{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T18:07:23Z","timestamp":1790186843828,"version":"4.1.0"},"reference-count":129,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2018,12,18]],"date-time":"2018-12-18T00:00:00Z","timestamp":1545091200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["1638283"],"award-info":[{"award-number":["1638283"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Center for Gerontology at Virginia Polytechnic Institute and State University","award":["000"],"award-info":[{"award-number":["000"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Coastal communities are increasingly exposed to more intense and frequent hurricanes, accelerated sea-level rise, and prolonged tidal inundation, yet they are often a preferred retirement destination for older adults vulnerable to flooding and extreme weather events. The unique physical and psychosocial challenges of older population age 65 and over may affect their level of preparedness, capacity to cope with, and ability to respond and recover from a hazard event. Despite the clear vulnerabilities of older residents living in high-risk areas when compared to younger coastal populations, there is a lack of empirical research on the integrated flood risks to this population group in the coastal context. This paper provides a holistic assessment of this emerging problem along the U.S. East Coast by measuring the exposure of older population to sea level rise and storm surge in coastal counties. It further evaluates how age-related vulnerabilities differ between rural and urban settings using the case study approach and geospatial and statistical analysis the paper also conducts a review of scientific literature to identify gaps in the current understanding of health and well-being risks to aging populations in coastal communities. The results show that older populations are unevenly distributed along the U.S. East Coast with some states and counties having significantly higher percent of residents age 65 and older living along the shoreline. Many places with larger older populations have other attributes that further shape the vulnerability of this age group such as older housing stock, disabilities, and lower income and that often differ between rural and urban settings. Lastly, our study found that vast majority of research on aging in high-risk coastal locations has been conducted in relation to major disasters and almost none on the recurrent nuisance flooding that is already affecting many coastal communities.<\/jats:p>","DOI":"10.3390\/ijerph15122900","type":"journal-article","created":{"date-parts":[[2018,12,18]],"date-time":"2018-12-18T05:47:45Z","timestamp":1545112065000},"page":"2900","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":68,"title":["Aging in Flood-Prone Coastal Areas: Discerning the Health and Well-Being Risk for Older Residents"],"prefix":"10.3390","volume":"15","author":[{"given":"Anamaria","family":"Bukvic","sequence":"first","affiliation":[{"name":"Department of Geography, Virginia Tech, Blacksburg, VA 24061, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Gohlke","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Virginia Tech, Blacksburg, VA 24061, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aishwarya","family":"Borate","sequence":"additional","affiliation":[{"name":"Urban Affairs and Planning, Virginia Tec h, Blacksburg, VA 24061, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Suggs","sequence":"additional","affiliation":[{"name":"Department of Statistics, Virginia Tech, Blacksburg, VA 24061, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,12,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1126\/science.1112551","article-title":"Uncertainty in hurricanes and global warming","volume":"308","author":"Trenberth","year":"2005","journal-title":"Science"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1038\/ngeo779","article-title":"Tropical cyclones and climate change","volume":"3","author":"Knutson","year":"2010","journal-title":"Nat. Geosci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1038\/nature07234","article-title":"The increasing intensity of the strongest tropical cyclones","volume":"455","author":"Elsner","year":"2008","journal-title":"Nature"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1038\/s41558-017-0007-7","article-title":"Increased rainfall volume from future convective storms in the US","volume":"7","author":"Prein","year":"2017","journal-title":"Nat. Clim. Chang."