Emergency Preparedness in Older Adults With and Without COPD During Power Outages and Natural Disasters

Abstract

Rural older adults, particularly those with Chronic Obstructive Pulmonary Disease (COPD), face significant risks to medical care during power outages caused by natural disasters. This cross-sectional study surveyed 222 Iowan adults aged 45–80 between March and May 2024 to assess disaster preparedness for power outages. Nearly nine in 10 participants experienced recent outages, yet 42% maintained a specific medical care plan for such events. Those with COPD exhibited moderately greater levels of preparedness, including higher rates of saving extra medication and establishing emergency communication plans. They were also twice as likely to have a care plan or emergency medication. Despite these gains, comprehensive preparedness remained low. The study highlights that recurrent disasters, such as windstorms and wildfire smoke, expose critical gaps in medical and emergency planning in rural communities. These results underscore the urgent need for tailored, disease-specific strategies and educational interventions to strengthen disaster resilience among rural populations.

Introduction

In the coming decade, adults aged 65 and older will outnumber those under 18 for the first time in U.S. history (Hamidi & Joseph, 2019), creating a population increasingly vulnerable to natural and man-made disasters. Age-related health declines, limited mobility, and social isolation hinder adaptation and recovery, leaving older adults disproportionately affected by heat waves, air pollution, and extreme weather (Gamble et al., 2013; Leyva et al., 2017).

Power outages during extreme weather events pose significant health risks, particularly for individuals with chronic illnesses. Older adults often lack sufficient emergency supplies and planning (Bethel et al., 2011; Dempsey et al., 2019). Socioeconomic challenges such as poverty and inadequate housing further heighten risk (Al-Rousan et al., 2015; Do et al., 2023).

Outages can restrict access to heating or cooling, thereby increasing the risk of heat-related illnesses or hypothermia, and disrupt medical devices, medication storage, and emergency services. Rural residents relying on electric pumps may lose access to drinking water. Studies link outages to increased illness and mortality among older adults with chronic health conditions (Dominianni et al., 2018; Downer et al., 2025; Skarha et al., 2021), with the greatest impact observed among those with Chronic Obstructive Pulmonary Disease (COPD) (Bayram et al., 2023; Bell et al., 2020; Wang et al., 2025).

Power outages are an emerging yet understudied trigger for COPD exacerbations and hospitalizations. Research links outages to increased hospital admissions, especially within the first week (Casey et al., 2020; Zhang et al., 2020), likely due to disrupted medical device use, impaired medication access, generator emissions, and thermal stress. Although mechanisms remain uncertain, evidence suggests outages can worsen respiratory health in vulnerable individuals, underscoring the importance of disaster preparedness for older adults with COPD.

Furthermore, rural older adults face additional risks from limited healthcare access, provider shortages, mobility limitations, and long travel distances that delay treatment. These barriers contribute to poorer outcomes and highlight the need for tailored preparedness strategies (Al-Rousan et al., 2015; Ashida et al., 2016; Liao & Hu, 2025).

In recent years, older adults living in rural Iowa have experienced the direct effects of severe disasters, such as wide-spread power outages caused by Derecho windstorms and hazardous air quality from Canadian wildfires. These events highlight not only the vulnerabilities of medically complex populations but also the necessity for targeted disaster preparedness. Leveraging the COPDGene Study cohort, which include individuals with varying degrees of chronic lung disease, our study aimed to assess the disaster preparedness needs, and gaps, among older adults with and without COPD. We hypothesized that, due to unique medical challenges and dependence on uninterrupted access to care and medication, individuals with COPD would exhibit different preparedness compared to their peers. By surveying responses to recent wind and smoke disasters, we sought to understand real-world experiences, test disease-specific preparedness strategies, and inform future interventions for this vulnerable group.

