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. Author manuscript; available in PMC: 2026 Jul 9.
Published in final edited form as: J Appl Gerontol. 2026 Apr 16;45(10):1862–1870. doi: 10.1177/07334648261442266

Associations Among Natural Disaster Exposure, Childhood Adversity, and Cognitive Functioning in Older Americans in the Health and Retirement Study

Karen A Lawrence 1, Yeon Jin Choi 1
PMCID: PMC13345151  NIHMSID: NIHMS2162276  PMID: 41989153

Abstract

Although adverse childhood experiences (ACEs) are linked to poorer later-life cognitive function, little is known about how natural disasters, which may be perceived as stressful or traumatic, influence this relationship. Using the Health and Retirement Study, we investigated whether disaster exposure moderates the ACE–cognition association in 12,951 adults aged 50+ years [Mage = 64.6, SD = 10.1]. Cognitive performance score (range: 0–27) was calculated from word recall, serial 7’s, and backward counting. At least one ACE was experienced by 35.6% and a natural disaster by 15.4% of the sample. In weighted regression models, ACEs and the ACEs*Disaster interaction were associated with 0.15 and 0.29 points lower cognitive performance scores, respectively. Stratified models revealed stronger associations in women than men. These findings suggest that natural disaster exposure is a potential environmental stressor that can exacerbate the effects of ACEs on cognitive performance later in life, especially in women.

Keywords: early life history, environmental stressor, trauma, moderation analysis

Natural disaster exposure is on the rise across the United States (U.S.) and globally, with projections indicating a continuing upward trend (Batibeniz et al., 2020; Buszta et al., 2023; Summers et al., 2022). In the U.S., heat waves, drought, hurricanes, and tropical storms are examples of extreme weather and natural disasters with strong evidence of increases in frequency, intensity, and changes in spatial patterns (Habeeb et al., 2015; Smith et al., 2013; Summers et al., 2022). Older adults are disproportionately at risk for adverse health, mental health, cognitive, and psychosocial consequences during and after natural disasters (Adams et al., 2011; Cherry et al., 2010; Fonseca et al., 2009; Liu et al., 2015; Malik et al., 2018; Parker et al., 2016; Wilson-Genderson et al., 2018). Efforts to improve our understanding of weather-related disaster impacts on older adults may benefit from considering how their life histories, such as early-life adversity, shape vulnerability to disaster-related adverse health outcomes. However, early-life adversity has rarely been considered in the disaster aging literature.

The allostatic load model posits that chronic or repeated stress, over time, results in wear-and-tear, leading to physiological decline (McEwen & Stellar, 1993). Prospective longitudinal research findings suggest that adverse childhood experiences (ACEs) may result in ‘biologically embedded’ physiological changes that predispose individuals to developing chronic conditions and disease including cognitive decline, cognitive impairments, and dementia (Barboza Solís et al., 2015; see Berens et al., 2017, for a review). For example, a meta-analysis of 32 prospective studies revealed that baseline ACEs had significant small-to-medium negative associations with working memory and executive functions at follow-up (Rahapsari & Levita, 2024). Further, recent meta-analyses suggest that ACEs are associated with increased risk of mild cognitive impairment (MCI) and dementia (Abouelmagd et al., 2025; Severs et al., 2023). Exposure to natural disasters may serve as an additional stressor that exacerbates the adverse effects of ACEs on later-life cognitive functioning.

Natural disaster exposure also negatively impacts cognitive aging. A recent meta-analysis revealed that natural disaster exposure was associated with a 25% increased risk of cognitive decline and a 7% increased risk of developing either all-cause dementia or Alzheimer’s disease (AD) with the greatest magnitude effects observed for hurricanes, earthquakes with tsunamis, and heat waves (Thompson & Vasefi, 2025). One published study of Japanese older adult survivors of the 2011 Great East Japan Earthquake found that experiencing post-natural disaster stressors, including home loss and relocation, was longitudinally associated with increased cognitive disability 5.5 years after disaster and, the magnitude of effect of home loss on cognitive disability was stronger among those with ≥2 ACEs versus <2 ACEs (Okuzono et al., 2024). This suggests that, for at least some post-disaster stressors, having more ACEs is associated with worse long-term cognitive outcomes.