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Trenberth, K.E., Cheng, L., Jacobs, P., Zhang, Y., and Fasullo, J. (2018). Hurricane Harvey links to Ocean Heat Content and Climate Change Adaptation. Earths Future.","DOI":"10.1029\/2018EF000825"},{"key":"ref_6","unstructured":"Karl, T.R., Melillo, J.M., and Peterson, T.C. (2009). Global Climate Change Impacts in the United States, Cambridge University Press."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1007\/s00382-013-1713-0","article-title":"Recent intense hurricane response to global climate change","volume":"42","author":"Holland","year":"2014","journal-title":"Clim. Dyn."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/s11625-008-0042-4","article-title":"Understanding global sea levels: Past, present and future","volume":"3","author":"Church","year":"2008","journal-title":"Sustain. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1126\/science.1185782","article-title":"Sea-Level Rise and Its Impact on Coastal Zones","volume":"328","author":"Nicholls","year":"2010","journal-title":"Science"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Reidmiller, D.R., Avery, C.W., Easterling, D.R., Kunkel, K.E., Lewis, K.L.M., Maycock, T.K., and Stewart, B.C. (2018). Our Changing Climate, Impacts, Risks, and Adaptation in the United States: Fourth National Climate Assessment.","DOI":"10.7930\/NCA4.2018"},{"key":"ref_11","unstructured":"Titus, J.G., and Anderson, K.E. (2009). Coastal Sensitivity to Sea-Level Rise: A Focus on the Mid-Atlantic Region."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"6033","DOI":"10.1038\/s41598-017-05792-1","article-title":"Extreme coastal erosion enhanced by anomalous extratropical storm wave direction","volume":"7","author":"Harley","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_13","unstructured":"(2018, December 05). The contribution of local land subsidence to coastal flooding hazard along the US Atlantic coast. Available online: http:\/\/paduaresearch.cab.unipd.it\/9896\/1\/Fiaschi_Simone_tesi.pdf#page=69."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1016\/j.gloenvcha.2008.05.002","article-title":"Impacts of climate change and sea-level rise on cyclonic storm surge floods in Bangladesh","volume":"18","author":"Karim","year":"2008","journal-title":"Glob. Environ. Chang."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1007\/s10584-013-0749-9","article-title":"Modelling the combined impacts of sea-level rise and land subsidence on storm tides induced flooding of the Huangpu River in Shanghai, China","volume":"119","author":"Yin","year":"2013","journal-title":"Clim. Chang."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"34","DOI":"10.4031\/MTSJ.52.2.6","article-title":"The Increased Risk of Flooding in Hampton Roads: On the Roles of Sea Level Rise, Storm Surges, Hurricanes, and the Gulf Stream","volume":"52","author":"Ezer","year":"2018","journal-title":"Mar. Technol. Soc. J."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Melillo, J.M. (2014). Climate Change Impacts in the United States, Highlights: US National Climate Assessment.","DOI":"10.7930\/J0H41PB6"},{"key":"ref_18","unstructured":"Crossett, K., Ache, B., Pacheco, P., and Haber, K. (2013). National Coastal Population Report, Population Trends from 1970 to 2020."},{"key":"ref_19","unstructured":"Frey, W.H. (2003). Boomers and Seniors in the Suburbs, Brooking Institution Center on Urban and Metropolitan Policy."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.apgeog.2015.04.010","article-title":"Appreciating migration flows for health\/social services planning: A case study of older adults leaving from New York to Florida","volume":"62","author":"Sharma","year":"2015","journal-title":"Appl. Geogr."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Thieler, E.R., and Hammar-Klose, E.S. (2000). National Assessment of Coastal Vulnerability to Sea-Level Rise; Preliminary Results for the US Gulf of Mexico Coast.","DOI":"10.3133\/ofr00179"},{"key":"ref_22","unstructured":"Davey, J.A., de Joux, V., Nana, G., and Arcus, M. (2004). Accommodation Options for Older People in Aotearoa\/New Zealand, Citeseer."