Perceptions of Climate Change and Health Risks Among Urban Older Adults in Mexico City: A Pilot Study

Abstract

Climate change poses significant risks to public health, particularly for vulnerable populations such as older adults. In Mexico, where extreme weather events are becoming more frequent, understanding how this demographic perceives climate-related health risks is crucial for designing effective adaptation strategies. Limited research exists on this topic; this pilot study aims to assess the perceptions of climate related health risks among older adults from a multidisciplinary team, with data collected at the Centro Médico Nacional “La Raza” in Mexico City. Using a cross-sectional, descriptive, and observational survey design, data were collected from hospitalized and outpatient individuals using a validated instrument that measures perceived environmental and emotional impacts of climate change. Key findings reveal varying levels of awareness and emotional responses to environmental changes, such as heatwaves, droughts, and ecosystem degradation. Participants’ sociodemographic characteristics and existing health conditions are also documented to explore their association with climate risk perceptions. The study highlights the need for tailored health communication strategies and adaptive policies that address the specific vulnerabilities and perceptions of older adults. Results will contribute to building climate-resilient health interventions and support the development of inclusive public health strategies amid global climate change in the country.

1. Introduction

Climate change constitutes one of the most pressing global public health challenges of the 21st century. Its complex impacts are not limited to environmental degradation and economic disruption, but extend deeply into human health, particularly among vulnerable populations such as older adults [1]. The growing scientific consensus confirms that anthropogenic climate change is intensifying the frequency and severity of extreme weather events, altering disease transmission patterns, and exacerbating air and water pollution—each of which poses direct and indirect risks to human health [2]. A key recommendation from the Intergovernmental Panel on Climate Change (IPCC) Sixth Assessment Report (AR6) in WG 2 (Impacts, Adaptation and Vulnerability), emphasizes the urgent need to improve understanding of public perceptions of climate risks, particularly among vulnerable populations, as a foundation for enhancing adaptive capacity and informing inclusive policy in North America [3].

The implications of climate change for older populations remain underexplored despite growing evidence of its impacts. In the case of Mexico, older adults are disproportionately affected by climate-related health threats due to a combination of physiological, environmental, and social vulnerabilities. Aging is associated with a decline in thermoregulation, immune response, and resilience to physical and psychological stressors, making this demographic especially susceptible to heatwaves, air pollution, and disasters [4]. Additionally, pre-existing chronic conditions such as cardiovascular disease, diabetes, chronic obstructive pulmonary disease (COPD), and kidney disease—prevalent among older adults—can be aggravated by climate-related stressors [5,6].

A systematic review investigating vulnerability to heat-related mortality (based on studies changes per degree increase above a city-specific threshold or comparing two percentiles of temperature distributions, the highest percentile was always above the 95th percentile) revealed a ratio of relative risk, or increased risk, of 1.02 (95% CI: 1.01, 1.03) for persons aged >65 years when compared to younger age groups, similar to our findings, and 1.04 (95% CI = 1.02, 1.07) for ages > 75 years [7]. Furthermore, exposure to air pollutants such as fine particulate matter (PM2.5) has been associated with premature deaths and increased hospital admissions, especially in densely populated urban centers like Mexico City. The dual burden of environmental and health risks is compounded by social inequalities, limited access to healthcare, and insufficient public awareness, particularly among aging populations [8,9]. Climate change is also associated with the rising incidence of vector-borne diseases such as dengue, chikungunya, and Zika in Mexico. These diseases pose a serious threat to seniors, who may not have the same immune defenses or access to timely healthcare as younger populations. Mental health is another area where climate change exerts a significant toll. Studies suggest that climate-related events such as floods, droughts, and heatwaves can increase levels of anxiety, depression, and post-traumatic stress disorder (PTSD), especially among individuals with limited coping resources [10,11]. While most existing studies focus on youth and middle-aged adults, it is growing recognition that older adults may also suffer from eco-anxiety, grief, and loss related to environmental change, albeit often in silence [12]. The relevance of this research is twofold. First, it provides empirical evidence to support the development of age-inclusive public health campaigns that raise awareness of climate-related health threats. Second, it underscores the importance of involving older adults in climate adaptation planning. It is finally crucial to note that patients do not typically present to hospitals stating they have been affected directly by climate change. Instead, the health impacts of climate change often manifest indirectly through increased vulnerability to heat-related illnesses, respiratory problems due to air pollution or wildfire smoke, vector-borne diseases, or complications from extreme weather events. These connections are often diffuse and mediated by environmental and social factors, making them less visible in clinical settings. Therefore, this pilot study focuses on patients’ perceptions of environmental changes and their perceived health impacts to better understand these complex, indirect pathways.

