Energy insecurity and health among older adults: chronic disease management and resilience strategies in rural Puerto Rico

OBJECTIVES: This article explores the impact of energy insecurity on chronic disease management among older adults (≥ 50 years) in rural areas of Puerto Rico. It documents their lived experiences during power outages and assesses the role of community-driven solar energy initiatives led by the community-based organization Casa Pueblo in enhancing health resilience in a disaster-prone region. METHODS: An exploratory-descriptive qualitative approach was employed, incorporating semi-structured interviews with 60 participants across three levels of solar energy access (direct, indirect, and no access) and key stakeholders. Thematic analysis was conducted using NVivo to explore the health impacts of energy insecurity and the resilience strategies used to address it. RESULTS: Energy insecurity exacerbated health vulnerabilities by disrupting the use of critical medical equipment and the refrigeration of medications, worsening chronic conditions such as diabetes and respiratory ailments. Participants reported significant psychological stress, including elevated anxiety during blackouts. Casa Pueblo’s solar initiative proved essential, mitigating immediate health risks while fostering a sense of security and well-being. Yet systemic challenges—such as insufficient government support—highlighted the urgent need for scalable, sustainable solutions that ensure equity. CONCLUSIONS: Reliable energy access is crucial for managing chronic diseases among older adults and strengthening public health resilience in disaster-prone settings like Puerto Rico. Community-driven solar initiatives, exemplified by Casa Pueblo, offer scalable models to enhance health outcomes in vulnerable populations. Realizing their full potential will require coordinated efforts, including public-private partnerships, policy reforms, and measures to overcome structural barriers. This study provides actionable insights for disaster-prone regions worldwide, emphasizing the integration of energy resilience into public health planning.