Just a couple weeks ago, the majority of the nation was battling bitter cold temperatures and high snowfall, a result of extensive winter storms and the polar vortex. New research from the American Journal of Public Health finds that those least prepared during natural disasters, as some experienced this winter, may be our nation’s seniors.

Whether a dangerous winter storm, hurricane or earthquake, researcher Tala Al-Rousan, MD, offers insight on preparedness concerns for older Americans in the U.S. Al-Rousan is currently working toward a Master of Public Health at the University of Iowa, studied medicine at Cairo University – Egypt, worked with Doctors Without Borders and maintains research interests in disaster preparedness, aging and preventive medicine. She discusses her recent findings with Public Health Newswire.


Q: How are older adults less prepared than other Americans for natural disasters?
We continue to see a disproportionately large number of older adults affected by natural disasters despite both greater vulnerability and continuous growth in the number of older adults.

In Hurricane Katrina, the highest mortality rates were among older adults. Senior citizens have the highest health decline and suicide rates in almost all disasters, which says something about them being under prepared. Many older adults live alone and are at the risk of isolation during disasters. The worst health outcomes after a disaster can descend on those without working phones, electricity, transportation or relatives who can help them. They already have poorer functional and mental status than other Americans and this increases the chances of them being invisible to the relief and emergency system.

Lower socioeconomic status of older adults also impairs their ability to evacuate during a disaster, or recover from it. We continue to hear of older friends or relatives who suffered or perished during a calamity because they were not prepared enough or their caregivers underestimated disasters’ effect on them.

Q: What was the most alarming finding in your analysis of preparedness among older adults?
Among the many factors that come into play when taking care of the elderly during disasters are health status, living situation and physical ability.

We analyzed data using a nationally representative cohort of older Americans using the Health and Retirement Study. About one-quarter of them live alone, many live in poverty and about one-third of them reported some form of disability and a fair or poor general health status. A considerable number reported using electrically powered medical devices that might be at risk in a power outage and some had hearing impairment to a level that prevents them from hearing warning sirens. These all show an increased risk for worse outcomes.

Only one-third of older adults queried reported participating in an educational program or reading any materials about disaster preparation. About half did not know of a specific shelter location in their community in case they had to abandon their homes. A quarter of the respondents did not have access to a car and stated they could not secure private transportation had disaster struck. Only a modest percentage reported having any specific plan of what to do in case of an emergency or disaster.

We also found correlations between factors such as increasing age, race, physical disability and lower educational attainment and income and disaster preparedness.

Q: What kind of risks — physical, mental, etc. — does being unprepared for emergencies put on older adults?
Limitations in activities of daily living and instrumental activities of daily living render older adults particularly vulnerable to physiologic stresses during natural disasters. Chronic illness exacerbations, damage to assistive devices and service or treatment interruption are all possible scenarios that deplete the physical and emotional reserves during crises.

Some use mobility devices that need electricity. Others cannot hear warning sirens. It is stated in the literature that older adults are more prone to suffer the consequences of extreme temperatures or noisy crowded shelters. Their chronic conditions are worsened by these weather changes more than younger people and at a lower threshold.

Other studies have shown that emotional and mental distress could result from natural disasters. Disasters can be very “disequilibrating,” especially to patients with early stages of Alzheimer’s disease or dementia as well as other older adults at risk of post-traumatic stress disorder. Also, the shortage in medication and the fact that meals and packages distributed to shelters during a disaster usually contain too much sodium and sugar is not an acute problem, but highlights the importance of preparedness.

Q: What kinds of steps are being made to improve preparedness among older Americans? Are any of these steps that the general public can help with?
The Centers for Disease Control and Prevention, the National Institute on Aging as well as other governmental and non-governmental aging networks at the state and national levels are concerned with older adults’ preparedness. There are several examples of state and local preparedness plans and tool-kits such as the CDC’s guide used by states and communities. Useful guides are out there and some of them are written by older adults, which make them more valuable than others. For example, this guide is written by a group of older adults who experienced a two-week power outage because of an ice storm in New York area.

The community itself plays an important role in preparing and responding to disasters. Trained local leaders, health coaches, “block captains” and other residents from the community who are able to identify, reach older adults and help them prepare and respond to emergencies are examples that proved valuable.

Understanding potential older adult health, medical and social concerns is key in order to appropriately plan for disasters. Whether living in assisted living, nursing homes or in the community, developing a plan, cross-sector collaboration and proper communication before, during and after disasters are vital.