2. Materials and Methods

2.1. Study Design

Pilot study, Cross-sectional, analytical, observational design.

2.2. Study Site and Participants

The research was conducted at the Unidad Médica de Alta Especialidad (UMAE) Hospital General “Dr. Gaudencio González Garza,” one of the two most important social security tertiary centers in Mexico, located in Mexico City, part of the Instituto Mexicano del Seguro Social (IMSS). It provides a wide range of specialized healthcare services and serves as a referral center for patients from across the country. As a high-complexity hospital, the UMAE “La Raza” integrates clinical care, teaching, and investigation, particularly in internal medicine, geriatrics, and chronic disease management. The study was specifically carried out in the Internal Medicine and Geriatrics Departments. The internal medicine and geriatrics departments of this hospital provided access to a sample of older adults with diverse age, sex, sociodemographic status, and health profiles, suitable for exploring perceptions of climate change and health-related vulnerabilities. The older adults surveyed were mostly from the Metropolitan Area of Mexico City and Mexico Valley (ZMVM). Eligibility criteria for participation included: Age ≥ 60 years; ability to provide informed consent; adequate cognitive function to complete a structured interview (assessed by clinical staff); and “no severe acute illness or terminal condition at the time of recruitment”, while exclusion criteria included diagnosed moderate to severe cognitive impairment and unstable medical conditions impeding participation. Patients were approached during their clinic visit or during their in-hospital stay. For inpatients (contacted directly in their hospital rooms), recruitment included individuals admitted for acute medical conditions requiring tertiary care. For outpatient participants (clinic visit to medical consultation room), these were typically patients receiving follow-up care after a previous hospitalization. Informed consent was obtained before participation. The recruitment period was in March 2025. No incentives were provided to the participants. We finally consider the article as a pilot study, meaning a small-scale preliminary investigation conducted in preparation for future, larger study that informs the design, conduct and justification of a subsequent definitive trial, including sample size calculations and refinement.

2.3. Sample Size and Data Sources

The sample size was determined using a proportion formula based on an estimated universe of 90 inpatient admissions and 35 outpatient visits per month and an anticipated frequency of 50% for older adults with high environmental awareness; the calculated sample size for one month was 95 patients, with a 95% confidence interval. The study population consisted of 101 older adults recruited from outpatient and inpatient services in internal medicine and geriatrics. The primary instrument used was the Climate Change Perceptual Awareness Scale (CCPAS), based on Cipriani et al. (2024) [12]. To ensure accurate translation, it was adapted to Spanish through using a forward–backward process with iterative revisions and compared for conceptual equivalence. The Spanish version was then pilot tested with older adults (n = 10), and minor adjustments were made to improve clarity (

Table 1. CCPAS Items and Their Categories.

CCPAS Item	Category
I have noticed that rivers and lakes dry up more frequently	Physical/Sensory Change
I have noticed more news about forest fires	Media/Public Discourse
I have noticed more dry plants than before	Physical/Sensory Change
I felt that nature is suffering a lot	Emotional Response
I have noticed an increase in the number of heat waves	Physical/Sensory Change
I have noticed changes in temperatures during winter	Physical/Sensory Change
I have noticed more news about droughts	Media/Public Discourse
I have noticed changes in autumn temperatures	Physical/Sensory Change
I felt that animals are suffering a lot	Emotional Response
I felt angry about how the environment is changing	Emotional Response
I felt frustrated seeing how the environment is changing	Emotional Response
I felt that we have failed due to how the environment is changing	Emotional Response
I felt upset seeing how the environment is changing	Emotional Response
I have noticed more news about floods	Media/Public Discourse
I have noticed that leaves turn yellow more frequently	Physical/Sensory Change