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Smith, A.E. (2009). Ageing in Urban Neighbourhoods: Place Attachment and Social Exclusion, Policy Press.","DOI":"10.46692\/9781847422729"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1289\/ehp.1205223","article-title":"Climate change and older Americans: State of the science","volume":"121","author":"Gamble","year":"2012","journal-title":"Environ. Health Perspect."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s10113-014-0688-7","article-title":"Characterising vulnerability of the elderly to climate change in the Nordic region","volume":"16","author":"Carter","year":"2014","journal-title":"Reg. Environ. Chang."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1097\/01.NHH.0000305552.32597.4d","article-title":"Elders at risk during disasters","volume":"26","author":"Lamb","year":"2008","journal-title":"Home Healthc. Now"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1111\/1468-5973.00036","article-title":"Principles for Managing Community Relocation as a Hazard Mitigation Measure","volume":"5","author":"Perry","year":"1997","journal-title":"J. Conting. Crisis Manag."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"8","DOI":"10.3200\/ENVT.49.7.8-21","article-title":"The U.S. Hurricane Coasts: Increasingly Vulnerable?","volume":"49","author":"Cutter","year":"2007","journal-title":"Environ. Sci. Policy Sustain. Dev."},{"key":"ref_29","unstructured":"Benson, W.F., and Aldrich, N. (2007). CDC\u2019s Disaster Planning Goal: Protect Vulnerable Older Adults."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Wood, M.M., and Bourque, L.B. (2018). Morbidity and Mortality Associated with Disasters. Handbook of Disaster Research, Springer.","DOI":"10.1007\/978-3-319-63254-4_18"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1175\/BAMS-D-15-00276.1","article-title":"A situation-based analysis of flash flood fatalities in the United States","volume":"98","author":"Terti","year":"2017","journal-title":"Bull. Am. Meteorol. Soc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1007\/s11069-012-0151-3","article-title":"The vulnerability of the elderly to hurricane hazards in Sarasota, Florida","volume":"63","author":"Wang","year":"2012","journal-title":"Nat. Hazards"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1017\/S1049023X00000200","article-title":"Frail elderly as disaster victims: Emergency management strategies","volume":"17","author":"Fernandez","year":"2002","journal-title":"Prehospital Disaster Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1111\/j.1467-9523.2006.00307.x","article-title":"Climate change and disaster management","volume":"30","author":"Rose","year":"2006","journal-title":"Disasters"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s11625-010-0108-y","article-title":"Integrating disaster risk reduction and climate change adaptation: Key challenges\u2014Scales, knowledge, and norms","volume":"5","author":"Birkmann","year":"2010","journal-title":"Sustain. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.envsci.2015.01.017","article-title":"Maximising synergies between disaster risk reduction and climate change adaptation: Potential enablers for improved planning outcomes","volume":"50","author":"Crick","year":"2015","journal-title":"Environ. Sci. Policy"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"506","DOI":"10.2105\/AJPH.2013.301559","article-title":"Preparedness for Natural Disasters among Older US Adults: A Nationwide Survey","volume":"104","author":"Rubenstein","year":"2014","journal-title":"Am. J. Public Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1111\/j.1748-3743.2009.00203.x","article-title":"Perceptions of older people on disaster response and preparedness","volume":"5","author":"Duggan","year":"2010","journal-title":"Int. J. Older People Nurs."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1111\/nhs.12133","article-title":"Disaster preparedness among vulnerable older adults with chronic diseases: Results from a cross-sectional study in Incheon, Korea","volume":"16","author":"Kang","year":"2014","journal-title":"Nurs. Health Sci."