When Climate Change Meets Aging: Protecting the Health of Our Elders
Original Characters by Renwu Beijing, November 11, 2024
As extreme weather becomes more frequent, how will climate change impact each of our daily lives?
Lu Hui, a doctor at a public hospital in Zhaoqing, Guangdong, with 16 years of clinical emergency experience, believes that its effects are far beyond what most people imagine. In his view, elderly people with pre-existing conditions have become an involuntary “climate-sensitive” group. They are more prone to heatstroke during heat waves, and their chronic conditions often worsen when cold fronts arrive.
Zhaoqing, a city at the intersection of urban and rural areas in the Pearl River Delta, has seen many young people from villages migrate to the cities for work, leaving behind many “empty nest” elderly. Lu often encounters these elderly patients. In 2022, he began a long-term research project aimed at helping the elderly adapt to climate change. Together with volunteers, he visited nursing homes and communities in Zhaoqing during his free time.
He discovered that these elderly people have not been able to fully benefit from the conveniences of technological advancement. They lack the knowledge needed to cope with climate change, and even the traditional methods they once used to manage extreme heat or cold are now often ineffective. To address these challenges, Lu and his volunteers wrote a handbook titled Elderly Health Protection in Extreme Heat and Heatwaves, and have tried to conduct as much educational outreach as possible to help them prepare for climate impacts.
Some have questioned Lu, wondering if it is overly ambitious to discuss climate issues when healthcare resources are still unevenly distributed. However, his fieldwork has shown him that climate change is deeply connected to everyone, especially vulnerable groups like the elderly. They don’t understand climate change; they just feel that they are in more pain more often. By the time they seek emergency care, irreversible harm has often already been done.
Through his outreach work, Lu has gained a deeper understanding of his patient base. He has found that the elderly hesitate to go to the hospital, as they feel they are unable to contribute to their families, perceiving themselves as “old,” “useless,” or a “burden on their children.” They are also slow to connect changes in their health to shifts in the environment, instead attributing symptoms solely to aging. In Lu’s view, educating the elderly about climate change is as valuable as helping them understand their own health and the aging process.
Perhaps, rather than expecting the elderly to prepare for climate change on their own, the social support system surrounding them should take action. After all, climate change will only become more significant over time, and each generation will grow old; eventually, we will all face these same issues as the elderly do now.
Based on Lu Hui’s Account
Story by: Li Yuning
Editor: Huaiyang
Photos: Provided by Interviewees (unless otherwise noted)
1
As a frontline doctor who rotates to the emergency department regularly, there are two particularly busy times of the year for me: one is during peak summer heat, when we brace for patients suffering from heatstroke. Severe cases of heatstroke can escalate to heat illness or heat stroke. In high heat and humidity, without proper ventilation, the body’s cooling system can fail. In the worst cases, cells die rapidly, with internal organs resembling the effect of boiling water.
Last summer, a tour guide in northern China tragically died from heat stroke. Here in Zhaoqing, a similar case involved an elderly man who was found in his home with all windows shut and only a ceiling fan running. The temperature had soared above 35°C (95°F), and when he was admitted, he was drenched in sweat, with a body temperature over 40°C (104°F). He was rushed to the ICU, but ultimately his family opted for palliative care at home.
The media frequently covers cases of “exertional heat stroke” among young adults who work long hours in high-heat environments, but there is a second type: “classic heat stroke,” primarily affecting the elderly with pre-existing health conditions. In peak summer, we treat elderly patients for heatstroke daily. Mild cases can recover with oxygen and fluids, but severe cases, especially those involving classic heat stroke, are often irreversible.
The second particularly busy time for us is in winter, during rainstorms and cold fronts. For example, around the 2022 Lunar New Year, Zhaoqing experienced unusually warm weather. Then, right after the holiday, temperatures dropped significantly. This abrupt change led to a surge of patients in the emergency department, particularly elderly individuals with chronic conditions. Many presented with digestive issues, chronic bronchitis, respiratory problems, arthritis, and injuries from falls.
In the past, clinicians would attribute these situations to seasonal changes. In summer, we prepared for heatstroke; in winter, for heart and respiratory issues. But recent years have shown more extreme weather, with typhoons causing flooding, making it hard for both patients and ambulances to get around. Our emergency fleet might typically run 20 trips a day, but heavy rain demands its own contingency plans.