Relationships among ACEs, natural disaster exposure, and later-life cognitive function may also differ by sex. According to an annual national survey of U.S. adults (N = 211, 376), females have a higher frequency of ACEs than males (Giano et al., 2020). Further, dose–response relationships have been observed between ACEs and later-life cognitive function (Nilaweera et al., 2022) as well as between ACEs and dementia incidence (Tani et al., 2020) in women but not men. Therefore, it is possible that any exacerbating effects of natural disaster exposure on the association between ACEs and cognitive function could be exclusive to women or that the magnitude of association could be greater in women than men.

In the present study, we leveraged data from the U.S. Health and Retirement Study (HRS) to test the hypothesis that ACE score, operationalized as the total number of different types of ACEs, interacts additively with natural disaster exposure (ACEs*Disaster) to associate with worse later-life global cognitive functioning. We further tested the hypothesis that the association between ACEs and later-life cognitive function would be stronger in women than men by examining this relationship in parallel models in men and women, stratified by disaster-exposure status.

Methods

Participants and Procedures

De-identified data were drawn from the HRS (https://hrs.isr.umich.edu/), a publicly available longitudinal panel study of a nationally representative sample of U.S. adults aged 50 and older and their spouses [University of Michigan Health Sciences/Behavioral Sciences IRB Protocol #HUM00061128]. Since 1992, the HRS has conducted biennial surveys collecting information on sociodemographic characteristics, health, and well-being. In 2006, the HRS first administered a Psychosocial and Lifestyle Questionnaire, also known as the Leave Behind (LB) Section to obtain information on respondents’ life circumstances and experiences (Survey Research Center, 2006). The LB questionnaire was administered to a random half of the sample in 2006 and to the remaining half in 2008. Thereafter, each subsample was re-interviewed every 4 years. Although ACEs were assessed on the LB questionnaire across waves, natural disaster exposure was queried only in 2008, 2010, and 2012. Therefore, to create a full sample, we combined the 2010 and 2012 LB data (Survey Research Center, 2020, 2021). Imputed cognitive performance data (Survey Research Center, 2023) and the tracker file containing covariates collected in the corresponding wave (e.g., 2010 data for 2010 LB participants) (Survey Research Center, 2024) were merged. Of the 14,768 respondents who completed the 2010 and 2012 LB questionnaire, n = 1,167 with a history of stroke were excluded due to a potential impact on cognitive performance (Knopman et al., 2009; Tatemichi et al., 1994). After excluding 650 respondents with missing data on key variables and covariates: natural disaster exposure (n = 269), cognitive performance (n = 228), smoking status (n = 71), education (n = 57), race/ethnicity (n = 18), and marital status (n = 7), the final analytic sample comprised 12,951 individuals.

Measures

Cognitive Performance.

The HRS administers a range of cognitive tests adapted from the Telephone Interview for Cognitive Status [TICS] (Brandt et al., 1988). The TICS is modeled after the Mini-Mental State Exam (Folstein et al., 1975) for use over the telephone and has been shown to be a valid and reliable measure of cognitive function (Breitner et al., 1995; Desmond et al., 1994). Following previous work (Crimmins et al., 2011; Langa et al., 2017), we used three tests: total word recall, serial 7’s test, and backwards counting. Total word recall, which sums immediate and delayed recall of 10 nouns, assessed memory (scale: 0 to 20). Backward counting, in which respondents counted backward from 20 and from 86, measured processing speed (scale: 0 to 2). The serial sevens subtraction test, in which respondents repeatedly subtracted seven starting from 100, assessed working memory (scale: 0 to 5). Scores from the three tests were summed to produce a global cognitive performance score on a scale from 0 (severely impaired) to 27 (high functioning).

ACEs.

ACEs were assessed retrospectively using four items shown to impact physical health in older adults (Krause et al., 2004) as follows: “Before you were 18 years old, (1) did you have to do a year of school, (2) were you ever in trouble with the police, (3) did either of your parents drink or use drugs so often that it caused problems in the family, and (4) were you ever physically abused by either of your parents?” Response options were “no” or “yes,” and affirmative responses were summed to create a cumulative ACE score on a scale from 0 to 4.

