Beiträge zum Themenschwerpunkt Z Gerontol Geriat 2014 · 47:462–467 DOI 10.1007/s00391-014-0677-y Published online: 6. August 2014 © Springer-Verlag Berlin Heidelberg 2014
G. Haq1 · G. Gutman2 1 Stockholm Environment Institute, Environment Department, University of York 2 Gerontology Research Centre, Simon Fraser University, Vancouver
Climate gerontology Meeting the challenge of population ageing and climate change
Introduction The global population is ageing at a time when climate change is also occurring. By the end of this century the global surface temperature is likely to increase by 1.5– 2°C [1]. As the planet warms, we can expect increasing climate variability that will have direct and indirect positive (e.g. increased crop yield) and negative effects on human well-being [2]. Warmer global temperatures are likely to increase the frequency, severity and duration of extreme weather events, such as heat waves, tropical cyclones, flooding, sea level rise and severe storms. Major indirect adverse effects of climate change include temperature-related illnesses and deaths, water stress, air pollution and vector-borne disease. It is argued that if we are to prevent and minimize the negative impact of environmental change on older people, interdisciplinary study of the convergence of the two trends, “climate gerontology”, is needed. At the outset it is important to recognize that while many older people are healthy and socially and economically active, others are not, rendering them physically, financially and/or emotionally less resilient than their peers or other population groups in coping with environmental change.
Population ageing, climate change and geography Population ageing is the result of a change from high to low levels of fertility and mortality. By 2050 there will be a dramatic increase in the number of people aged
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60 and over, who will represent nearly one quarter (just over 2.5 billion) of the global population. While currently the majority of older persons live in developed countries, increasing numbers are expected to live past the age of 60 years, the World Health Organization’s (WHO) threshold for entry into old age, in developing countries [3]. Estimates of deaths from weather-related disasters and gradual environmental deterioration due to climate change, range from 235,000 to over 300,000 per year. These are mainly due to hunger and communicable diseases in vulnerable groups, especially in low income developing countries where the majority of weather-related disasters occur [4].
Heat waves
Climate vulnerability
Warmer temperatures can lead to increased fire activity. Globally, approximately 350 million hectares are burned each year, an area equivalent to the size of India [10]. Wildland fires impact on human health, cause loss of life, damage to property, community disruption and have effects on water, air quality, agriculture and natural ecosystems. The 2009 Australian “Black Saturday” bushfires resulted in 172 deaths. Almost one third of deaths (30%) were among people aged 60 years and over, 9% had a chronic disability and were aged 70 years or over. When the fire fatality data were compared with the age distribution of the 2009 fire affected area, two long-standing fire fatality findings were highlighted: more older people (twice as many) and far fewer children and teenagers (half as many) died
Human vulnerability results from the erosion of individual resilience over time, i.e. in the ability to absorb shocks, self-organize and to adapt [5]. The extent to which climate change will affect individual older people will be dependent on their age, i.e. whether they are younger old (age 60– 74 years) or older old (age 75+ years), their sex, health and functional status, seasonal exposure level, magnitude of the threat and their differential coping capacities. The evidence reviewed here suggests, however, that as a group older persons are disproportionately affected by extreme weather events, such as heat waves, tropical cyclones and flooding.
Zeitschrift für Gerontologie und Geriatrie 6 · 2014
Since the middle of the twentieth century large parts of Europe, Asia and Australia have experienced a rise in the frequency of heat waves [6]. The August 2003 European heat wave saw temperatures reaching 40°C, which resulted in the death of an estimated 14,802 mainly elderly people in France [7] and 2139 excess deaths in England and Wales [8, 9]. A similar pattern of mostly elderly deaths was observed in 2010 when Eastern Europe experienced a heat wave with extremely high day time (e.g. 38°C in Moscow) and night time (25°C in Kiev) temperatures.
Wildland fires
Beiträge zum Themenschwerpunkt than would be expected from the population figures [11].
Cold winter extremes The risk of winter deaths in extreme cold waves (e.g. 2014 North America cold wave) tends to be disproportionately distributed among the elderly with up to 30% of deaths occurring in individuals aged 75 years and over [12]. Women in this age category with respiratory disease are thought to be at particular risk. Countries with poor thermal efficiency standards in housing (e.g. Portugal, Greece and the UK) tend to have high excess winter mortality [13].
Flooding Floods have a number of potential negative effects on health which include mortality, injuries, fecal-oral disease, vectorborne disease, rodent-borne disease and mental disorders. In Europe, a total of 19 flash floods and 162 general floods were reported in the period 2003–2012 [14]. Flooding can cause stress, which together with pre-existing health conditions can have a significant impact on the health and well-being of flood victims. In particular, populations in low-income countries who inhabit high-risk flood plains and coastal zones are more vulnerable due to lack of public health infrastructure, preexisting poverty and not being covered by insurance. There is increasing evidence to suggest that older people in these areas have more difficulty than other groups when it comes to leaving their place of residence in emergency situations [15].
Tropical cyclones Tropical cyclones are expected to occur more often and to be more severe due to the changing climate. The 2013 Typhoon Haiyan that devastated the Philippines is considered to be the most powerful tropical cyclone ever recorded. In the past half century, approximately 2544 people died in the United States or its coastal waters due to tropical cyclones. Hurricane Katrina in 2005 was responsible for an estimated 1100 deaths, approximately 2000 injuries and the displacement of more than
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1 million people [16]. Nearly 60% of the flooding-related fatalities following Hurricane Katrina were among persons ≥65 years of age [17].