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"34","DOI":"10.5365\/wpsar.2015.6.2.HYN_005","article-title":"An assessment of disaster-related mortality post-Haiyan in Tacloban City","volume":"6","author":"Ching","year":"2015","journal-title":"West. Pac. Surveill. Response J. WPSAR"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Roberto, K.A., Kamo, Y., and Henderson, T. (2009). Encounters with Katrina: Dynamics of older adults\u2019 social support networks. Lifespan Perspectives on Natural Disasters, Springer.","DOI":"10.1007\/978-1-4419-0393-8_7"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1017\/dmp.2016.118","article-title":"Psychological and physical impacts of extreme events on older adults: Implications for communications","volume":"11","author":"McClelland","year":"2017","journal-title":"Disaster Med. Public Health Prep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1177\/0192513X11412495","article-title":"Displaced older adults\u2019 reactions to and coping with the aftermath of Hurricane Katrina","volume":"32","author":"Kamo","year":"2011","journal-title":"J. Fam. Issues"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1007\/s12144-015-9356-4","article-title":"Perceptions of Older Adults in a Community Accepting Displaced Survivors of Hurricane Katrina","volume":"34","author":"Kamo","year":"2015","journal-title":"Curr. Psychol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1177\/0733464809334287","article-title":"Older adults\u2019 responses to Hurricane Katrina: Daily hassles and coping strategies","volume":"29","author":"Henderson","year":"2010","journal-title":"J. Appl. Gerontol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2117","DOI":"10.1017\/S0144686X15000914","article-title":"Motivating rural older residents to prepare for disasters: Moving beyond personal benefits","volume":"36","author":"Ashida","year":"2016","journal-title":"Ageing Soc."},{"key":"ref_47","unstructured":"Federal Emergency Management Agency (2011). A Whole Community Approach to Emergency Management: Principles, Themes, and Pathways for Action."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"133","DOI":"10.5055\/ajdm.2008.0018","article-title":"The impact of natural disasters on the elderly","volume":"3","author":"Cherniack","year":"2008","journal-title":"Am. J. Disaster Med."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Cherry, K.E., Silva, J.L., and Galea, S. (2009). Natural disasters and the oldest-old: A psychological perspective on coping and health in late life. Lifespan Perspectives on Natural Disasters, Springer.","DOI":"10.1007\/978-1-4419-0393-8_9"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/j.1751-9861.2011.00073.x","article-title":"Longitudinal Assessment of Cognitive and Psychosocial Functioning After Hurricanes Katrina and Rita: Exploring Disaster Impact on Middle-Aged, Older, and Oldest-Old Adults","volume":"16","author":"Cherry","year":"2011","journal-title":"J. Appl. Biobehav. Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1177\/0192513X11412491","article-title":"The Utility of Vulnerability and Social Capital Theories in Studying the Impact of Hurricane Katrina on the Elderly","volume":"32","author":"Durant","year":"2011","journal-title":"J. Fam. Issues"},{"key":"ref_52","unstructured":"National Oceanic and Atmospheric Administration (2017, June 22). Coastal Counties, Available online: https:\/\/coast.noaa.gov\/data\/digitalcoast\/pdf\/qrt-coastal-county-definitions.pdf."},{"key":"ref_53","unstructured":"United States Census Bureau (2017, June 05). American Community Survey (ACS), Available online: https:\/\/www.census.gov\/programs-surveys\/acs."},{"key":"ref_54","unstructured":"National Oceanic and Atmospheric Administration (2017, May 10). Sea level rise data, Available online: https:\/\/coast.noaa.gov\/slrdata\/."},{"key":"ref_55","unstructured":"National Oceanic and Atmospheric Administration (2017, May 27). Sea, lake, and overland surges from hurricanes (SLOSH) Data, Available online: https:\/\/www.nhc.noaa.gov\/nationalsurge\/#data."},{"key":"ref_56","unstructured":"National Oceanic and Atmospheric Administration (2017, June 05). Sea, lake, and overland surges from hurricanes (SLOSH) Model, Available online: https:\/\/www.nhc.noaa.gov\/surge\/slosh.php."},{"key":"ref_57","unstructured":"Socioeconomic Data and Applications Center (SEDAC) (2017, June 24). Gridded population of the world (GPW), v4. Available online: http:\/\/sedac.ciesin.columbia.edu\/data\/collection\/gpw-v4 2017."},{"key":"ref_58","unstructured":"United States Census Bureau (2018, March 08). Urban and Rural Geography, Available online: https:\/\/www.census.gov\/geo\/reference\/urban-rural.html."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Neumann, B., Vafeidis, A.T., Zimmermann, J., and Nicholls, R.J. (2015). Future coastal population growth and exposure to sea-level rise and coastal flooding-a global assessment. