertook to achieve thermal comfort.
Interviews with staff from residential care settings provided insights into heat adaptation, including feasibility and challenges. Baldwin et al. [78] conducted a focus group and workshop with senior management staff to understand the feasibility of green infrastructure uptake to improve building heat resilience. Participants recognized the value of such modifications but believed compelling evidence regarding benefits to residents and the cost-effectiveness was warranted to justify investment. McInnes and Ibrahim [79] interviewed senior staff to depict the role of a heat wave resource manual in the preparedness of older adults in residential care settings for extreme heat events. Twelve of the 14 facilities in the study had facility-specific heat wave action plans that emphasized early preparation and response. Early preparation included AC maintenance, staff training, maintaining supplies of emergency food and drink, and testing backup generators. Response activities during a heat wave included offering residents additional fluids, monitoring internal building temperatures, and rescheduling resident activities. Maintaining AC systems was the most frequently discussed challenge. Expanding on the theme of heat preparedness, Gupta et al. [80] monitored four care homes over one summer and ran a series of thermal performance simulations to examine causes and remedies for internal overheating. The authors noted that the effectiveness of adaptive measures, such as adding canopy and green cover as well as external shutters, varied within and across buildings and had different implications depending on whether the goal was long-term prevention of overheating or an acute heat wave response.
Heat action plans and policy affecting older adults.
Five studies focused on heat-related policies, including heat wave response plans, heat action plans, heat warning systems, and national heat plans. Heat action plans and warning systems are often established after significant heat events to safeguard communities in future occurrences; once established, they are triggered by a predetermined heat threshold [47]. Though heat action plans vary by region, they may include universally applicable advice on preventing heat stress, increased calls and home visits to identified vulnerable groups, heat-related hotlines, and increased staff at cooling centers [47]. A heat action plan that included heat alerts and health advisories in Montreal was effective in reducing mortality among older adults during hot days [81].
In response to research suggesting that older adults in institutional settings face worse heat-related health outcomes, two studies focused on heat policy in institutional settings. A review of heat wave response plans in Australia, Canada, New Zealand, the United Kingdom, and the United States showed that only three out of 23 plans include guidance for aged care facilities [48]. An evaluation of the implementation of the Netherlands’ National Heatwave Plan in long-term care settings in Amsterdam revealed that 67% of facilities had an established heat protocol, and most care managers viewed institutional cooling measures as important [82]. An analysis of climate adaptation plans in the United States indicated that 19 states had plans addressing the needs of older adults, and heat was among the most named health threats [83].
Discussion
This rapid review updates and expands the broader climate resilience knowledge base by synthesizing scholarship on extreme heat preparedness and coping behaviors focused on older adults within the context of the social-ecological model. Next, we situate key study findings within existing scholarship on climate implications for vulnerable groups, identify directions for future research, and weave in research, policy, and practice implications anchored in previous calls to action [84]. Centering older adults within their care networks and the various contexts they inhabit represents a critical consideration for practice, policy, and future research [85]. The analysis and classification across social-ecological levels highlight the importance of understanding multilevel and multimodal coping and preparedness among older adults facing increased risks of extreme heat.
Key findings and implications
Our review identified multiple individual-level heat-protective behaviors to maintain thermal comfort during extreme temperatures. This included hydration and cooling, altering immediate environments or accessing cooler spaces, and spending time outdoors in natural surroundings. Air conditioners were noted as a main cooling strategy across multiple studies. At structural and community levels, sustained service delivery focusing on hot weather resources was critical in supporting older adults. Tailored care plans, periodic check-ins, and health promotion campaigns were recommended ways of enhancing supportive infrastructure and engagement strategies in preparation for extreme heat, with a focus on equitable access to resources. Ensuring resident safety necessitates active preparations alongside adequate infrastructure support. Additionally, the most effective heat action policies incorporated active alerts and advisories on high temperatures.
Our synthesis suggests that heat-related risk awareness remains low among older adults and their caregivers or social contacts, indicating a need for targeted interventions to increase heat risk knowledge among this vulnerable population, particularly those living outside of institutional settings. Most studies focused on older adults’ reactive behaviors, reinforcing evidence of low risk perception. Combined with climate change skepticism, this presents significant challenges for effective communication and response to extreme heat. To increase risk awareness, public health messaging should leverage communication streams frequented and trusted by older adults. For instance, during the COVID-19 crisis, age-friendly communities utilized a rapid response approach rooted in disaster management principles to identify and integrate emergent short-term needs into existing crisis response systems [86]. Similar cross-sectoral approaches can be implemented for extreme heat contexts, with human service professionals collaborating with trusted community partners to increase heat risk assessment and awareness before extreme heat events, enabling rapid interventions during these crises. Communications should be concise and straightforward to expedite the transfer and uptake of information among service users [87], while also being strengths-based and nonstigmatizing [52] to bolster perceived behavioral control and agency among older adults [88].