Natural Disaster Exposure at or After Age 18.

Natural disaster exposure was assessed using a question: “Have you ever been in a major fire, flood, earthquake, or other natural disaster?” Response options were “no” or “yes.” To capture exposure during adulthood and older adulthood, we included only natural disasters that occurred at/after age 18.

Covariates.

Sociodemographic covariates included age, sex (male; female), race/ethnicity (non-Hispanic White; non-Hispanic Black; non-Hispanic other; Hispanic), education (less than high school; high school or higher), and marital status (married/partnered; single). Health-related covariates included smoking status (no; yes), diabetes (no; yes), heart disease (no; yes), and depression (no; yes).

Statistical Analyses

Hypotheses were tested using ordinary least squares (OLS) regression modeling. Table 2 displays the results of the adjusted models containing cognitive performance as the dependent variable and total ACE score along with natural disaster exposure as independent variables (Model 1) as well as the addition of the ACEs*Disaster interaction term (Model 2). OLS regression modeling was also performed on a sex- and disaster exposure-stratified sample (Table 4). Sample weights provided by the HRS were applied in all analyses to account for differential probabilities of selection, non-response, and post-stratification adjustments, ensuring population-level representation (Ofstedal et al., 2011). Analyses were conducted using Stata 18 (StataCorp, 2023).

Table 2.

Multiple regression analysis of ACEs, natural disaster exposure at age ≥18 years, and their interaction on later-life cognitive performance (N = 12,951)

Model 1
 Model 2
B SE B SE
ACEs (sample range: 0–4) −0.20*** (0.04) −0.15** (0.06)
Natural disaster exposure at/after age 18 (ref: No)
 Yes 0.22 (0.12) 0.38* (0.14)
ACEs*Disaster −0.29* (0.14)
Age −0.14*** (0.00) −0.14*** (0.00)
Sex (ref: Male)
 Female 0.67*** (0.08) 0.67*** (0.08)
Race/Ethnicity (ref: Non-Hispanic White)
 Non-Hispanic Black −2.78*** (0.14) −2.77*** (0.14)
 Non-Hispanic other −1.92*** (0.21) −1.93*** (0.21)
 Hispanic −1.99*** (0.20) −1.98*** (0.20)
Education (ref: Less than high school)
 High school or more 2.84*** (0.11) 2.85*** (0.11)
Marital status (ref: Married/Partnered)
 Not married −0.50*** (0.09) −0.50*** (0.09)
Smoking status (ref: No)
 Yes −0.82*** (0.13) −0.82*** (0.13)
Diabetes (ref: No)
 Yes −0.29** (0.10) −0.29** (0.10)
Heart disease (ref: No)
 Yes −0.24* (0.10) −0.24* (0.10)
Depression (ref: No)
 Yes −1.15*** (0.10) −1.14*** (0.10)
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Note. B = unstandardized coefficient; SE = standard error; ref = reference.

*

p < .05

**

p < .01

***

p < .001.

Table 4.

Multiple regression analysis of ACEs on later-life cognitive performance, stratified by sex and natural disaster exposure at age ≥18 years (N = 12,951)

Characteristic Male
 Female
Disaster-unexposed (n = 4,395)
 Disaster-exposed (n = 871)
 Disaster-unexposed (n = 6,511)
 Disaster-exposed (n = 1,114)
B SE B SE B SE B SE
ACEs (sample range: 0–4) −0.12 (0.08) −0.37* (0.18) −0.17* (0.08) −0.65** (0.19)
Age −0.13*** (0.01) −0.12*** (0.02) −0.14*** (0.01) −0.14*** (0.01)
Race/Ethnicity (ref: Non-Hispanic White)
 Non-Hispanic Black −2.55*** (0.22) −3.15*** (0.46) −2.84*** (0.16) −3.00*** (0.40)
 Non-Hispanic other −1.20** (0.37) −1.29* (0.62) −2.59*** (0.35) −2.21*** (0.59)
 Hispanic −1.80*** (0.25) −0.78 (0.52) −2.20*** (0.24) −2.67*** (0.53)
Education (ref: Less than high school)
 High school or more 2.94*** (0.20) 2.75*** (0.47) 2.85*** (0.17) 2.10*** (0.42)
Marital status (ref: Married/Partnered)
 Not married −0.57*** (0.15) −0.49 (0.33) −0.45*** (0.12) −0.24 (0.29)
Smoking status (ref: No)
 Yes −0.91*** (0.18) −1.02* (0.44) −0.77*** (0.17) −0.62 (0.38)
Diabetes (ref: No)
 Yes −0.12 (0.15) 0.48 (0.33) −0.51*** (0.14) −0.60 (0.34)
Heart disease (ref: No)
 Yes −0.28 (0.15) 0.13 (0.35) −0.32* (0.15) −0.08 (0.35)
Depression (ref: No)
 Yes −1.09*** (0.19) −0.90* (0.39) −1.19*** (0.14) −1.09** (0.33)
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Note. B = unstandardized coefficient; SE = standard error; ref = reference.