Methods

A cross-sectional survey-based research study was conducted in Iowa between March and May 2024. Its primary aim was to understand disaster preparedness among COPD patients, with a focus on how individuals prepared for and responded to power outages following the billion-dollar wind events in 2020 and 2023—the August 10th, 2020 and the June 29th, 2023 Derecho. We also queried about exposure to Canadian wildfire smoke (June 2023). Survey items were adapted in part from Laberge et al. (Laberge et al., 2021). Other questions were developed by the study team for face validity and were not formally psychometrically tested. Recognized scales were used where applicable; see Appendix A for the source of each item. We designed the study to compare participants with COPD to smokers and non-smokers without COPD to examine potential relationships between this chronic lung condition and participant disaster preparedness.

Iowa residents were identified from the COPDGene study cohort, which is part of a large, multicenter, longitudinal observational study designed to investigate the genetic and epidemiological determinants of COPD. The study enrolled over 10,000 non-Hispanic Black and non-Hispanic White individuals aged 45 to 80 years with a history of at least 10 pack-years (quantification of cumulative smoking exposure, calculated as the number of cigarette packs smoked per day multiplied by years of smoking) of cigarette smoking at 21 clinical centers across the US, between November 2007 and April 2011, with follow-up visits at 5 and 10 years (Lowe et al., 2019). While Iowa initially enrolled 1,179 participants, the cohort has since diminished due to loss to follow-up. All individuals (n = 479) within the cohort were contacted to ensure inclusivity. This cohort includes smokers with mild to severe COPD (n = 77) and smokers without COPD (n = 145). Throughout the process, participants retained the right to skip any questions they did not wish to answer. The study protocol was reviewed and approved by the Institutional Review Board (IRB # 201602753). All participants provided informed consent.

To accommodate participants’ preferences and needs, the survey was offered in multiple formats. During in-person COPDGene study visits, participants who had provided consent were given a paper copy of the questionnaire. For those requiring assistance, a study team member read the questions aloud and recorded responses, either in person or by phone. For those who prefer digital communication, a clinical coordinator emailed an invitation to complete the survey via REDCap (Supplement: https://redcap.icts.uiowa.edu/redcap/). Sociodemographic data was collected including age, sex, highest educational degree, working status, marital status, and medical disability. For tracking purposes, records of completed and declined surveys were kept. Non-respondents received a follow-up email or were approached again at their next COPDGene visit during the same season.

Statistical Analysis

Analyses proceeded in the following sequence: (a) descriptive statistics for the whole cohort; (b) comparison of disaster preparedness across COPD and non-COPD groups; (c) subgroup analysis for rural versus urban residence; and (d) event-specific responses to Derecho windstorms and Canadian wildfires. Frequency statistics were applied to summarize responses, while Chi-square tests were employed to examine associations between categorical variables, such as disaster preparedness behaviors in participants with and without COPD. Comparisons were considered statistically significant at p < .05. Statistical analyses were conducted using SPSS v.28 (IBM SPSS Statistics, Armonk, NY, USA). In addition, open-ended questions were embedded within the same disaster preparedness questionnaire administered between March and May 2024, following the quantitative items on power outages and wildfire smoke. The responses were either handwritten on paper surveys or typed directly into REDCap. For participants who needed assistance (in person or by phone), study staff read the questions aloud and recorded the participant’s answers as written text in the data capture system. Open-ended responses from the survey were analyzed by a single independent rater with a background in the management of patient with COPD. This rater reviewed all narrative answers, developed a coding scheme inductively, grouped responses into thematic categories (e.g., personal preparedness practices, social support, perceived health consequences, behavioral changes, and survey prompted awareness), and summarized patterns across participants. Because only one rater coded the data, formal inter-rater reliability statistics were not applicable.