Initially, like many others, I had a narrow view of climate change. It was just “global warming” and “hotter weather.” Working in emergency care, we rarely have time to think about the broader factors behind individual cases. But that changed for me in late 2019.
Due to irregular meals, I suffered from acute cholecystitis, requiring an emergency visit to the hospital. During my recovery, I slowed down my daily pace, started to pay more attention to my own health, and began to walk outdoors more often.
When I ventured outside, I noticed that the climate in Zhaoqing felt different from before. The first summer after my recovery, I had to walk a kilometer to meet someone. I quickly felt dizzy, my vision was filled with a shimmering haze, my concentration faded, and my limbs felt weak. I recognized these symptoms as early signs of heat stress. I ducked into an air-conditioned store and quickly drank a bottle of room-temperature water before I felt slightly better.
This was a new experience. Ten years ago, Zhaoqing summers were not this intense. Back then, I could climb mountains with colleagues after night shifts without feeling “overheated.” Yet, during this recent ordinary summer afternoon, with no high-temperature alert issued and after taking precautions like hydrating and wearing a hat, I still almost succumbed to the heat.
2
Another patient we treated in the emergency room had a similar experience.
In July 2022, a forest ranger from a nearby county was brought in after collapsing from heat stroke. This man had decades of experience in forestry, had endured high temperatures countless times, and considered himself resilient to heat. On that day, he purposely waited until after 3:00 p.m. to avoid peak heat but still suffered a heat stroke. Even as late as September, we were still seeing four or five heatstroke cases daily in the emergency room.
Reports on climate change have been abundant in recent years, often citing “the hottest year on record” or “rare cold spells.” Like many places, Zhaoqing’s climate has become more erratic and extreme. Summers start earlier, last longer, and this November, temperatures are still reaching nearly 30°C (86°F) at midday. Meanwhile, winter arrives quickly with little transition. While winters in Guangdong are mild, Zhaoqing has seen temperatures drop to freezing, hailstorms, and even occasional snow.
For most people who work indoors, climate change is just a concept, a vague notion that it’s hotter outside. But in reality, these changes could be more drastic than we realize. During summer, it’s virtually impossible to stay outside for extended periods without risking heatstroke.
After experiencing this change firsthand, I took the opportunity to join a citizen climate action project. During workshops, climate experts explained how climate change impacts public health. I began to realize that much of what I learned from these sessions correlated directly with cases I encountered in my work. Chronic health conditions, mental health issues, and infectious diseases are all affected by climate change. These have come to be known as “climate-sensitive illnesses.”
According to the Lancet Countdown on Health and Climate Change, heat-related deaths in China reached a record high of over 50,000 in 2022. In clinical practice, I felt the impact of that year’s prolonged heat firsthand, and it was during that year that the forest ranger was admitted to our emergency room with heat stroke.
Research has shown that high temperatures also influence behavior, potentially increasing rates of suicide, homicide, and violence. I recall one particularly hot summer where two groups of people, already injured from a brawl, clashed again right in front of the emergency room, forcing our medical staff to intervene.
Those most vulnerable to climate change include outdoor workers, elderly individuals with pre-existing conditions, pregnant women, and children. Many of these labels overlap, and in Japan, research has indicated that heatstroke is a growing cause of isolated deaths among the elderly, correlating with what I’ve seen in our emergency room.
Zhaoqing’s unique characteristic as a migrant city has left many elderly people as “empty nesters.” Many of these elderly people have chronic illnesses. On normal days, they can manage with regular medication, but sudden temperature drops in winter can exacerbate conditions like rheumatoid arthritis, causing severe pain. The construction workers who continue to labor through September’s heat, for example, are mostly elderly farmers.
Other research indicates that weather events can exacerbate conditions like asthma, as seen in Inner Mongolia when thunderstorms heightened the concentration of pollen and mold particles in the air. Many allergic asthma patients experienced acute exacerbations, with emergency rooms overwhelmed. In Guangdong, prolonged flowering seasons and rising temperatures have led to an increase in allergic rhinitis cases. Infectious diseases, like dengue fever, which is spread by mosquitoes, have also become more prevalent in southern and even northern parts of China.
