Uncovering the Impact of Disasters on the Health and Wellbeing of Older Adults: Insights from Longitudinal Ageing Study in India

doi:10.21203/rs.3.rs-3605506/v1

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Uncovering the Impact of Disasters on the Health and Wellbeing of Older Adults: Insights from Longitudinal Ageing Study in India

https://doi.org/10.21203/rs.3.rs-3605506/v1

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This study analyzes the impact of disasters on the health of older adults in India, using data from LASI Wave-1 (2017-18) with 2,487 participants. Descriptive and multivariate analyses examined the link between health outcomes and disasters in older adults. The research reveals that drought, floods, and earthquakes are prevalent disaster, while traffic accidents and building collapses are significant man-made disasters. Older adults exposed to disasters caused by natural hazards experienced higher rates of psychological trauma, chronic illness, and physical disabilities. Man-made disasters were associated with increased risk of physical disability and chronic illness. Disasters were strongly linked to psychological trauma. This study emphasizes the importance of disaster preparedness and response strategies tailored to the needs of older adults. It calls for policies to improve healthcare access, social support, and disaster resilience, particularly in rural areas. Conducted through personal interviews, this research offers valuable insights for shaping policy and disaster management.

Natural hazards

man-made disasters

physical disability

psychological trauma

chronic illness

There is considerable evidence that older adults (aged 60 years and above) are at disproportionally high risk of injury, disability, and even death as a result of disasters (1–3). Disasters can occur naturally or as a result of man-made events. Naturally caused disasters includes, landslides, droughts, earthquakes, hurricanes/ cyclones, floods, or tornadoes/tsunami-related events. Similarly, accidental (such as an accidental toxic spill, nuclear power plant failure, building collapse, fire, or traffic accident) or deliberately caused (such as a terrorist bombing, poisoning, riot, or stampede) or other miscellaneous accidents are considered as human-made disasters (4). The effect of disaster depends on pre-exposure health status, psychological wellbeing, and social and economic status of older adults (5). Therefore, aged with poor health or poor socioeconomic status are more vulnerable to disasters than the youngster (6). It is also noticed that older adults, particularly those with physical or cognitive disabilities, are also vulnerable to disaster (7). They are particularly vulnerable during and after the crisis because they are more likely to have limited physical mobility, sensory awareness, chronic health concerns, or social and economic constraints. (8).

India is one of the most disaster-prone areas in the world. Over 85% of India's land area is vulnerable to several threats to natural hazards such as droughts, floods, earthquakes, landslides, and cyclones. According to Shah (2011), roughly three-fourths of Indian states and union territories are vulnerable to calamities. Droughts and floods are recurring issues in many states, particularly in central India (10). India is observed to have roughly 68% of its territory categorized as "drought-prone," while about 12% of its land faces frequent floods. Furthermore, almost 57% of the area falls under the high seismic zone, leading to acute seismic activity resulting in earthquakes (11). Even an average earthquake with a value of 6.0 on the Richter scale in Sikkim in 2011 caused significant destruction and countless casualties. The Eastern coast of India experiences various sea-induced disturbances with approximately 8% of the coastal area is prone to cyclones. The eastern coast is more vulnerable since the 2004 tsunamis in the Indian Ocean. Deshpande (10) reported that, there were 402 disasters throughout the period of a century, from 1900 to 2000, with 354 more occurring in the following two decades (2001-21). He also found that, in the roughly two decades since 2001, a total of 100 crore people have been affected, and almost 83,000 lives have been lost as a result of these natural hazards. Another study by the Centre for Research on the Epidemiology of Disasters' Emergency Events Database (EM-DAT) has reported that India has encountered a significant number of storms and floods as natural calamitiess over the past century, whereas nearly 4.6 million Indians died due to natural calamities alone, during last three decades (12). At the same time, the frequency and intensity of both natural and human-made disasters are also increasing (13).

Indian roads are more prone to the traffic accidents causing nearly 3.84 lakhs injuries out of 4.12 lakhs accidents in the year 2021, and nearly 1.53 lakhs fatality in road accidents out of this 33% were older adults (14). It is also revealed that physical impairment and disability among older adults were mainly caused by road traffic injuries (15). Studies also shows that, older adults who have lost physical function may face difficulty with activities of daily living (ADLs), such as bathing, dressing, eating, or using the bathroom without aid, and instrumental activities of daily living (IADL) were also one of the major cause of physical disability among older adults (16). On the other hand, a nationally representative survey (17) shows that approximately 24% older adults aged 60 year and above had faced at least one ADL limitation, in contrast to the 9% in the 45–59 age group. Additionally, nearly half of the elderly, specifically those aged 60 and above, reported at least one IADL limitation (48%), which is notably higher than the 26% reported by older adults aged 45–59 years old.