Indirect effects of climate change Air pollution Due to climate change, air pollution patterns are changing in many urban centers around the world [18]. High temperatures can result in changes in air quality with an increase in ground level ozone levels [19]. This has a significant effect on respiratory health both independently and synergistically with weather conditions. The risk to older people from air pollution is especially high in individuals suffering from pre-existing medical conditions, such as chronic obstructive pulmonary disease. In particular, there is a high association between levels of nitrogen dioxide and particulate matter and heart and lung disease in older people and hospitalization for community-acquired pneumonia. Longterm exposure to traffic-related air pollution also increases the risk for asthma hospitalization in older people [20].
Food shortages and water stress Climate variability is expected to pose a risk to the stability of food systems further exacerbating food insecurity in those regions which are currently vulnerable to hunger and under-nutrition. This will increase food inequalities making vulnerable older people and communities less resilient to extreme weather [21]. Access and utilization of food is expected to be further affected by indirect climate effects on income, access to safe drinking water and health.
Infectious disease Higher temperatures and changes in precipitation can cause proliferation of vector organisms (e.g. fleas, mosquitoes and ticks) and immediate hosts. This is likely to result in increased risk of diseases, such as malaria, dengue fever, lyme borreliosis and schistosomiasis [22]. Flooding can increase contamination by waterborne and
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foodborne pathogens via flood waters affecting food crops and sewer run-off. Drinking water, seafood and fresh produce can be affected. There is increased risk of waterborne disease (e.g. leptospirosis, norovirus, salmonellosis and legionellosis) following flooding. Older people are more vulnerable to gastrointestinal disease from waterborne pathogens due to pre-existing medical conditions and changes in immune system and gastrointestinal function that occurs with ageing. In addition, they may fail to seek prompt medical attention which could lead to dehydration.
Ageing and carbon emissions Changes in population composition can have significant effects on greenhouse gas (GHG) emissions associated with housing, food, energy and personal travel [23]. In China, India, the United States and Europe, urbanization, reduction in household size, changing lifestyles and changing levels of consumption in later life are having an impact on energy use and carbon emissions [24]. In particular, post-war baby boomers are re-inventing old age as reflected in new mainly carbon-intensive consumption and leisure-oriented lifestyles. Many are highly car-dependent and enjoy international air travel while changes in living arrangements have resulted in changes to residential energy efficiency. Age-specific estimates of per capita CO2 emissions in the USA for a set of selected carbon intensive goods (e.g. electricity, natural gas, gasoline, air flights, tobacco products, clothes, food and cars) show that average emissions increase with age. This continues until people reach their late 60s after which per capita emissions decrease, with the consumption of energy-intensive goods decreasing at very old ages [23]. However, if retirement is postponed the emission-reducing affects in later life would be lessened [24]. Older people should therefore be seen as both contributors to and casualties of climate change.
Abstract · Zusammenfassung
Attitudes of seniors to climate change An international web-based survey of 1028 older people across 5 countries (Australia, Canada, UK, USA and Sweden) that we conducted suggests that while seniors are concerned about climate change they fail to recognize that they could personally be affected [25]. Over 25 % of respondents were “very much” concerned about the effects of more frequent severe floods and storms; however, a relatively low number were “very much” concerned about the impact of climate change on their personal safety and security (13%) and on their health (14%). Lack of information and guidance about how to respond to climate change were seen as barriers to taking action. Despite the limitations of web-based surveys, it is clear that there is a need to raise awareness of the effects that climate change will have on the health and wellbeing of older people among older people themselves as well as among service providers and policy makers.
Need for climate gerontology To do this, in conjunction with developing appropriate interventions, we advocate the development of “climate gerontology”. Climate gerontology is the study of the intersection between climate change and the unique challenges and needs of older people exposed to extreme weather events. This emergent interdisciplinary field has developed in recent years from a confluence of three factors: a dramatic increase in the numbers of persons living into old age, the increase of climate-related extreme weather events and an appreciation of how a changing climate can profoundly influence the quality of life of older people. Older persons require a range of capacities if they are to prepare for and avoid climate-related threats. These include individual level capacities (e.g. income, education and health), social networks (e.g. family, friends, neighbors, community institutions, such as religious and voluntary groups) and social protection policies (e.g. formal welfare provision, such as pensions, healthcare and social services, [26]). These will determine whether they suffer a bad outcome, such as damage or
Z Gerontol Geriat 2014 · 47:462–467 DOI 10.1007/s00391-014-0677-y © Springer-Verlag Berlin Heidelberg 2014 G. Haq · G. Gutman
Climate gerontology. Meeting the challenge of population ageing and climate change Abstract The global population is ageing at a time when climate variability is increasing. It is argued that if we are to minimize the negative impact of environmental change on older people, interdisciplinary study of the convergence of the two trends, “climate gerontology”, is needed. Climate gerontology can examine the unique challenges and needs of older people in coping with extreme weather events. It can contribute to our understanding of the everyday challenges of growing old in a changing climate and how we can
