Heatwaves in India are no longer seasonal inconveniences. Around 84 heatstroke deaths have been recorded in the summer of 2025. The devastating 2010 heatwave led to 1,344 additional deaths, most of them above 65 years of age.
Globally, stroke ranks among the top 10 cause of death. Between 2000 and 2019, the World Health Organization and United Nations Environment Programme projected around 489,000 heat-related deaths worldwide, with more than 85 per cent of these deaths occurring in the age group of 65 and above.
In India, Abhik Sinha’s studies highlighted the major concerns of elderly patients with chronic conditions. Heat-related deaths among those over 65 have risen by 70 per cent in two decades and accidents like those in 2003 in France demonstrate the critical need of attention.
The India Meteorological Department (IMD) issued red alerts for many states after Delhi reached 43°C. A spike in heatstroke and dehydration cases followed in Noida and Ghaziabad, especially among the elderly.
There are 1.1 billion persons aged 60 and above globally as of 2022. This number is expected to double to 2.1 billion by 2050. Asia is home to 54 of the world’s elderly population, which will rise to nearly 1.3 billion or 25 per cent of its total population by 2050
Recent studies show daily mortality among the elderly in India is 14.7 per cent when the temperature is at 97th percentile for the 2 consecutive days. These are predictions of mortality among the elderly living in a South Indian urban community: 92.5 per annum for men and 51.0 per annum for women. Among rural regions, eastern Maharashtra, which has 78 per cent of its population living outside cities, reports that nearly 30 per cent of patients admitted to the outpatient department daily fall sick due to heat exposure.
A 2 C temperature rise is linked to a 65 per cent increase in communicable diseases. With the elderly population expected to double by 2050, this overlap of climate stress highlights the urgent need for adaptive measures.
Heatwaves do not impact all populations equally, with the vulnerable bearing a disproportionate burden. Studies show 82 per cent to 92 per cent of mortality is among older populations. Multiple interacting factors exacerbate the severity of the suffering population.
Biological factors, contribute to this risk. Patients already suffering from severe conditions like respiratory illnesses, renal disease, mental and behavioural disorders, and cardiovascular problems are more vulnerable. These diseases show positive associations with heat-related mortality. During heatwaves, thermoregulation lowers the sweat response. Dehydration and fluid loss put a strain on kidneys. At the same time, increased heart rate and decreased blood pressure cause cardiovascular strain, further increasing morbidity in vulnerable populations.
Economic and social factors also raise risk. Low-income groups with limited access to resources and support are more vulnerable. Studies have shown that increasing heat stress during night time heightens discomfort for older people. Moreover, social isolation, delayed risk recognition and unequal access to adaptive resources also contributes to higher mortality.
The phenomenon of heat trap in high-density urban areas increases the health burden. Although urban areas often have more cooling resources, rural regions often struggle with limited facilities and exhibit higher risk for mortality and morbidity.
Significant gaps limit the effectiveness of Heat Action Plans (HAPs) for older adults. Insufficient outreach to rural and remote areas perpetuates a critical urban-rural divide. Models such as climate resilience for all and the deployment of community health workers aim to address these rural gaps. For example, Ahmedabad equips Accredited Social Health Activists (ASHA) with heat resilience training, while Bhubaneswar’s HAP incorporates gender-sensitive outreach by frontline workers in slum areas.
The insufficient integration of geriatric care into climate adaptation plans remains a persistent challenge. Urban planning often overlooks the needs of older adults, especially those living alone or in institutional settings.
Inadequate monitoring and evaluation impede progress. The absence of age-specific health data prevents local governments from effectively tracking outcomes or designing targeted interventions.
The lack of a unified national strategy exacerbates structural disparities. Fragmented, localised approaches, particularly in peri-urban areas, contribute to inconsistent outcomes.
Policy frameworks should be more data-driven, inclusive, and locally tailored to effectively protect India’s ageing population. Heat Action Plans must adapt emergency shelter designs, medical responses, and hydration strategies. Reliable, age-appropriate health monitoring systems are essential. Investment in AI-powered dashboards and geographic mapping can help identify at-risk older adults and enable real-time tracking of heat-related health impacts. This data-driven approach is especially important in remote areas to guide timely interventions and resource allocation.
Establishing a national climate-health fund dedicated to elder care could significantly enhance infrastructure and program delivery. Key priorities should include expanding cooling shelters in rural and semi-urban areas, establishing mobile clinics, and upgrading homes with heat-resistant features.
Experiences from the European Union and Japan demonstrate the effectiveness of technology-driven home care and tailored heat warning systems. Public education through accessible media, such as television, radio, and brochures, can further equip communities and caregivers to support older adults during periods of extreme heat.
Natasha Lodhi is Research fellow, Department of Social and Political Studies, School of Behavioral and Social Sciences, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana
Views expressed are the author’s own and don’t necessarily reflect those of Down To Earth