The India aging population is rapidly rising, it is expected that by 2050, older people (60 years and above) will comprise around 20% (319 million) of India’s population (18). The epidemiological transition in India has shifted a major share of the country’s burden of disease to the older population. This shift is characterized by a reduction in infectious and acute diseases and a growing incidence of chronic and degenerative conditions. Yet, infectious and parasitic diseases remain a significant challenge for the public health system, leading to India's dual disease burden (19). According to the LASI report (17), around one-fourth of the older adults (aged 45 years and above) are suffering from chronic disease in India. On the other hand, NCDs account for 63% of all deaths in India; deaths from CVDs, chronic respiratory diseases, cancers, and other NCDs account for 27%, 11%, 9%, and 13%, respectively (20). Furthermore, elderly persons are more likely to suffer from multiple chronic diseases and illnesses, which can exacerbate during and after the disaster due to interruptions in care, lack of regular check-ups, and physical, social, and emotional distress (21). Due to disaster, they consume low-nutrient foods and contaminated foods, leading to high levels of exposure to disease and deaths from contamination (22). They also experience a greater burden of endemic such as, malaria, dengue, cholera, diarrhea, and typhoid, which are largely diagnosed after the disaster through clinical examination (1), whereas, One in every four older adults age 45 and above reported at least one of these endemic diseases (17). The long-term health effects of natural disasters include cardiovascular diseases, chronic kidney diseases, bronchial asthma, and ischemic heart disease (2).

Furthermore, older women are at greater risk than older men. For example, in 2016, a retrospective study was carried out on older adults at Forensic Medicine & Toxicology Department of King George’s Medical University, Lucknow, India found that in all burn deaths among older adults, 41.6% of the victims were males and 58.4% were females (23). Additionally, Kumar & Verma, (2016) found that age of older populations is strongly associated with fire burn and increasing mortality risk. Another study concurred in Odisha (India), found that deaths due to cold waves depicting that the largest share among the older population, and it was notably higher in the case of older women (3). Another study based on natural disaster-related mortality in India found that a higher proportion of individuals who were 60 years or older died due to cold (47%) and heat waves (42%) during the period of 2001 to 2014 (24).

Studies have also shown that older adults experience mental and psychological health problems than others in the aftermath of severe disasters (2). Some older adults who survive disasters experience high rates of survivor’s guilt, especially when they lose children or grandchildren. They have been found to have high rates of post-traumatic stress and depression (5). Many older adults felt that they received less mental health support from their relatives (8, 13, 25). Older adults afflicted by political strife have a higher prevalence of anxiety and depression than their younger counterparts. (26). However, it is important to note that older adults with greater self-efficacy for coping with disaster effects reported fewer depression and PTSD symptoms (27).

Based on the above citied evidences, it is very clear that older adults are the most vulnerable segment and lack attention in terms of disaster and health effects. But still, no study on a large scale based in India covered both natural and human-made disasters and health effects on older adults. The lack of studies on health effects after disasters could result in an incomplete understanding of the cumulative effects of exposure on older adults. To fill this gap, there is need to understand what factors influence the health across a range of disasters caused by human and natural events. Therefore, this study aims to examine the health effects among older adults during and immediately after natural catastrophies and human-made disasters in India, based on a nationally representative survey data. We hypothesize that natural catastrophies and human-made disasters positively affect older adults' overall health and wellbeing.

Data

The Longitudinal Ageing Study in India (LASI) Wave-1 (2017-18) is a nationally representative data used in this study. The LASI collected data from 73,396 people aged 45 and over, as well as their spouses (irrespective of age), across India's states and union territories. This is a collaborative survey between the International Institute for Population Sciences (IIPS), Harvard T.H. Chan School of Public Health, and the University of Southern California (USC). LASI data was collected based on internationally comparable research design, instruments, and by adopting cutting-edge scientific procedures (28). The survey collected information related to demographics, household economic status, family and social networks, work and employment, retirement, chronic health conditions, functional health, symptom-based health conditions, mental health, biomarkers, health insurance and healthcare utilization, welfare programmes, and life satisfaction. The sampling is based on the multistage stratified cluster sample design, which includes three and four separate phases of rural and urban region selection (17). More detailed information about the survey design is available at https://www.iipsindia.ac.in/lasi. The present study examines a sample size of 2,487 older adults who suffered from natural and man-made disasters.

