Improving Disaster Resilience Among Older Adults: Insights from Public Health Departments and Aging-in-Place Efforts
Jan 23, 2018
Older adults — those age 65 and up — are especially vulnerable to natural disasters. A disproportionate number of deaths and injuries from disasters occur in this population. In the United States, most older adults are unprepared for an emergency, and many are socially isolated. Older adults are also more likely to have chronic health problems and functional limitations that hamper their ability to prepare for and respond to a disaster. Many need help evacuating during an emergency. Yet, some older adults can also contribute assets to disaster response: They can draw on their experience, resources, and relationship-building skills to prepare themselves and to support others during an emergency.
Public health programs are needed to identify older adults at risk in the event of disasters and to address their needs. Public health departments are the government entities primarily responsible for disaster-related public health and safety. However, because public health departments focus on the entire community, their programs may not meet the needs of all older adults.
Disaster resilience is the ability to recover from disasters and other problems and emerge stronger and better able to withstand future adverse events. One set of resources for improving the disaster resilience of older adults may already exist: efforts to promote aging in place, which is the ability to live in one's own home and community safely and independently, regardless of age. Research has shown that most older adults prefer to continue living in their homes rather than in institutional settings. Two kinds of organizations that currently promote aging in place are age-friendly communities (AFCs) and villages (see box). Both seek to link older adults to useful programs and services, such as transportation and home repair, and keep them connected to others in their communities.
Can current aging-in-place efforts help strengthen the disaster resilience of older adults? A research team led by RAND and the Centers for Disease Control and Prevention (CDC) conducted a study to address this question and assess the state of disaster resilience efforts for older adults. The team interviewed key informants from three stakeholder groups — staff from 11 public health departments, 16 AFC leaders, and 10 village executive directors. In addition, the team developed a toolkit intended to help these stakeholder groups build stronger connections with each other and bridge gaps in preparedness efforts for older adults in order to make them more resilient.
The interviews had two goals:
Stakeholder interviews revealed that most AFCs and villages did not place a high priority on promoting disaster preparedness. Many of these organizations cited a lack of demand among their constituents as the reason why they did not place greater emphasis on disaster preparedness. Village leaders in particular noted that most of their members were interested in daily quality-of-life issues. Village and AFC leaders also pointed to resource constraints and a lack of expertise in disaster preparedness as further explanation.
Public health departments focus on disaster preparedness, as well as preventing and managing chronic disease among the local population. Most departments, however, reported not having programs tailored specifically to older adults. Public health department programs targeted individuals with functional limitations (which encompass some older adults), but public health leaders did not view programming for all older adults as their responsibility. They cited government agencies that are focused on aging or older adults as the usual lead agency for such programming. Public health leaders also pointed out that there is often no single lead agency responsible for preparing or protecting older adults during a disaster. Most public health leaders in our sample were not assigned this responsibility, though they felt that their organization was capable of playing this role.
However, all of these stakeholders offered programing with direct relevance to disaster preparedness for older adults. Most villages conducted activities to improve information-sharing and outreach about household preparedness, communication with first responders, and assessment and planning, such as home safety inspections. Although these activities focus on household emergencies, there are clear connections between these preparations and readiness for natural disasters. Some AFC respondents observed that preparedness was a logical extension of their work on neighborhood cohesion and social engagement. They felt that these activities played a role in linking community preparedness in general with the specific needs of older adults and that bridging this gap — rather than delivering any specific services — holds promise for boosting older-adult preparedness.
The public health departments in our sample all engaged in preparedness planning and education, most of it focused on health emergencies or the health-specific part of a disaster event, such as rapid dispensing of medication or containing infectious diseases. Some also had programs related to chronic disease prevention and management (e.g., depression and diabetes), as well as reduction of health risks, such as tobacco use and fall prevention, all of which disproportionately affect older adults.
Leaders from all stakeholder groups also reported that there is currently little, if any, collaboration between aging-in-place efforts and public health departments in boosting the preparedness of older adults, despite the clear relevance and potential overlap of current efforts to help adults age in place and to improve disaster preparedness among local populations (see figure).
The interviews illuminated aging-in-place efforts that focus on older adults' daily needs rather than disaster preparedness and public health department efforts that promote disaster preparedness but are not tailored to older adults. Yet both efforts have relevance to the older adult population and its special disaster preparedness needs. To support collaboration between aging-in-place groups and public health departments, the research team developed a toolkit to clarify common ground between the activities of these groups and to build on this common ground to promote activities to enhance older adults' resilience.
Current aging-in-place efforts can be harnessed to strengthen the disaster preparedness of older adults, and existing public health programs can be adapted to focus on the preparedness of older adults.
The work was funded by the Centers for Disease Control and Prevention.