Healthcare Readiness for Rural Older Adults with Critical Illness During Disasters

Background: Rural older Americans are at heightened risk for developing and dying from critical illness. Yet despite having 22% of America’s older adults, rural communities only have 1% of America’s intensive care unit (ICU) beds. As such, rural ICUs are dependent on the network of hospitals around them to help care for their critically ill—making rural ICUs particularly vulnerable to external disruptions. Extreme weather events disrupt this network of ICU care and place older adults at risk of increased hospitalizations and mortality. Therefore, there is an urgent need to understand the long-term effects of extreme weather events on rural ICUs and the older adults they serve. Project Methods: Aim 1: The effect of extreme weather on one-year mortality among critically ill, rural older adults. Survival analyses will evaluate differences in one-year mortality after critical illness among older adults based on exposure to disaster and rurality using Medicare claims. Aim 2: Associations between rural hospital networks, interhospital transfers, and mortality among critically ill, rural older adults affected by disaster. Network analyses will characterize rural hospitals based on interhospital transfer networks. Then, relationships between rural hospital networks and 30-day mortality will be examined among critically ill, rural older adults affected by disaster. Aim 3: Healthcare readiness during disaster events when caring for critically ill, rural older adults. Semi-structured interviews with 45 staff members from four hospitals who cared for critically ill, rural older adults during disasters will create a framework that defines essential elements of healthcare readiness. Unique Aspects of this Proposal: This application tackles a pressing problem—the impact of extreme weather on vulnerable critically ill, older adults in rural communities—by uniting a physician-researcher with expertise in rural ICU care delivery with a nurse-researcher with expertise in the impact of disasters on the health and well-being of older adults. With an experienced team, expert National Advisory Board, and blend of quantitative and qualitative analyses, the PIs are uniquely equipped to address this urgent challenge. Anticipated Impact: Extreme weather events pose a major threat to critically ill older adults who receive healthcare in rural communities. This study will lead to interventions across individual, health system, and community levels that strengthen systems of ICU care and recovery and mitigate adverse health consequences for vulnerable, rural older adults. Project Number: 1R01AG092567-01A1 | Fiscal Year: 2026 | NIH Institute/Center: National Institute on Aging (NIA) | Principal Investigator: Thomas Valley (+1 co-PI) | Institution: UNIVERSITY OF COLORADO DENVER, Aurora, CO | Award Amount: $657,426 | Activity Code: R01 | Study Section: Organization and Delivery of Health Services Study Section[ODHS] View on NIH RePORTER: https://reporter.nih.gov/project-details/11292663