Outcome variables

In this analysis, we have considered the two different variables from the LASI individual quesstionnair i.e. natural disaster and man-made disasters which have affected on the health of adults in the last five years. Natural disaster consist of floods, landslides, extreme cold and hot weather, cyclone/typhoons, droughts, earthquakes, tsunamis, or any other natural calamities. On the other side, man-made disaster consists of riots, terrorism, building collapses, fires, traffic accidents or any other man-made incidents. Respondents who were affected either due to the natural or man-made disasters, further question was asked “What were the health consequences that you suffered as a result of these disasters or incidents?”. This question was covering the information about the health consequences which the respondents suffered. Permanent physical disability, psychological trauma, and chronic illness were major health consequences captured through this question, and those who reported suffered (“yes”) were considered for the analysis. The responses were based on self-reporting.

Control variable

This study considered individual-level potential predictors, including; age (aged under 60, 60–69, 70–79, and 80 + years), gender (males and females), work status (never worked, not working, working), place of residence (rural and urban), regions (north, central, east, northeast, west, south). Other potential behavioural and health-related variables such as activities of daily living (ADL) (yes and no), instrumental activities of daily living (IADL) (yes and no), self-rated health (poor, moderate, good) and life satisfaction (satisfied and dissatisfied) were also considered.

Statistical Analyses

Descriptive statistics were used to summarize the study population. The significance level of the bivariate model was tested using the chi-square test (χ² test). Natural and man-made disasters were determined in the study samples; national sample weight was used for computing percentage distribution. Controlling various respondents’ characteristics in the multivariate analysis has been performed on health consequences of the person who have suffered during any event of disaster. All statistical analysis was performed using STATA version 16.1. All Maps were created using ESRI product ArcGIS version 10.4.1.

Table 1 represents the percentage distribution of different types of disaster experienced by older adults, stratified by age groups. A total of 2487 older adults had suffered from disasters, among them, 1661 older adults faced natural hazardss and 826 faced manmade disasters. Older adults, specifically aged 80 and over, experienced a significant impact from drought (40%), followed by earthquake (33%), cyclone (31.2%), while younger older adults (aged under 60) had faced higher drought calamities (44.7%), followed by floods (23.7%). Traffic accidents significantly affected a considerable number of individuals, with the highest incidence (70.4%) occurred in the 60–69 age group followed by 64.6% in the 70–79 age group as man-made disasters.

Table 1

Weighted percentage distribution of affected older adults (age 45 year & above) by type of disaster, LASI 2017-18
Type of Disasters	Age Groups
Type of Disasters	< 60	60–69	70–79	80+
Natural Events (N = 1661)
Floods	23.7	23.8	27.9	16.4
Landslides	0.6	0.7	0.3	2.5
Cyclone	15.3	18.7	13.8	31.2
Earthquakes	21.5	21.2	16.7	33.0
Tsunami	1.0	1.9	0.8	0.0
Droughts	44.7	34.7	44.5	40.1
Other	19.2	20.1	17.4	21.7
Man-Made Disasters (N = 826)
Riots	13.0	10.1	8.7	3.5
Terrorism	4.8	2.3	2.3	0.0
Building collapses	14.0	8.3	11.0	19.2
Fires	7.5	10.4	10.5	13.5
Traffic accidents	62.6	70.4	64.6	63.8
Other	21.2	18.9	28.9	10.8

Interestingly, riots and terrorism displayed a decline in impact with age, potentially indicating that older adults might be less exposed to situations leading to civil unrest. In contrast, fire accidents were rising with the increasing of age. Out of all the building collapses that occurred in the five years before the survey, twenty percent of them affected individuals aged 80 and over.

Figure 1 shows that, drought was the leading natural hazard in most part of the country which affected nearly 42% of respondents who faced any disasters followed by, floods (24%) and earthquakes (21%). Whereas, traffic accidents and building collapses were the leading incidents which affected 65% and 12% of individuals who encountered man-made disasters in past five years prior to the survey.

Table 2 reveals a contrasting distribution of respondent characteristics between natural and man-made disasters. Older adults (aged 80 and over) experienced a substantially higher proportion of natural calamities s (84.1%), whereas 32.2% of young adults (aged below 60 years) experienced man-made disasters. Surprisingly, Females were more affected by natural calamities s (79.5%) compared to males (70.9%), though males were affected at a higher percentage by man-made disasters (34.8%) than females (28.0%). Natural catastrophes affected a higher proportion of rural Indians (77.9%) than urban Indians (61.0%), whereas, it was observed a reverse pattern for man-made disasters, wherein urban residents suffered a higher percentage (41.1%) than rural residents (29.6%). Older adults with IADL difficulties were most severely affected by natural calamities s (77.8%), whereas 31.5% older individuals suffered from man-made disasters had ADL difficulties. Seventy-eight percent of respondents with "Good" self-rated health had experienced natural calamities, whereas those with "Poor" health experienced more man-made disasters (35.3%). Similarly, with a majority of those who encountered natural calamities (77.3%) expressed being dissatisfied with their lives, contrary 33% of individual’s experienced man-made disasters reported as being satisfied.