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0118571"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1038\/nclimate2631","article-title":"Future population exposure to US heat extremes","volume":"5","author":"Jones","year":"2015","journal-title":"Nat. Clim. Chang."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1038\/nclimate2961","article-title":"Millions projected to be at risk from sea-level rise in the continental United States","volume":"6","author":"Hauer","year":"2016","journal-title":"Nat. Clim. Chang."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e200","DOI":"10.1016\/S2542-5196(17)30082-7","article-title":"Increasing risk over time of weather-related hazards to the European population: A data-driven prognostic study","volume":"1","author":"Forzieri","year":"2017","journal-title":"Lancet Planet. Health"},{"key":"ref_63","unstructured":"Ortman, J.M., Velkoff, V.A., and Hogan, H. (2014). An Aging Nation: The Older Population in the United States."},{"key":"ref_64","unstructured":"(2018, September 11). Federal Interagency Forum on Aging Related Statistics Population Aging in the United States: Global Perspective 2018, Available online: https:\/\/agingstats.gov\/images\/olderamericans_agingpopulation.pdf."},{"key":"ref_65","unstructured":"United States Census Bureau (2018, December 03). Geographic terms and concepts\u2014Census Tract, Available online: https:\/\/www.census.gov\/geo\/reference\/gtc\/gtc_ct.html."},{"key":"ref_66","unstructured":"(2018, December 05). United States Department of Homeland Security Homeland Infrastructure Foundation-Level Data (HIFLD). Available online: https:\/\/hifld-geoplatform.opendata.arcgis.com\/datasets\/78c58035fb3942ba82af991bb4476f13_0."},{"key":"ref_67","unstructured":"(2018, December 05). United States Census Bureau TIGER Products, Available online: https:\/\/www.census.gov\/geo\/maps-data\/data\/tiger.html."},{"key":"ref_68","unstructured":"Ratcliffe, M., Burd, C., Holder, K., and Fields, A. (2016). Defining Rural at the US Census Bureau. American Community Survey and Geography Brief."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"05015005","DOI":"10.1061\/(ASCE)NH.1527-6996.0000205","article-title":"Component-based vulnerability analysis for residential structures subjected to storm surge impact from Hurricane Sandy","volume":"17","author":"Hatzikyriakou","year":"2015","journal-title":"Nat. Hazards Rev."},{"key":"ref_70","unstructured":"Federal Emergency Management Agency (2013). Hurricane Sandy in New Jersey and New York: Building Performance Observations, Recommendations, and Technical Guidance."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/S0167-6105(02)00462-2","article-title":"Cyclone damage and temporal changes to building vulnerability and economic risks for residential construction","volume":"91","author":"Stewart","year":"2003","journal-title":"J. Wind Eng. Ind. Aerodyn."},{"key":"ref_72","unstructured":"Federal Emergency Management Agency (2018, October 15). The National Flood Insurance Program, Available online: https:\/\/www.fema.gov\/national-flood-insurance-program."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1038\/nclimate3222","article-title":"Forecasting societies\u2019 adaptive capacities through a demographic metabolism model","volume":"7","author":"Lutz","year":"2017","journal-title":"Nat. Clim. Chang."},{"key":"ref_74","unstructured":"Bukvic, A., and Borate, A. (2018). Role of Mobility and Transiency in Resilience of Coastal Communities: Miami-Dade County, Florida. Geogr. J., in preparation."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Cutter, S.L., Burton, C.G., and Emrich, C.T. (2010). Disaster resilience indicators for benchmarking baseline conditions. J. Homel. Secur. Emerg. Manag., 7.","DOI":"10.2202\/1547-7355.1732"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1002\/rhc3.12043","article-title":"Disaster preparedness and resilience for rural communities","volume":"4","author":"Kapucu","year":"2013","journal-title":"Risk Hazards Crisis Public Policy"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.ssresearch.2006.02.003","article-title":"Race, class, and Hurricane Katrina: Social differences in human responses to disaster","volume":"35","author":"Elliott","year":"2006","journal-title":"Soc. Sci. Res."