achieve the “longevity dividend”. In particular, it can lead the way to the development of effective policies to reduce the carbon footprint of people during their life course, protect older people from climate-related threats and mobilize their wealth of knowledge and experience to address these. Keywords Population ageing · Climate change · Carbon emissions · Vulnerability · Resilience
„Klima-Gerontologie“. Herausforderung Bevölkerungsalterung und Klimawandel Zusammenfassung Zur gleichen Zeit, in der sich die Klimavariabilität erhöht, altert die globale Bevölkerung. Die Minimierung der negativen Effekte von Umweltveränderungen auf ältere Menschen erfordert die interdisziplinäre Erforschung dieser beiden Trends: eine Klima-Gerontologie. Mit ihr lässt sich untersuchen, welche Herausforderungen und Bedürfnisse speziell für ältere Menschen beim Umgang mit extremen Wetterereignissen bestehen. Klima-Gerontologie kann zum Verständnis dafür beitragen, welche Schwierigkeiten beim Älterwerden in sich verändernden klimatischen Bedingungen entstehen und
loss of property (home and belongings), become physically weaker, economically impoverished, socially dependent, and/or psychologically harmed. Extending the healthy life of older people creates additional capacity, which can offset higher healthcare and pension costs [27]. Good health in later life is a product of investments in earlier parts of the life course. It requires adopting a health model that meets personal needs and seeks to prevent disease and disability rather than just treating these after they develop. New approaches are necessary that combine health promotion, disease prevention and gerontology. This will produce a ‘longevity dividend’, multiple health, economic and social benefits, which will extend healthy life and provide a more climate resilient older population [28]. Climate
wie sich die „Langlebigkeitsdividende“ erreichen lässt. Klima-Gerontologie kann eine Führungsrolle einnehmen bei der Entwicklung effektiver Maßnahmen zur Reduktion des „CO2-Fußabdrucks“ für alle Menschen. Ältere kann sie vor klimabedingten Bedrohungen schützen und ihre Wissens- und Erfahrungsressourcen mobilisieren, um mit diesen Risiken umzugehen. Schlüsselwörter Bevölkerungsalterung · Klimawandel · Kohlendioxidemissionen · Vulnerabilität · Resilienz
gerontology can contribute to our understanding of how we can achieve the “longevity dividend”. In particular, how appropriate policies can be developed to reduce the contribution that older people make to climate change, protect older people from climate-related threats and mobilize their wealth of knowledge and experience in addressing these.
Reducing the carbon footprint of an ageing population Promoting greener attitudes and behaviors to influence individual lifestyle choices of older people is one measure that can be used to reduce their carbon footprint. There is a need to use more appropriate approaches to engage older people, such as peer-to-peer approaches which could
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Beiträge zum Themenschwerpunkt provide more credibility than current topdown approaches [29]. Appropriate infrastructure and incentives that encourage greener behavior in later life will also be needed.
Protecting vulnerable older people Appropriate policies are required to reduce the climate vulnerability of older people, policies that focus on each part of the dynamic process that creates vulnerability. These factors will be different for older people in the developed and developing world.
Mobilizing the experience of older people Seniors’ knowledge of the local environment, its vulnerabilities and how the community has responded in the past allows them to play a key role in reducing the negative impact of current climate change related disasters. In particular, their knowledge of coping mechanisms can be critical when developing local disaster risk reduction and adaptation plans. There is still a general lack of political awareness of the potential of older people in environmental volunteering. Barriers to volunteering for older people such as insurance restrictions, health and safety regulations and lack of access for disabled people need to be removed.
Conclusion Global ageing and environmental change bring together two key policy challenges which need to be addressed to ensure a safe, secure, equitable and sustainable future. Growing old in the twenty-first century brings with it the unique challenge of coping with variable climate that will impact on all aspects of life [30]. In order to effectively manage the impact of climate change it will be necessary to confront and integrate social dimensions in adaptation planning. This requires a better understanding of the effects a changing environment will have on older people at the local, regional, national and international level and in different geographical and socio-economic contexts. Understanding how so-
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cial factors contribute to older people’s vulnerability and resilience to environmental change can strengthen the capacity of governments and agencies to prevent and minimize the negative impact of global climate change on this demographic group. Our social and economic policies need to be shaped by a concurrent understanding of the ageing of our society and global environmental change. We can adapt to each of these separately but that risks seeking solutions in one area that might adversely impact on another area. For example, we might drive up the cost of fuel in order to restrain usage but impose in consequence, on the older population, an inability to keep adequately warm and price them out of the car using public when that might be their only option to get out and about. Likewise, we might develop more technologies to sustain older people living independently at home but fail to appreciate the hazards of hotter summers, storms and high winds and flash floods and power failures which could negate the value of those technologies. Climate gerontology can contribute to providing the evidence base to ‘age and climate proof’ policies so they can harness the contribution of older people in addressing environmental threats and ensure they reach later life with greater resilience.
Corresponding address G. Haq Stockholm Environment Institute, Environment Department, University of York YO10 5DD York UK [email protected]
Compliance with ethical guidelines Conflict of interest. G. Haq and G. Gutman: state that there is no conflict of interest.