Table 2

Percentage distribution of the respondent’s characteristics by natural and man-made disasters, LASI, Wave- 1 (2017-18).
Respondent’s Characteristics	Naturally Caused Disasters N = 1661	Man-made Disasters N = 826
Respondent’s Characteristics	(W %)	(W %)
Age Group
< 60	74.6	32.2
60–69	74.4	31.3
70–79	77.9	29.4
80+	84.1	25.0
Gender
Male	70.9	34.8
Female	79.5	28.0
Place of Residence
Urban	61.0	41.1
Rural	77.9	29.6
Work Status
Never worked	78.3	33.4
Currently working	75.3	30.0
Not currently working	73.1	31.9
Regions
North	62.5	52.4
Central	81.7	25.8
East	81.8	25.2
Northeast	63.3	38.5
West	46.7	57.1
South	63.3	38.6
ADL difficulties
No	75.5	31.1
Yes	75.4	31.5
IADL difficulties
No	73.4	32.6
Yes	77.8	29.8
Self-Rated Health
Good	78.0	25.7
Moderate	77.2	27.6
Poor	73.4	35.3
Life Satisfaction
Dissatisfied	77.3	27.6
Satisfied	74.4	33.2
Total	75.4	31.3
Note: W% = National weight provided by LASI Wave-1 has been applied to calculate weighted percentages.

Figure 2 shows that, most of the people residing in eastern region of India had suffered more of natural calamities s (81.7%), while the western Indians had encountered more of man-made disasters (57.1%).

The findings (Table 3) uncover intriguing patterns in health outcomes resulting from different types of disasters across respondent characteristics. On an average, three-fourths of older individuals reported psychological trauma as a health consequence due to natural calamities s, while 45.7% experienced such trauma due to man-made disasters. However, northeastern (6.4% vs. 22.3%) and western (33.1% vs. 29.2%) region residents reported relatively lower psychological trauma from natural and man-made disasters, respectively. Interestingly, over 80% of respondents who experienced psychological trauma due to natural calamities expressed dissatisfaction with their lives and reported moderate self-rated health. These respondents were mainly from the central and eastern region of India and belonged to the 70–79 age group.

Table 3

Weighted Percentage Distribution of Health Consequences due to Disasters by Respondents Characteristics, LASI, Wave – 1, 2017-18
Respondents Characteristics	Physical Disability		Psychological Trauma		Chronic Illness
Respondents Characteristics	Natural (N = 67)	Man-made (N = 162)	Natural (N = 1105)	Man-made (N = 350)	Natural (N = 323)	Man-made (N = 261)
Age Groups
< 60	4.06	17.00	79.06	47.3	11.96	32.95
60–69	4.10	27.61	71.11	39.86	16.77	31.55
70–79	2.84	26.29	81.73	49.49	8.17	28.86
80+	15.30	19.22	70.39	53.35	12.06	24.2
Gender
Male	5.05	22.3	74.99	40.64	13.76	36.7
Female	3.86	20.1	78.38	51.51	11.92	26.02
Place of Residence
Urban	4.46	20.57	75.02	34.91	12.85	42.11
Rural	4.39	21.4	77.11	48.42	11.99	29.12
Work Status
Never worked	4.53	14.63	78.56	56.33	8.68	22.04
Currently working	3.05	18.01	79.14	43.61	12.05	35.7
Not currently working	7.09	32.98	70.54	40.51	17.86	32.63
Regions
North	8.62	22.24	53.99	40.69	22.44	24.07
Central	2.99	28.87	83.09	58.69	3.96	12.5
East	3.52	16.93	86.9	54.9	10.34	23.95
Northeast	24.95	26.73	6.38	22.31	65.85	50.21
West	8.52	10.5	33.05	29.22	58.56	68.02
South	5.87	19.18	60.07	27.07	24.85	55.3
ADL difficulties
No	3.82	18.0	77.27	48.77	11.66	31.21
Yes	6.22	31.6	75.48	36.58	16.2	33.28
IADL difficulties
No	3.15	18.9	78.42	42.27	11.4	36.06
Yes	5.58	24.1	75.31	49.95	14.13	26.65
Self-Rated Health
Good	0.96	16.92	77.08	42.66	7.87	35.45
Moderate	3.62	18.41	82.23	45.22	6.13	32
Poor	5.78	22.98	73.56	46.71	18.58	31.23
Life Satisfaction
Dissatisfied	3.41	19.2	80.54	56.12	11.32	26.43
Satisfied	4.81	21.5	74.73	41.32	13.63	34.91
Overall	4.4	21.3	76.85	45.71	12.75	31.72
Note: National weight provided by LASI have been applied to calculate weighted percentages.

