California’s aging population is on the front lines of extreme heat

This article was originally published by Public Health Watch, a nonprofit investigative news organization. Find out more at publichealthwatch.org.

SAN JOAQUIN VALLEY, California — Every year, Lisa Gluskin dreads the onset of summer. 

She tapes her windows shut. She packs her door frame with foil. She hangs blankets to block out the sun. 

The punishing heat, though, still permeates her mobile home. 

“You can feel the hot air blowing in,” she said. “Because the mobile home itself is just falling apart.”

Gluskin, 68, lives in one of the hottest and most rapidly warming regions in California: the San Joaquin Valley. 

This agricultural stretch of land — locked between California’s two great mountain ranges, the Sierra Nevada and the Coast Ranges — endures an average of 106 days per year with temperatures at or above 90 degrees and 40 days per year with temperatures at or above 100 degrees, according to the San Joaquin Valley Air Pollution Control District. 

Those prolonged periods of extreme heat are the deadliest forms of weather in the country, killing more Americans each year than floods, tornadoes or hurricanes.

They’re especially dangerous for older adults, who make up an oversized share of heat-related fatalities. 

In the San Joaquin Valley, adults aged 65 and over account for 12% of the population but 28% of all heat-related deaths since 2020, according to provisional data from the Centers for Disease Control and Prevention. Unlike other age groups, older adults have sweat glands that are less active, a muted sense of thirst, a higher rate of chronic conditions and — most notably — a more fragile heart. When the body’s core temperature rises, the heart beats harder and faster to redistribute heat from the internal organs to the skin. That strain on the aging heart increases the likelihood of heart attacks, heart arrhythmias or heart failure. The body’s muted sweat glands and thirst receptors also increase the risk of dehydration, heat exhaustion or heat stroke. By the time seniors are thirsty, they’re often already in the early stages of dehydration. 

That’s a significant issue, says Kai Chen, an associate professor of epidemiology at Yale and the lead author of a February study on age and climate mortality published in Nature Communications. “We’re not in a scenario where only climate is changing. The world is facing another public health challenge — aging,” he said. As the U.S. population grows older, the prospect of climate-related deaths looms larger. “Each additional bit of warming, the health consequences are substantial,” Chen said. “We’re not talking about the next generation.”

Over the next three decades in the San Joaquin Valley, the annual average maximum temperature is expected to rise by 4 to 5 degrees, according to California’s latest climate change report. 

Gluskin, 68, is one of the Valley’s roughly 550,000 senior residents. She hopes to get her mobile home fixed before the climate gets any warmer.

“I’ve tried and tried, you know, to get help,” Gluskin said. “I just can’t seem to get anybody to help me.” 

Since purchasing her mobile home in Tulare County in 2017, the side door has started to sag and the windows have gotten drafty. The old evaporative cooler propped in her living room window doesn’t work anymore. When it was working, the device — also called a swamp cooler — drew hot outside air across a wet filter to lower the room temperature. The cooler now acts as a conduit to usher the heat inside, turning Gluskin’s home into a sweltering box in the summer. 

Gluskin’s air conditioning unit doesn’t help much, either. 

Because of the home’s insulation problems, it’s impossible to keep it cool — even with the functional AC unit she has. The cold air it blows is lost to the constant flow of hot air streaming in. Every time she turns on her AC, she’s “burning money” she can’t afford to spend, Gluskin said. 

Since being diagnosed with breast cancer in 2018, her life savings have been depleted by medical bills. The little money she has left goes toward a second health insurance plan to cover the costs that Medicare doesn’t.

“Being broke, it sucks,” Gluskin said. “But I’ve accepted that. Being stuck inside, hot, is more miserable.” 

The San Joaquin Valley is home to seven of the 10 most disadvantaged communities in the state, according to the California Office of Environmental Health. The state’s average cost of energy has increased nearly 16% since last year alone, according to the Energy Information Administration. Welfare initiatives like the California Alternate Rates for Energy program, or CARE, only cover 30% to 35% of monthly electric bills. 

Gluskin turned to her energy provider, Southern California Edison, for help. She applied in March of 2023 to the company’s energy saving assistance program, which covers the cost of insulation problems in low-income households. 

In the weeks that followed, representatives of Southern California Edison told Gluskin her  request was being processed. They never provided updates. 

Two months after she submitted her application, Gluskin was hospitalized for dehydration. 