Each of these cases is connected to climate change. Climate change is subtly but significantly impacting human health.
With these connections in mind, I began to reflect on how climate change affects people in their everyday lives beyond the hospital. As a doctor, is there anything I can do for my patients before they reach the point of needing emergency care? Could we push the preventive line a bit further, particularly for the elderly?
In the summer of 2022, I decided to initiate a project in Zhaoqing to help the elderly improve their resilience to climate change.
3
The first phase of our climate resilience study for the elderly began in June 2022 and lasted for about a year. Since we didn’t want to disrupt hospital operations, most of our research was conducted during weekends and holidays in local fields, villages, or patients’ homes. Occasionally, I would include survey questions when visiting patients or offering free consultations in nearby towns.
We encountered significant difficulties at the start of the study. Nursing home managers and community staff were skeptical about our work, dismissing “climate change” as irrelevant. Some even suspected us of trying to sell health supplements under the guise of environmental activism. Nearly six or seven nursing homes refused us entry. Eventually, we were able to get into one facility because the deputy director was an old colleague of mine and trusted that we had no ill intent.
Talking to the elderly, however, was only the beginning. In one nursing home, we prepared a detailed PowerPoint presentation to explain how “climate change happens” and what the “IPCC (Intergovernmental Panel on Climate Change) scientists say.” After two hours, we realized that our audience had mostly fallen asleep. Just like many of us, the elderly didn’t respond well to abstract discussions about climate change, leaving us feeling frustrated.
On reflection, we realized these abstract concepts weren’t relevant to them. They needed practical knowledge and skills. We changed our approach, focusing less on “what climate change is” and more on concrete cases, starting with “how to prevent heatstroke.” We demonstrated basic first-aid measures, such as how to help someone turn over and clear their airway if they’re vomiting from heatstroke, or how to perform CPR in case of cardiac arrest on a hot day. We also learned that limiting each session to an hour was crucial, making it easier for both nursing homes and elderly participants to engage.
Our field research often took place under large banyan trees where elders gathered for shade. In Guangdong, these trees can grow exceptionally large, and the shade attracts many people in the summer. We’d join them casually, listening to their stories. Starting with simple comments like, “It’s really hot today, isn’t it?” we would naturally hear their observations about climate. Asking if it had always been this way would often prompt stories about how the climate had changed over their lifetimes.
During these visits, I gathered information that I could never have learned from the hospital alone. In the hospital, I only saw the effects of climate change on their health, not the behaviors leading up to it. Some elderly people told me that before going out on hot days, they would drink strong tea or even alcohol to “hydrate.” They believed these could substitute for water, not realizing that these actually increase dehydration. Alcohol, for instance, speeds up dehydration, making them more vulnerable to heatstroke when they went outside to work.
Others would show me their medications, concerned that the treatments that used to work weren’t as effective anymore. I came to realize that some traditional treatments might actually backfire in the context of climate change. Many elderly people, for example, take blood pressure medications that contain diuretics, which increase water loss. Under high temperatures, this diuretic effect makes them more susceptible to heatstroke. One elderly patient taking antidepressants was at particular risk, as the medication affected her ability to regulate her body temperature during extreme weather.
Over time, I also learned that when talking with elderly people, I had to adjust my usual medical language. For example, when discussing heatstroke and heat illness, our primary goal was simply to convince them to turn on their air conditioners once the temperature exceeded 35°C (95°F), since fans alone wouldn’t prevent overheating, especially with windows shut. However, simply saying “heatstroke” wasn’t effective. We had to share extreme cases, like instances of serious or even fatal heatstroke, to make them aware of how severe the consequences could be.
“Combined day-and-night heat” was another key concept we emphasized. These days, nights no longer cool down as they once did, and cases of nighttime heatstroke are becoming more common. Elderly people who turn off their air conditioners at night or reduce their water intake to avoid bathroom trips may be at risk. Much of our work involves helping them make these small adjustments to their routines.
We also realized that some messages are better received if they come from someone the elderly already trust. In our culture, this often means grandchildren, who can remind their grandparents not to go outside on hot days or to drink more water. When advice comes from their grandchildren, elderly people are much more likely to follow it.