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References 1. IPCC (2013) Summary for policymakers. In: Stocker TF, Qin D, Plattner G-K, Tignor M, Allen SK, Nauels BA, Xia Y, Bex V, Midgley PM (eds) Climate change 2013: the physical science basis. Contribution of Working Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge University Press, Cambridge 2. Bouzid M, Hooper L, Hunter R (2013) The effectiveness of public health interventions to reduce the health impact of climate change: a systematic review of systematic reviews. PLoS One 8(4):e62041 3. Pison G (2009) Population ageing will be faster in the South than in the North. Population and Societies: 457. Ined, Paris, ISSN 01847783 4. The Global Humanitarian Forum (2009) Global human impact report: climate change. Geneva. http://www.ghf-ge.org/human-impact-report.pdf. Accessed 5. Adger WN (2006) Vulnerability. Glob Environ Change 16:268–281 6. Coumou D, Rahmstorf S (2012) A decade of weather extremes. Nat Clim Change 2:491–496 7. Zanobetti A, O’Neil MS, Gronhand CJ, Schwartz JD (2012) Summer temperature variability and longterm survival among elderly people with chronic disease. Proc Natl Acad Sci U S A 109(17):6608– 6613 8. Bhattacharya S (2003) European heatwave caused 35,000 deaths, New Scientist, 13/38, 10 October 2003. http://www.newscientist.com/article. ns?id=dn4259. Accessed 6 Sept 2012 9. Johnson H, Kovats RS, McGregor G et al (2005) The impact of the 2003 heatwave on daily mortality in England and Wales and the use of rapid weekly mortality estimates. Euro Surveill 10(7):168–171 10. Flannigan M, Cantin AS, Groot WJ de et al (2013) Global wildland fire season severity in the 21st century. For Ecol Manag 294:54–61 11. Handmer J, O’Neill SJ, Killalea D (2010) Review of fatalities in the February 7, 2009 bush fires. Report prepared for the Victorian Bushfires Royal Commission, April 2010. Melbourne: Centre for Risk and Community Safety, RMIT University and Bushfire CRC 12. Callaly E, Mikulich O, Silke B (2013) Increased winter mortality: the effect of season, temperature and deprivation in the acutely ill medical patient. Eur J Intern Med 546–551 13. Healy JD (2003) Excess winter mortality in Europe: a cross country analysis identifying key risk factors. J Epidemiol Community Health 57:784–789 14. Brown L, Murray V (2013) Examining the relationship between infectious diseases and flooding in Europe A systematic literature review and summary of possible public health interventions. Disaster Health 1(2):1–11 15. Oven KJ, Curtis SE, Reaney S et al (2012) Climate change and health and social care: defining future hazard, vulnerability and risk for infrastructure systems supporting older people’s health care in England. Appl Geogr 33:16–24 16. Henderson TL, Roberto KA, Kamo Y (2010) Older adults’ responses to Hurricane Katrina daily hassles and coping strategies. J Appl Gerontol 29(1):48–69 17. Jonkman S, Maaskant B, Boyd E, Levitan M (2009) Loss of life caused by the flooding of New Orleans after Hurricane Katrina: analysis of the relationship between flood characteristics and mortality. Risk Anal 29(5):676–698
Fachnachrichten 18. Horton DE, Skinner CB, Singh D, Diffenbaugh NS (2014) Occurrence and persistence of future atmospheric stagnation events. Nat Clim Change. DOI 10.1038/nclimate2272 19. McMichael T, Montgomery H, Costello A (2012) Health risks, present and future, from global climate change. BMJ 344:e1359 20. Andersen ZJ, Bennelykke K, Hvidberg M et al (2012) Long-term exposure to air pollution and asthma hospitalisation in older adults: a cohort study. Thorax 67:6–11 21. Trenberth KE, Dai A, Schrier G van der et al (2014) Global warming and changes in drought. Nat Clim Change 1:17–21 22. Gamble JL, Hurley BJ, Schultz PA et al (2013) Climate change and older Americans: state of the science. Environ Health Perspect 121(1):15–22 23. O’Neil BC, Dalton M, Fuchs R et al (2012) Global demographic trends and future carbon emissions. Proc Natl Acad Sci U S A 17(41):17521–17526 24. Zagheni E (2011) The leverage of demographic dynamics on carbon dioxide emissions: does age structure matter? Demography 48:371–399 25. Haq G, Snell C, Gutman G, Brown D (2013) Global ageing and environmental change. Stockholm Environment Institute, University of York, York 26. Cardona OD et al (2012) Managing the risks of extreme events and disasters to advance climate change adaptation. Cambridge University Press, Cambridge. http://dx.doi.org/10.1017/ CBO9781139177245.005 27. Butler RN et al (2008) New model of health promotion and disease prevention for the 21st century. BMJ 337:149–150 28. Olshansky SJ, Beard J, Börsch-Supan A (2012) The longevity dividend: health as an investment. In: Beard JR, Biggs S, Bloom DE et al. Global population ageing: peril or promise? World Economic Forum, Geneva, pp 57–60 29. Reed J, Cook G, Bolter V, Douglas B (2008) Older people involved in policy and planning: factors which support engagement. J Aging Studies 22:273–281 30. Haq G, Whitelegg J Kohler M (2008) Growing old in a changing climate: meeting the challenges of an ageing population and climate change. Stockholm Environment Institute, University of York, UK
Herzwochen 2014
Erstes „atz-Alterstraumatologisches Zentrum“ in Heidelberg
Die Deutsche Herzstiftung hat Herzrhythmusstörungen zum Thema der Herzwochen 2014 gewählt und veranstaltet dazu im November unter dem Motto „Aus dem Takt – Herzrhythmusstörungen“ eine bundesweite Aufklärungskampagne. Viele Menschen sind von Herzrhythmusstörungen betroffen. Oft herrscht dabei eine große Unsicherheit darüber, ob diese harmlos oder gefährlich sind und wie sie behandelt werden können. Umfassende Aufklärung, der Abbau von Ängsten bei Betroffenen und Hilfe im Umgang mit Herzrhythmusstörungen stehen daher im Fokus der Informationskampagne der Deutschen Herzstiftung. Als Grundlage der Kampagne dienen die neuen Experten-Broschüren „Aus dem Takt: Herzrhythmusstörungen heute“ und „Gerinnungshemmung bei Vorhofflimmern“ mit Beiträgen von Kardiologen, Herzchirurgen und Pharmakologen, die laienverständlich über die Erkrankung informieren. In mehr als 1200 Veranstaltungen wie Vorträgen, Seminaren, Telefonaktionen und Gesundheitstagen werden Experten über den aktuellen Stand von Diagnostik und Therapie sowie neue Entwicklungen informieren. Dabei wird die Beteiligung von mehreren tausend Aktions partnern erwartet, darunter Krankenhäuser, Herzzentren, niedergelassene Kardiologen, Gesundheitsämter, Krankenkassen, Volks hochschulen, Apotheken und Betriebe. Veranstaltungstermine der Herzwochen können ab Mitte Oktober im Internet unter www. herzstiftung.de/herzwochen.html abgerufen oder unter Tel. 0049-69-955128-333 erfragt werden.