},{"key":"ref_78","first-page":"111","article-title":"Uncovering the hidden dimensions of rural disaster mitigation: Capacity building through community emergency response teams","volume":"22","author":"Brennan","year":"2007","journal-title":"South. Rural Sociol."},{"key":"ref_79","first-page":"40","article-title":"Disaster planning in rural America","volume":"35","author":"Janssen","year":"2006","journal-title":"Public Manag."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1046\/j.1440-1584.2000.00304.x","article-title":"Rural mental health: Neither romanticism nor despair","volume":"8","author":"Wainer","year":"2000","journal-title":"Aust. J. Rural Health"},{"key":"ref_81","unstructured":"United States Census Bureau (2018, October 22). Quick Facts, Available online: https:\/\/www.census.gov\/quickfacts\/fact\/table\/US\/PST045217."},{"key":"ref_82","unstructured":"Federal Emergency Management Agency (2013). Flood insurance study #51115CV000B."},{"key":"ref_83","unstructured":"Mobley, J.A. (1991). Pamlico County: A Brief History."},{"key":"ref_84","unstructured":"(2017). Pamlico County Hurricane Matthew Resilient Redevelopment Plan: Pamlico County."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1061\/(ASCE)1527-6988(2003)4:3(136)","article-title":"Urban hazard mitigation: Creating resilient cities","volume":"4","author":"Godschalk","year":"2003","journal-title":"Nat. Hazards Rev."},{"key":"ref_86","unstructured":"Scott, A., Gilbert, A., and Gelan, A. (2007). The Urban-Rural Divide: Myth or Reality?, Macaulay Institute Aberdeen."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"255","DOI":"10.3354\/cr022255","article-title":"Vulnerability of coastal communities to sea-level rise: A case study of Cape May County, New Jersey, USA","volume":"22","author":"Wu","year":"2002","journal-title":"Clim. Res."},{"key":"ref_88","first-page":"428","article-title":"Nor\u2019easters","volume":"81","author":"Davis","year":"1993","journal-title":"Am. Sci."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/s10584-008-9422-0","article-title":"The potential impacts of sea level rise on the coastal region of New Jersey, USA","volume":"90","author":"Cooper","year":"2008","journal-title":"Clim. Chang."},{"key":"ref_90","unstructured":"Hurless, C.R. (2009). Cape May County, New Jersey Floodplain Management Plan."},{"key":"ref_91","unstructured":"Clark, R. (2010). Critically Eroding Beaches in Florida."},{"key":"ref_92","unstructured":"Federal Emergency Management Agency (2014). Flood Insurance Study # 12009CV000A: Brevard County, Florida and Incorporated Areas."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1007\/s10584-011-0086-9","article-title":"Assessing municipal vulnerability to predicted sea level rise: City of Satellite Beach, Florida","volume":"107","author":"Parkinson","year":"2011","journal-title":"Clim. Chang."},{"key":"ref_94","unstructured":"(2018, November 01). Florida Legislature: Office of Economic and Demographic Research. Available online: http:\/\/edr.state.fl.us\/Content\/area-profiles\/county\/brevard.pdf."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"913064","DOI":"10.1155\/2013\/913064","article-title":"Health effects of coastal storms and flooding in urban areas: A review and vulnerability assessment","volume":"2013","author":"Lane","year":"2013","journal-title":"J. Environ. Public Health"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.ypmed.2015.11.014","article-title":"Post-nuclear disaster evacuation and survival amongst elderly people in Fukushima: A comparative analysis between evacuees and non-evacuees","volume":"82","author":"Nomura","year":"2016","journal-title":"Prev. Med."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s11111-009-0093-1","article-title":"Supplemental Security Income recipients affected by Hurricanes Katrina and Rita: An analysis of two years of administrative data","volume":"31","author":"Davies","year":"2010","journal-title":"Popul. Environ."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1111\/j.0361-3666.2005.00324.x","article-title":"Tsunami mortality and displacement in Aceh province, Indonesia","volume":"30","author":"Rofi","year":"2006","journal-title":"Disasters"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1111\/j.1539-6924.2008.01190.x","article-title":"Loss of life caused by the flooding of New Orleans after Hurricane Katrina: Analysis of the relationship between flood characteristics and mortality","volume":"29","author":"Jonkman","year":"2009","journal-title":"Risk Anal. Int. J."