First responders search an area along the Guadalupe River near Blue Oak RV Park in Ingram, Texas, on Monday. More than 100 people were killed in floods in central Texas, At least 27 of them died when floodwaters swept through a summer camp and nearby homes early on Friday . Photo by Dustin Safranek/EPA
Hurricanes, tornadoes and other extreme weather do not distinguish between urban and rural boundaries. But when a disaster strikes, there are big differences in how well people are able to respond and recover — and older adults in rural areas are especially vulnerable.
If a disaster causes injuries, getting health care can take longer in rural areas. Many rural hospitals have closed, leaving patients traveling longer distances for care.
At the same time, rural areas have higher percentages of older adults, a group that is more likely to have chronic health problems that make experiencing natural disasters especially dangerous.
Medical treatments, such as dialysis, can be disrupted when power goes out or clinics are damaged, and injuries are more likely around property damaged by flooding or powerful winds.
As a sociologist who studies rural issues and directs the Institute of Behavioral Science at the University of Colorado Boulder, I believe that understanding the risks is essential for ensuring healthier lives for older adults. I see many different ways rural communities are helping reduce their vulnerability in disasters.
Disasters disrupt health care, especially in isolated rural regions
According to the U.S. Census Bureau, about 20% of the country’s rural population is age 65 and over, compared with only 16% of urban residents. That’s about 10 million older adults living in rural areas.
There are three primary reasons rural America has been aging faster than the rest of the country: Young people have been leaving for college and job opportunities, meaning fewer residents are starting new families. Many older rural residents are choosing to “age in place” where they have strong social ties. And some rural areas are gaining older adults who choose to retire there.
An aging population means rural areas tend to have a larger percentage of residents with chronic disease, such as dementia, heart disease, respiratory illness and diabetes.
According to research from the National Council on Aging, nearly 95% of adults age 60 and older have at least one chronic condition, while more than 78% have two or more. Rural areas also have higher rates of death from chronic diseases, particularly heart disease.
At the same time, health care access in rural areas is rapidly declining.
Nearly 200 rural hospitals have closed or stopped providing in-patient care since 2005. Over 700 more — one-third of the nation’s remaining rural hospitals — were considered to be at risk of closing even before the cuts to Medicaid that the president signed in July 2025.
Hospital closures have left rural residents traveling about 20 miles farther for common in-patient health care services than they did two decades ago, and even farther for specialist care.
Those miles might seem trivial, but in emergencies when roads are damaged or flooded, they can mean losing access to care and treatment.
After Hurricane Katrina struck New Orleans in 2005, 44% of patients on dialysis missed at least one treatment session, and almost 17% missed three or more.
When Hurricanes Matthew and Florence hit rural Robeson County, North Carolina, in 2016 and 2018, some patients who relied on insulin to manage their blood sugar levels went without insulin for weeks. The county had high rates of poverty and poor health already, and the healthy foods people needed to manage the disease were also hard to find after the storm.
Insulin is important for treating diabetes — a chronic disease estimated to affect nearly one-third of adults age 65 and older. But a sufficient supply can be harder to maintain when a disaster knocks out power, because insulin should be kept cool, and medical facilities and drugstores may be harder for patients to reach.
Rural residents also often live farther from community centers, schools or other facilities that can serve as cooling centers during heat waves or evacuation centers in times of crisis.
Alzheimer’s disease can make evacuation difficult
Cognitive decline also affects older adults’ ability to manage disasters.
Over 11% of Americans age 65 and older — more than 7 million people — have Alzheimer’s disease or related dementia, and the prevalence is higher in rural areas’ older populations compared with urban areas.
Caregivers for family members living with dementia may struggle to find time to prepare for disasters. And when disaster strikes, they face unique challenges. Disasters disrupt routines, which can cause agitation for people with Alzheimer’s, and patients may resist evacuation.
Living through a disaster can also worsen brain health over the long run. Older adults who lived through the 2011 Great East Japan earthquake and tsunami were found to have greater cognitive decline over the following decade, especially those who lost their homes or jobs, or whose health care routines were disrupted.
Social safety nets are essential
One thing that many rural communities have that helps is a strong social fabric. Those social connections can help reduce older adults’ vulnerability when disasters strike.
Following severe flooding in Colorado in 2013, social connections helped older adults navigate the maze of paperwork required for disaster aid, and some even provided personal loans.
Friends, family and neighbors in rural areas often check in on seniors, particularly those living alone. They can help them develop disaster response plans to ensure older residents have access to medications and medical treatment, and that they have an evacuation plan.
Rural communities and local groups can also help build up older adults’ mental and physical health before and after storms by developing educational, social and exercise programs. Better health and social connections can improve resilience, including older adults’ ability to respond to alerts and recover after disasters.
Ensuring that everyone in the community has that kind of support is important in rural areas and cities alike as storm and flood risks worsen, particularly for older adults.
Lori Hunter is a professor of Sociology and director of the Institute of Behavioral Science at the University of Colorado-Boulder. This article is republished from The Conversation under a Creative Commons license. Read the original article. The views and opinions in this commentary are solely the opinions of the author.