Findings from our review suggest that older adults who are resource-constrained due to low income, social isolation, or limited mobility deserve special attention and sustained advocacy for additional resources to dismantle inequities and barriers to heat preparedness and coping. For instance, incentives to improve insulation and weatherization in older adults’ homes and care facilities would help maintain comfortable indoor temperatures and reduce energy costs [64]. Cities and municipal corporations should prioritize investments in weatherizing existing buildings to ensure infrastructure upgrades are not optional or confined only to those who can afford them. Targeted inclusion of and interventions with older renters, those in high-rise buildings, or those with limited access to outdoor spaces and cooling solutions should be prioritized in localized plans. Strategic interventions in lower-income housing properties for older adults can highlight the specific needs and experiences of older adults facing multiple individual and structural barriers, potentially informing more efficient and inclusive strategies.
This review provides evidence that heat action plans that include alerts and advisories may reduce mortality during extreme heat events; however, the implementation of such policies ought to be improved and expanded [47] across social-ecological levels, from individual to community and policy levels [89]. It is important for planners and human service professionals to engage with heat action planning with older adults themselves and to advocate for equitable and just policies grounded in real-world experiences. With extreme heat events accelerating globally, it is imperative that funding be prioritized for heat action planning, coordination, implementation, and ongoing research and data collection.
Recommendations for future research
Most studies in our review were conducted in higher-income countries, with only a few focusing on low-and-middle-income countries, thus limiting the generalizability of findings to many countries most burdened by climate change and extreme heat. Regional contexts matter in heat preparedness and response, and the scale of issues and access to resources differ across countries. For instance, a lack of infrastructural access and power failures in India can prevent the use of fans in slum dwellings [65], a reality vastly different from high-income country contexts. Given the findings from this study, the geographic scope of previous studies thus far is insufficient. A critical area for future research involves examining older adults and family systems in regions increasingly exposed to extreme heat, particularly where infrastructural support and essential services remain inadequate. Recognizing strengths and variations across these contexts will be crucial in developing customized responses and preparedness strategies for older adults. Community-engaged researchers can implement extreme heat participatory planning with older adults and service providers to increase risk awareness and bolster communication among older adults and groups that support them across a range of regional and policy contexts [7].
Multiple studies included here revealed a reliance on air-conditioning as an individual cooling strategy, yet ACs are expensive, energy-intensive, vulnerable to electricity outages, and unsustainable in the long term. Accessible and low-technology cooling interventions, such as communal cooling spaces, offer potential co-benefits including the support of social networks and the facilitation of information exchange, and therefore warrant future exploration [67,90,91]. This is especially pertinent for low-and-middle-income countries where most people do not have access to AC and face an increasing threat of extreme heat events.
The role of social capital in older adults’ heat-coping behaviors also warrants further study. Social capital–enhancing initiatives such as Rome’s Long Live the Elderly program [76] should be explored in additional regional contexts to connect older adults to requisite care and social support. The village model, typically directed and governed by older adults to support each other in aging in place, is another community-led intervention that can aid in the development of social support among older adults and improve heat resilience [92].
Lastly, the quality assessment process offers research directions focused on improving the knowledge base, especially strategies around sampling, design, and analytical rigor. Nearly all studies were observational or exploratory, and the two intervention articles had small sample sizes and limited information. More protracted research efforts are warranted to assess the longitudinal impacts of actions enhancing older adults’ heat preparedness and coping.
Limitations
Some relevant studies may have been missed due to the streamlined rapid review search strategy (e.g., limited number of databases, gray literature exclusion) and language restrictions [21,93]. The search was not comprehensive in keeping with rapid review guidelines. The research team strove to include as many updated studies as feasible, through a collection of documented search strategies to facilitate reproducibility. For example, the search terms did not specifically incorporate long-term care settings, and while some included articles take place in that context, the list may not be exhaustive. The theoretical framework facilitating the narrative synthesis likely explains some but not all of the heterogeneity in factors and contexts across included studies. Lastly, review processes for full-text article screening, data extraction, and quality assessment have the potential to introduce researcher bias; the team discussed and resolved biases as much as practicable [93].
Conclusion
The number of communities exposed to dangerous heat levels worldwide is increasing exponentially, while the global population of older adults is also rising, together posing a severe threat to community health and well-being [1,94]. Our rapid review synthesizes and updates the current knowledge on extreme heat preparedness and coping focused on older adults, one of the population groups most at risk. Our findings across social-ecological levels underscore the need for targeted policy and program interventions prioritizing older adults, as a failure to address existing vulnerabilities and disparities will disrupt the social and health systems designed to support people as they age. A range of stakeholders, including community planners, policymakers, public health officials, and disaster preparedness agencies, can use the findings from this review to integrate the specific needs of older adults into broader climate resilience strategies. Finally, insights from this study also can extend to other vulnerable groups, such as women, children, people with disabilities, those with chronic illnesses, and people living in poverty, as extreme heat events increase because of climate change.
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