},{"key":"ref_100","first-page":"950","article-title":"Nonfatal injuries 1 week after hurricane sandy\u2013New York city metropolitan area, October 2012","volume":"63","author":"Brackbill","year":"2014","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"e009190","DOI":"10.1136\/bmjopen-2015-009190","article-title":"Characteristics of pneumonia deaths after an earthquake and tsunami: An ecological study of 5.7 million participants in 131 municipalities, Japan","volume":"6","author":"Shibata","year":"2016","journal-title":"BMJ Open"},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Kamigaki, T., Seino, J., Tohma, K., Nukiwa-Soma, N., Otani, K., and Oshitani, H. (2014). Investigation of an Influenza A (H3N2) outbreak in evacuation centres following the Great East Japan earthquake, 2011. BMC Public Health, 14.","DOI":"10.1186\/1471-2458-14-34"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1038\/ki.2009.5","article-title":"Missed dialysis sessions and hospitalization in hemodialysis patients after Hurricane Katrina","volume":"75","author":"Anderson","year":"2009","journal-title":"Kidney Int."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1097\/DMP.0b013e3181b9db91","article-title":"Effect of Hurricane Katrina on the incidence of acute coronary syndrome at a primary angioplasty center in New Orleans","volume":"3","author":"Gautam","year":"2009","journal-title":"Disaster Med. Public Health Prep."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1097\/EDE.0b013e318245c61c","article-title":"Lights out: Impact of the August 2003 power outage on mortality in New York, NY","volume":"23","author":"Anderson","year":"2012","journal-title":"Epidemiol. Camb. Mass"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"29016","DOI":"10.3402\/gha.v8.29016","article-title":"Indirect consequences of extreme weather and climate events and their associations with physical health in coastal Bangladesh: A cross-sectional study","volume":"8","author":"Beier","year":"2015","journal-title":"Glob. Health Action"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"e007008","DOI":"10.1136\/bmjopen-2014-007008","article-title":"Serological investigation to identify risk factors for post-flood infectious diseases: A longitudinal survey among people displaced by Typhoon Morakot in Taiwan","volume":"5","author":"Lin","year":"2015","journal-title":"BMJ Open"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1017\/dmp.2016.177","article-title":"Health-related quality of life in older coastal residents after multiple disasters","volume":"11","author":"Cherry","year":"2017","journal-title":"Disaster Med. Public Health Prep."},{"key":"ref_109","doi-asserted-by":"crossref","unstructured":"Wu, J., Xiao, J., Li, T., Li, X., Sun, H., Chow, E.P., Lu, Y., Tian, T., Li, X., and Wang, Q. (2015). A cross-sectional survey on the health status and the health-related quality of life of the elderly after flood disaster in Bazhong city, Sichuan, China. BMC Public Health, 15.","DOI":"10.1186\/s12889-015-1402-5"},{"key":"ref_110","doi-asserted-by":"crossref","unstructured":"Ishiki, A., Okinaga, S., Tomita, N., Kawahara, R., Tsuji, I., Nagatomi, R., Taki, Y., Takahashi, T., Kuzuya, M., and Morimoto, S. (2016). Changes in cognitive functions in the elderly living in temporary housing after the Great East Japan Earthquake. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0147025"},{"key":"ref_111","doi-asserted-by":"crossref","unstructured":"Dai, W., Chen, L., Tan, H., Wang, J., Lai, Z., Kaminga, A.C., Li, Y., and Liu, A. (2016). Association between social support and recovery from post-traumatic stress disorder after flood: A 13\u201314 year follow-up study in Hunan, China. BMC Public Health, 16.","DOI":"10.1186\/s12889-016-2871-x"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1007\/s11524-006-9147-1","article-title":"Symptoms of posttraumatic stress disorder in a New Orleans workforce following Hurricane Katrina","volume":"84","author":"DeSalvo","year":"2007","journal-title":"J. Urban Health"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1080\/13607863.2013.799119","article-title":"A prospective study of the impact of floods on the mental and physical health of older adults","volume":"17","author":"Bei","year":"2013","journal-title":"Aging Ment. Health"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s11069-006-0004-z","article-title":"Vulnerability of Hampton Roads, Virginia to storm-surge flooding and sea-level rise","volume":"40","author":"Kleinosky","year":"2007","journal-title":"Nat. Hazards"},{"key":"ref_115","unstructured":"National Council on Aging (2018, October 04). Healthy Aging Facts. Available online: https:\/\/www.ncoa.org\/news\/resources-for-reporters\/get-the-facts\/healthy-aging-facts\/."