). The CCPAS consists of 15 items that assess perceived changes in environmental patterns (e.g., heat waves, droughts, floods), emotional responses (e.g., frustration, anger, sadness), and media coverage about climate change. Each item was rated on a 5-point Likert scale (Never, Rarely, Occasionally, Frequently, Very Frequently). The CCPAS was selected for this study based on its ability to capture both sensory perceptions and emotional responses to environmental and climate change. Research shows that older adults process information differently from younger populations, often relying more on embodied experience, memory, and familiarity rather than probabilistic reasoning.

The questions used in the CCPAS framework are meant to be direct, concrete, and reflective of everyday experiences, which are cognitively more accessible to older individuals. Moreover, the inclusion if items such as media exposure (noticing news about floods or forest fires) acknowledges the role of indirect informational sources that influence perception, especially in urban settings like Mexico City. Some questions such as—I feel that animals are suffering a lot—provide a window into moral and emphatic dimensions of climate perception, beyond human centered domains.

The survey generated 1515 total responses from 101 participants (15 items × 101 participants). In addition to the CCPAS, a demographic and health questionnaire was administered to collect data on age, sex, place of residence, years of education, and medical history (

Table 2. Demographic and Health Variables Collected.

Variable	Description
Age	Participant’s age in years
Sex	Biological sex (male or female)
Place of Residence	City or region of residence (e.g., Valley of Mexico)
Years of Education	Total number of years of formal education completed
Hypertension	Self-reported diagnosis of hypertension
Diabetes	Self-reported diagnosis of diabetes mellitus
Heart Disease	History of chronic coronary syndrome or heart failure
Chronic Kidney Disease	Self-reported diagnosis of chronic kidney disease
COPD	Self-reported diagnosis of chronic obstructive pulmonary disease
Osteoarthritis	Self-reported diagnosis of osteoarthritis
Dyslipidemia	Self-reported diagnosis of abnormal blood lipid levels

).

2.4. Statistical Analysis

All statistical analyses were conducted using IBM SPSS Statistics version 25. Descriptive statistics were used to summarize demographic and clinical variables, as well as the frequency of responses to each item in the CCPAS. For categorical variables such as sex, disease history, and place of residence, results were expressed as frequencies and percentages. For continuous variables like age and years of education, means and standard deviations (SD) were used for normally distributed data, while medians and interquartile ranges (IQR) were reported for skewed distributions. To determine the distribution of continuous variables, the Kolmogorov–Smirnov test was also applied; this helped to identify the appropriate statistical tests for subsequent analyses based on the normality of the data. To explore the relationship between independent variables (e.g., sex, chronic conditions, education level, geographic location) and levels of climate change awareness or emotional response, Chi-square tests (χ²) were used. Tests were suitable for evaluating associations between categorical variables, such as the frequency of specific CCPAS responses and participant characteristics. A significance level of p < 0.05 was considered statistically significant. Where relevant, post hoc analysis was conducted to identify specific group differences contributing to significant χ² results. Subgroup analyses included comparisons between men and women, between residents and non-residents of the Valley of Mexico, and among participants with and without chronic conditions such as hypertension and diabetes. No imputation was performed for missing data, as the completeness rate exceeded 95% for all items. All statistical decisions were based on two-tailed tests.