Over the course of the year, we visited nearly every community and nursing home within a 40-minute drive of Zhaoqing. Eventually, we started noticing recurring questions among the elderly. We compiled these into a booklet on coping with extreme heat, printing it in large font with plenty of illustrations. We also recorded audio explanations, so that even those who couldn’t read well could still understand the contents.
In the end, we distributed a few hundred copies locally and shared an electronic version online. Public service organizations in Chongqing, Guizhou, Guangxi, and Yunnan saw it and began promoting it in their regions as well. Originally, I thought the program would only cover Zhaoqing, but the increasing download count made us feel that even small efforts can add up to something meaningful.
4
At the same time, I couldn’t help but feel that the impact of our efforts was ultimately limited.
For food delivery workers, extreme weather often means peak work hours. And despite all our warnings, some elderly people continue to refuse air conditioning even though their younger relatives installed it for them and regularly send them enough money to cover the costs. In Cantonese, we call this “hard-necked,” referring to their stubbornness. One example is an elderly man who insisted on saving electricity, even though his grandchildren had provided for it, just to “hold on to something for them.”
Initially, I found this stubbornness puzzling. An elderly person once told me that back when he was younger, he would wet his shirt with well water, wear a straw hat, and drink plum juice, surviving all summer without air conditioning. Now, despite being less active than before, he still insists on working his fields because he relies on them for food.
Such stories helped me understand the elderly’s mindset: for some, especially those in rural areas, survival may mean choosing between personal health and crops. High temperatures may threaten the harvest, so some are left to weigh human health against crop survival. Income, especially for rural elderly, is a key factor.
There are also those who grew up without air conditioning and still find it uncomfortable or difficult to operate. Some even develop “air conditioning illnesses,” like itchy skin or sore throats, and prefer not to use it at all.
In a world progressing at breakneck speed, with technology creating new conveniences every day, many of these advances have yet to reach the elderly. Knowledge that younger people may take for granted — concepts like climate change or the IPCC — remains foreign to them. Many don’t even know how to use a smartphone, relying instead on limited life experience that may no longer apply.
And truthfully, not only the elderly but many of us are reluctant to acknowledge aging. Aging is a gradual process, happening slowly and subtly, until one day we realize we can no longer bend down to clip our toenails or lift heavy objects. Until that moment, we tend to deny aging, holding on to the belief that we will always be able to adapt.
But once this realization hits, the elderly’s first response is often fear of losing their social value. In rural areas, this mindset is common, as many elderly feel that growing old means they must “make the most of their last bit of usefulness,” as one said, “for their children and grandchildren.”
In the medical field, we often say that if an elderly person shows up at the hospital, they’re already in severe pain. By the time they reach the emergency room, they can barely walk or have endured the pain for so long that they have no choice but to call for help. I’ve been on ambulance rides to old housing complexes with no elevators, helping carry patients down the stairs.
Elderly people living in rural areas often choose not to seek treatment unless absolutely necessary. They prefer to buy over-the-counter medications rather than see a doctor. I remember one elderly man who, while working in his field during a heatwave, injured his foot with a wooden splinter. He treated the wound himself with antiseptic, only to have it become infected, eventually requiring surgery. His young family members scolded him, wondering why he hadn’t sought treatment sooner. He replied, “I was just trying to save money,” though in the end, it caused more trouble.
Other elderly patients reluctantly agree to hospitalization, only to insist on discharging as soon as possible. Guangdong, at least, has a well-covered basic healthcare insurance system, yet many elderly people still feel that it’s because they’re old and worn out. They feel like they can no longer tolerate the same things they used to. Some stay a few days in the hospital and quickly ask to leave, as they don’t want to feel like a burden.
So, improving elderly people’s climate resilience isn’t just about educating them. It also involves raising awareness among their family members and caregivers, who must understand the significance of climate change.
Among those who support the elderly, we emphasize small changes — such as making sure they use air conditioning when it’s hot, helping them stay hydrated with electrolyte drinks or herbal teas, and paying attention to their mental health during extreme weather. Simple changes in behavior can help tremendously, and while these adjustments won’t happen overnight, we hope our work sparks the beginning of a shift in how people approach elder care and climate resilience.
Only by raising awareness across the entire support network surrounding the elderly can we make meaningful progress.
