There is evidence that the ageing population of Barbados is being disproportionately affected by climate-related illnesses such as dengue fever, respiratory infections, asthma, and heat exhaustion.
Informed, strategic interventions are however stymied by the fact that there has been little systematic employment of data and targeted research.
According to the experts interviewed for this investigation, an increase in adverse climate events is both worsening health conditions and affecting the delivery of care.
After two National Elder Wellness consultations, numerous town hall meetings, and a comprehensive Pan American Health Organization (PAHO) study on “Measuring the Responsiveness of the Health System in Barbados to the Needs of the Aging Population”, there is still uncertainty about how to keep the elderly healthy or address the care necessary to combat their climate-related illnesses.
The study does not address how climate-related events such as Sahara dust, excessive rainfall, and heat which can lead to increases in dengue fever, respiratory illnesses, or heat exhaustion/stroke. This is so despite evidence that these are illnesses that affect the elderly more than any other age cohort.
Nurse Anastacia Jordan says the country is yet to understand the impact climate change is having on the health needs of the elderly.
“When an elderly patient is affected by heat when we see them in the clinics or we see them at A&E (Accident & Emergency), it doesn’t go off in our heads that oh shoot, this is related to temperatures being thirty-seven (37 degrees Celsius) or as a result of dehydration…”
Gerontologist Dr Lana Husbands supports this view. She also believes specific data can assist in meeting the health needs of the elderly. She says the availability of data would significantly change their approach.
A growing number of senior citizens today reach emergency rooms seeking care for asthma, respiratory infections, and constant coughing – conditions linked to changes in climate events and weather patterns.
Pulmonologist Dr Dawn Alleyne notes that whenever there is Sahara dust, there is an increase in people seeking care.
“During the months that we have heavy Sahara dust clouds, we also have a concomitant increase in the number of people who use inhalers, the number of people who have to use antihistamines, and the number of people who present with respiratory symptoms,” she said.
Dr Alleyne believes the heat could pose numerous challenges for older patients because the mechanism to regulate body temperatures as people age does not work as well as it should.
A recent outbreak of dengue fever claimed the lives of four elderly patients. They represent the group most affected by the outbreak.
“The reason you are seeing an increase in dengue is because rainfall patterns are changing. Climate change lessens water supply and people have less access to clean water, thus increasing the threats of diseases,” said climate expert Dr James Fletcher.
He admitted that there are not sufficient studies about the impact of climate change on the elderly and the subject requires closer attention.
Recent plumes of Sahara dust have noticeably created a hazy cover over the island.
As Dr Edmund Blades of the Sahara Dust Observatory explains, not only is the island getting more dust, but the chemical composition of particles has also changed. Dr Blades told CIJN the immune system has a lot to do with how someone’s body responds.
“You have your immune system in the young, it’s not fully developed, but in the old, it’s not as strong as it could be. And if inflammation is a big thing with dust causing inflammation, inflammation is a killer if it gets widespread in the body,” he said.
“And we don’t understand everything about it, but we know that when people are old, they might not have the ability to fight off things, and anything that will help you to reduce your resistance is not good,” Dr Blades added.
Sahara dust normally blows across the Caribbean between the months of May and August, but with the changes in climate conditions, Barbados has been dealing with the problem of dust since late January. And, as a tropical island, warm temperatures are typically present.
Senior citizen Earl Pilgrim says his tolerance for the heat is extremely low.
“Heat has been ever-present, so I try to adjust to what’s happening around me, but since it’s been so intense, I’ve been trying to stay out of it a lot. My heat tolerance is very low,” he said.
He admitted he never paid attention to how hot the temperature had risen over the years, though he can feel its effects.
“I would sweat a lot, so I drink a lot of fluids or go to the beach to cool down,” he said. “I’ve been adjusting and adopting measures to deal with the heat, the mosquitoes, and the dust.”
The dust has also been an issue for Pilgrim. He said whenever there is Sahara dust, he has difficulty breathing, so he stays indoors or wears a mask when necessary.
As a premier tourist destination, visitors to Barbados are attracted to its fame for clean air, blue-green seas, pristine sands, and comfortably warm temperatures.
But the same temperatures that attract tourists to the island who contribute 15% of the island’s GDP (gross domestic product) are also wreaking havoc on the elderly.
The outlook is even more dismal when it is considered that two out of every five Barbadians are now over the age of sixty, and this is expected to increase to three in five by 2030.
The region of the Americas is one of the fastest-ageing regions in the world with demands for acute and long-term care, the PAHO study says. Compared alongside other Caribbean countries, Barbados is experiencing the fastest rate of ageing.
Projections are that 20% of Barbadians are going to require rehabilitation and long-term care.
Consultant Geriatrician Dr Ambrose Ramsay says the health system is unable to meet the demands of those seeking long-term care in the four facilities that currently house approximately 540 older persons. The number of patients seeking care because of climate-related illnesses is unknown.
“There is a gap of approximately five years between the life expectancy and the healthy life expectancy for adults at age 60 in Barbados. This gap shows an increasing trend over time, which can be explained by the burden of disease,” says PAHO.
