Older Adults and Disaster: Preparedness and Response

A Mental Health Care Guide

A guide for older adults, and their family members and caregivers, on how to prepare for a possible disaster and how to respond following one.

Each year, people all over the world suffer various disasters—both natural, such as hurricanes, tornadoes, floods, earthquakes, and extreme heat, and man-made, including terrorist attacks. While we typically cannot predict when and where these destructive forces will occur, we learn more from each disaster and can take certain steps to safeguard our physical and mental well being.

How do disasters affect us?

Whether we are immediately impacted by a disaster, such as having to evacuate because of flooding, or we follow the news of others suffering terrible events, as much of the world did after the September 11, 2001 terrorist attacks, everyone is affected by disaster.

For those whose lives are most changed by a disaster, such as the loss of a home or physical injury, the trauma can cause extreme physical and mental illness and pain. Stress and grief are normal responses, and the psychological reaction to disaster experiences can last a long time. In response to a traumatic event, some will develop behavioral changes (increased drinking, domestic violence) and some will suffer the onset or worsening of a mental illness. Those who are directly exposed to an event and in physical danger, or close to someone whose life is threatened by the disaster, can feel intense fear, helplessness, or horror. These feelings can result in disorganized or agitated behavior. Constant or recurring stress can be overwhelming. For some, the psychological consequences of a disaster can be disabling.

Those who watch the news of a disaster hundreds of miles away or who worry about friends and family in the affected region can also experience nervousness, anxiety, irritability, sleep problems, and depressed mood.

In times of crisis, what concerns are there for older persons?

In some respects, older adults may experience fewer psychological effects of stress after a disaster compared to younger adults. From past experiences, some older people may be better prepared and have better coping skills.

However, while older adults often have the resiliency and experience to weather a disaster, the physical strain can take an extreme toll. When disaster strikes, older adults are more likely to be at risk for illness or even death. Frail elderly or those with psychiatric or medical limitations are especially vulnerable to stress caused by disasters.

The loss of treasured possessions, the means to get around, property such as homes, and even the normalcy of everyday life can be devastating.

After the hurricanes and flooding in New Orleans in 2005, many older adults experienced mental health problems. Many felt they had lost their life’s work and savings, and became hopeless. Family members were often separated from each other, and medical and psychiatric care was often interrupted. Health care providers saw problems of anxiety, depression, insomnia, memory complaints, and suicide attempts among older patients. High rates of psychosomatic problems (illnesses with physical symptoms caused by emotional or psychiatric distress) were seen, with worsening health problems and increased death rates.

When compared to younger people, the elderly are more likely to need social support to reduce the effects of stress and to enhance emotional well being and recovery. It is important to understand that some older adults may be dealing with the loss of loved ones plus the loss of physical capabilities and possibly independence.

Special Planning

Older persons who need special preparedness and early response planning are those:

• Of an advanced age or frailty
• Who are cognitively impaired (e.g., dementia)
• With a severe mental illness or chronic disability due to mental illness (e.g., schizophrenia, anxiety, depression)
• In poor physical health, with a complex medical illness or impaired mobility
• With sensory impairment (poor vision or hearing)
• Who lack close family caregivers or local social supports

Who is most vulnerable during disasters?

Factors that may put older adults at increased risk for illness during and after a disaster:

• Hearing and vision problems can contribute to injuries in unfamiliar surroundings and for those trying to avoid hazards.
  Physical disabilities and mobility limitations (such as the use of a wheelchair) can delay or prevent urgent evacuations.
• Loss of electricity. Older adults are vulnerable to hypothermia (below normal body temperature) and hyperthermia (exceptionally high fever) during temperature extremes. A loss of electrical power prevents the use of needed medical equipment, such as nebulizers and home oxygen therapy.
• A loss of access to prescription medication and treatments, such as dialysis and chemotherapy.
• The absence of family members or other supportive individuals at home.
• Barriers to receiving disaster financial aid, such as complex procedures and a reluctance to ask for help.
• Forced relocation can cause a severe stress on frail elderly, hastening their decline or death.
• In general, those needing assistance with daily activities of living (e.g., walking, bathing, eating, medication administration) are more vulnerable to injury or illness during or after a disaster.

Those at most risk for negative psychiatric outcomes and who need special planning for response include those with cognitive impairment, those with a history of severe mental illness or chronic disability due to mental illness, and those in poor physical health.

What concerns are there for older persons with cognitive impairment?

During a crisis, some older adults are vulnerable to cognitive impairment: the ability to think, remember, and make decisions.