Results

Study Population and Cohort Characteristics

Four hundred seventy nine older adults were invited to participate, of whom 256 completed the questionnaire; of these, 222 had complete data and sufficient numbers and were included in the analysis. One hundred and twenty-four were from rural areas based on the U.S. Census Bureau’s definition of urban (rural are diffuse populations or clusters with fewer than 2,500 people (Bureau, 2020). The average age of all participants, with and without COPD, was 76 years, reflecting the region’s older demographic. Cohort 1 consisted of all participants without COPD (n = 145), of whom 82 were classified as rural, with an average age of 75 years old. Cohort 2 included all participants with COPD (n = 77), of whom 42 were classified as rural, with an average age of 79. COPD severity was determined using the GOLD (Global Initiative for Chronic Obstructive Lung Disease) strategy, a standardized system for assessing COPD severity (Celli & Wedzicha, 2019), with the cohort including individuals across all stages from GOLD 1 (mild COPD) to GOLD 4 (very severe COPD), as well as PRISm (Preserved Ratio, Impaired Spirometry) cases (Table 1). In addition, out of the sociodemographic variables, the only statistically significant (p < .01) group difference was the working status, with 38% participants without COPD being fully or partially employed vs 34% of COPD participants. However, the effect size was very small (0.034) suggesting little practical significance. Furthermore, no statistical difference was found on educational degree, marital status, and medical disability.

Table 1.

Demographics and COPD Stage of the Cohort

Global initiative for chronic obstructive lung disease (GOLD) category	Count	Mean age (years)	Female count (%)
GOLD 0	145	75	95 (66)
GOLD 1	15	77	7 (50)
GOLD 2	33	80	17 (52)
GOLD 3	5	82	3 (60)
GOLD 4	1	81	1 (100)
PRISm	23	75	10 (43)

Preparedness Within the Entire Cohort

Experiences with power outages were common among the study population, with 89% of participants reporting at least one outage per year, 3% experiencing monthly outages, and fewer than 1% facing outages on a weekly basis. Despite this frequency, 58% of participants did not have a plan for continuing their medical care during an outage. Emergency preparedness-related communication was limited: 35% had discussed emergency plans with family members, with 15% having practiced plans through drills. Forty-two percent had a method to stay in contact with family or friends during outages, and 29% had asked friends or family for assistance during such events. If evacuation was required, 41% had thought about what they would need to take with them, and 20% had a pre-prepared emergency supply kit ready (Table 2).

Table 2.

General Preparedness of the Entire Cohort

Preparedness measure	% Of participants	Count (N = 222)
Power outage experience
At least one outage per year	89	198
Monthly outages	3	7
Weekly outages	<1	1
Medical care planning during outage
No plan for continuing medical care	58	129
Has a plan for continuing medical care	42	93
Communication and emergency drills
Discussed emergency plans with family	35	78
Practiced emergency plans through drills	16	35
Established method to stay in contact during outages	40	89
Asked friends/family for assistance during outages	29	64
Evacuation preparedness
Considered what to take if evacuating	41	91
Pre-prepared emergency supply kit	20	44
Home safety resources
Working smoke detector	98	218
Access to transportation for evacuation	96	213
Identified a shelter to go to during power outage	44	98
Way to receive disaster-related information	85	189
Week supply of non-perishable food	68	151
Flashlights or similar devices	99	220
Extra batteries	97	215
Unexpired fire extinguisher at home	72	160
Medical preparedness
Wears a medical alert bracelet	6	13
Has copy of advanced directives	60	133
Keeps a list of medications	78	173
Regularly checks medication expiration dates	71	158
Discussed with provider what to do if out of medication	8	18
Keeps extra medications at home	50	111

Most participants reported owning some basic preparedness resources at home. A working smoke detector was present in 98% of homes, and 96% had access to transportation for evacuation. However, only 44% had identified a shelter to go to in the event of a power outage. A majority (85%) had identified means to receive disaster-related information, and a week’s supply of non-perishable food (68%). Portable lighting devices were present in nearly all homes (99%), and a similarly high proportion (97%) reported having extra batteries. Seventy-two percent had an unexpired fire extinguisher at home (Table 2). Ownership of these resources in the survey instrument was assessed as a standalone item, without specification of intended use.