The sixty-and-under population is contracting while the over-sixty cohort is expanding. It means the government will be spending more on elderly care in the years to come.
However, the recognition of how climate change is adversely affecting the Caribbean or internationally shows little focus on health. “Less than 1.5% of international finance for climate change adaptation is currently allocated to health projects,” says PAHO.
Small Island Developing States (SIDS) are most susceptible to adverse climate events even though they have minimally contributed to global carbon emissions.
Rising temperatures and sea levels, excessive heat, and rapid changes in weather patterns are causing frenzied talks about how to get to net zero emissions and to attempt to keep the global average at less than 1.5 degrees Celsius above pre-industrial global temperatures.
“Net zero” emissions mean that countries are expected not to contribute any more human-caused carbon to the atmosphere than they remove from it.
The United Nations Framework Convention on Climate Change (UNFCCC) refers to health as one of the three main adverse effects of climate change.
As a result, the Ministers of Health gathered at the World Health Assembly in 2008 and passed a resolution on climate change and health. However, implementation and political will remain weak and Barbados is no exception.
Challenges
In March 2024, the Minister of People Empowerment and Elder Affairs of Barbados, Kirk Humphrey, said legislation to protect the elderly will be coming soon. In the meantime, there is a national policy on ageing.
However, one of the main challenges that remains is that there is no specific legislation to help Barbados’ growing elderly population stave off the effects of climate change.
“Climate change is much like COVID-19, it exposes one’s comorbidities.” says climate expert Steve Maximay. His concern for the elderly in the age of climate change remains high.
Dr Fletcher added, “it’s an area that hasn’t been studied sufficiently and there are so many different impacts.”
Maximay went further in highlighting his concerns about the training some caregivers may have had and whether it meets the needs of the elderly in this new age of climate change impacts.
He said, “I have been concerned about the type of training for the people who manage these facilities.”
He went further in adding, “There ought to be training for these caregivers, for those people who now own homes. They’re not just retirement homes but they’re elderly care homes.
“Like, what do you do when you have a hurricane alert? What are some of the protocols you should have in place? What are the emergency supplies you should have on hand? Those are some of the ways they will adapt to the potential problems.”
Solutions
Added to that, Dr Husbands advises that people should check for signs of the elderly dealing with climate change.
“Make sure that if you recognise the signs of heat exhaustion, have a thermometer and have fluids. Make sure the elderly person is hydrated and taken care of. Know the signs of heat exhaustion.”
Dr Fletcher went further in stating that awareness is critical if the elderly are to stave off the effects of climate change.
“The first thing is public awareness where climate change is concerned. The most important tool at our disposal is always public education because, for some people, climate change is still a new area.
When people hear about climate change, they think about warmer temperatures and stronger hurricanes, but climate change is so much more than that.”
He used the rise in vector-borne diseases as an example and Dr Fletcher insists the health authorities “have to do a better job” removing areas where mosquitoes can breed.
“We have to ensure that those sources are not available, so it’s an area our health authorities have to be aware of and proactive in preventing dengue from being the next pandemic in the Caribbean,” he said.
“I think the Chief Medical Officers across the Caribbean need to put this at the doorstep of the Caribbean Public Health Agency (CARPHA), and together with them, come up with a plan to deal with the impacts of climate change in elderly populations in the Caribbean.”
Dr Fletcher says the problem is much broader than the elderly and Barbados and requires a Caribbean conversation.
However, Dr Alleyne has warned those caring for the elderly have to be more cognisant of the impacts of their suffering.
She remarked: “My concerns specifically as a respiratory physician, as a pulmonologist, relate to whether or not the people who are caring for these individuals are able to understand when they need additional help over and above what they are able to say or to communicate.”
“Are we aware of when these people need to be artificially cooled? Often these patients who develop asthma or other respiratory illnesses as they get older, are not necessarily able to communicate exactly how they’re feeling, and often they will present with atypical presentations,” Dr Alleyne added.
She said that caregivers who are in close contact with these individuals need to be sensitive to changes that occur, and to not hesitate to seek medical attention if they are having any doubts as to what is happening at any particular point in time.
“If you intervene early, we often avoid the ICU.”
From the heat on the ground to the Sahara dust that infiltrates the air, Maximay says little empirical evidence is required to see the impact Sahara dust is having on the elderly population, especially those who suffer from respiratory problems.
He says the early warning system present in Barbados is key to forecasting when the levels will increase.
Nurse Jordan goes further in calling for support systems. “Is there an evaluation and a monitoring tool that we need to implement to make sure that we make some contact?
“For example;’ Hello, Miss Jones, I’m just checking in on you. The temperature is supposed to rise today, but you realize you don’t have a support system? Do you need us to come in? Do you need me to send a nurse or somebody to provide you with XYZ?’
“Those types of systems we don’t have, but those are things that we need to start thinking about.”
It’s all to protect what Maximay calls the “forgotten few” when it comes to the impacts of climate change.
To hear the podcast on this topic – “Seniors: Climate Change Forgotten Few”, click here.
Research support for this article provided by Esther Jones.
This story was supported via a Fellowship from Media Institute of the Caribbean (MIC) and Internews with funding provided by Clara Lionel Foundation (CLF).