“I wound up in the hospital for five days,” she said. “I thought I was drinking lots and lots of water.” Until her hospitalization, Gluskin hadn’t thought of herself as a senior who needed to pay extra attention to her health during extreme heat days. “I try to be really good about that now … it’s hard to accept. No matter what age you are, in your mind you feel like you’re still 35 years old.”

As of August 2024 — nearly a year and a half after submitting her application — Southern California Edison still hadn’t followed up on Gluskin’s request for assistance. 

In a statement, an Edison representative said that due to the “high volume” of applications, the energy saving assistance program is backlogged. But the utility is “in contact with the customer and working to expedite their enrollment.” 

Gluskin’s dilemma isn’t unusual in the Valley. 

Edison provides coverage to roughly 12 million people across Southern California, and public demand for its energy saving assistance program has been surging for years, according to the utility company. But despite the backlog and risk of heat exposure, there are no other options for people like Gluskin, except one.

Community Services Employment Training, or CSET, is a local nonprofit group that has partnered with the state and county to address low-income weatherization issues in Tulare County. 

“Housing is very poor and the need is great,” said Raquel Gomez, division director for CSET. “Almost all our seniors live on a fixed income with high utility bills.” 

CSET offers its own energy assistance initiative, funded through the federal Low-Income Energy Assistance Program. Like Edison, CSET’s program covers the cost of insulation problems in low-income households. Unlike Edison, CSET says the average timeline from application to home installation is 60 to 90 days. In life-threatening situations, it can complete a request for weatherization help in as little as 48 hours. “We respond quickly when something is needed,” Gomez said. “Our phones are [ringing] off the hook.”

The organization is also one of only a handful of agencies that provide free support for low-income seniors who need mental health care. 

During hot weather, cortisol — a “stress hormone” associated with feelings of anxiety and restlessness — has been shown to rise. Excessive heat also triggers adrenaline, which increases the likelihood of mood swings and irritability. What’s more, studies show that adequate sleep is one of the most important components to maintaining mental health during the summer. But heat can make that difficult, too. Sleep patterns are disrupted when the environment is too hot. Those without access to air conditioning or cooler surroundings during the night are at higher risk of distress and fatigue.  

CSET offers at-home mental health screenings. “We’re able to do checkups on seniors in the community,” Gomez said. “Our drivers are trained to look for evidence of depression, anxiety, or just check if their air conditioner went out.” If a senior meets certain criteria for declining mental health, they’re referred to a counselor who can escalate the case. 

Albert Barrera, 64, understands the toll that aging and heat put on the mind. He lives in Kern County, in the southern part of the Valley. 

For 25 years, he spent almost every day outside as a youth football coach for his community sports league. Barrera was always hyper-aware of the heat. It would determine when he scheduled practice, what level of intensity his team could endure and for how long. 

“I always liked the summers,” Barrera said. “People say it’s too hot, but I loved to go outside, soak up that vitamin D. I can’t do that now.”

After retiring in 2017, Barrera was diagnosed with chronic health conditions including cirrhosis of the liver and diabetes. As a result, his doctors say he now has to avoid becoming too hot or too cold. 

“They told me, don’t go out when it’s real hot out, don’t go out when it’s cold — just don’t go out,” he said. “It’s really depressing.” 

Barrera’s mobility has been affected as well. He depends on a scooter to get around, which further restricts his formerly very active lifestyle. His local senior center has been a godsend for his mental health, he said. Barrera goes to the facility every day that it’s open, and he’s looking for more opportunities to stay engaged and active. 

“I don’t know what the state offers, but this place is a blessing,” he said. 

The state, for its part, has set housing, health and inclusion benchmarks it wants to achieve by 2030 to prepare for California’s shifting demographics. Gov. Gavin Newsom’s Master Plan on Aging, released in 2021, aims to create a volunteer experience corps for seniors that would place older adults in positions as mentors for children and peer-support personnel for other seniors dealing with isolation. The initiative would also create a centralized marketplace for aging services to help individuals find local, regional and statewide resources more easily. To inform the most vulnerable people about cooling centers and the signs of heat exposure, the state-led outreach campaign, Heat Ready California, has partnered with local community organizations in every county. Those organizations have already begun door-to-door canvassing and holding community events on heat safety in the Valley. 

Whether those efforts will be enough to support the fastest-growing age group in the state is uncertain. 

Nonetheless, Barrera is grateful that they’re in progress. “As long as seniors aren’t being forgotten about,” he said.