Extreme Heat Poses Rising Deadly Threat to Older Americans as Policies Lag Behind

Extreme heat is quietly becoming one of the most dangerous consequences of a warming climate for the United States, and the people most at risk are often the least equipped to protect themselves. A new policy analysis published in Public Policy & Aging Report argues that as heatwaves grow more frequent and more severe across the country, older adults face health threats that extend far beyond simple discomfort. The analysis, authored by researchers affiliated with the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife and the University of Waterloo, contends that public policy has not kept pace with the realities of a hotter America and frequently overlooks the financial, physical, and structural barriers that prevent older adults from staying safe when temperatures climb.

The central argument of the paper is provocative precisely because it challenges a widespread assumption: that access to air conditioning guarantees protection from dangerous heat. According to the authors, air conditioning only protects people if they can afford to run it, maintain it, and use it safely. Rising utility costs, the expense of repairing or replacing aging cooling systems, mobility limitations that make installing window units difficult, and an aging housing stock that was never designed to withstand prolonged extreme heat all combine to leave many older Americans exposed even when they technically have cooling equipment in their homes. Cognitive decline adds another layer of risk, because some individuals may fail to recognize when indoor temperatures have reached dangerous levels or may be unable to take appropriate action on their own behalf.

The physiological reasons behind this vulnerability are well established. Aging reduces the body’s ability to regulate temperature, making older adults less efficient at dissipating heat through sweating and cardiovascular adjustments. Common chronic conditions, including diabetes and neurodegenerative diseases, further heighten heat-related risks, as do many medications frequently prescribed to older adults, which can interfere with thermoregulation or hydration. The health consequences of extreme heat exposure are not limited to heat stroke. The analysis links exposure to cardiovascular and respiratory problems, sleep disruption, cognitive impairment, reduced attention, and mental health concerns, painting a picture of heat as a systemic threat to the health of aging populations rather than a short-lived inconvenience.

Heat is, as co-author Amir Baniassadi, PhD, Assistant Scientist II at the Marcus Institute, notes, one of the deadliest weather-related hazards in the United States, and older adults are among those at greatest risk. But the analysis emphasizes that the nature of that risk varies dramatically from region to region, which means a one-size-fits-all national policy is unlikely to succeed. In the Desert Southwest, where air conditioning is often essential for survival, questions of affordability and performance standards have become critical public health concerns. Some Arizona cities have responded with rental housing laws that require air-conditioning systems to be operational, repaired promptly, and capable of cooling a residence to as much as 20 degrees Fahrenheit below outdoor temperatures. These are among the strongest such protections in the country, yet the analysis shows they may still fall short in a rapidly warming climate.

The numbers from Phoenix illustrate the problem starkly. In 2024, the city experienced 70 days on which temperatures reached 110 degrees Fahrenheit or higher. Under the local rules, a legally compliant cooling system could still leave indoor temperatures above 90 degrees Fahrenheit on such days. Lead author Peter Crank, PhD, Assistant Professor in the Department of Geography and Environmental Management at the University of Waterloo, states that indoor temperatures above 90 degrees are not safe for many older adults, and that clear, objective standards for cooling performance are critical to protecting health and ensuring safe living conditions. In other words, even the regulatory gold standard in the hottest part of the country leaves a gap between legal compliance and genuine physiological safety, a gap that widens with every additional extreme heat day.

The analysis also scrutinizes cooling centers, which are frequently promoted by municipalities as a frontline public response to extreme heat. While these facilities can provide meaningful relief, the authors document a series of barriers that limit their usefulness for the very population they are meant to serve. Transportation challenges can make reaching a cooling center difficult or impossible for people with mobility limitations. Limited operating hours, particularly the lack of overnight and weekend availability, mean that the most dangerous hours of a heatwave often occur when centers are closed. Safety concerns and simple lack of awareness of available services further reduce utilization. A resource that exists on paper but cannot be reached, or is closed during the hottest hours, offers little protection to a frail older adult in an overheated apartment.

The challenges look strikingly different in historically colder climates, and the analysis devotes particular attention to the Northeast. In cities such as Boston, many older adults live in older buildings designed to retain heat during harsh winters, a feature that becomes a liability during prolonged hot weather. Much of this housing stock lacks central air conditioning and can trap heat indoors, exposing residents to dangerous temperatures even during periods when outdoor conditions might seem manageable. Yet the regulatory and social safety net in the region has not adapted. Regulations governing indoor cooling, renter protections, and utility assistance have not kept pace with increasingly frequent heatwaves, leaving a mismatch between the climate older Americans actually face and the policies built for the climate of the past.

The financial asymmetry the authors identify is particularly striking. Substantial public resources exist to help households cover heating costs during the winter months, reflecting decades of policy attention to cold-related mortality. Comparable protections for cooling remain limited across much of the Northeast. Maximum indoor temperature standards are largely absent from housing codes, and most energy-assistance programs continue to focus primarily on winter heating needs despite rising summertime heat risks. For an older adult on a fixed income, this means the choice between an unbearable utility bill and an unsafe indoor environment is one that policy has largely left unaddressed, even as summer temperatures in northern cities increasingly rival those of southern ones.

In response, the authors call for policies that recognize regional differences in climate, housing, and infrastructure while directly confronting affordability and accessibility challenges. Their recommended approaches include stronger renter protections, the adoption of indoor temperature standards, expanded utility assistance programs that cover cooling as well as heating, support for the maintenance and replacement of cooling systems, and improvements to the availability and accessibility of cooling centers, including extended hours. As Crank observes, the barriers facing an older adult in Phoenix are not necessarily the same as those facing someone in Boston, and effective heat policy must account for differences in climate, housing, infrastructure, and resources while ensuring that all older adults have access to safe indoor temperatures.

The broader significance of this analysis lies in its reframing of extreme heat as a policy failure rather than merely a meteorological hazard. The tools needed to protect older adults largely already exist: cooling technology, utility assistance frameworks, housing regulation, and public health infrastructure. What is missing, the authors argue, is the political and regulatory adaptation to a climate in which heat has become a chronic, deadly, and regionally diverse threat. As heatwaves intensify in both the Desert Southwest and the historically temperate Northeast, the gap between what buildings, budgets, and laws were designed for and what older Americans now experience will continue to widen. Closing that gap, the analysis suggests, is not simply a matter of installing more air conditioners, but of rethinking how housing, energy, and health policy intersect for a population whose lives increasingly depend on it.

Subject of Research: Health and policy risks of extreme heat exposure among older adults in the United States

Article Title: New analysis underscores the rising threat of extreme heat on older adults

Article References: New analysis underscores the rising threat of extreme heat on older adults. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: extreme heat, older adults, aging, air conditioning, public health, heat policy, cooling centers, housing, utility assistance, Phoenix, Boston, climate change