Medical Preparedness Within the Entire Cohort

Medical preparedness was more limited. Only 6% of participants wore a medical alert bracelet, and 60% had a copy of their advanced directives or provider’s order for life-sustaining treatment. Most kept a list of their medications and regularly checked expiration dates (78% and 71%, respectively). However, just 8% had discussed with their healthcare provider what to do if they ran out of medication during an emergency. Half of the participants kept extra medications at home in case of a power outage (Table 2).

Comparison Between COPD and Non-COPD Participants

Overall, individuals living with COPD (n = 77) had higher levels of preparedness for emergency situations compared to those without COPD (n = 145). Planned communication strategies were higher in those with COPD—51% compared to 35% of non-COPD participants (p < .05). Requests for help from family or friends during a power outage were reported by 39% of individuals with COPD and 24% of those without COPD (p < .05). 13 percent of participants with COPD had discussed emergency medication plans with providers, compared to 5% of those without COPD (p < .05). More participants with COPD kept extra medications at home compared to those without (63% vs. 44% of the non-COPD group, p < .05). The effect size for these was small to moderate, with COPD participants 2 times more likely to have a medical care plan and extra medication available (Table 3). Of the entire COPD cohort, 17% had extra prednisone and 20% extra antibiotics at home.

Table 3.

Emergency Preparedness Between COPD vs Non-COPD

Preparedness measure	Cohort 1 (non-COPD) N = 145	Cohort 2 (COPD) N = 77	p-value	Cramer’s V	OR
Developed plans for medical care continuity during PO	51/145 (35%)	39/77 (50.6%)	.03	0.14 (p = .04)	1.89
Practiced emergency plan	19/145 (l3.l%)	14/77 (18.2%)	n.s.	0.05	N/A
Sheltering plans in case of PO	57/145 (39.3%)	39/77 (50.6%)	n.s.	0.1	1.58
1 week supply of non-perishable food	99/145 (68.3%)	53/77 (68.8%)	n.s.	N/A	N/A
Flashlight/portable lighting available	143/145 (98.6%)	76/77 (98.7%)	n.s.	N/A	N/A
Extra batteries available	140/145 (96.6%)	76/77 (98.7%)	n.s.	0.03	N/A
Unexpired fire extinguisher	101/145 (69.7%)	58/77 (75.3%)	n.s.	0.05	N/A
Extra medication available for emergencies	64/145 (44.1%)	48/77 (62.3%)	.015	0.16 (p = .01)	2.09

Cramer’s V: quantification of strength of association. OR: odds ratio. n.s. = p > .05.

There were no statistically significant differences in the level of preparedness between rural and urban participants, experience with power outages, and COPD status.

Qualitative Analysis of Free-Text Responses

Written comments were provided by 93 of 222 participants. Across written comments, participants described how prior disasters transformed abstract risk into concrete threat, prompting new behaviors such as acquiring generators, stockpiling medications, or identifying an alternative shelter. These narratives suggest that lived experience acts as a catalyst, moving individuals from awareness of potential danger to active preparedness, particularly when disruptions directly affect health or essential resources such as electricity and water. For example, one respondent shared: “Bigger generator and extra gas cans. A direct outlet to plug generator into my electrical panel. Canned food.” Another noted, “I have flashlights located in various parts of my house and have extra batteries. I have plenty of candles, blankets and food. My cell phone is not dependent on electrical power.” Others described the importance of having medications ready: “All my current meds are in a bag in a dresser drawer. I don’t have a bag packed with extra clothes or toiletries, so should do that. I keep my cell phone charged, as well as my iPad.”

