While politicians debate air conditioning in residential care homes, we still know surprisingly little about what climate change means for people in the final phase of life. A new international study even shows that this topic is currently hardly considered a research priority. In the opinion piece published in the weekly magazine Knack, VUB researcher Steven Vanderstichelen argues that this blind spot should be addressed now, before the impact of climate change becomes even greater.
Should residential care homes be allowed to increase their daily rates in order to install air conditioning? The recent heatwaves have once again placed that question on the political agenda. It is an understandable debate. Extreme heat disproportionately affects older people and those with chronic illnesses. Comfort and safety are not luxuries when temperatures remain above thirty degrees for days on end. But the discussion also raises another question. What does a changing climate actually mean for people in the final phase of life? Remarkably, we still know surprisingly little about this.
On behalf of the European Association for Palliative Care, several colleagues and I mapped international research priorities for palliative care. Experts from sixteen countries assessed nearly fifty possible research topics for the coming ten years. The outcome was surprising. The impact of climate change on palliative care ended up right at the bottom of the priority list.
“Are we sufficiently prepared for what climate change means for people in the final phase of life?”
This does not mean that experts consider climate change unimportant. Rather, it means that other challenges are currently regarded as more urgent. The highest priority is given to the question of how we can better reach people in vulnerable situations, how we can reduce social inequality in the final phase of life and how we can embed palliative care more firmly in neighbourhoods and communities. Methodologically, too, there is still much work to be done in order to properly study complex societal initiatives.
These priorities are justified. Yet at the same time, something feels amiss. While scientists still regard climate as an “emerging horizon”, healthcare professionals are increasingly confronted with its concrete consequences. Heatwaves are becoming more frequent, lasting longer and affecting precisely those people who are central to palliative care: older people, people with serious chronic conditions and patients with limited physical reserves.
The discussion about air conditioning in residential care homes makes this visible. Of course, a comfortable indoor temperature is important. But the challenge does not end with cooling alone. How do we organise palliative home care during periods of extreme heat? How do we support informal carers when hot periods last longer? What impact do heat, poor air quality or prolonged drought have on comfort, symptom control and quality of life? How do we reach socially isolated people spending the final phase of life at home? And how do we ensure that the most vulnerable are not the last to benefit from climate adaptation? For many of these questions, there are still hardly any scientific answers today.
Research requires choices to be made, and resources are limited. But that is precisely why it is important to regularly reflect on the topics that remain under the radar. Scientific agendas are not static. They evolve alongside societal developments. The current attention being paid to heatwaves therefore offers an opportunity to broaden the debate. Not because climate change would suddenly outweigh all other challenges in palliative care, but because we must avoid only beginning research once its effects are already being fully felt.
Heatwaves will no longer be exceptional events. If we only begin researching the impact of climate change on palliative care when the consequences are visible everywhere, we will already be too late.
Ultimately, good palliative care is about dignity, comfort and quality of life, even when a cure is no longer possible. In a changing climate, we will need to rethink how we can continue to guarantee those values. Perhaps the discussion about air conditioning is therefore less an end point than a starting point. Not only for investments in buildings, but also for investments in knowledge. Because only if we understand how climate change affects the final phase of life can we make the right choices for the future.