For those who are already cognitively impaired, even minor stress can cause problems. Disruptions of the daily routine can disorient a person with dementia who is stable under normal circumstances. Cognitively impaired older adults who are overstimulated, in a new situation, or have unmet needs may have a sudden outburst of emotion or behavior.

Crises can overwhelm or create stress in the cognitively impaired older adult because the situation may be beyond the person’s ability to comprehend or cope. During or after a disaster, caregivers of individuals with cognitive impairment may be less available to provide care and support, and so the risk of wandering may increase if the older adult becomes upset, agitated, or is faced with a stressful situation.

Caregivers should also be aware that those with dementia may form new memories when an experience is traumatic, despite typically being unable to remember recent events. This has been observed in studies of older individuals after the 9/11 disaster in New York City and the Kobe earthquake in Japan in 1995.

How can older people and caregivers prepare for a disaster?

Although we cannot know how or when a disaster will strike, older adults and their families can plan ahead for a possible emergency. Being prepared can help reduce anxiety and hardship.

• The American Red Cross recommends that older adults establish a personal support network of at least three family members, friends, or neighbors who will check on them in an emergency. Arrangements should be made before an emergency. Exchange keys and show where you keep emergency supplies. Share copies of relevant emergency documents and health information. Older adults and their support network members should notify each other when they leave town and arrive back home. Keep a list of these individuals with their contact information.
• Consider electronic payments of federal benefits, like Social Security payments. Disasters can disrupt mail delivery. Direct deposits can be made to a checking or savings bank account, or to a debit card for federal benefits.
• If you rely on medicine or a medical treatment, be sure to have at least a two weeks’ supply on hand. Keep lists of prescription medicines including dosage, treatment, and food- and medication-allergy information. Talk to your pharmacist or doctor about what else you need to be prepared.
• If you undergo routine treatments administered by a clinic or hospital or if you receive regular services such as home health care, treatment or transportation, talk to your service provider about their emergency plans. Work with them to identify back-up service providers and incorporate them into your personal support network.
• Consider other personal needs such as eyeglasses, hearing aids and hearing aid batteries, wheelchair batteries, and oxygen. (See “Basic Disaster Supplies Kit” on page 11.)
• In your emergency supply kit, keep important documents such as family records, medical records, wills, deeds, Social Security number, information about credit cards and bank accounts, tax records, medical insurance and Medicare cards, a list of medical devices or other lifesustaining devices along with styles and serial numbers.
• Keep additional copies of these records with members of your support network. (See “Documents to Collect Prior to a Disaster” on page 12.)
• If you have a communication disability such as trouble hearing or talking, note in your emergency documents, wallet and purse, the best way to communicate with you about your emergency information.
• If you care for an older person with impaired memory, learn about the MedicAlert® + Alzheimer’s Association Safe Return® program, which is a 24-hour nationwide emergency response service for individuals with Alzheimer’s or a related dementia who wander or have a medical emergency. For more information, go online to www.alz.org/safetycenter.

What steps should be taken when disaster strikes?

If possible, older individuals should stay with their family and pets.

Keep fragile older adults with a family member, companion, or caregiver.

If you are with an older person during a disaster, promote a sense of safety and calmness, and a feeling of connectedness and hope. Provide information and offer reassurance.

What can caregivers do during the aftermath and recovery period?

If you are caring for an older adult after a disaster, continue to provide information and reassurance that the environment is safe.

Be an advocate for the older person and that person’s health and mental health needs. In the aftermath of a disaster, older adults may be less likely to report mental health conditions. Know the signs of depression and anxiety, and see a health care provider if you or someone you are caring for is suffering.

Help older adults express their feelings. During the reconstruction phase after a disaster, older persons may feel frustration with the complexities of recovering, and feel apathy or depression. Anniversary observances can help by giving participants an opportunity to express their feelings.

Help older adults navigate through the complexities of disaster relief procedures, which may be confusing for survivors, causing low self-esteem and feelings of anger and helplessness.

Advocate for financial assistance. Older adults may refuse offers of help. Seeking financial assistance from the government or relief agencies may be confusing and burdensome.

Collect information about available resources. If an older family member is relocated and now living with family or friends, they should learn all they can about health and other services that may have already been provided or are yet to begin.

What help can older adults provide in times of disaster?

During a disaster, not all older adults fall into the category of those needing help, and many can provide much-needed assistance. Many older adults already volunteer much of their time and expertise, and many are familiar with community resources. If you wish to provide help, check with your local government, hospitals, faith-based organizations, and Red Cross chapter to find out where you are needed.