3. Results

As previously mentioned, a total of 101 older adults participated in the study and a total of 1515 individual responses to perception statements were analyzed. Most participants were recruited from inpatient wards (>80%). We had no non-participation requests when applying the survey. Among these, the most prevalent comorbidities were hypertension (62%), diabetes mellitus (37%), and heart disease (14%). The mean age of participants was 69 years (±9), and 56% were women. The educational attainment was generally low, with a median of 8 years of schooling (IQR 4–9). Most participants (84%) resided in the Valley of Mexico region. The most frequently selected response overall was VERY FREQUENT, which accounted for 53% of the responses (809 out of 1515). In contrast, the least selected response was NEVER, appearing in only 2% of the responses (30 instances). These results suggest a relatively high level of perceived awareness regarding the environmental changes associated with climate change. When examining specific perception statements, the most identified item as VERY FREQUENT was “I have noticed an increase in the number of heat waves”. This suggests that heat waves are one of the most recognizable and impactful environmental changes experienced by older adults in this context. This aligns with recent reports highlighting a growing frequency and intensity of extreme heat events in Mexico. Other top-ranking perceptions included “I felt like animals were suffering more and more” and “I felt like nature was suffering more and more”. These responses indicate a high level of ecological awareness and empathy toward the broader impacts of climate change beyond human health, possibly reflecting a strong emotional connection with the natural environment. Conversely, the least frequently selected statements were those reflecting direct emotional responses to climate change. For instance, “I felt a sense of frustration due to the changes that are happening in the environment” and “I felt a sense of anger because of the changes that are happening in the environment” were among the lowest rated, with many respondents selecting NEVER or RARELY. This reveals a potential disconnect between the recognition of environmental changes and emotional mobilization or concern. Notably, “I have noticed an increase in the amount of news reports about floods” was also among the least frequently acknowledged items, suggesting that some climate-related events may receive less attention or are perceived as less relevant by this demographic (

Table 3. Distribution of the responses to the CCPAS items.

CCPAS Item	Never n (%)	Rarely n (%)	Occasionally n (%)	Frequently n (%)	Very Frequently n (%)
I have noticed that rivers and lakes dry up more frequently	2 (2)	3 (3)	9 (8.9)	27 (26.7)	60 (59.4)
I have noticed more news about forest fires	0	1 (1)	6 (5.9)	39 (38.6)	55 (55.4)
I have noticed more dry plants than before	2 (2)	1 (1)	11 (10.9)	38 (37.6)	49 (48.5)
I felt that nature is suffering a lot	2 (2)	0	7 (6.9)	31 (30.7)	61 (60.4)
I have noticed an increase in the number of heat waves	0	0	9 (8.9)	22 (21.8)	70 (69.3)
I have noticed changes in temperatures during winter	0	2 (2)	11 (10.9)	33 (32.7)	55 (55.4)
I have noticed more news about droughts	0	1 (1)	12 (11.9)	39 (38.6)	49 (48.5)
I have noticed changes in autumn temperatures	1 (1)	1 (1)	18 (17.8)	38 (37.6)	43 (42.6)
I felt that animals are suffering a lot	2 (2)	2 (2)	9 (8.9)	28 (27.7)	60 (59.4)
I felt angry about how the environment is changing	3 (3)	5 (5)	12 (11.9)	31 (30.7)	50 (49.5)
I felt frustrated seeing how the environment is changing	4 (4)	6 (5.9)	13 (12.9)	27 (26.7)	51 (50.5)
I felt that we have failed due to how the environment is changing	3 (3)	1 (1)	8 (7.9)	34 (33.7)	55 (54.5)
I felt upset seeing how the environment is changing	3 (3)	3 (3)	16 (15.8)	31 (30.7)	48 (47.5)
I have noticed more news about floods	0	3 (3)	7 (6.9)	35 (34.7)	56 (55.4)
I have noticed that leaves turn yellow more frequently	4 (4)	3 (3)	13 (12.9)	33 (32.7)	48 (47.5)

). Statistical analysis revealed several significant associations. Men were significantly more likely to report lower awareness of animal suffering (p = 0.02), while residents of the Valley of Mexico showed greater awareness of drought-related phenomena (p = 0.02). The presence of chronic diseases, particularly hypertension, was associated with increased emotional responses, such as a greater frequency of reported frustration and a heightened perception of the volume of climate-related news, particularly on floods (p < 0.01). Additionally, individuals with hypertension expressed a stronger sense of failure regarding human responsibility for environmental change (p < 0.01) (

Table 4. Statistical results.