Participants also highlighted social networks as a core element of their preparedness strategies, describing plans to stay with relatives who owned generators, rely on neighbors’ wells for water, or seek help from nearby family for transportation and COPD equipment needs during outages. These accounts indicate that informal social ties function as de facto preparedness infrastructure, providing access to power, shelter, and information in settings where formal emergency resources or medical plans are limited. As one participant explained, “Plans to go to relatives in case of extended power outage,” while another emphasized, “Our daughter and family have a generator, and they live within a mile of us. They know that we would come there with our COPD equipment and his portable oxygen machine.” The role of friends and family was echoed in comments like “Relatives and friends!!”

A subset of respondents reported that completing the survey itself prompted recognition of their own underpreparedness, leading them to consider actions such as assembling go-bags, increasing food and medication reserves, or identifying items needed for evacuation. These comments point to survey participation as a trigger for reappraisal of risk and readiness, revealing gaps between perceived and actual preparedness and motivating some participants to initiate concrete planning steps. For instance, a respondent reported “I will keep a close watch on our food and medicine supply.” After exposure to wildfire smoke, another respondent reported “I will make sure to have prednisone and/or antibiotics at home.”

Experiences of resource loss often drove changes in planning behaviors. A participant reported, “The Derecho was a lesson on what I needed to do and have if needed.” Another noted, “Without electricity, we did not have water. Purchased a generator for the well so we will have water.” Many described learning and adapting: “Due to the Derecho I am now better prepared for disasters and my health needs.”

Survey participation itself occasionally triggered new awareness and preparedness actions. Typical comments included, “The survey made me more aware of steps needed in case of a disaster,” and “After filling out the survey, I realize I need to get more supplies ready for emergencies.” One respondent reflected, “This survey has prompted me to think about what else I can do to be better prepared.”

Impact of Derecho Events (2020, 2023) on COPD and Non-COPD Participants

Forty-one percent of participants reported being directly affected by the August 10, 2020, Midwest Derecho, which produced winds exceeding 120 mph and resulted in $11.2 billion in damages. This disaster occurred during the pandemic, posing a significant challenge to emergency response efforts. Of those affected, 93% lost power. Most (65%) reported outages lasting for several days; however, 10% of the population experienced outages for weeks. While only 2% reported negative health impacts from the event, fewer than half (47%) felt prepared for future events. A second major Derecho occurred on June 29th, 2023, with similar direct impacts (11% affected, 44% regained power within hours, 48% within days, and 9% after several weeks). While health impacts remained rare, only one percent more of the cohort felt prepared for future events (48%). After the second Derecho event, perceived preparedness for future events was higher among COPD patients compared to non-COPD (67% vs. 42%), although this difference was not statistically significant. Power outages during the Derecho were similar between groups, with 45% of COPD participants and 37% of non-COPD participants affected.

Impact of 2023 Wildfires on COPD and Non-COPD Participants

In the summer of 2023, Canada experienced its most severe wildfire season on record, with fires burning over 40 million acres and generating unprecedented quantities of smoke. The Iowa Department of Natural Resources (DNR) issued statewide Air Quality Alerts at several points, warning of levels reaching the “red” or unhealthy for everyone category, especially for sensitive groups such as children, older adults, and individuals with heart or lung conditions. Overall, 87% of the cohort reported not monitoring air quality during the event. While 71% reported no health effects, 13% experienced health impacts, and 16% were unsure. Worsening respiratory symptoms, such as cough, shortness of breath, or wheezing, were reported by 19%. Only 2% sought care at urgent care or emergency departments, with no hospitalizations reported. For future wildfire events, 78% planned to stay indoors, 28% intended to wear face masks, and 13% planned to use air purifiers. When comparing groups, 16% of COPD participants reported health impacts from wildfire smoke, compared to 10% of non-COPD participants. COPD participants also reported more frequent symptoms, but the need for medical interventions remained low and not significantly different between groups at 1–2%.