Als erste Klinik bundesweit wird die Asklepios Klinik Nord – Heidberg als „atz - Alterstraumatologisches Zentrum“ nach dem Zertifizierungsverfahren der Deutschen Gesellschaft für Geriatrie, der Deutschen Gesellschaft für Gerontologie und Geriatrie und dem Bundesverband Geriatrie ausgewiesen. Das Zertifikat bescheinigt eine hohe Qualität bei der Versorgung älterer Patienten mit Verletzungen, speziell Knochenbrüchen. Die Patienten erhalten dabei eine ganzheitliche unfallchirurgische und geriatrische Behandlung. Zum Team des Zentrums gehören Ärzte verschiedener Fachrichtungen, besonders geschulte Pflegekräfte, Physiotherapeuten, Ergotherapeuten, Logopäden, Neuropsychologen, eine Ernährungsberaterin, ein Seelsorger und ein Sozialarbeiter. Ziel der fachübergreifenden Zusammenarbeit ist es, die Selbstständigkeit der Patienten zu erhalten und die Rückkehr in die häusliche Umgebung zu ermöglichen. Das atz-Zertifizierungsverfahren ist eine Initiative zur Förderung und Sicherung der Qualität der Versorgung alterstraumatologischer Patienten. Es basiert auf einem Anforderungskatalog, der aus der Versorgungspraxis heraus von Unfallchirurgen und Geriatern entwickelt wurde. Die Prüfung sowie die Zertifikatsvergabe erfolgen unabhängig von den herausgebenden Gesellschaften durch eine bei der nationalen Akkreditierungsstelle der Bundesrepublik Deutschland (DAkkS) akkreditierten Zertifizierungsgesellschaft. Die Unabhängigkeit des Zertifizierungsverfahren ist in dieser Art einzigartig und unterscheidet das neue atz-Zertifikat von vergleichbaren Zertifikaten am Markt. Quelle: http://www.asklepios.com
Quelle: Deutsche Herzstiftung e.V., www.herzstiftung.de
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G. Haq1 · G. Gutman2 1 Stockholm Environment Institute, Environment Department, University of York 2 Gerontology Research Centre, Simon Fraser University, Vancouver
Climate gerontology Meeting the challenge of population ageing and climate change
Introduction The global population is ageing at a time when climate change is also occurring. By the end of this century the global surface temperature is likely to increase by 1.5– 2°C [1]. As the planet warms, we can expect increasing climate variability that will have direct and indirect positive (e.g. increased crop yield) and negative effects on human well-being [2]. Warmer global temperatures are likely to increase the frequency, severity and duration of extreme weather events, such as heat waves, tropical cyclones, flooding, sea level rise and severe storms. Major indirect adverse effects of climate change include temperature-related illnesses and deaths, water stress, air pollution and vector-borne disease. It is argued that if we are to prevent and minimize the negative impact of environmental change on older people, interdisciplinary study of the convergence of the two trends, “climate gerontology”, is needed. At the outset it is important to recognize that while many older people are healthy and socially and economically active, others are not, rendering them physically, financially and/or emotionally less resilient than their peers or other population groups in coping with environmental change.
Population ageing, climate change and geography Population ageing is the result of a change from high to low levels of fertility and mortality. By 2050 there will be a dramatic increase in the number of people aged
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60 and over, who will represent nearly one quarter (just over 2.5 billion) of the global population. While currently the majority of older persons live in developed countries, increasing numbers are expected to live past the age of 60 years, the World Health Organization’s (WHO) threshold for entry into old age, in developing countries [3]. Estimates of deaths from weather-related disasters and gradual environmental deterioration due to climate change, range from 235,000 to over 300,000 per year. These are mainly due to hunger and communicable diseases in vulnerable groups, especially in low income developing countries where the majority of weather-related disasters occur [4].
Heat waves
Climate vulnerability
Warmer temperatures can lead to increased fire activity. Globally, approximately 350 million hectares are burned each year, an area equivalent to the size of India [10]. Wildland fires impact on human health, cause loss of life, damage to property, community disruption and have effects on water, air quality, agriculture and natural ecosystems. The 2009 Australian “Black Saturday” bushfires resulted in 172 deaths. Almost one third of deaths (30%) were among people aged 60 years and over, 9% had a chronic disability and were aged 70 years or over. When the fire fatality data were compared with the age distribution of the 2009 fire affected area, two long-standing fire fatality findings were highlighted: more older people (twice as many) and far fewer children and teenagers (half as many) died
Human vulnerability results from the erosion of individual resilience over time, i.e. in the ability to absorb shocks, self-organize and to adapt [5]. The extent to which climate change will affect individual older people will be dependent on their age, i.e. whether they are younger old (age 60– 74 years) or older old (age 75+ years), their sex, health and functional status, seasonal exposure level, magnitude of the threat and their differential coping capacities. The evidence reviewed here suggests, however, that as a group older persons are disproportionately affected by extreme weather events, such as heat waves, tropical cyclones and flooding.