Climate Change Perceptions in Older Adults
N = 101
Característics	Values	p (X2)
Age (years), mean	69 ± 9
Sex, n (%)
Women	57 (56)
Men	44 (44)	0.02 ♂
Valley of Mexico	85 (84)	0.02 ┬
Disease	80 (79)	<0.01 * 0.05 +
Hypertension	63 (62)	<0.01 ° 0.01 * 0.02 +
Diabetes	37 (37)
Heart disease (previous chronic coronary syndrome or Heart failure)	14 (14)
Years of study, median (IQR)	8 (4–9)
	Statements
	n = 1515
Most common answer, n (%)	Very frequently, 810 (53)
Least common answer	Never, 26 (2)
Highest awareness statement (occasionally, frequently and very frequently)	I have noticed an increase in the number of heat waves
Lowest awareness statement (never, rarely)	I have noticed an increase in the amount of news reports about floods.
Top 3 highest awareness statements (occasionally, frequently, Very frequently)	(1) I have noticed an increase in the number of heat waves (2) I felt like nature was suffering more and more. (3) I felt like animals were suffering more and more.
Top 3 lowest awareness statements (never and rarely)	(1) I felt a sense of frustration due to the changes that are happening in the environment. (2) I felt a sense of anger because of the changes that are happening in the environment. (3) I have noticed an increase in leaf yellowing on plants.

Abbreviations: N: number of patients, n: number of statements, IQR: interquartile range, p: ♂ Men have higher risk of showing low awareness in animal suffering, ┬ Citizens of the valley of Mexico have more awareness of droughts, * within persons with diseases and hypertension sensation of frustration is higher, + within persons with diseases and hypertension awareness of amount of news reports about floods is higher, ° within persons with hypertension awareness of failure due to the changes that are happening in the environment is higher.

). While environmental awareness appears relatively high, particularly regarding observable phenomena like heat waves, emotional engagement with climate change remains limited in many participants. Chronic health conditions may heighten sensitivity to perceived climate risks, suggesting that perceived vulnerability could play a role in shaping both cognitive and affective responses.

4. Discussion

While this study captures perceptions of climate and environmental change, it does not assume that participants explicitly attribute the changes to anthropogenic climate change. The CCPAS tool is designed to identify subjective environmental and emotional awareness, which may not necessarily align with scientifically grounded attribution. As such, results should be interpreted as reflections of perceived environmental degradation and anticipated climate related impacts from the perspective of adult participants, rather than as evidence of a scientifically informed understanding of causality.

Therefore, the findings from this pilot study provide a better understanding of how older adults perceive the risks associated with climate change and its impacts on health in Mexico. The sample of 101 older individuals—coming from different parts of the country—reveals an important awareness of certain aspects of climate change and sensitivity to risks associated with extreme events, particularly heat waves. The sociodemographic profile of the participants shows a majority with a low educational level (median of 8 years of schooling) and a high burden of chronic diseases, especially hypertension (62%) and diabetes (37%). These factors are key to understanding how information about climate change is interpreted and processed. Previous studies have shown that higher educational attainment is associated with a better understanding of complex phenomena such as climate change [13]. However, in this study, we found that even with relatively low educational levels, sensory awareness of climate-related effects (such as temperature changes or drought) remains high, suggesting that lived experience may be more influential than formal knowledge.

Findings can be clustered in the following dimensions:

