Abstract
Background
Research on extreme heat has predominantly focused on acute heatwaves, obscuring the mental health risks of cumulative heat exposure for aging populations. As a proactive public health intervention, preventive health services represent a critical but underexamined dimension of community resilience to climate-related health risks. This study examines the relationships between cumulative heat exposure and depressive symptoms among older adults and explores whether preventive health services utilization attenuates this risk.Methods
We analyzed longitudinal data from 7,464 older adults (yielding 21,383 observations) in the China Longitudinal Aging Social Survey (2016-2018-2020), linked with city-level meteorological data. Cumulative heat exposure was measured by the annual count of extreme heat days. Depressive symptoms were assessed using the CES-D-9 scale. Two-way fixed-effects regression models were employed. To mitigate confounding by indication and multiple-testing inflation, Inverse Probability of Treatment Weighting (IPTW) and Benjamini-Hochberg False-Discovery-Rate (FDR) adjustments were applied.Results
Cumulative heat exposure significantly exacerbated depressive symptoms among older adults (β = 0.013, p Conclusion
Cumulative heat exposure poses a significant risk to older adults' mental health, but community-based preventive health services can serve as vital institutional adaptation capital to buffer this risk. Prioritizing targeted health education to bridge the knowledge-action gap, alongside continuous health records monitoring in resource-constrained rural and middle regions, offers an equitable strategy for enhancing climate resilience in aging societies.