Paramedics summoned to an Arizona retirement community last summer found an 80-year-old woman slumped inside her mobile home, enveloped in the suffocating 99-degree heat she suffered for days after her air conditioner broke down. Efforts to revive her failed, and her death was ruled environmental heat exposure aggravated by heart disease and diabetes.
In America’s hottest big metro, older people like the Sun Lakes mobile home resident accounted for most of the 77 people who died last summer in broiling heat inside their homes, almost all without air conditioning. Now, the heat dangers long known in greater Phoenix are becoming familiar nationwide as global warming creates new challenges to protect the aged.
From the Pacific Northwest to Chicago to North Carolina, health clinics, utilities and local governments are being tested to keep older people safe when temperatures soar. They’re adopting rules for disconnecting electricity, mandating when to switch on communal air conditioning and improving communication with at-risk people living alone.
Situated in the Sonoran Desert, Phoenix and its suburbs are ground zero for heat-associated deaths in the U.S. Such fatalities are so common that Arizona’s largest county keeps a weekly online tally during the six-month hot season from May through October. Temperatures this year were already hitting the high 90s the first week of April.
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A warming world
“Phoenix really is the model for what we’ll be seeing in other places,” said researcher Jennifer Ailshire, a native of the desert city now at the University of Southern California's Leonard Davis School of Gerontology where she studies how environmental factors affect health and aging. “The world is changing rapidly and I fear we are not acting fast enough to teach people how harmful rising temperatures can be."
A 2021 study estimated more than a third of U.S. heat deaths each year can be attributed to human-caused global warming. It found more than 1,100 deaths a year from climate change-caused heat in some 200 U.S. cities, many in the East and Midwest, where people often don’t have air conditioning or are not acclimated to hot weather. Another study showed that in coming decades dangerous heat will hit much of the world at least three times as hard as climate change worsens.
Isolated and vulnerable, the heat victims last year during Maricopa County's deadliest summer on record included a couple in their 80s without known relatives, an 83-year-old woman with dementia living alone after her husband entered hospice care and a 62-year-old Rwandan refugee whose air conditioner broke down.
While most of the county's confirmed 378 heat-associated deaths were outdoors, those who died indoors were especially vulnerable because of isolation, mobility issues or medical problems as outside summertime highs hit 115 degrees.
Older people of color, with a greater tendency for chronic conditions like diabetes, obesity and high blood pressure are especially at risk.
In Chicago, three African American women in their 60s and 70s died in spring 2022 when the centrally controlled heating in their housing complex remained on and the air conditioning was off despite unseasonable 90-degree weather in mid-May.
An undetermined number of older people died during the summer of 2021 when an unexpected heat wave swept across the U.S. Pacific Northwest. Canada reported that coroners confirmed more than 600 people died from the heat in neighboring British Columbia.
Checking on older people
Many U.S. cities, including Phoenix, have plans to protect people during heat waves, opening cooling centers and distributing bottled water.
But many older people need personalized attention, said Dr. Aaron Bernstein, who directs the Center for Climate, Health, and the Global Environment at the Harvard T.H. Chan School of Public Health.
“If you are elderly and sick you are unlikely to get into an Uber or bus to get to a cooling center,” said Bernstein, who vividly recalls a 1995 heat wave that killed 739 mostly older people in Chicago, his hometown. “So many were socially isolated and at tremendous risk.”
Sociologist Eric M. Klinenberg, who wrote about the catastrophe in his book “Heat Wave: A Social Autopsy of Disaster in Chicago,” has noted social contacts can protect older people during disasters.
“Older people are more prone to live alone," he said, "and they are the most likely to die.”
That's true of all extreme weather.
When Hurricane Katrina devastated Louisiana in 2005, around half of the 1,000 people killed were 75 or older, most of them drowned when their homes flooded.
Chicago encourages residents to check on older relatives and neighbors on hot days and city workers visit people's home. But last year's deaths at a Chicago apartment house shows more is needed.
Community health clinics can help
Bernstein's center is working with relief organization Americares to help community health clinics prepare vulnerable patients for heat waves and other extreme weather.
A "climate resilience tool kit" includes tips like making sure patients have wall thermometers and know how to check weather forecasts on a smart phone. Patients learn simple ways to beat the heat, like taking a shower or sponge bath to cool off and drinking plenty of water.
Alexis Hodges, a family nurse practitioner at the Community Care Clinic of Dare in coastal North Carolina, said rising temperatures can cause renal failure in patients with kidney problems and exacerbate dehydration from medications like diuretics.
Hodges contributed to the climate kit from a region that experiences all the weather events it covers: extreme heat, hurricanes, flooding and wildfires.
At the nonprofit Mountain Park Health centers that annually serve 100,000 patients in greater Phoenix, nurse practitioner Anthony Carano has written numerous letters to utility companies for low-income patients with chronic conditions, asking them not to turn off power despite missed payments.
“This is such an at-risk population,” Carano said of the overwhelmingly Latino patient population that suffer from diabetes and other ailments aggravated by warm weather. About one-tenth of the patients are 60 and older.
Francisca Canes, a 77-year-old patient visiting for back pain, said she's fortunate to live with two daughters who take care of her during hot spells. In the summertime, she stays in shape by joining several women friends at 4 a.m. most mornings for a 4-mile walk.
Air conditioning replacement and repair
Maricopa County in April used federal funds to to allocate another $10 million to its air conditioner replacement and repair program for people who qualify, brining total funding to $13.65 million. In greater Phoenix and several rural Arizona counties, older low-income people can apply for free repair or replacement of air conditioners through a separate non-profit program.
The Healthy Homes Air Conditioning Program run by the nonprofit Foundation for Senior Living last summer ensured about 30 people got new air conditioners or repairs and helped others with home improvements.
Priority goes to older people, those with disabilities and families with very small children, who are also vulnerable to the heat. A person living alone must earn $27,180 or less, said Laura Simone, program coordinator for FSL Home Improvements.
The program recently installed energy efficient windows in the 1930s home of 81-year-old widow Socorro Silvas.
“I am so grateful they are taking care of low-income people like me,” said Silvas, who got her air conditioner in the middle of a sweltering summer several years ago through a program run by Tolleson, a suburb west of Phoenix.
Utility companies can also help protect vulnerable people by halting power disconnections during hot periods.
“In Arizona, air conditioning is a matter of life and death, especially if you are older,” said Dana Kennedy, the state director of AARP, which has fought for stricter regulations preventing summertime power cutoffs.
New rules for Arizona utilities were adopted after 72-year-old Stephanie Pullman died in August 2018 at her Phoenix area home as outside temperatures reached 107 degrees.
The medical examiner's office said Pullman died from “environmental heat exposure” combined with cardiovascular disease after her power was shut off over a $176.84. debt.
The Arizona agency that regulates utilities now bans electricity cutoffs for nonpayment during the hottest months.
After the three Chicago women died last year, residential buildings for older people in the city now must provide air-conditioned common areas and administrators no longer have to keep centrally controlled heat on during unseasonably warm weather. The Illinois state Senate recently passed legislation requiring that all affordable housing have air-conditioning operating when the temperature is 80 degrees (26.6 C) or higher and must be operable by residents.
Kennedy said mobile homes are especially dangerous as high temperatures transform them into a hot metal containers.
“A lot are not insulated,” said Kennedy, who has advised an Arizona State University group working to make mobile homes safer with more surrounding shade and on-site cooling centers. “These heat deaths truly are heartbreaking. But in many cases we can help prevent them.”