Impact of extreme weather events on mental health among older adults in China: A longitudinal study

• Extreme heat events significantly reduce the mental health of the elderly. • Chronic disease, exercise, and contact with children had mediating effects. • Social, medical, and digital services mitigated the negative impact. • The impacts of extreme heat vary by individual and city. Extreme weather events pose significant health risks, particularly for vulnerable populations such as older adults, potentially exacerbating existing health inequalities. This longitudinal study examines the impacts of extreme weather events on the mental health of older persons in China, using data from the China Health and Retirement Longitudinal Study (CHARLS) matched with city-level extreme weather events from 2011 to 2020. Our analysis reveals that exposure to extreme heat events is significantly associated with decreased mental health scores among older adults. This negative impact is mediated through increased incidence of chronic diseases, reduced physical activity, and decreased contact with their children. Social, medical, and digital services positively moderate the negative impacts of extreme heat. Subgroup analyses identify women, individuals under 75 years, those with low education, and rural residents as more vulnerable to the mental health effects of extreme heat, highlighting disparities in climate resilience. Older adults living in cities lacking health-promoting, smart, or low-carbon features show greater sensitivity to hot weather, underscoring urban-rural and socioeconomic inequalities in adaptation capacity. These findings emphasize the urgent need to prioritize the well-being of older populations and address health inequalities, particularly in rapidly aging societies.