Aging under scarcity and insecurity: chronic disease, functional limitation, and basic need material insecurity among...

Older adults in low-income and fragile states often age with intersecting burdens of chronic disease, functional decline, and material deprivation, yet they remain largely invisible in research and policy. In Haiti, recurrent political crises, violence, and weak health and social protection systems may amplify late-life inequities, but national data are scarce. We examined the distribution and social determinants of health, functioning, and material insecurity among older Haitian adults.

We analyzed data from adults aged ≥ 60 years (n = 1,408) drawn from a 2024 nationally representative household survey on hypertension, plant use, and nutrition in Haiti. The survey used a two-stage stratified sampling design across all 10 departments, with household listing in selected census tracts and inclusion of all resident adults. We estimated weighted prevalences and 95% confidence intervals (CI) for self-rated health, vision and mobility limitations, hypertension, diabetes, psychosocial stress, food insecurity, water insecurity, and underweight (BMI < 23 kg/m²). Multivariable logistic and multinomial logistic regression models assessed associations with age, sex, marital status, rural residence, household socioeconomic status, and residence in areas classified as unsafe due to armed-group control. Analyses accounted for clustering at the household level.

Older adults experienced substantial multiple burdens. Poor self-rated health was reported by 29.9% (95% CI 26.3-33.8), vision impairment by 42.3% (95% CI 37.8-46.9), mobility limitation by 27.3% (95% CI 23.3-31.7), and high stress by 31.0% (95% CI 26.8-35.6). Hypertension affected 62.5% (95% CI 57.8-66.9) and diabetes 16.6% (95% CI 13.1-20.7). Food insecurity reached 53.0% (95% CI 48.3-57.6), water insecurity 28.4% (95% CI 24.1-33.2), and underweight status 60.5% (95% CI 55.7-65.2). Older age predicted poorer health, functional limitations, and stress. Women had higher odds of hypertension (OR 1.8, 95% CI 1.45-2.32) and tended toward worse functional outcomes. Rural residence was associated with poorer self-rated health (OR 1.9, 95% CI 1.46-2.47) and higher food insecurity, while higher socioeconomic status and living with a partner were partially protective. Residence in unsafe areas was linked to higher stress, hypertension, and food insecurity. Supplementary sex-stratified models suggested broadly similar patterns across men and women, although some associations differed in magnitude.

Aging in Haiti is characterized by a high burden of chronic disease, functional impairment, and basic-need deprivation, patterned by sex, place, and household resources. These findings highlight the urgency of developing integrated chronic care, robust social protection, and food and water security policies that explicitly prioritize older adults in fragile health systems.