Post-Disaster Health Symptom Profiles Among Older Adults Following Hurricane Helene Flooding In Southern Appalachia

Background:
Hurricane Helene made landfall on September 26, 2024, as a Category 4 storm before moving inland and producing catastrophic flooding across Southern Appalachia. These impacts were disproportionately concentrated in communities with higher proportions of older adults, individuals with disabilities, and lower-income populations. Despite growing recognition of inland flooding risks, limited research has examined the co-occurring physical and mental health impacts of disasters among older adults during the recovery period. This study addresses this gap by examining physical and mental health symptom profiles among older adults approximately five months after Hurricane Helene–related flooding in Southern Appalachia.

Methods: Survey data were collected from 233 older adults and assessed physical health symptoms, post-traumatic stress disorder, depressive symptoms, flood event exposure, environmental contaminant exposure, and post-flood stressors. Cluster analysis was conducted to identify post-disaster physical and mental health symptom profiles, and analysis of variance and chi-square tests were conducted to examine differences in disaster exposure, post-flood stressors, and sociodemographic characteristics across profiles.

Results: Results revealed substantial post-disaster health burden among older adults following Hurricane Helene Flooding in Southern Appalachia. Approximately 24.4% of respondents reported moderate to severe PTSD symptoms, and 10.3% reported moderate to severe depressive symptoms. Physical health symptoms, including headaches, respiratory issues, and gastrointestinal problems, were also commonly reported. Cluster analysis identified three distinct post-disaster health profiles: (i.) a lower symptom burden profile (50.6%), (ii.) an elevated mental health symptom profile (26.2%), and (iii.) a combined elevated physical and mental health symptom profile (23.2%). Disaster exposure, contaminant exposure, and post-flood stressors increased in a graded manner across profiles, indicating a dose–response of disaster-related health impacts. Higher symptom burden profiles were disproportionately represented among older adults with disabilities/chronic illness and among older age groups.

Discussion: Findings underscore the heterogeneity of post-disaster health experiences among older adults and highlight the compounding effects of disaster exposure, post-flood environmental conditions, and ongoing recovery-related stressors. These results point to the need for more tailored, multi-dimensional approaches to post-disaster recovery that account for both physical and mental health burdens. In terms of implications, gerontological social workers are uniquely positioned to address these complex, co-occurring needs through comprehensive assessment, care coordination, and advocacy.