Furthermore, more than half of the female respondents experienced trauma due to man-made disasters, with nearly 60% residing in the central region of India and 56% expressing dissatisfaction with their lives. Similarly, 21.3% of older individuals interviewed reported physical disabilities as a health consequence due to man-made disasters, while only 4.4% reported such disabilities arising out of natural calamities. Notably, approximately 33% of older individuals who were not currently working reported physical disabilities due to man-made disasters, in contrast to 7% reporting disabilities due to natural calamities s. Among those facing difficulties in ADL and IADL, 31.6% and 24.1%, respectively, also reported physical disabilities due to human-made disasters. Around 23% of them also reported poor self-rated health.

Additionally, almost one-third of older individuals reported physical disabilities due to natural calamities s were from the Northeastern region of India, with the highest incidence among those aged 80 and above. Nearly 32% of chronic illnesses were reported as health consequences caused by man-made disasters among older individuals, whereas nearly 13% caused by natural hazards s. The prevalence of chronic illness caused by man-made disasters decreased from 33–24.2% as age advances. However, chronic illness due to natural calamities s did not exhibit a clear pattern. Males reported higher prevalence of chronic illness (13.8% vs. 36.7%) as compared to females (11.9% vs. 26.0%) in natural and man-made disasters, respectively.

Urban residents showed higher rates of man-made disaster-induced chronic illnesses (42.1%) than rural residents (29.1%). Non-working individuals had a higher prevalence of chronic illness caused by both types of disasters as compared to the never-worked and currently-working groups. The Northeastern (65.9%) and Western (58.6%) regions reported the highest rates of chronic illness due to natural calamities s, while Western (68%) and Southern (55.3%) regions reported higher rates due to man-made disasters. In contrast, only 4% of central Indian residents reported chronic illness due to natural calamities. The presence of ADL and IADL difficulties correlated with higher rates of chronic illness, with rates of 16.2% vs. 33.3% for ADL and 14.1% vs. 26.7% for IADL. Conversely, poor self-rated health corresponded to a higher prevalence (18.6%) caused by natural hazards, whereas good self-rated health (35.5%) and life satisfaction (34.9%) were linked to chronic health issues due to man-made disasters.

Table 4 indicates the effects of health consequences by disaster exposure and respondents characteristics. Notably, individuals affected by natural calamities demonstrated significantly higher odds of experiencing psychological trauma (OR: 3.49, CI: 2.89–4.21) compared to those unaffected. These effects remained consistent even after adjustment (AOR: 3.45, CI: 2.19–5.44) with respondents characteristics. In contrast, the odds of physical disability and chronic illness were notably lower in both adjusted and unadjusted models. Similarly, those impacted by man-made disasters exhibited significantly elevated odds of physical disability (OR: 6.43, CI: 4.68–8.84) and a higher likelihood of chronic illness (OR: 1.87, CI: 1.54–2.27). However, these effects were notably attenuated in the adjusted model (AOR: 1.78, CI: 0.86–3.65) and (AOR: 0.61, CI: 0.35–1.06), respectively. Interestingly, the initially observed lower odds of psychological trauma (OR: 0.36, CI: 0.3–0.43) for this group lost significance after adjustment (AOR: 1.11, CI: 0.72–1.73).

The odds of experiencing physical disability insignificantly increase with age, and the adjusted odds do not exhibit a consistent pattern. Conversely, females and individuals residing in rural areas show significantly higher odds of psychological trauma. After adjusting for other characteristics, only females maintain higher odds. Those currently not employed display significantly higher odds of physical disability (OR: 1.9, CI: 1.3–2.77) and chronic illness (OR: 1.72, CI: 1.3–2.27), although these effects slightly diminish after adjusting model.

