Sari Puspa Dewi

Introduction Extreme heat causes a major health burden, especially for older Australians. Objective To assess the impact of extreme heat on older regional and rural Australians, including clinical presentations, social implications, and health‐seeking behaviours and adaptations. Design A systematic review and narrative synthesis. Findings Ten articles were included in the review with research on this topic limited. Extreme heat causes an increase in mortality and ambulance dispatches for older rural Australians. Social connectedness is negatively affected by extreme heat due to cancellation of events and individuals becoming housebound. Air conditioning is the main cooling mechanism used, although cost is a major concern. Despite this, older rural populations display a depth of knowledge regarding practical behavioural responses to adapt to extreme heat. Studies show older rural Australians do not consider extreme heat to be a threat to health. Discussion Further research needs to examine the role extreme heat may play in contributing to experiences of loneliness. Air conditioning cannot be the ultimate solution in responding to extreme heat due to cost and increased carbon emissions. The low‐risk perception of extreme heat for older rural people may inform effective heat health warnings and effective use of primary health care in heat‐health education. Listening to First Nations knowledge in dealing with heat may provide a powerful mechanism in which to protect health. Conclusion The extensive health effects of extreme heat highlights the necessity of further research and strengthening of services in preparation for an ageing rural population enduring climate change.