Expats at risk: Extreme heat leads to mental-health related fatalities

“After a weekend of ‘sizzling’ extremes, forecasters warned the next month could be ‘the earth’s hottest in more than 120,000 years.” (The Metro)

Greek mythological metaphors seem to be the running theme. Last week’s heat wave was named Cerberus, named after Hades’ multi-headed dog that guards the gates of the Underworld to prevent the dead from leaving. “He devoured anyone who tried to escape the kingdom of Hades.” (Britannica)

Now, Europe is bracing itself for a heatwave Charon. “The European Space Agency (ESA) said the next week could bring the hottest temperatures ever recorded in Europe in a heatwave named Charon, after the Greek mythological boatman who ferries souls to the underworld.” (The Guardian) It’s as though it’s the European Space Agency’s creative new way of saying ‘tell me you’re trapped and going to die, without actually saying it’.

Europeans alongside British expats and holidaymakers in mainland Europe are sweating it out in extreme heat of up to 60°C, “but there won’t be much respite in the foreseeable future.” (The Metro) “The World Meteorological Organisation warned the heatwave in Europe could continue into August…Scientists say climate change is making heat waves longer, more intense and more frequent.” (BBC News)

“The World Meteorological Organization said in a statement on Tuesday that naming heat wave events puts the focus on the wrong issues. The organisation, which has a membership of 193 member states and territories, added that assigning names could misdirect public and media attention away from the messages that matter most, including who was in danger and how to respond.” (New York Times)

Urgent warning issued for tourists

The Foreign Office has issued an urgent warning for “UK tourists as thousands flee Europe” (The Daily Express) and those booked to visit the Mediterranean this week onwards, as wildfires rage on in Greece and Spain (The Guardian)

Sicily is set to “break the European record of 48.8 degrees this week, but that isn’t stopping holidaymakers” already out there grilling on the beach. (The Telegraph)

Whilst “British holidaymakers aiming to travel to mainland Europe this summer are worried they are not going to be able to cope with temperatures that may exceed 40C, with some having to cancel their tourist plans.” (The Guardian)

Airport strikes

The situation is worsened by inevitable summer airport strikes, making it harder for expats and tourists to escape the deadly heat. Across Europe, thousands of flights have already been delayed and cancelled due to industrial action. So, here are the latest strikes taking place at European airports between July and August.

Gatwick airport workers will be striking between Friday July 28 to Tuesday August 1, then from Friday August 4 to Tuesday August 8. (The Times) Therefore, there’s a good chance strikes will spread to other UK airports.

So, summer travel in 2023 is looking just as chaotic as summer 2022, which “saw a post-pandemic summer of travel chaos as airlines, airports and rail services across the country struggled to manage the demand for sunny escapes.” (CN Traveller)

High risk of heat-related fatalities for the elderly expats

So, what does this mean for expats who may have moved to Southern Europe for a better life and blissful retirement? As there is a significant population of British elderly expats living in Southern Europe. With Portugal, Spain, Italy, Greece, Bulgaria, France, Slovenia, Croatia and Malta considered as the best destinations for retired British expats for long life expectancy and sunshine. (Daily Express)

Well, they’re currently at high risk of heat-related fatalities. As “extreme heat is killing Europe’s elderly. Researchers estimate more than 61,000 people died in Europe from the record-breaking 2022 heatwaves – it could become the new normal.” (The Telegraph)

Elderly expats are at higher risk of heatstroke. As we age, our bodies become less efficient at regulating temperature, making seniors more susceptible to the effects of extreme heat. As older adults are more likely to suffer from heat-related illnesses such as heat exhaustion and heatstroke. (Centers for Disease Control and Prevention)

Heat-related fatalities are expected to rise amongst older adults, as human populations skew older as the Earth gets hotter. More intense, frequent and longer heat waves are driven by climate change. As it raises nighttime lows which prevents body temperatures from resetting when the sun sets. Climate change volatility “provokes in day-to-day highs can truncate the lives of older people with certain health conditions…It can be hard for even healthy older adults to tell when it’s too hot or if they’re dehydrated…Older bodies also hold more heat than younger ones when the temperature climbs.” (Harvard T.H. Chan School of Public Health)

We can already see this happening in Southern Europe, which has and will continue in the 30 degree range late at night this week onwards. Which is preventing the necessary nighttime lows from happening, as a result the elderly are not being given the chance to recover from the extreme daytime heat.

Southern Europe - predicted heat at 23:00 (18/07/23 to 25/07/23):

1. Athens, Greece: 31°C (Hellenic National Meteorological Service)

2. Madrid, Spain: 31°C (Spanish State Meteorological Agency)

3. Seville, Spain: 31°C (Spanish State Meteorological Agency)

4. Valletta, Malta: 31°C (UK Met Office)

5. Cagliari, Sardinia: 31°C (Italian Air Force National Meteorological Service)

6. Rome, Italy: 30°C (Italian Air Force National Meteorological Service)

7. Alicante, Spain: 29°C (Spanish State Meteorological Agency)

8. Barcelona, Spain: 28°C (Spanish State Meteorological Agency)

9. Naples, Italy: 28°C (Italian Air Force National Meteorological Service)

10. Palermo, Sicily: 27°C (Italian Air Force National Meteorological Service)

Across the pond it’s no different, as on July 18th, “officials in Texas confirmed the first death as a result of the ongoing ‘heat dome’ that is bringing triple-digit temperatures to many parts of the US.” (The Metro) “Victor Ramos, 67, was found in his home in south-west Houston, which did not have air conditioning.” (The Guardian)

Extreme heat waves can lead to dehydration, respiratory disease, heat cramps, heat rash, heatstroke, heat exhaustion, kidney damage and exacerbation of existing mental health conditions. (World Health Organization (WHO)) However, what’s not common knowledge is how extreme heat can exacerbate pre-existing mental health conditions and lead to mental-health related fatalities, which needs critical attention and preventative care.

