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Study Links Air Conditioning in Nursing Homes to Reduced Mortality During Heat Waves

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Air Conditioning Linked to Reduced Mortality in Nursing Homes During Heat Waves

A recent study published in JAMA Internal Medicine indicates that resident-room air conditioning (AC) in nursing homes is associated with reduced mortality among residents during periods of extreme heat. The research, conducted in Ontario, Canada, analyzed mortality rates in nursing homes with and without AC from 2010 to 2023.

Air conditioning in nursing homes is associated with reduced mortality among residents during periods of extreme heat.

Vulnerability of Older Adults

Older adults face heightened vulnerability to heat waves due to several factors, including limited mobility, age-related thermoregulation issues, the effects of common medications, and social isolation. Globally, heat-related deaths among seniors have increased by 167% since the 1990s. Despite air conditioning being a proven protection, many individuals, including those in care settings, lack access to it.

Regulatory Landscape and Ontario's Mandate

Before 2020, over half of Ontario's more than 600 nursing homes did not have AC in resident rooms, often relying on designated cooled common areas. In the U.S., federal regulations require specific temperature ranges for facilities certified after October 1, 1990, but do not explicitly mandate AC, leaving nearly half of facilities predating this requirement.

Following the COVID-19 pandemic, Ontario mandated AC in all resident rooms by July 2020, with full compliance achieved by May 2023 at an approximate cost of CAD 200 million. By this time, 99.5% of facilities met the requirement.

Study Methodology and Findings

The study employed a case-crossover analysis across 615 Ontario nursing homes during warm months (June–September) from 2010 to 2023. Researchers compared mortality risk on extreme heat days (defined as the 90th percentile heat index or above for each location) in facilities with and without AC. The analysis included 73,578 nursing home deaths, with roughly 68% of residents aged 85 or older, 65% female, and 70% living with dementia.

Key Findings:

  • Extreme heat significantly increased mortality risk in nursing homes without AC but not in those with AC.
  • Approximately 13.8% of deaths in facilities without AC occurred on extreme heat days, compared to 12.1% in facilities with AC.
  • The protective effect of AC was strongest during the first three days following heat exposure.
  • Ontario's AC mandate was associated with an estimated 33 fewer deaths on extreme heat days from 2020 to 2023, averaging about 10 deaths per year.
  • Modeling suggested that implementing the mandate in 2010 could have prevented 131 deaths over that decade, or approximately 13 deaths annually.

Conclusions and Policy Implications

The study concludes that air conditioning is associated with lower mortality in nursing homes during extreme heat, though it does not completely eliminate heat-related risks. The findings suggest an urgent need for policy action.

The study advocates for universal air conditioning mandates in all congregate care settings housing vulnerable populations, such as assisted living facilities, group homes, prisons, and psychiatric institutions, to protect residents as heat waves intensify globally.