Differential vulnerabilities: Extreme heat, health and well-being of older adults in Sunbelt cities in the United States

Abstract

Heat impacts vary disproportionately across geographic regions and social groups. Older adults in Sunbelt cities of the United States (US) are particularly vulnerable to localized urban warming, which threatens their health and well-being. Prevailing scientific evidence suggests that extreme heat events account for higher fatalities among older adults in the US compared to other extreme weather events. Despite existing studies on the impacts of extreme heat on older adults, limited research has addressed the specific socio-demographic, health-related conditions, and strategic coping factors influencing heat stress experiences among older urban populations. As part of a larger study examining heat and ozone-related risks in Sunbelt cities, this thesis adopts a retrospective cross-sectional study design, leveraging the strengths of mixed-methodology to examine predictors of heat stress and coping strategies among older adults in Los Angeles, Houston, and Phoenix. Utilizing a cross-sectional household survey data from 909 older adults in the three cities, the thesis sought to: (1) examine the factors affecting heat stress among older adults; and (2) explore coping strategies among older adults during extreme heat events. Qualitative data were generated from the open-ended survey questionnaire from 67 respondents across the three cities. Data was analyzed using thematic qualitative coding and multiple binary logistic regression analyses. The results reveal that marital status, income, respiratory diseases, physical activity, cool showers, and city of residence were significantly associated with a higher risk of experiencing heat stress. Also, older adults aged 80 and older were less likely to experience heat stress compared to their relatively younger counterparts. Further, the qualitative results uncovered a mix of heat-related coping behaviors adopted by older adults to protect themselves during extreme heat events. These results underscore the complex interplay of geographic, socio-demographic, behavioral and health-related factors affecting heat stress. The study makes important contributions to theory, policy and practice. First, the study contributes to the literature on the geographies of ageing and the relational processes that shape ageing across place, space and scale. Secondly, the study highlights the importance of integrating varied approaches within the geographies of health and healthcare, hence advancing the methodological diversity of the sub-discipline. Finally, the study underscores the need for policies aimed at strengthening social support for older adults, emergency heat risk warning awareness and public cooling systems in Sunbelt cities. The study recommends that urban health strategies should prioritize these demographics, fostering micro-level coping strategies to enhance resilience and reduce vulnerability to heat stress among older populations.