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Since the middle of the twentieth century large parts of Europe, Asia and Australia have experienced a rise in the frequency of heat waves [6]. The August 2003 European heat wave saw temperatures reaching 40°C, which resulted in the death of an estimated 14,802 mainly elderly people in France [7] and 2139 excess deaths in England and Wales [8, 9]. A similar pattern of mostly elderly deaths was observed in 2010 when Eastern Europe experienced a heat wave with extremely high day time (e.g. 38°C in Moscow) and night time (25°C in Kiev) temperatures.
Wildland fires
Beiträge zum Themenschwerpunkt than would be expected from the population figures [11].
Cold winter extremes The risk of winter deaths in extreme cold waves (e.g. 2014 North America cold wave) tends to be disproportionately distributed among the elderly with up to 30% of deaths occurring in individuals aged 75 years and over [12]. Women in this age category with respiratory disease are thought to be at particular risk. Countries with poor thermal efficiency standards in housing (e.g. Portugal, Greece and the UK) tend to have high excess winter mortality [13].
Flooding Floods have a number of potential negative effects on health which include mortality, injuries, fecal-oral disease, vectorborne disease, rodent-borne disease and mental disorders. In Europe, a total of 19 flash floods and 162 general floods were reported in the period 2003–2012 [14]. Flooding can cause stress, which together with pre-existing health conditions can have a significant impact on the health and well-being of flood victims. In particular, populations in low-income countries who inhabit high-risk flood plains and coastal zones are more vulnerable due to lack of public health infrastructure, preexisting poverty and not being covered by insurance. There is increasing evidence to suggest that older people in these areas have more difficulty than other groups when it comes to leaving their place of residence in emergency situations [15].
Tropical cyclones Tropical cyclones are expected to occur more often and to be more severe due to the changing climate. The 2013 Typhoon Haiyan that devastated the Philippines is considered to be the most powerful tropical cyclone ever recorded. In the past half century, approximately 2544 people died in the United States or its coastal waters due to tropical cyclones. Hurricane Katrina in 2005 was responsible for an estimated 1100 deaths, approximately 2000 injuries and the displacement of more than
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1 million people [16]. Nearly 60% of the flooding-related fatalities following Hurricane Katrina were among persons ≥65 years of age [17].
Indirect effects of climate change Air pollution Due to climate change, air pollution patterns are changing in many urban centers around the world [18]. High temperatures can result in changes in air quality with an increase in ground level ozone levels [19]. This has a significant effect on respiratory health both independently and synergistically with weather conditions. The risk to older people from air pollution is especially high in individuals suffering from pre-existing medical conditions, such as chronic obstructive pulmonary disease. In particular, there is a high association between levels of nitrogen dioxide and particulate matter and heart and lung disease in older people and hospitalization for community-acquired pneumonia. Longterm exposure to traffic-related air pollution also increases the risk for asthma hospitalization in older people [20].
Food shortages and water stress Climate variability is expected to pose a risk to the stability of food systems further exacerbating food insecurity in those regions which are currently vulnerable to hunger and under-nutrition. This will increase food inequalities making vulnerable older people and communities less resilient to extreme weather [21]. Access and utilization of food is expected to be further affected by indirect climate effects on income, access to safe drinking water and health.
Infectious disease Higher temperatures and changes in precipitation can cause proliferation of vector organisms (e.g. fleas, mosquitoes and ticks) and immediate hosts. This is likely to result in increased risk of diseases, such as malaria, dengue fever, lyme borreliosis and schistosomiasis [22]. Flooding can increase contamination by waterborne and
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foodborne pathogens via flood waters affecting food crops and sewer run-off. Drinking water, seafood and fresh produce can be affected. There is increased risk of waterborne disease (e.g. leptospirosis, norovirus, salmonellosis and legionellosis) following flooding. Older people are more vulnerable to gastrointestinal disease from waterborne pathogens due to pre-existing medical conditions and changes in immune system and gastrointestinal function that occurs with ageing. In addition, they may fail to seek prompt medical attention which could lead to dehydration.
Ageing and carbon emissions Changes in population composition can have significant effects on greenhouse gas (GHG) emissions associated with housing, food, energy and personal travel [23]. In China, India, the United States and Europe, urbanization, reduction in household size, changing lifestyles and changing levels of consumption in later life are having an impact on energy use and carbon emissions [24]. In particular, post-war baby boomers are re-inventing old age as reflected in new mainly carbon-intensive consumption and leisure-oriented lifestyles. Many are highly car-dependent and enjoy international air travel while changes in living arrangements have resulted in changes to residential energy efficiency. Age-specific estimates of per capita CO2 emissions in the USA for a set of selected carbon intensive goods (e.g. electricity, natural gas, gasoline, air flights, tobacco products, clothes, food and cars) show that average emissions increase with age. This continues until people reach their late 60s after which per capita emissions decrease, with the consumption of energy-intensive goods decreasing at very old ages [23]. However, if retirement is postponed the emission-reducing affects in later life would be lessened [24]. Older people should therefore be seen as both contributors to and casualties of climate change.