• Broader Environmental and Climate Awareness: Results show that the most frequently acknowledged perceptions are related to both physical and sensory effects of climate change [14]. In particular, the statement “I have noticed an increase in the number of heat waves” was most rated as “very frequent” by participants. This confirms a direct experience of extreme temperature events and aligns with documented increases in the frequency and intensity of heat waves in Mexico, as reported by international bodies such as The Lancet Countdown [15]). Other statements, such as “I felt like nature was suffering more and more,” reflect a strong perceptual connection between environmental well-being and ecosystem distress. These responses may be explained by personal experiences and place of living, but they also point to a deeper emotional connection that some older adults develop with their surroundings over time. For instance, the degradation of nature in Mexico City serves as a trigger for emotional responses among older adults. Their statement that “nature is suffering” reflects not only physical observations but also emotional and historical consciousness, tied to both personal memory and present-day urban realities.
• Perceptions of extreme events like wildfires, heatwaves, and droughts: One of the key findings of this study is the high frequency of perceived environmental changes related to extreme events. Among all items, the statement “I have noticed an increase in the number of heat waves” received the highest percentage of very frequent responses, followed closely by items related to drought-like conditions (e.g., more dry plants, yellowing leaves) and media coverage of forest fires. This result aligns with meteorological and public health data confirming that Mexico, particularly in urban areas like the Valley of Mexico, has experienced a measurable increase in extreme heat events in recent years. Likewise, the perception of drought conditions—such as dry-ing rivers, plant desiccation, and reduced rainfall—they all reflect the water shortage and water crisis in the area. Participants consistent selection of very frequent in relation to these indicators suggests a strong embodied awareness of water scarcity, even in the absence of formal environmental education. Interestingly, media-based items such as “I have noticed more news about forest fires” were also frequently marked as very frequently. This suggests that media coverage is functioning as an amplifier of environmental risk perception, especially when the events being reported—like wildfires—are highly visual and emotionally charged. These patterns speak to the sensory accessibility of climate impacts such as heat, drought, and smoke. Heat can be felt, drought can be seen, and wildfire smoke can be smelled—making them perceptually available phenomena even for older adults with limited access to scientific information or digital technologies. The high sensory awareness among older adults—particularly in relation to observable phenomena such as heatwaves, drought, and ecosystem degradation—suggests that communication efforts should prioritize concrete, locally relevant, and relatable experiences over abstract scientific messages. For example, messages emphasizing changes in temperature, impacts on plants and animals, or disruptions to daily routines may resonate more strongly than those relying on technical climate terminology. Additionally, the relative low levels of intense emotional response (e.g., frustration and anger) observed in this group may indicate that older adults engage with climate risks in a more reflective or experimental manner. As such, national communication campaigns should focus on actionable guidance tailored to their specific health needs and life context. Given the participants’ limited access to digital technologies and the dominance of traditional media, communication efforts should also consider preferred channels, such as community radio, printed materials, health center posters, and interpersonal outreach by trusted healthcare professionals.
• Emotional response to climate change: Contrary to younger generations, whose climate emotions and anger are channeled through collective actions, social media, and radical movements, for older generations, it seems that their emotional repertoire and perceptions about climate change may be simply less reactive and more reserved, shaped by a different era of civic expression [16]. One of the most noteworthy observations in this analysis is the low frequency of intense emotional responses like frustration or anger towards climate change. This suggests a possible dissonance between the perception of environmental impacts and the internalization of the problem: older adults may have developed different coping strategies or prioritize more immediate concerns related to health or economic well-being. Climate change is probably not perceived as a more direct threat to their future as it could be for much younger generations.
• Sociodemographic factors and comorbidities: During the COVID-19 pandemic, a clear link emerged in Mexico between fatalities from the virus and pre-existing conditions such as diabetes and hypertension [16,17]. For this pilot study, relationships were identified between specific chronic illnesses and heightened emotional sensitivity to climate change. For instance, individuals with hypertension exhibited higher levels of frustration and greater awareness of the increase in news reports about floods. This relationship may be due to an increased perception of physical vulnerability, which amplifies sensitivity to external threats, especially those related to environmental conditions.
• An important finding of this study is that residents of Mexico City and the Valley of Mexico exhibited significantly greater awareness of phenomena such as drought. This heightened awareness may be attributed to the region’s complex environmental conditions and intense media coverage of water-related issues, including chronic water scarcity, air pollution, and the urban heat island effect. These problems are pronounced in Mexico City, a megacity facing daily infrastructural and ecological stress [17,18]. The Valley of Mexico, which surrounds and includes Mexico City, is one of the most urbanized and densely populated areas in Latin America and has long faced systemic challenges in water availability and management due to both natural and anthropogenic causes. In this context, media coverage and public discourse have played a critical role in shaping public perceptions of climate-related risks over time. Studies suggest that exposure to local news reports and environmental campaigns significantly influences how people understand and emotionally engage with environmental threats, particularly in urban environments where the visibility of such threats is higher [19,20]. Residents of Mexico City, for instance, are frequently confronted with news about droughts, heatwaves, poor air quality indexes, and emergency water supply measures, which may contribute to a greater sense of immediacy and concern around climate change issues [21]. Furthermore, the urban heat island effect, which amplifies perceived heat in densely built environments, is more intense in metropolitan areas such as Mexico City, making climate change impacts more physically perceptible to residents [22]. This may help explain why individuals in these areas report higher levels of awareness regarding heat-related and drought-related events.

