Building Vulnerability in a Changing Climate: Using Sensors to Track Environmental Conditions and Health Outcomes during a Heatwave in Low-Income Older Adults

Abstract

Human vulnerability to HWs arises from many risk factors (i.e. age, social isolation, low income, low education, minority status, non-English speaking, etc.). Older adults in particular are extremely vulnerable to extreme heat exposures. High prevalence of pre-existing disease, medications, and autonomic nervous system impairments affect the thermoregulation and perception of extreme temperature exposure, making them more susceptible to poor health outcomes during HWs. Extreme temperatures may be mitigated or exacerbated indoors compared to outdoor temperatures during HW events due to building archetype and air conditioning (AC) use. In the present study, we aimed to characterize the indoor environmental quality and relate it to health outcomes through the use of personal, indoor monitoring with 51 (central AC, n=24; non-central AC, n=27) low-income senior residents of affordable housing in Cambridge, MA during a HW event in 2015. Indoor environmental temperature, noise, and carbon dioxide were all significantly higher (p<0.001 for all) for the non-central AC building when compared to the central AC building. Within the non-central AC building, there was a 36% increase in the mean of all self-reported health symptoms during the HW event compared to the central AC building (p=0.013). The mean number of heat-related health symptoms was 72% higher for those in non-central AC than for central AC residents during the HW (p=0.0013), despite similar age, income, and prevalence of pre-existing conditions between building types. Capturing a more representative description of the temperature exposure, while also incorporating changing behavioral modifications and other important environmental features that compound the effects of heat exposure in real life settings, we gain a more comprehensive understanding of the complex impact of HWs on health and drivers of vulnerability to heat exposure.