Exploring the Impact of Extreme Heat on Mental Health and Coping Strategies Among Older Adults In Rural Alabama: A Storytelling and Photo-Elicitation Approach

Background and Purpose: Extreme heat is one of the leading weather-related causes of morbidity and mortality in the United States, affecting older adults. These risks are further intensified in rural and underserved regions such as Alabama’s Black Belt, where structural disadvantages, including poverty, aging housing, limited healthcare access, and inadequate cooling resources, heighten vulnerability. While prior research has largely focused on the physical health impacts of extreme heat, limited attention has been given to its psychological and emotional consequences, particularly among rural older adults. Additionally, existing studies have rarely centered the lived experiences of this population. This study addressed these gaps by examining how extreme heat influenced the mental health, daily functioning, and coping strategies of community-dwelling older adults in rural Alabama.

Methods: This study employed a qualitative phenomenological design grounded in a social constructivist framework. Participants included community-dwelling older adults aged 60 and above residing in Alabama’s Black Belt region, recruited through purposive sampling. Data were collected through in-depth interviews, complemented by an art-based participatory method, specifically photo-elicitation. Participants shared personal narratives and photographs that reflected their experiences with extreme heat, enabling the exploration of emotional, social, and psychological dimensions. Data were analyzed using thematic analysis, guided by Bronfenbrenner’s Ecological Systems Theory, Resilience Theory, and the Stress Process Model to examine how individual, community, and structural factors shaped experiences and coping processes.

Results: Findings revealed that extreme heat significantly affected older adults’ mental health, contributing to increased stress, anxiety, social isolation, and emotional distress. Participants reported disruptions to daily routines, reduced mobility, and limited social engagement during heat events. Structural barriers, including inadequate housing conditions, unreliable electricity, and financial constraints, further exacerbated these challenges. Despite these stressors, participants demonstrated resilience through adaptive coping strategies such as reliance on social networks, behavioral modifications, and personal resourcefulness. However, the effectiveness of these strategies varied depending on socioeconomic and environmental conditions.

Conclusions and Implications: The study demonstrated that extreme heat is not only a physical health concern but also a significant mental health challenge for older adults in rural, underserved communities. The findings underscore the need for culturally responsive, community-based interventions that integrate mental health into climate adaptation strategies. Policy implications include improving infrastructure, expanding access to cooling resources, and strengthening community support systems. This study contributes to a more comprehensive understanding of climate-related health disparities and informs efforts to enhance resilience and well-being among vulnerable populations.