Limitations and Opportunities for Future Research on the Topic

This study presents several important limitations: to start, the sample size—while adequate for a descriptive pilot study—does not allow for general statistical inferences across the entire Mexican older adult population. Another limitation is the data collection period, which was restricted to a single month (March 2025). While this short timeframe was adequate for a pilot study aimed at exploring initial perceptions and testing the methodology, it does not allow for an assessment of seasonal variations in perceptions or the influence of specific events outside this period. Moreover, the survey was conducted in a single hospital center (IMSS La Raza) in Mexico City, which limits the geographic and cultural diversity of the participants. Notably, 84% of participants reported residing in the Valley of Mexico, reflecting a strong urban concentration. While this urban context provides valuable insights into climate change perceptions within a densely populated and infrastructure-stressed area, it also introduces a significant bias that limits the generalizability of the findings to other populations. Other adults living in rural, semiurban, or climatically distinct regions of Mexico, such as the arid north or the tropical southeast of the country, may experience and interpret environmental risks very differently due to variations in exposure, media access, and livelihood dependency on natural resources, among others. These populations often have differing degrees of vulnerability, resilience, and risk perception shaped by environmental conditions, marginalization, or education

This focus on an urban hospital setting may limit the generalizability of the findings to other older adults in rural areas, who may experience different environmental exposures and have varying levels of access to information and healthcare. Furthermore, recruiting participants from the internal medicine and geriatrics departments may have resulted in a sample with a higher prevalence of chronic illnesses than the general older adult population, potentially influencing the observed relationships between comorbidities and climate change perception. Another relevant limitation is the use of the Climate Change Perceptual Awareness Scale (CCPAS), which was translated into Spanish but has not yet undergone full validation in this language. This may affect the accuracy of the results. These potential biases should be considered when interpreting the study results. Nevertheless, the richness of data obtained and processed suggests that the scale holds the potential as a preliminary diagnostic tool and highlights the need for future studies to assess its psychometric properties in the Mexican context. Future research could delve into regional comparisons, include qualitative analysis of personal narratives, and test the survey instrument in rural settings where relationships with the environment differ significantly. Additionally, incorporating questions about information sources, institutional trust, and willingness to act on climate change would deepen our understanding of behavioral responses in this age group.

Finally, while the study found an association between chronic conditions—especially hypertension—and stronger emotional responses to climate change, these results should not be interpreted as evidence of causality. Given the cross-sectional design, the direction of this relationship remains unclear. Future longitudinal or experimental studies are needed to improve our understanding of how chronic illness and emotional sensitivity to environmental risks may interact over time.

5. Conclusions

This pilot study provides explanatory insights into how older adults in Mexico perceive environmental changes associated with climate change and its related health risks. While participants did not explicitly identify climate change as the cause of their health conditions, their high level of sensory awareness—particularly regarding heatwaves, drought, and ecosystem degradation—suggest a strong experiential understanding of environmental stressors. These perceptions are shaped by factors such as age, chronic illness, and urban context.

The results show a high frequency of perceived environmental changes (over 50% of the surveyed) indicating a strong sensory awareness of these shifts. Geographic location also mattered: residents of the Valley of Mexico displayed greater sensitivity to drought and environmental effects, likely reflecting the region’s urban environmental stress and information exposure.

The findings also have direct implications for the design of public health policies and climate communication strategies aimed at older adults. First, communication should emphasize relatable sensory experiences, such as increased heat waves and drought, as these resonate strongly with this age group. Second, it is important to recognize that emotional responses may not always accurately reflect awareness or concern due to cultural, generational, or health-related factors. This population group, due to its life experience, can also serve as a key factor in promoting community resilience by engaging them in climate adaptation initiatives that would contribute not only to their well-being but also to enriching local strategies for intergenerational decision-making.