Clinicians are witnessing the harmful effects of climate change on patient health, particularly the effects of extreme heat on older patients who are at high risk for heat-related illness, explained Ann Kriebel-Gasparro, DrNP, MSN, FNP BC, GNP BC, FAANP, in a poster session at the Gerontological Advanced Practice Nurses Association (GAPNA) 2022 Annual Conference held September 15 to 17 in Orlando, Florida.
The effects of climate change (heatwaves, droughts, wildfires) can lead to poor air quality, which exacerbates lung conditions in patients with asthma, COPD, and allergies. Climate change also leads to longer growing seasons, which increase pollen levels over a greater period. The cardiovascular and renal effects of hotter climates include dehydration, which can lead to kidney failure. Mosquito and tick-borne diseases are spreading across geographical areas as the climate warms up. The psychological effects of disasters related to climate change also must be considered, said Dr Kriebel-Gasparro, who is a faculty member at Walden University.
“As NPs we need to have a plan when we see older patients who may be hyperthermic,” Dr Kriebel-Gasparro said.
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Heat Stress or Exhaustion
Older patients tend to have decreased thirst and are prone to dehydration on normal temperature days; this is exacerbated on high heat days, Dr Kriebel-Gasparro said. Physical examination findings of heat stress or exhaustion should focus on appearance, skin turgor, temperature (>100 °F), loss of consciousness, and ability to ambulate.
Patients with heat stress or exhaustion should be hydrated with cold fluids, take a cool shower or bath, rest, and stay in the shade if outside. If these methods are not effective at resolving symptoms, patients should contact a health care provider.
Heat stroke is considered a medical emergency and is characterized by a temperature of 104 °F, nausea/vomiting, dizziness, confusion, blurry vision, and falling. Telehealth is useful for evaluating older adults, who are likely to have blood pressure cuffs and thermometers at home. Patients with heat stroke should be transported to the hospital by calling 911 and should not drive themselves or have anyone drive them.
Pharmacotherapy May Increase Risk for Heat-Related Conditions
Medications that put older adults at risk for dehydration and heat-related illnesses include:
- Antiepileptics
- Antihistamines
- Antihypertensives
- Antipsychotics
- Atypical antipsychotics
- β-blockers
- Calcium channel blockers
- Cyclosporine
- Digoxin
- Lithium
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Serotonergic agonists
- Sulfonamides
- Tricyclic antidepressants
- Vasoconstrictors
- Vasodilators
- Warfarin
Dr Kriebel-Gasparro concluded that APRNs can be advocates for climate change mitigation in their communities as well as at a local, state, and national level (Table). Lastly, she encouraged attendees to join the Alliance of Nurses for Healthy Environments (ANHE).
Table. How ARPNs Can Help Older Adults With Climate Change
| Get involved in planning policies to care for older patients living in areas with excessive heat |
| Educate patients and families on strategies to stay cool and hydrate |
| Recognize symptoms that require immediate action (call, office visit, call 911) |
| Advocate for policy change at the local and national level to reduce the effects of climate change; advocate for green islands in urban areas |
| Integrate climate change into curricula in nursing schools and conduct research |
Visit Clinical Advisor’s meetings section for complete coverage of GAPNA 2022.
Source
Kriebel-Gasparro. Effects of climate change (cc) on older adults. Poster presented at: GAPNA 2022; September 15-17, 2022; Orlando, Florida.
