New Analysis Underscores Rising Threat of Extreme Heat on Older Adults

As extreme heat events become more frequent and severe across the United States, older adults face growing health risks that extend far beyond discomfort, according to a new policy analysis published in Public Policy & Aging Report.

In the analysis, “On the Regional Spectrum of Barriers and Obstacles for Older Adults Facing Extreme Heat: Air Conditioning and Beyond,” scientists argue that public policies have not kept pace with a warming climate and often fail to address the financial, physical, and structural barriers that prevent older adults from staying safe during heat waves. These barriers include rising utility costs, the expense of maintaining or repairing cooling systems, mobility limitations, and aging housing ill-equipped to handle extreme heat.

“Heat is one of the deadliest weather-related hazards in the United States, and older adults are among those at greatest risk,” said Amir Baniassadi, PhD, assistant scientist II at Hebrew SeniorLife’s Hinda and Arthur Marcus Institute for Aging Research and a co-author of the article. “As temperatures rise, protecting older adults requires more than simply installing air conditioning. Air conditioning only protects people if they can afford to run it, maintain it, and use it safely.”

Older adults are particularly vulnerable to heat because aging reduces the body’s ability to regulate temperature. Common chronic conditions, including diabetes and neurodegenerative diseases, as well as medications frequently prescribed to older adults, can further increase heat-related risks. Exposure to extreme heat has been linked to cardiovascular and respiratory problems, sleep disruption, cognitive impairment, reduced attention, and mental health conditions.

The authors note that heat vulnerability differs dramatically across regions, requiring policies tailored to local climates and housing conditions.

In the Desert Southwest, where air conditioning is often essential for survival, affordability and performance standards have become critical public health concerns. In some Arizona cities, rental housing laws require that air conditioning systems be operational, repaired promptly, and capable of cooling a residence to up to 20 degrees Fahrenheit below outdoor temperatures. Yet Phoenix experienced 70 days in 2024 when temperatures reached 110 degrees or higher, meaning some legally compliant homes could still exceed 90 degrees indoors.

“Indoor temperatures above 90 degrees are not safe for many older adults,” said lead paper author Peter Crank, PhD, assistant professor, Department of Geography and Environmental Management, University of Waterloo. “Clear, objective standards for cooling performance are critical to protecting health and ensuring safe living conditions.”

The analysis challenges the common assumption that access to air conditioning guarantees protection. Older adults may struggle to pay rising utility bills, afford repairs, or physically install and maintain window air conditioning units. Cognitive decline may also reduce an individual’s ability to recognize dangerous indoor temperatures or take appropriate action.

The analysis also examined the limitations of cooling centers, which are frequently promoted as a public response to extreme heat. While cooling centers can provide relief, many older adults face barriers, including transportation challenges, limited operating hours — particularly overnight and weekend availability — mobility limitations, safety concerns, and lack of awareness of available services.

The challenges are different in historically colder climates. In the Northeast, many older adults live in buildings designed to retain heat during harsh winters, yet regulations governing indoor cooling, renter protections, and utility assistance have not kept pace with increasingly frequent heat waves. In cities such as Boston, older housing often lacks central air conditioning and can trap heat during prolonged hot weather, exposing residents to dangerous indoor temperatures.

The researchers note that while substantial public resources help cover heating costs during the winter months, comparable protections for cooling remain limited across much of the Northeast. Maximum indoor temperature standards are largely absent, and most energy assistance programs continue to focus primarily on winter heating needs despite rising summertime heat risks.

The authors call for policies that recognize regional differences in climate, housing, and infrastructure while addressing affordability and accessibility challenges. Recommended approaches include stronger renter protections, indoor temperature standards, expanded utility assistance programs, support for cooling system maintenance and replacement, and improvements to the availability and accessibility of cooling centers.

“The barriers facing an older adult in Phoenix are not necessarily the same as those facing someone in Boston,” said Dr. Crank. “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.”

About Hebrew SeniorLife
Hebrew SeniorLife is a national leader working to create a world where aging is defined by possibility, not limitation. We care for more than 4,500 older adults each day across seven campuses throughout Greater Boston, and offer support for families in the aging journey. Our services include in-home care, outpatient therapies, an outpatient memory clinic, short- and long-term inpatient care, hospice, independent and assisted living, and affordable housing with services. We conduct influential research on aging at our Hinda and Arthur Marcus Institute for Aging Research, which has a grant portfolio of $87 million, and train future health care workers at the Lunder CareForce Institute. Hebrew SeniorLife is a Harvard Medical School affiliate. Follow us on our blog, Facebook, Instagram, and LinkedIn.