*

p < .05

**

p < .01

***

p < .001.

Results

Sociodemographic characteristics are displayed in Table 1. Mean cognitive performance for the sample was 15.77 (standard deviation [SD] = 4.22), which falls toward the lower bound of the 12 to 27 range classified as “normal” (Crimmins et al., 2011; Langa et al., 2017). The mean ACE score was 0.49 (SD = 0.76) and approximately 15.4% of the sample reported experiencing a natural disaster at or after age 18.

Table 1.

Sociodemographic and key study variables for included participants (N = 12,951)

Sociodemographic characteristics M SD %
Age (years; range: 50–101) 64.61 10.08
Sex
 Male 45.3
 Female 54.7
Race/Ethnicity
 Non-Hispanic White 79.1
 Non-Hispanic Black   9.5
 Non-Hispanic other   3.1
 Hispanic   8.3
Education
 Less than high school 14.8
 High school or more 85.2
Marital status
 Married/Partnered 62.1
 Not married 37.9
Smoking status
 No 85.7
 Yes 14.3
Diabetes
 No 81.0
 Yes 19.1
Heart disease
 No 81.1
 Yes 18.9
Depression
 No 81.1
 Yes 18.9
Key study variables M SD %
Cognitive performance (sample range: 0–27) 15.77 4.22
ACEs (sample range: 0–4)   0.49 0.76
Natural disaster exposure age at/after age 18
 No 84.6
 Yes 15.4
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Note. M = mean; SD = standard deviation.

Higher ACE scores, indicating endorsement of more types of ACEs, were associated with lower cognitive performance scores (B = −0.20, SE = 0.04, p < .001), whereas natural disaster-exposure status was not significantly associated with cognitive performance (B = 0.22, SE = 0.12, p = .66) [Table 2, Model 1]. Addition of the ACEs*Disaster interaction term to the model revealed a significant association with poorer cognitive performance (B = −0.29, SE = 0.14, p = .04) [Table 2, Model 2].

In Figure 1, predicted global cognitive performance score is illustrated by the number of ACEs and natural disaster-exposure status at/after age 18. Among disaster-exposed individuals, the estimated cognitive function score was 16.19 (SE = 0.12) for those with no ACE, slightly higher (better performance) than the overall sample [Table 3]. For disaster-unexposed individuals, cognitive performance scores were 15.81 (SE = 0.06) for those with no ACE, 15.66 (SE = 0.06) for one, 15.51 (SE = 0.10) for two, 15.37 (SE = 0.15) for three, and 15.22 (SE = 0.20) for four ACEs, respectively [Table 3].

Figure 1.

Figure 1.

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Plot of ACEs interaction with natural disaster exposure at/after age 18 on later-life global cognitive performance

Table 3.

Predicted Global Cognitive Performance by the Number of ACEs and Natural Disaster-Exposure Status at/After Age 18

Number of ACEs Disaster-unexposed
 Disaster-exposed
Predicted Cognitive Performance (Std. Err.) Predicted Cognitive Performance (Std. Err.)
0 15.81 (.06) 16.19 (.12)
1 15.66 (.06) 14.76 (.12)
2 15.51 (.10) 15.32 (.19)
3 15.37 (.15) 14.88 (.29)
4 15.22 (.20) 14.45 (.39)
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Stratification by sex and disaster exposure revealed that there was no significant association between ACEs and later-life cognitive performance in men who were disaster-unexposed whereas men who were disaster-exposed exhibited a 0.37 decrease in cognitive performance for every 1-point increase in ACE score (B = −0.37, SE = 0.18, p = .04). Among women, for every 1-point increase in ACE score, the disaster-unexposed subsample exhibited a 0.17-point decrease in cognitive performance (B = −0.17, SE = 0.08, p = .04) whereas the disaster-exposed sample exhibited a 0.65-point decrease in cognitive performance (B = −0.65, SE = 0.19, p = .001) [Table 4].