Table 5

Logistic regression model estimating effects of various health aliments by disaster and respondents characteristics, LASI Wave-1 (2017-18)
Respondents Characteristics	Physical Disability		Psychological Trauma		Chronic Illness
Respondents Characteristics	OR (95%C.I)	AOR (95% C.I)	OR (95% C.I)	AOR (95% C.I)	OR (95% C.I)	AOR (95% C.I)
Naturally Caused Disasters
Not Affected®
Affected	0.15***(0.11–0.2)	0.24***(0.12–0.48)	3.49***(2.89–4.21)	3.45***(2.19–5.44)	0.44***(0.36–0.53)	0.35***(0.2–0.61)
Man-made Disasters
Not Affected®
Affected	6.43***(4.68–8.84)	1.78 (0.86–3.65)	0.36***(0.3–0.43)	1.11 (0.72–1.73)	1.87***(1.54–2.27)	0.61*(0.35–1.06)
Age Group
< 60®
60–69	1.21 (0.88–1.67)	1.03 (0.71–1.49)	1.09 (0.9–1.32)	0.98 (0.77–1.25)	0.86 (0.69–1.07)	0.92 (0.7–1.2)
70–79	1.31 (0.85–2)	0.94 (0.56–1.57)	1.08 (0.83–1.42)	1.18 (0.84–1.66)	0.82 (0.6–1.11)	0.8 (0.54–1.17)
80+	1.64 (0.88–3.03)	1.18 (0.57–2.44)	1 (0.65–1.51)	1.22 (0.7–2.12)	0.93 (0.58–1.5)	0.72 (0.38–1.34)
Gender
Male®
Female	0.64***(0.48–0.84)	0.7*(0.49–1.01)	1.46***(1.23–1.72)	1.32**(1.04–1.66)	0.79**(0.66–0.96)	1.02 (0.79–1.31)
Place of Residence
Urban®
Rural	0.81 (0.6–1.11)	0.99 (0.69–1.41)	1.75***(1.45–2.13)	0.81*(0.64–1.04)	0.66***(0.53–0.81)	1.24 (0.96–1.61)
Work Status
Never worked®
Currently working	0.94 (0.65–1.37)	0.78 (0.49–1.25)	0.79**(0.64–0.98)	1.08 (0.81–1.43)	1.62***(1.26–2.08)	1.46**(1.06–2.02)
Not currently working	1.9***(1.3–2.77)	1.37 (0.86–2.19)	0.66***(0.52–0.84)	0.91 (0.67–1.24)	1.72***(1.3–2.27)	1.43**(1.01–2.02)
Regions
North®
Central	0.75 (0.48–1.16)	1.14 (0.69–1.87)	2.25***(1.66–3.04)	2.07***(1.49–2.88)	0.25***(0.16–0.37)	0.23***(0.15–0.36)
East	0.41***(0.25–0.67)	0.68 (0.4–1.18)	3.78***(2.74–5.21)	3.09***(2.19–4.37)	0.35***(0.24–0.51)	0.36***(0.24–0.54)
Northeast	0.82 (0.48–1.41)	1.07 (0.59–1.96)	0.15***(0.1–0.23)	0.12***(0.08–0.19)	5.14***(3.51–7.54)	5.48***(3.64–8.24)
West	0.85 (0.46–1.56)	0.62 (0.31–1.25)	0.31***(0.2–0.47)	0.37***(0.23–0.59)	4.19***(2.75–6.4)	3.41***(2.15–5.39)
South	0.79 (0.49–1.25)	0.81 (0.48–1.36)	0.58***(0.43–0.78)	0.51***(0.37–0.72)	1.67***(1.2–2.34)	1.64***(1.14–2.34)
ADL difficulties
No®
Yes	2.1***(1.56–2.82)	1.65**(1.12–2.41)	0.83*(0.68–1.01)	0.75**(0.57–0.99)	1.25*(1–1.56)	1.42**(1.05–1.92)
IADL difficulties
No®
Yes	1.49***(1.13–1.98)	1.27 (0.88–1.83)	1.31***(1.1–1.55)	1.18 (0.93–1.48)	0.69***(0.57–0.84)	0.65***(0.5–0.85)
Self-Rated Health
Good®
Moderate	0.9 (0.57–1.42)	0.93 (0.57–1.53)	1.19 (0.93–1.52)	1.3*(0.96–1.75)	0.94 (0.7–1.26)	0.9 (0.64–1.26)
Poor	1.49*(0.98–2.24)	1.21 (0.76–1.92)	1.11 (0.88–1.4)	1.05 (0.78–1.41)	1.27*(0.97–1.66)	1.66***(1.18–2.33)
Life Satisfaction
Dissatisfied®
Satisfied	0.86 (0.63–1.17)	0.81 (0.58–1.13)	1.76***(1.46–2.12)	1.65***(1.32–2.06)	0.65***(0.52–0.8)	0.72**(0.56–0.92)
Note: Level of significance: * p < 0.10; p < 0.05; * p < 0.01
OR: Unadjusted Odds Ratio; AOR: Adjusted Odds Ratio; ®: Reference Category

The Central and Eastern regions of India display two and three times significantly higher likelihoods of psychological trauma, while the Northeastern and Western region shows five and four times significantly higher likelihood of chronic illness in both adjusted and unadjusted models. When examining ADL difficulties, individuals facing such challenges display significantly higher probabilities of experiencing physical disabilities and chronic illness. After accounting for other factors, the odds of physical disabilities slightly decrease, while the odds of chronic illness remain elevated. Similarly, IADL limitations significantly associate with a higher risk of physical disability and psychological trauma, even after controlling for other variables. In contrast, IADL difficulties correlate with a reduced risk of chronic illness. On the other hand, poor self-rated health significantly elevates the risk of chronic illness, and this relationship remains significant even after making adjustments. Life satisfaction is linked to a higher likelihood of psychological trauma, while the association between chronic illness and life satisfaction is notably weaker.