Discussion

Gaps in Disaster Medical Preparedness

This study found that, although most older adults, regardless of their health status, experienced frequent power outages and possessed basic emergency resources, significant gaps persisted in their medical preparedness. Only 40% of the cohort had a plan for continuing medical care during outages, and very few had discussed or practiced emergency strategies. Planning for medication access during emergencies remained limited, highlighting vulnerable areas in disaster readiness for this rural population.

Qualitative Insights: Context and Mechanisms

Analysis of open-ended survey responses helped clarify these quantitative gaps. Many participants described how social networks, perceived risk, and prior disaster experience acted as powerful motivators for their preparedness actions. These narratives demonstrate that personal experience and social support have a significant impact on preparedness, providing context for the observed disparities in planning and resource acquisition. Taken together, these findings highlight the importance of integrating targeted education by their medical care team and community-based interventions into preparedness efforts for at-risk groups.

COPD: Higher Risk, Greater Preparedness

Compared to those without COPD, individuals with COPD were nearly twice as likely to have formal medical care plans or extra medication available during outages, reflected by small to moderate effect sizes and statistically significant outcomes. COPD participants also reported more comprehensive communication strategies and stronger social networks, as seen in both quantitative and qualitative responses. Although major events such as Derechos and wildfires exposed vulnerabilities in the overall cohort, those with COPD demonstrated greater readiness for future disasters. This pattern supports the hypothesis that living with a chronic condition may heighten awareness of disaster-related risk and prompt proactive measures.

Broader Vulnerabilities Among Older Adults

Cohort-wide, the vulnerability of older adults was compounded by age-related decline, frailty, and comorbidities (Kakkera et al., 2023; Wang et al., 2025). The increasing frequency and severity of natural disasters in the United States, averaging 23 billion-dollar events annually from 2020 to 2024 (Smith, 2024) poses a growing threat to public health. Findings from this study confirm other consistent results that most older adults do not engage in comprehensive disaster preparedness behaviors. Reports in the literature show that only a minority of older adults report securing household items, preparing emergency kits, or planning evacuation routes, with most preparedness actions undertaken by less than one-third of older adults (Al-Rousan et al., 2015; Liao & Hu, 2025). Liao et al. reported that other barriers to preparedness include limited financial resources, social isolation, lack of awareness or motivation, and impaired health (Liao & Hu, 2025). Community involvement, prior disaster experience, and higher perceived risk are associated with better preparedness (Blackburn et al., 2025; Cisternas et al., 2024; Ni et al., 2025).

Power Outages and Disaster-Specific Threats

Power outages amplify these risks. Across 2,447 U.S. counties, outages caused over 520 million customer hours of lost electricity annually, often coinciding with extreme weather events (Do et al., 2023). Areas with higher dependence on electricity-powered medical devices, such as Arkansas, Louisiana, and Michigan, were disproportionately affected. Interruptions to devices, including oxygen concentrators, CPAP/BiPAP machines, and nebulizers, pose a threat to COPD management and patient safety.

Although most participants in this study did not report immediate health impacts due to Derechos, prolonged power outages, and lack of preparedness, such as absence of emergency kits or evacuation plans, put patients with COPD at risk of losing critical equipment to manage their disease. The low preparedness levels reported by the participants of this study elucidate the vulnerability experienced by individuals with COPD in rural places like Iowa, where residents are increasingly experiencing extreme weather events like Derechos, yet have less immediate access to care when they experience significant medical events due to a power outage.

Wildfire smoke, hazardous to respiratory and cardiovascular systems, resulted in more symptoms among COPD patients. Prior studies confirmed that PM_2.5 is strongly associated with increased COPD hospitalizations and mortality (Konstantinoudis et al., 2022; Medina-Ramon et al., 2006; Zhu et al., 2013). Indoor air quality often deteriorates during power outages due to generator emissions and a lack of active ventilation. Hazards such as these are particularly problematic for COPD patients, who are sensitive to airborne irritants (Kurmi et al., 2010; Wedzicha & Seemungal, 2007). The inability to access online health resources during outages also limits self-management and increases psychological stress (Nyberg et al., 2019) that can further exacerbate COPD symptoms.