Abstract · Zusammenfassung
Attitudes of seniors to climate change An international web-based survey of 1028 older people across 5 countries (Australia, Canada, UK, USA and Sweden) that we conducted suggests that while seniors are concerned about climate change they fail to recognize that they could personally be affected [25]. Over 25 % of respondents were “very much” concerned about the effects of more frequent severe floods and storms; however, a relatively low number were “very much” concerned about the impact of climate change on their personal safety and security (13%) and on their health (14%). Lack of information and guidance about how to respond to climate change were seen as barriers to taking action. Despite the limitations of web-based surveys, it is clear that there is a need to raise awareness of the effects that climate change will have on the health and wellbeing of older people among older people themselves as well as among service providers and policy makers.
Need for climate gerontology To do this, in conjunction with developing appropriate interventions, we advocate the development of “climate gerontology”. Climate gerontology is the study of the intersection between climate change and the unique challenges and needs of older people exposed to extreme weather events. This emergent interdisciplinary field has developed in recent years from a confluence of three factors: a dramatic increase in the numbers of persons living into old age, the increase of climate-related extreme weather events and an appreciation of how a changing climate can profoundly influence the quality of life of older people. Older persons require a range of capacities if they are to prepare for and avoid climate-related threats. These include individual level capacities (e.g. income, education and health), social networks (e.g. family, friends, neighbors, community institutions, such as religious and voluntary groups) and social protection policies (e.g. formal welfare provision, such as pensions, healthcare and social services, [26]). These will determine whether they suffer a bad outcome, such as damage or
Z Gerontol Geriat 2014 · 47:462–467 DOI 10.1007/s00391-014-0677-y © Springer-Verlag Berlin Heidelberg 2014 G. Haq · G. Gutman
Climate gerontology. Meeting the challenge of population ageing and climate change Abstract The global population is ageing at a time when climate variability is increasing. It is argued that if we are to minimize the negative impact of environmental change on older people, interdisciplinary study of the convergence of the two trends, “climate gerontology”, is needed. Climate gerontology can examine the unique challenges and needs of older people in coping with extreme weather events. It can contribute to our understanding of the everyday challenges of growing old in a changing climate and how we can
achieve the “longevity dividend”. In particular, it can lead the way to the development of effective policies to reduce the carbon footprint of people during their life course, protect older people from climate-related threats and mobilize their wealth of knowledge and experience to address these. Keywords Population ageing · Climate change · Carbon emissions · Vulnerability · Resilience
„Klima-Gerontologie“. Herausforderung Bevölkerungsalterung und Klimawandel Zusammenfassung Zur gleichen Zeit, in der sich die Klimavariabilität erhöht, altert die globale Bevölkerung. Die Minimierung der negativen Effekte von Umweltveränderungen auf ältere Menschen erfordert die interdisziplinäre Erforschung dieser beiden Trends: eine Klima-Gerontologie. Mit ihr lässt sich untersuchen, welche Herausforderungen und Bedürfnisse speziell für ältere Menschen beim Umgang mit extremen Wetterereignissen bestehen. Klima-Gerontologie kann zum Verständnis dafür beitragen, welche Schwierigkeiten beim Älterwerden in sich verändernden klimatischen Bedingungen entstehen und
loss of property (home and belongings), become physically weaker, economically impoverished, socially dependent, and/or psychologically harmed. Extending the healthy life of older people creates additional capacity, which can offset higher healthcare and pension costs [27]. Good health in later life is a product of investments in earlier parts of the life course. It requires adopting a health model that meets personal needs and seeks to prevent disease and disability rather than just treating these after they develop. New approaches are necessary that combine health promotion, disease prevention and gerontology. This will produce a ‘longevity dividend’, multiple health, economic and social benefits, which will extend healthy life and provide a more climate resilient older population [28]. Climate
wie sich die „Langlebigkeitsdividende“ erreichen lässt. Klima-Gerontologie kann eine Führungsrolle einnehmen bei der Entwicklung effektiver Maßnahmen zur Reduktion des „CO2-Fußabdrucks“ für alle Menschen. Ältere kann sie vor klimabedingten Bedrohungen schützen und ihre Wissens- und Erfahrungsressourcen mobilisieren, um mit diesen Risiken umzugehen. Schlüsselwörter Bevölkerungsalterung · Klimawandel · Kohlendioxidemissionen · Vulnerabilität · Resilienz
gerontology can contribute to our understanding of how we can achieve the “longevity dividend”. In particular, how appropriate policies can be developed to reduce the contribution that older people make to climate change, protect older people from climate-related threats and mobilize their wealth of knowledge and experience in addressing these.
Reducing the carbon footprint of an ageing population Promoting greener attitudes and behaviors to influence individual lifestyle choices of older people is one measure that can be used to reduce their carbon footprint. There is a need to use more appropriate approaches to engage older people, such as peer-to-peer approaches which could
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Beiträge zum Themenschwerpunkt provide more credibility than current topdown approaches [29]. Appropriate infrastructure and incentives that encourage greener behavior in later life will also be needed.
Protecting vulnerable older people Appropriate policies are required to reduce the climate vulnerability of older people, policies that focus on each part of the dynamic process that creates vulnerability. These factors will be different for older people in the developed and developing world.
Mobilizing the experience of older people Seniors’ knowledge of the local environment, its vulnerabilities and how the community has responded in the past allows them to play a key role in reducing the negative impact of current climate change related disasters. In particular, their knowledge of coping mechanisms can be critical when developing local disaster risk reduction and adaptation plans. There is still a general lack of political awareness of the potential of older people in environmental volunteering. Barriers to volunteering for older people such as insurance restrictions, health and safety regulations and lack of access for disabled people need to be removed.