The findings presented in this study shed light on the complex interplay between disaster exposure, respondent characteristics, and health consequences. The results demonstrate the multifaceted nature of disaster impact on older adults and the importance of considering various dimensions when formulating disaster preparedness and response strategies.

The observed prevalence of different types of disasters among older adults underscores the need for targeted interventions and resource allocation. Older adults are vulnerable to the adverse effects of natural hazard’s like droughts, earthquakes, and cyclones. The findings aligns with previous research highlighting the vulnerability of this segment of population to natural events (29, 30). For example, a study found that severe drought conditions increased the risk of mortality among older adults (31). Furthermore, the higher prevalence of drought and floods among younger adults (aged under 60) suggests that disaster mitigation measures must take a generational approach, considering the particular vulnerabilities of diverse age groups (11, 31, 32). This study found that older adults who experienced earthquakes had lower health-related quality of life than those who did not experience natural disasters, which is consistent with the previous studies (33).

Traffic accidents in India have emerged as a significant public health and safety concern, with a specific and growing focus on the vulnerability of older adults. Our study found that traffic accident is the leading human-caused disaster encountered by nearly seven out of ten older adults. This alarming rise in accidents involving older adults can be attributed to several factors. Age-related declines in vision, reflexes, and cognitive abilities can impact their ability to navigate the complex and often chaotic traffic scenarios (14, 15, 34). Furthermore, the lack of dedicated pedestrian pathways and safe crossing zones adds to the risks faced by this age group. It is also worth noting that older adults are more prone to sustaining serious injuries due to their increased fragility (15, 32).

The fact that nearly twenty percent of the total building collapse cases involved the oldest-old individuals (aged 80 years and above) signifies the vulnerability of this age group to the consequences of such incidents. This vulnerability can be attributed to various factors, including physical frailty, potential mobility limitations, and the challenges of evacuating during such disasters. Previous studies also found that older adults are more vulnerable to affect from disaster prone buildings which leads to their poor mental health and physical disabilities (35, 36). It is important to note that while the incidence of riots and terrorism decreases with age, these events can still have a significant impact on older adults who may have reduced mobility and poor access to resources. Conversely, the increasing incidence of fire incidents involving older adults have significant impact on their subjective wellbeing. The risk of fire-related incidents exhibits a notable increase with advancing age. This heightened vulnerability can be attributed to factors such as decreased mobility, impaired sensory perception, and a higher likelihood of living alone (7, 23, 37).

In terms of sociodemographic factors, older adults experienced a higher proportion of natural hazard’s, while young adults experienced more man-made disasters. Females were more affected by natural calamities than males, while males were affected at a higher percentage by man-made disasters. Previous study also support our findings that older persons were more vulnerable to the effects of the disaster due to their reduced mobility and increased dependence on others for assistance (38). This could be due to variety of factors, including differences in vulnerability and exposure to risks especially for women during natural calamities such as drought, flood, and earthquakes. A study on the Manipur Earthquake in 2016 found that women were more likely to suffer from post-traumatic stress disorder (PTSD) due to their increased vulnerability and reduced access to resources (39). Moreover, females being more affected by disasters caused by natural events and males being more affected by man-made disasters.

According to our analysis, natural calamities affected a higher proportion of rural older Indians, while man-made disasters affected a higher proportion of urban residence. This could be due to differences in geography, climate, and industrial development between rural and urban areas. A study by NIDM on the role of landscape approach in disaster management found that rural areas were more susceptible to natural disasters such as droughts, floods and landslides due to their location and topography (40). This could also explain the regional differences of natural and man-made disasters, where older adults had experienced the highest percentage of natural calamities in Eastern India, followed by Central India. However, most of the older adults does not feel safe in Western India especially due to fire, building collapse, road/railway accidents. In terms of life satisfaction and health status, those with poor-health experienced more man-made disasters, while those who were dissatisfied with their lives experienced a higher proportion of natural calamities. These results suggest that there may be a relationship between health status, life satisfaction, and the type of disaster experienced. This align with previous studies, where individuals with poor health were more vulnerable to the effects of disasters due to their reduced ability to cope with stressors (41, 42).