Consistent with the Strength and Vulnerability Integration (SAVI) model (Charles, 2010), the general under-preparedness of older adults may reflect positivity biases that reduce attention to threats, while greater preparedness among COPD participants suggests increased risk awareness that drives action. Addressing these psychological mechanisms could be key to effective intervention design.

Study Strengths and Weaknesses

Our study has several strengths, including its focus on a high-risk population compared to a cohort of participants of a similar age but not suffering from COPD. It assesses the relevance of real-world events along with a thorough evaluation of preparedness. An additional strength of this study was the inclusion of open-ended questions which permitted a more nuanced analysis of participants’ insights into their own under-preparedness. These narrative data speak to the need for reappraisals of risks and readiness, a potentially important direction for future research. Study limitations include the cross-sectional survey design, which restricts causal inference and limits temporal interpretation of associations. The modest sample size decreases statistical power and may reduce the ability to detect smaller effect sizes. The inclusion of research volunteers introduces potential selection bias, as participants may be more health-conscious or engaged than the general population. Reliance on self-reported data introduces recall bias and possible social desirability effects, which could lead participants to overestimate preparedness behaviors or underreport barriers. Additionally, unmeasured confounding variables, such as prior disaster experience, access to local community resources, and trust in governmental or institutional authorities, may further influence the observed relationships. Furthermore, some of the survey questions did not have a designed logic connecting general preparedness with supplies such as batteries. Finally, presence of a designated caregiver was not collected. Collectively, these limitations suggest the need for future studies with larger, more diverse samples, longitudinal designs, and richer contextual data to strengthen validity and generalizability.

Conclusions and Implications

Our results illustrate the growing need for targeted education on emergency preparedness of older adults, especially for patients with COPD, with particular attention to rural populations who face unique challenges. Specifically, only a small number of participants reported having identified a shelter during a power outage, use of medical alert bracelets, having a copy of advance directives, discussing with their healthcare provider what to do in case of running out of medication during an emergency, have planned communication strategies with family and friends in case of an emergency, and emergency medication plans. Target areas include increasing access to backup power and emergency medication supplies, integration of disaster planning into routine COPD care, and community-level interventions to enhance support for vulnerable populations, especially those in rural communities, during outages. Given the projected increase of an aging population and the heightened risks faced by rural residents due to limited healthcare access and infrastructure, these measures are essential to reduce hospitalizations, prevent avoidable deaths, and alleviate strain on the healthcare system. Overall, proactive measures are essential to protect the health and lives of those with chronic respiratory diseases, particularly in rural areas where continuity of care and access to essential resources are most threatened. It is time to rethink disaster preparedness to account for chronic disease management and health equity, with a focus on the specific needs of rural, aging populations.

Supplementary Material

Supplemental Material

Supplemental material is available online.

What This Paper Adds.

• Provides quantitative assessment of disaster and power outage preparedness among rural older adults with comparing to those and without COPD, an understudied group in resilience research.

• Identifies that having COPD is associated with moderately improved medical preparedness for natural disasters, like maintaining extra medications and communication plans, suggesting that chronic disease status may result in heightened individual engagement in planning behaviors.

• Examines real-world impacts of disasters (Derechos, wildfire smoke events) and documents persistent gaps and health vulnerabilities across populations with and without COPD.

Applications of Study Findings.

• Highlights the need for incorporating disease-specific emergency planning, such as medication supply strategies and communication protocols, into routine care for older adults with chronic illness.

• Informs policy-makers and healthcare systems to prioritize infrastructure (backup power, emergency support) and patient education in rural, aging communities due to low levels of preparedness.

• Guides future research to develop and rigorously evaluate interventions that strengthen disaster readiness and continuity of care for at-risk older rural populations.

Data Availability Statement

Not available as the participants did not consent to share their data.