},{"key":"ref_116","doi-asserted-by":"crossref","unstructured":"Ryan, B., Franklin, R.C., Burkle, F.M., Aitken, P., Smith, E., Watt, K., and Leggat, P. (2015). Identifying and describing the impact of cyclone, storm and flood related disasters on treatment management, care and exacerbations of non-communicable diseases and the implications for public health. PLoS Curr., 7.","DOI":"10.1371\/currents.dis.62e9286d152de04799644dcca47d9288"},{"key":"ref_117","unstructured":"Center for Disease Control (2005). Vibrio Illnesses after Hurricane Katrina\u2014Multiple States, August\u2013September 2005. Morb. Mortal. Wkly. Rep., 54, 928\u2013931."},{"key":"ref_118","unstructured":"Center for Disease Control (2006). Prevention Surveillance for illness and injury after Hurricane Katrina\u2013three counties, Mississippi, September 5\u2013October 11, 2005. MMWR Morb. Mortal. Wkly. Rep., 55, 231\u2013234."},{"key":"ref_119","unstructured":"Florida Department of Health (2015). Health Effects of Tropical Storms and Hurricanes in Florida."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1017\/dmp.2016.85","article-title":"Food and waterborne disease in the greater New York City area following Hurricane Sandy in 2012","volume":"10","author":"Bloom","year":"2016","journal-title":"Disaster Med. Public Health Prep."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"1804","DOI":"10.1056\/NEJMp1712854","article-title":"Preparing for the next Harvey, Irma, or Maria\u2014Addressing research gaps","volume":"377","author":"Shultz","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1037\/0022-3514.57.6.1069","article-title":"Happiness is everything, or is it? Explorations on the meaning of psychological well-being","volume":"57","author":"Ryff","year":"1989","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/0891-4222(94)00028-8","article-title":"Quality of life: Its definition and measurement","volume":"16","author":"Felce","year":"1995","journal-title":"Res. Dev. Disabil."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1016\/j.cpr.2010.01.002","article-title":"Assessment of positive functioning in clinical psychology: Theoretical and practical issues","volume":"30","author":"Joseph","year":"2010","journal-title":"Clin. Psychol. Rev."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.ijdrr.2015.06.008","article-title":"Evaluating drivers of coastal relocation in Hurricane Sandy affected communities","volume":"13","author":"Bukvic","year":"2015","journal-title":"Int. J. Disaster Risk Reduct."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1037\/0882-7974.15.4.627","article-title":"Age and emotional response to the Northridge earthquake: A longitudinal analysis","volume":"15","author":"Knight","year":"2000","journal-title":"Psychol. Aging"},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.2147\/CIA.S122122","article-title":"Are older people more vulnerable to long-term impacts of disasters?","volume":"11","author":"Rafiey","year":"2016","journal-title":"Clin. Interv. Aging"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"S109","DOI":"10.2105\/AJPH.2005.084335","article-title":"Disaster planning and risk communication with vulnerable communities: Lessons from Hurricane Katrina","volume":"97","author":"Eisenman","year":"2007","journal-title":"Am. J. Public Health"},{"key":"ref_129","unstructured":"Ferris, E., and Petz, D. (2012). The Year that Shook the Rich: A Review of Natural Disasters in 2011, Brookings Institution-London School of Economics Project on Internal Displacement."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/12\/2900\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:34:42Z","timestamp":1760196882000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/12\/2900"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12,18]]},"references-count":129,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2018,12]]}},"alternative-id":["ijerph15122900"],"URL":"https:\/\/doi.org\/10.3390\/ijerph15122900","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12,18]]}}}