Flooding and Cognitive Health among Middle‑Aged and Older Adults in Thailand: A Case Study of Resilient City Policy in Bangkok

Background: Thailand, a developing country in Southeast Asia, faces significant challenges due to urbanization, population aging, and climate change. This case study focuses on an adaptation strategy implemented in Bangkok to address the impacts of flooding. The study aims to examine the short‑, medium‑, and long‑term effects of flooding exposure on cognitive health among middle‑aged and older adults in Thailand and to identify the role of resilient city policy (RCP) in mitigating these impacts. Methods: Data on cognitive health (memory, calculation, and orientation to time) were obtained from the three waves (2017, 2020, and 2022) of the Health, Aging, and Retirement (HART) surveys. Flooding data were retrieved from Thai flood hazard records in the EM‑DAT database from 2017 to 2022. Panel data analyses with a fixed effects model were used to estimate the effects of flooding on cognitive health and the moderating effects of RCP. Results: Findings indicate that exposure to flooding negatively impacts memory and orientation to time, with these effects worsening over time. RCP was found to mitigate the negative effects of flooding on memory scores and calculation scores. Additionally, RCP was associated with reduced risks for diabetes and depressive symptoms, indirectly protecting cognitive health. Discussion: Flooding has long‑lasting negative effects on certain cognitive health domains, specifically memory and orientation to time. This study suggests that RCP, a multi‑component policy aimed at improving structural systems, community preparedness, and healthcare access, shows promise in mitigating the adverse effects of flooding on residents’ cognitive health. Further research is needed to link specific policy components to cognitive health outcomes and to understand their roles in protecting cognitive health.