After a Disaster

Once immediate danger has passed, caregivers and family can help:

• Establish the older person’s feelings of security, stability, and safety
• Reunite the older person with family or a caregiver, and reestablish social contacts
• Obtain financial assistance
• Connect the older person with a health care provider and/or a mental health care provider if necessary, and reestablish medication regimens
• Return the older person home if possible, or if relocation is necessary, to a suitable residence, ideally in familiar surroundings with family, friends or acquaintances.
• Recover physical possessions, make frequent home visits, and arrange for companions

Signs of Psychological Distress Following a Disaster

• Withdrawal
• Apathy (lack of emotion or interest)
• Agitation
• Anger
• Irritability
• Suspiciousness
• Disorientation
• Confusion
• Memory loss
• Rapid physical decline
• Increase in physical symptoms for which there may be no medical reason
• Transfer trauma (the distress and disorientation of being evacuated)
• Sleep disorders
• Feelings of isolation from family and familiar patterns of life
• Regressive behavior (a lower level of functioning; or child- or infant-like behaviors, such as finger-sucking)

Recovery: Advice to Older Adults and Family Members

• Allow time for grief and healing. Do not expect recovery by a certain deadline.
• Speak openly about your feelings of fear, anxiety, irritability, or other unexpected emotional reactions
• Ask for financial, emotional, and medical help if needed
• Take time to relax
• Join in recovery efforts, if possible

Beware the Silent Killer: Carbon Monoxide

During disasters, electricity is often unavailable and many people turn to alternate sources of power and heat, such as generators or gas barbecues and heaters, which should never be used indoors. The fumes from these devices contain carbon monoxide (CO), which is an odorless, colorless gas. Approximately 500 deaths and 15,000 emergency room visits occur each year due to unintentional CO poisoning. Older adults over 65 years of age are especially vulnerable due to pre-existing medical conditions.

First signs of exposure to CO include mild headache and shortness of breath with moderate exercise. Continued or acute exposure can lead to flu-like symptoms including more severe headaches, dizziness, tiredness, nausea, confusion, irritability, and impaired judgment, memory and coordination. CO is called the “silent killer” because if these early signs are ignored, a person may lose consciousness and be unable to escape the danger, and eventually will die.

Checklists

Developing a Disaster Response Plan

• Determine if you live in an evacuation zone
• Know where you would evacuate to and how you would get there—know official evacuation routes
• Keep a full tank of gas in your car if an evacuation seems likely
• Know how to operate a generator properly (always keep generators outside and away from doors, windows, and vents; fumes can be deadly)
• Give keys to your home and car to a member of your support network
• Assemble a disaster supplies kit

Basic Disaster Supplies Kit

• Water (one gallon per person per day for at least three days)
• Non-perishable foods for at least three days
• Manual can opener
• Portable, battery-powered radio or television and extra batteries
• Flashlight with extra batteries
• List of medications and contact names/phone numbers ofhealth care providers
• Important family documents in water-proof container (See “Documents to Collect Prior to a Disaster” on page 12)
• Moist towelettes
• First-aid kit
• Whistle
• Cash (ATMs rely on electricity, which may be out)
• Special needs items, such as prescription medications (a two weeks’ supply), eye glasses, contact lens solutions, and hearing aid batteries
• Pet food and extra water for a pet
• Extra clothing

Documents to Collect Prior to a Disaster

• Driver’s license, identification card, VA card, passport
  Social Security card or number
• Name and contact information for relative or close friend
• Family records
• Personal medical information/records (blood type, diseases, conditions, allergies)
• Medical insurance and Medicare cards
• Medical providers’ names and contact information
• Credit card and bank account information (names, account numbers)
• Savings and investment records
• List of insurance policies with name of company, type of policy and policy number
• Copy of will and trust documents, living will
• Deeds and titles (house, car, other property)
• Certificates or a copy of them: birth, marriage, divorce, death, and adoption
• Tax records
• Keys
• Make/model and serial number of medical devices or other life-sustaining devices
• Additional copies of these records sent to members of your support network

Resources

Organizations

American Red Cross
An emergency response organization.
National Headquarters
2025 E Street, NW
Washington, DC 20006
202-303-5000
For Disaster Services & Emergency Assistance, phone:
1-800-REDCROSS (1-800-733-2767) or
1-800-257-7575 (Español)
www.redcross.org

Centers for Disease Control and Prevention (CDC)
Emergency Preparedness and Response
Information on preparing for and responding to public health emergencies.
1600 Clifton Road
Atlanta, GA 30333
800-CDC-INFO (800-232-4636)
http://emergency.cdc.gov

Eldercare Locator
A public service of the U.S. Administration on Aging, providing help finding local agencies that can help older persons and their families access home and community-based services like transportation, meals, home care, and caregiver support services.
800-677-1116
E-mail: eldercarelocator@n4a.org
www.eldercare.gov