5
In April and June this year, Guangdong experienced torrential rains that, within a short span, delivered the equivalent of a month’s rainfall. During this period, hospital staff were wading home after shifts, with water reaching thigh height in some areas. In recent years, it’s become clear that extreme weather events disrupt nearly everyone’s lives.
Now, when I discuss how sudden temperature drops from heavy rains can worsen cardiovascular conditions, “climate change” is no longer an abstract or distant concept for the elderly; it has become something tangible, seen in the news about heavy rainfall. Some elderly people even told me they’ve watched videos about rainstorms on short-video platforms and WeChat. Surprisingly, these platforms, popular with older audiences, have helped us better communicate climate-related health advice.
People often ask me, “With such uneven healthcare resources, why focus on something as ‘distant’ as climate change instead of more immediate health issues and treatments?”
My response is that, whether broadly noticed or not, climate change is already affecting the elderly in increasingly direct ways. One woman we met in our research, for example, had fractured her lower back as a young woman. With few treatment options back then, she just lay in bed for half a year until she “healed” on her own. Now, her back pain intensifies before every major cold front, prompting her to relocate further south. As one of China’s earliest “climate migrants,” she has lived in Zhaoqing for over a decade and once found it a comfortable place. But even here, the recent climate shifts have begun to aggravate her condition.
Similarly, elderly people with disabilities face challenges from climate change. One diabetic patient, for instance, found his skin condition worsened during the summer due to sweat rashes that turned into open sores, eventually requiring hospitalization. People with limited mobility, who are often bedridden or use wheelchairs, face an increased risk of pressure sores, particularly as high temperatures make it harder to keep cool and prevent skin breakdown. Many elderly people wear adult diapers for convenience, which only worsens this problem in the heat. And let’s not forget, China has over 85 million people living with disabilities who are also vulnerable to climate changes affecting their health and well-being.
It’s clear that climate change will increasingly impact human health, and this trend will only become more pronounced. Having recognized this early, why wouldn’t we act to prevent and address these issues? Besides our high-temperature handbook, we plan to release a guide for winter cold waves.
But to be frank, at least at the grassroots level, there’s still a lack of awareness regarding climate-sensitive health risks. A common misconception is that climate change only means warming, but it also brings more frequent extreme weather shifts — hotter summers, colder winters, and shorter transition periods between them. Young people, too, are at risk of becoming climate-sensitive, and we’ve already seen cases of thunderstorm asthma and seasonal allergies among younger patients.
So, what can young people do? First, we should prepare ourselves — staying hydrated during hot days, wearing appropriate clothing, maintaining a healthy routine, and avoiding prolonged outdoor activity during extreme weather to minimize heat or cold-related illnesses. Day-to-day, we can also contribute to slowing climate change by reducing our carbon footprint, taking public transport, and supporting sustainable practices.
When it comes to elderly family members, we need to be more proactive in looking after their health. For instance, heatstroke or a simple cold might seem minor, but they can be significant for elderly people and deserve serious attention. Using practical terms, we can introduce concepts like “electrolyte drinks” and show them how to operate air conditioners comfortably — simple, useful measures that enhance their resilience to climate challenges.
Supporting the elderly in adapting to climate change is, ultimately, also about caring for ourselves. Today’s elderly generation sets an example for our future, and over time, we, too, will grow older. As climate change gradually affects everyone, each generation will face these impacts in turn.
Reference
This article was originally published in Renwu Magazine. Original link: https://mp.weixin.qq.com/s/mz-RlBhq80ZsbCzrCYqmmQ.
Summary
This article mainly discusses the impact of climate change on elderly people, especially in the context of Zhaoqing. Doctor Lu Hui’s research and experiences reveal that climate change has significant effects on the health of the elderly. Despite efforts to help them adapt, challenges persist. The story emphasizes that the effects of climate change are not distant but can be felt in daily life, affecting anyone, anywhere.
Just as the effects of climate change can touch anyone, the significance of DODO Bird’s commitment to high-quality second-hand clothing circulation should not be underestimated. The full circulation and reuse of quality second-hand clothing can reduce energy consumption and carbon emissions, mitigating and even improving the trend of global climate change — a deed that benefits future generations.
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