The prevalence of health consequences (physical disability, psychological effects and chronic illness) caused by disasters is notable. The findings resonate with existing research that highlights the psychological toll of disasters on older adults, particularly in the wake of natural events (43, 44). The association between psychological trauma, dissatisfaction with life, and moderate self-rated health is a salient finding that aligns with the psychosocial dimensions of disaster aftermath described in the previous literatures (27, 35, 44–46). Whereas, higher prevalence of physical disabilities highlights the association between difficulties in ADL and IADL and physical disabilities due to man-made disasters accentuates the vulnerability of those with pre-existing limitations, consistent with research emphasizing the heightened risk faced by older adults with functional impairments in disaster scenarios (7, 30, 47). On the other hand, the prominence of psychological trauma among female respondents in the central region points to potential gender-specific vulnerabilities that resonate with studies emphasizing gender disparities in disaster impact (27, 45, 46, 48).

This study found that there is a strong significant association between chronic illness and human-caused disaster. Previous studies found that disasters may carry a large and measurable burden of chronic diseases, especially heart disease, respiratory disorders, cancer, diabetes, and stroke among disaster affected population, especially in older adults (49, 50). Disasters may also increase chronic illnesses by bringing along adverse conditions such as insufficient access to food and clean water, extreme temperature fluctuations, increased emotional and physical stress, increased risk of injuries, susceptibility to infections, and overall compromised wellbeing(47, 49, 50). This study also found the correlation between poor self-rated health and chronic illness due to natural calamities, along with the association of good self-rated health and life satisfaction with chronic health issues due to man-made disasters, adds a nuanced layer to the understanding of the subjective wellbeing impacts of different disaster types.

The elevated odds of psychological trauma following disasters caused by natural events resonate with previous studies highlighting the enduring psychological distress caused by such events (51). The pronounced increase in odds of physical disability and chronic illness following man-made disasters reflects the broader societal and infrastructural implications of human-induced catastrophes (52). The association between functional limitations and increased odds of physical disability and chronic illness reaffirms the importance of disability-inclusive disaster preparedness and response (20). Similarly, the link between self-rated health and disaster outcomes underscores the interplay between subjective wellbeing and disaster resilience (53, 54).

Moreover, the concentration of physical disability, psychological effects and chronic illness among specific age groups, gender and geographical regions underscores the need for targeted interventions and support systems, particularly in Central and Eastern regions of India. Conversely, the lower effects of these health consequences reported by Northeastern and Western Indian residents suggest potential regional variations in disaster resilience and coping strategies, an area warranting further investigation.

In summary, the study provides valuable insights into the complex and nuanced impacts of natural and man-made disasters on physical disability, mental health, and chronic illness. The study highlights the older adults, females, rural residents, and those with certain health conditions are more prone to the adverse impact of disasters caused by natural events, whereas man-made disasters tend to affect older male adults, urban Indians, and individuals with specific work status. There is need for tailored disaster responses and healthcare strategies considering the specific vulnerabilities of different population groups based on the characteristics of the older adults. By understanding these variations, policymakers and disaster management authorities can implement more effective and targeted interventions to ensure that vulnerable populations receive the necessary support and resources during times of crisis and minimize the long-term health and mental health consequences associated with disasters. This study also highlights the specific susceptibility of the older adults to infrastructure issues prompting the need for targeted urban planning and safety measures for older adults. It is important for older adults and their family members and caretakers to take steps to prepare for and protect against natural and man-made disasters. This can include making a medical plan, preparing a disaster kit, and planning for an evacuation in case of emergencies due to disaster. Additionally, this research serves as a foundation for future studies, aiding in the continuous improvement of disaster preparedness and response measures to protect health and wellbeing of affected individuals.

The study is the first of its kind which utilizes data of both natural and man-made disasters among older adults captured by LASI wave-1, contributes to the growing body of literature on disaster, offering valuable insights into the varied health consequences caused by natural and man-made disasters. The nationally representative sample size and rigorous statistical analyses enhance the study's reliability. However, the study is not without limitations. The cross-sectional nature of the data restricts causal interpretations, and the reliance on self-reported data introduces the potential for recall bias and social desirability bias.

The findings underscore the need for disaster preparedness and response strategies that account for the multifaceted nature of disaster impacts. Disaster relief efforts should prioritize mental health support for those affected by disasters, while also addressing the specific physical health risks associated with man-made disasters. Gender-sensitive interventions and region-specific approaches are essential to ensure equitable outcomes. Future research could delve deeper into the mechanisms through which gender, age, and health status influence disaster vulnerability. Longitudinal studies could provide a clearer understanding of the long-term health trajectories following different types of disasters. Additionally, qualitative research could capture the subjective and lived experiences of older adults in disaster contexts, providing valuable insights into their coping strategies, resilience factors, and unmet needs.

Disclosed Potential Conflict of Interest

The authors declare no conflict of interest

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Uncovering the Impact of Disasters on the Health and Wellbeing of Older Adults: Insights from Longitudinal Ageing Study in India

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