Discussion

This cross-sectional study analyzed data from the 2010 and 2012 HRS waves to examine associations among ACEs, natural disaster exposure, and cognitive function in later life, and to investigate these relationships in men and women. Our hypotheses that: (a) ACEs interact additively with natural disaster exposure to associate with worse later-life global cognitive performance and (b) that the magnitude of this association is stronger in women, were both supported. To our knowledge, only one published study by Okuzono et al. (2024) has examined similar relationships yet the two studies differ in several ways. Okuzono et al. (2024) used a longitudinal study design to examine cognitive function in relation to post-disaster stressors among disaster survivors whereas the present study used a cross-sectional study design to explicitly compare individuals exposed to natural disasters with those unexposed, representing a fundamentally different analytic contrast. In addition, a primary aim of the present study was to examine sex-specific associations between ACEs and later-life cognitive function. Our finding that natural disaster exposure amplified the negative association between higher ACE scores and later-life cognitive performance aligns with those of Okuzono et al. (2024) which reported that the association between some earthquake-related stressors and later-life cognitive disability, 5.5 years post-disaster, was stronger among those with higher ACEs. Taken together, and applying the lens of the allostatic load model (McEwen & Stellar, 1993), these findings suggest that ACEs contribute to physiological burden, which interacts additively with acute stressors in adulthood—natural disaster exposure in this case—thereby increasing allostatic load and vulnerability to cognitive impairment or decline in later life. However, natural disaster exposure alone was not significantly associated with cognitive function in our sample, which contrasts with previous findings (Hu et al., 2024; Thompson & Vasefi, 2025). This may be because the HRS measure of disaster exposure lacks detail on the type, intensity, duration, and frequency of events, as well as post-disaster stressors, which may be key factors influencing cognitive outcomes (Hu et al., 2024; Okuzono et al., 2024; Önder, 2024).

Supporting our second hypothesis, the association between the ACEs*Disaster interaction and later-life global cognitive function was stronger in women than men. In men unexposed to disaster, ACEs were not significantly associated with later-life cognitive performance whereas in women, there was a dose–response relationship between ACEs and cognitive performance regardless of disaster-exposure status, with disaster exposure amplifying the magnitude of the ACEs–cognitive function association. This accords with prior research reporting cross-sectional dose–response relationships between ACEs and later-life psychomotor speed and verbal fluency in women, but not in men (Nilaweera et al., 2022). The observed sex-specific outcomes in the ACE–cognition association and the amplifying effect of disaster exposure may reflect established sex-specific hormonal influences on cognitive function across the lifespan, mediated by interconnected hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal neuroendocrine pathways (Gurvich et al., 2018). Notably, we did observe that in disaster-exposed men, the dose–response relationship between ACEs and later-life cognitive performance was present, yet it was weaker than in women. Overall, our findings suggest that older adult men and women with a history of ACEs may be more vulnerable to disaster-related impacts on cognitive function with the impact being stronger in women.

Pathways linking ACEs to increased allostatic load that could lead to cognitive decline include indirect pathways such as socioeconomic status and health behaviors and direct stress-related effects on neural, endocrine, immune and/or metabolic physiology (Barboza Solís et al., 2015; Danese & McEwen, 2012). Emerging literature on disaster response and recovery has begun to address the need to intervene at the level of direct stress-related effects on physiology. In the context of disaster planning and response, some have called for improvements to existing disaster behavioral health programs to enhance accessibility, efficiency, and coordination of resources for stress reduction and treatment (Sandifer & Walker, 2018). Others have developed and advocated for a trauma-informed approach in recovery planning by mental health practitioners, grounded in principles such as “first, do no harm” to prevent community re-traumatization, active listening to assess community needs, careful observation to identify and reduce barriers, safe-guarding of practitioners from secondary trauma, and facilitation of community healing (Rosenberg et al., 2022). Such efforts may also aid in preventing cognitive decline and dysfunction outcomes associated with natural disaster exposure.