Conclusion Global ageing and environmental change bring together two key policy challenges which need to be addressed to ensure a safe, secure, equitable and sustainable future. Growing old in the twenty-first century brings with it the unique challenge of coping with variable climate that will impact on all aspects of life [30]. In order to effectively manage the impact of climate change it will be necessary to confront and integrate social dimensions in adaptation planning. This requires a better understanding of the effects a changing environment will have on older people at the local, regional, national and international level and in different geographical and socio-economic contexts. Understanding how so-
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cial factors contribute to older people’s vulnerability and resilience to environmental change can strengthen the capacity of governments and agencies to prevent and minimize the negative impact of global climate change on this demographic group. Our social and economic policies need to be shaped by a concurrent understanding of the ageing of our society and global environmental change. We can adapt to each of these separately but that risks seeking solutions in one area that might adversely impact on another area. For example, we might drive up the cost of fuel in order to restrain usage but impose in consequence, on the older population, an inability to keep adequately warm and price them out of the car using public when that might be their only option to get out and about. Likewise, we might develop more technologies to sustain older people living independently at home but fail to appreciate the hazards of hotter summers, storms and high winds and flash floods and power failures which could negate the value of those technologies. Climate gerontology can contribute to providing the evidence base to ‘age and climate proof’ policies so they can harness the contribution of older people in addressing environmental threats and ensure they reach later life with greater resilience.
Corresponding address G. Haq Stockholm Environment Institute, Environment Department, University of York YO10 5DD York UK [email protected]
Compliance with ethical guidelines Conflict of interest. G. Haq and G. Gutman: state that there is no conflict of interest.
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Herzwochen 2014
Erstes „atz-Alterstraumatologisches Zentrum“ in Heidelberg
Die Deutsche Herzstiftung hat Herzrhythmusstörungen zum Thema der Herzwochen 2014 gewählt und veranstaltet dazu im November unter dem Motto „Aus dem Takt – Herzrhythmusstörungen“ eine bundesweite Aufklärungskampagne. Viele Menschen sind von Herzrhythmusstörungen betroffen. Oft herrscht dabei eine große Unsicherheit darüber, ob diese harmlos oder gefährlich sind und wie sie behandelt werden können. Umfassende Aufklärung, der Abbau von Ängsten bei Betroffenen und Hilfe im Umgang mit Herzrhythmusstörungen stehen daher im Fokus der Informationskampagne der Deutschen Herzstiftung. Als Grundlage der Kampagne dienen die neuen Experten-Broschüren „Aus dem Takt: Herzrhythmusstörungen heute“ und „Gerinnungshemmung bei Vorhofflimmern“ mit Beiträgen von Kardiologen, Herzchirurgen und Pharmakologen, die laienverständlich über die Erkrankung informieren. In mehr als 1200 Veranstaltungen wie Vorträgen, Seminaren, Telefonaktionen und Gesundheitstagen werden Experten über den aktuellen Stand von Diagnostik und Therapie sowie neue Entwicklungen informieren. Dabei wird die Beteiligung von mehreren tausend Aktions partnern erwartet, darunter Krankenhäuser, Herzzentren, niedergelassene Kardiologen, Gesundheitsämter, Krankenkassen, Volks hochschulen, Apotheken und Betriebe. Veranstaltungstermine der Herzwochen können ab Mitte Oktober im Internet unter www. herzstiftung.de/herzwochen.html abgerufen oder unter Tel. 0049-69-955128-333 erfragt werden.
Als erste Klinik bundesweit wird die Asklepios Klinik Nord – Heidberg als „atz - Alterstraumatologisches Zentrum“ nach dem Zertifizierungsverfahren der Deutschen Gesellschaft für Geriatrie, der Deutschen Gesellschaft für Gerontologie und Geriatrie und dem Bundesverband Geriatrie ausgewiesen. Das Zertifikat bescheinigt eine hohe Qualität bei der Versorgung älterer Patienten mit Verletzungen, speziell Knochenbrüchen. Die Patienten erhalten dabei eine ganzheitliche unfallchirurgische und geriatrische Behandlung. Zum Team des Zentrums gehören Ärzte verschiedener Fachrichtungen, besonders geschulte Pflegekräfte, Physiotherapeuten, Ergotherapeuten, Logopäden, Neuropsychologen, eine Ernährungsberaterin, ein Seelsorger und ein Sozialarbeiter. Ziel der fachübergreifenden Zusammenarbeit ist es, die Selbstständigkeit der Patienten zu erhalten und die Rückkehr in die häusliche Umgebung zu ermöglichen. Das atz-Zertifizierungsverfahren ist eine Initiative zur Förderung und Sicherung der Qualität der Versorgung alterstraumatologischer Patienten. Es basiert auf einem Anforderungskatalog, der aus der Versorgungspraxis heraus von Unfallchirurgen und Geriatern entwickelt wurde. Die Prüfung sowie die Zertifikatsvergabe erfolgen unabhängig von den herausgebenden Gesellschaften durch eine bei der nationalen Akkreditierungsstelle der Bundesrepublik Deutschland (DAkkS) akkreditierten Zertifizierungsgesellschaft. Die Unabhängigkeit des Zertifizierungsverfahren ist in dieser Art einzigartig und unterscheidet das neue atz-Zertifikat von vergleichbaren Zertifikaten am Markt. Quelle: http://www.asklepios.com
Quelle: Deutsche Herzstiftung e.V., www.herzstiftung.de
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