What does the research say?

Therefore, the experts in safe home adaptations for the elderly, Mobility Plus have curated a briefing on some of the major research in the field. Which has investigated the relationship between heat waves and mental health, indicating major risk for the elderly:

1. Anxiety, depression and stress: Heat waves can increase rates of anxiety, depression, and stress, especially in the context of vulnerable populations. (Williams, A.A.; Spengler, J.D.; Catalano, P.; Allen, J.G.; Cedeno-Laurent, J.G.) The findings emphasise the need to understand and address the psychological consequences of heatwaves, especially as climate change continues to contribute to more frequent and intense heat events.

2. Social isolation: The elderly may face increased social isolation during heat waves, as they may be less likely to engage in outdoor activities or have limited access to air-conditioned environments. Lack of social interaction and support during heat waves can contribute to feelings of loneliness and emotional distress. “Reducing social isolation could limit the impact of heat waves on the mortality of the elderly population.” (Orlando S, Mosconi C, De Santo C, Emberti Gialloreti L, Inzerilli MC, Madaro O, Mancinelli S, Ciccacci F, Marazzi MC, Palombi L, Liotta G)

3. The correlation between temperature and mental-health related fatalities: “Research has found that for every 1C increase in monthly average temperature, mental health-related deaths increase by 2.2%. Heat waves also impact cognitive ability, increasing aggressive behaviour and violent crime rates.” (World Economic Forum)

4. Heat waves and living in hot climates: “Studies have found links between rising temperatures and a range of mental health issues including mental fatigue, aggression and even higher rates of suicide. This connection is not just limited to surges in temperature, Dr. Obradovich said, it’s also present for people living in climates where it is consistently hot. (Though of course mental health trends can depend on a variety of factors outside of temperature, too.)” (New York Times)

5 Short-Notice Home Adaptations for Heat Waves

So, even though the heat waves have already started, there’s still time to make some quick, easy and short-notice changes:

1. Emergency supplies: As heat waves can lead to power outages or water scarcity, it's best to prepare emergency supplies in case of disruptions. Have battery-powered fans, flashlights, and a battery-operated radio on hand. Stock up on bottled water, non-perishable food items, and essential medications.

2. Cool zones: On your ground floor, create a dedicated cool zone in your home, where you can retreat during the hottest part of the day. Best to keep it well-ventilated and equipped with fans or air conditioning.

3. Shade: Prevent direct sunlight from entering your home by using window coverings such as blinds, curtains, or shades. Shutters or exterior blinds can be effective in blocking heat before it reaches the windows.

4. Cross-Ventilation: Proper ventilation can significantly improve airflow and cooling inside your home. Cross-ventilation techniques can create a natural breeze, and portable fans promote air circulation.

5. Cooling roof gardens: Transform your roof into a green space with plants. A green roof absorbs less heat than traditional roofs and can help keep the temperature lower inside your home. As plants release moisture, which raises humidity and helps cool down your home, similar to a rainforest canopy.

10 Best Practices to Protect the Elderly in Heatwaves

The key to protecting the elderly during a heatwave is preparation, constant monitoring, and taking appropriate actions to prevent heat-related fatalities. So, here are some the best practices to keep on top of:

1. Stay Hydrated: Encourage the elderly to drink plenty of water, even if they don't feel thirsty. Avoid alcohol and caffeine, as they can lead to dehydration.

2. Limit Outdoor Activities: Encourage seniors to stay indoors during the hottest parts of the day (usually midday to late afternoon) when the heat is most intense.

3. Dress Appropriately: Help them choose light-coloured, loose-fitting, and breathable clothing to help them stay cool.

4. Cool Showers and Baths: Suggest taking cool showers or baths to lower body temperature.

5. Check on Them Regularly: If possible, have someone regularly check on elderly family members, neighbours, or friends to ensure they are coping well with the heat.

6. Offer Transportation: Help them with transportation to cooler places, such as shopping centres, community centres, or air-conditioned public spaces.

7. Prepare Heat-Appropriate Meals: Encourage the consumption of light, cold meals that do not require cooking, reducing heat exposure in the kitchen.

8. Medical Awareness: Ensure that elderly individuals are aware of their medications' side effects and how they might be affected by heat.

9. Know the Signs of Heat-Related Illnesses: Educate caregivers and the elderly themselves about the symptoms of heat exhaustion and heatstroke, such as dizziness, nausea, rapid heartbeat, confusion, and high body temperature. If any of these signs are noticed, seek immediate medical attention.

10. Evacuation Plan: If the heatwave intensifies and becomes dangerous, be prepared with an evacuation plan to move the elderly to a safer location.

Overall, elderly expats may have moved to Southern Europe for a blissful retirement and sunshine. However the research shows the major heatwaves are critical not only for physical health, but mental health too.

Therefore, it’s vital to take appropriate measures to safeguard the elderly during extreme heat waves, in terms of keeping them cool, hydrated, and connected with support networks. All of which can help mitigate the mental health risks associated with heat waves and reduce the mortality rate. As well as adapting homes for heat waves in Southern Europe, which is essential to ensure a comfortable and safe living environment in extreme heat.

On a public policy level, “the best thing we can do to help ourselves and future generations is to act on climate change, experts say.” (World Economic Forum) Governments need targeted interventions to safeguard the health of older adults during extreme heat events.