Recommendations

Sex-specific tailoring of disaster response and recovery interventions should consider the importance of a trauma-informed approach, particularly with women. Future research should use a sex-specific framework and incorporate pre- and post-disaster measurement of cognitive function and other health biomarkers when trauma-informed disaster resilience interventions are implemented to determine which interventions or components therein are effective at pre-serving cognitive aging health in male and female older adults with a history of ACEs.

Strengths and Limitations

Strengths of the present study include a substantial, nationally representative sample as well as data that are well-maintained and rigorously quality controlled. Another strength was the ability to investigate sex-specific outcomes, which helps identify at-risk populations and inform targeted intervention strategies. Limitations include a lack of data on type, intensity, duration, and frequency of natural disaster exposure precluding our ability to investigate effects of different types of disaster and dose–response patterns due to differences in intensity, duration, or frequency. Cross-sectional study design due to limited data availability is another limitation of this study. Future research should use a prospective longitudinal design to confirm these cross-sectional findings.

Conclusion

This study identifies additive negative interaction associations between ACEs and natural disaster exposure with later-life cognitive function, with stronger associations observed in women. The pattern of findings is consistent with the allostatic load framework, in which early-life adversity may contribute to heightened physiological vulnerability to acute stressors in adulthood with the potential to impact later-life cognitive performance. Observed sex-specific outcomes point to the potential value of targeted prevention and intervention strategies, particularly for older women with a history of ACEs. Incorporating trauma-informed approaches into disaster preparedness and recovery efforts may help address cognitive health risks in vulnerable populations. Longitudinal research with detailed exposure assessments is needed to confirm these associations and to evaluate resilience building interventions.

What This Paper Adds

  • This study uses a nationally representative sample of older Americans to examine how natural disaster exposure may modify the relationship between ACEs and later-life cognitive function, addressing a gap in the literature on early-life adversity, environmental stressors, and cognitive aging.

  • ACEs were associated with lower cognitive performance scores, and disaster exposure amplified the negative association between higher ACE scores and global cognitive function.

  • Women showed stronger dose–response associations between ACEs and cognitive function regardless of disaster exposure, while disaster-unexposed men showed no significant ACE–cognition association.

Applications of Study Findings

  • Individuals with a history of ACEs may be particularly vulnerable to the cognitive effects of disaster exposure, suggesting a need for targeted screening and support to address the physiological and psychological burden associated with ACEs.

  • The greater magnitude of the ACEs–cognitive function association in women emphasizes the importance of considering sex-specific outcomes when designing monitoring strategies and tailored interventions after disaster exposure.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Dr. K.A. Lawrence’s effort was supported by a Mentored Research Scientist Development Award (K01AG070279) from the NIA at the NIH. Dr. Y. J. Choi’s effort was supported by the University of Kentucky Center for Appalachian Research in Environmental Sciences through Grant P30ES026529 from the National Institute of Environmental Health Sciences (NIEHS) at the NIH. This content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH’s NIA or NIEHS.

Footnotes

Ethical Considerations

Ethical approval for this study was obtained from the University of Kentucky Institutional Review Board (#95554).This secondary data study used publicly available, de-identified data from the Health and Retirement Study at the University of Michigan [University of Michigan Health Sciences/Behavioral Sciences IRB Protocol #HUM00061128].

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The data used for this study are from the Health and Retirement Study (HRS), produced and distributed by the University of Michigan with funding from the National Institute on Aging (grant number NIA U01AG009740). The data are publicly available and can be downloaded from the HRS website: https://hrsdata.isr.umich.edu/data-products/public-survey-data. https://hrs.isr.umich.edu/

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data used for this study are from the Health and Retirement Study (HRS), produced and distributed by the University of Michigan with funding from the National Institute on Aging (grant number NIA U01AG009740). The data are publicly available and can be downloaded from the HRS website: https://hrsdata.isr.umich.edu/data-products/public-survey-data. https://hrs.isr.umich.edu/

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