Federal Emergency Management Agency (FEMA)
Agency of the U.S. government tasked with disaster mitigation, preparedness, response and recovery planning.
P.O. Box 10055
Hyattsville, MD 20782-7055
800-621-FEMA (3362)
FEMA-Correspondence-Unit@dhs.gov
www.fema.gov

National Center for Post-Traumatic Stress Disorder
(NCPTSD)
A center within the U.S. Department of Veterans Affairs providing fact sheets, videos, and more about trauma to help answer your questions about PTSD and related issues.
802-296-6300
ncptsd@va.gov
www.ncptsd.va.gov

Prepare.org
Disaster preparedness information from the American Red Cross.
www. prepare.org

Ready.gov
A website of the Federal Emergency Management Agency to educate Americans about how to prepare for emergencies including natural disasters and potential terrorist attacks.
www.ready.gov

U.S. Environmental Protection Agency (EPA) Natural
Disasters and Weather Emergencies
Disaster planning, preparation, response, and recovery information.
www.epa.gov/naturalevents

U.S. Food and Drug Administration (FDA) Tips about Medical
Devices and Hurricane Disasters
www.fda.gov/medicaldevices/safety/emergencysituations/ucm055987.htm

Publications

American Association for Geriatric Psychiatry (AAGP) Position Statement: Disaster Preparedness for Older Americans: Critical Issues for the Preservation of Mental Health. November 2008. Am
J Geriatr Psychiatry. 17:11, November 2009. AAGP website:
https://aagponline.org/prof/position_disasterprepare.asp.

Oriol, William. Psychosocial Issues for Older Adults in Disasters.
Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Department of Health and Human Services; 1999. SAMHSA website:
http://download.ncadi.samhsa.gov/ken/pdf/SMA99-3323/99-821.pdf

Substance Abuse & Mental Health Services Administration. Care Tips for Survivors of a Traumatic Event: What to Expect in Your Personal, Family, Work, and Financial Life. April 2003. SAMHSA
website: http://mentalhealth.samhsa.gov/publications/allpubs/KEN-01-0097/default.asp.

Wilken, Carolyn S. Preparing for a Disaster: Strategies for
Older Adults. University of Florida IFAS Extension. August 2005.
University of Florida IFAS website:
http://edis.ifas.ufl.edu/pdffiles/fy/fy75000.pdf.

Acknowledgment

This guide from the American Assocation for Geriatric Psychiatry is made possible by the work of the Disaster Preparedness Task Force of the American Association for Geriatric Psychiatry. American Assocation for Geriatric Psychiatry wishes to thank Kenneth M. Sakauye, MD; Joel E. Streim, MD; Gary J. Kennedy, MD; Paul D. Kirwin, MD; Maria D. Llorente, MD; Susan K. Schultz, MD; and Shilpa Srinivasan, MD.

Older Adults & Mental Health Brochure Series

This publication is part of a series of brochures published by the American Assocation for Geriatric Psychiatry to provide information about the mental health of the elderly. Other AAGP brochures include:

• Anxiety and Older Adults: Overcoming Worry and Fear
  Sleeping Well As We Age: Insomnia is Not a Normal Part of Aging
• Healthy Aging: Keeping Mentally Fit as You Age
• Substance Abuse and Misuse Among Older Adults
• A Guide to Mental Wellness in Older Age: Recognizing and Overcoming Depression (A Depression Recovery Toolkit)
• Depression in Late Life: Not a Natural Part of Aging
• Depression in Late Life (in Spanish) – Depresión Tardía: No Es Una Parte Natural Del Envejecimiento
• Coping with Depression and the Holidays
• Caring for the Alzheimer’s Disease Patient: How You Can Provide the Best Care and Maintain Your Own Well-Being

To view brochures online, visit Consumer/Patient Information. Order from the website or call 629-216-2013 .

Find a Geriatric Psychiatrist

A geriatric psychiatrist is a medical doctor with special training in the diagnosis and treatment of mental illnesses that may occur in older adults. These include, but are not limited to, dementia, depression, anxiety, alcohol and substance abuse/misuse, and late-life schizophrenia. Geriatric psychiatrists can help their patients navigate the health care system. The American Assocation for Geriatric Psychiatry can provide the names of geriatric psychiatrists. Visit www.aagponline.org or call 629-216-2013.

Help Spread the Word

If this information has been helpful, consider helping the American Assocation for Geriatric Psychiatry reach more people—older adults, their families and friends—by donating. Your donation will help spread the word that mental illness is not a normal part of aging, and that help is available. To donate, visit www.aagponline.org and select “How to
Contribute,” or call 629-216-2013.

 

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