Toolkit: Building Resilience in Older Adults: Step 03. Improving Older Adults' Resilience

This step summarizes activities that aging-in-place groups and public health departments can undertake collaboratively to promote older adults' resilience.

What Is This Step?

In this Step, we provide a summary of activities that aging-in-place groups and public health departments are already doing to promote older adults' resilience. Our interviews suggested that, in most locations, there is no agency working specifically on disaster preparedness or resilience education and outreach for older adults. However, villages, AFCs, and public health departments all reported engaging in some activities that can promote older adults' resilience (Table 3.1, Table 3.2, Figure 3.1, Figure 3.2).

This Step also summarizes activities that these groups can undertake collaboratively to promote older adults' resilience (Figure 3.3).

How Do Villages Promote Older Adults' Resilience?

Interviews with villages suggested that the majority of villages provided at least one activity aimed at improving the resilience of their members, ranging from educational sessions to one-on-one visits to prepare an emergency preparedness kit. The activities varied based on the needs of the village members and abilities of the village staff but could be grouped into three general approaches:

  1. outreach and information-sharing by village staff and volunteers to improve members' knowledge and supports,
  2. improving communication between members and first responders, and
  3. working with members to assess preparedness and plans for emergencies.

For each of these approaches, Table 3.1 lists example activities being done by villages we interviewed.

Table 3.1. Example Resilience Activities Currently Being Conducted by Villages

General Approach Example Activity
Information sharing and outreach
  • Provide brochures with information about disaster preparedness and emergency services
  • Call members before, during, and after disasters
  • Provide reminders and support to change smoke detector batteries
Improving communication with first responders
  • Assist members to enroll in Smart911 or other registries to make emergency responders aware of members' needs (e.g., Vial of Life program)
  • Host education sessions from local emergency response/preparedness entities
  • Support medical alert systems (monitors, buttons)
Assessment and planning
  • Provide home safety inspections (tripping hazards, fire safety) by villages, fire department, or another agency
  • Support emergency planning, including having supplies on hand and phone numbers of who to call
  • Support advance care planning conversations (wishes in case of a health event)

How Do Age-Friendly Communities Promote Older Adults' Resilience?

AFCs proactively engage their members around emergency preparedness and resilience issues specifically and coordinate with partners that are directly responsible for emergency preparedness (for example, emergency managers, fire, police)—usually other municipal agencies.

An example of a city AFC is Age-Friendly DC, based in Washington, D.C. This initiative is built on an overarching policy and community engagement framework focused on a broad array of issues, including transportation, housing, health, and finances. The goal of this collective-action effort is to ensure that "all DC residents are active, connected, healthy, engaged and happy in their environment" (Age-Friendly DC, undated).

Table 3.2 contains information from the Age-Friendly DC strategic plan that outlines key goals and objectives related to preparedness and resilience. This example shows how one city is integrating resilience into usual care systems—by asking individuals to register for emergency communication and identification systems during their intake for nonemergency direct services. This example also shows the wide range of partners that can contribute to building older adults' resilience.

Table 3.2. Age-Friendly DC Strategic Plan Excerpt, Emergency Preparedness and Resilience Domain

Domain 9. Emergency Preparedness and Resilience, a DC focus: Information, education, and training to ensure the safety, wellness, and readiness of seniors in emergency situations Lead Agency Partners
Goal 9.1: Identify, locate, and reach special, vulnerable, and at-risk older resident populations in an emergency.
9.1.1: Increase AlertDC, Smart911, and SmartPrepare enrollment by requiring direct service contractors and grantees to offer enrollment during the client intake process. DCOA, DDS, DHS, DBH, DHCD, DDOE, DCHA, CFSA OUC, HSEMA
9.1.2: Provide training on preparedness practices to shelter in place or relocate to accessible shelters when necessary DOH, Serve DC DHS, DGS, ODR
Goal 9.2: Build individual and community resilience
9.2.1: Develop a plan to ensure uninterrupted prescription refills to residents with chronic medical conditions in the event of an emergency. DHCF DOH (Board of Pharmacy)
9.2.2: Promote and support personal responsibility and first-responder opportunities for residents and neighborhoods. EOM
9.2.3: Create and assist community-supported neighbor-to-neighbor networks across the city that are accessible to all income levels (e.g., villages, fraternal organizations, faith-based communities, neighborhood associations). HSEMA, DCOA, EOM DMHHS
9.2.4: Provide guidance and require direct service contractors and grantees considered essential to develop a continuity of operations plan. HSEMA, OCP All agencies with direct service contracts and grants

PROGRAM DEFINITIONS: AlertDC: communications system that sends emergency alerts, notifications, and updates to devices; Smart911: can add key information about members of your household that would help first responders care for you in the vent of an emergency, whether from home or mobile; SmartPrepare: citizens share key information with emergency responders and public health officials, allowing officials to more effectively handle complex and dynamic incidents.

AGENCY ACRONYMS: DCOA: DC Office on Aging; DDS: Department on Disability Services; DHS: Department of Human Services; DBH: Department of Behavioral Health; DHCD: Department of Housing and Community Development; DDOE: Department of Energy & Environment; DCHA: DC Housing Authority; CFSA: Children and Family Services Agency; DOH: Department of Health; Serve DC: Mayor's Office on Volunteerism; DHCF: Department of Health Care Finance; EOM: Executive Office of the Mayor; HSEMA: Homeland Security and Emergency Management Agency; OCP: Office of Contracting and Procurement; OUC: Office of Unified Communications; DGS: Department of General Services; ODR: Office of Disability Rights; DMHHS: Office of the Deputy Mayor for Health and Human Services.

Interviews with AFC coordinators also suggested that some AFCs are engaged in resilience as an extension of their work around neighborhood cohesion and social engagement. The leader of one of these AFCs, for example, described how the everyday engagement of older adults with friends, neighbors, and trusted institutions supported other agencies' resilience efforts by strengthening informal ties and building information networks. In the event of a disaster, they believed that older adults would be less isolated and more able and willing to reach out for help or follow instructions because of the AFC's social engagement efforts.

Figure 3.1. shows an example of how one AFC incorporated resilience into its social participation and inclusion work. In this example, resilience is framed as being a key outcome for the community and is linked with improved health and recreation programs.

Figure 3.1. An Excerpt from Age-Friendly Portland's Strategic Plan Highlighting Its Resilience Work

Charge
Portland will see a substantial increase in the population of older adults, both in size and as a percentage of the population. Properly supported, this generational shift can result in a more resilient Portland with stronger neighborhoods where people can grow up and grow old.
Recommendation
Recreation Rx: Health programs that promote recreation should be incorporated into neighborhoods. Physical activity and recreation are important for the health of all people; older adults often lack accessible recreational opportunities and information about activities that are available. The expansion of social and recreational opportunities to engage people's bodies and minds will keep older adults more resilient.
Implementation strategies
Improve coordination between Portland Parks and Recreation (PP&R) and local health providers.
Work with health care providers and local advocacy partners to expore and expand a scholarship program for low-income seniors.
Add additional PP&R staff members to meet the demand for senior recreational services.
Expand PP&R scholarship and fee-waiver budget in order to provide additional older adults with recreational opportunities.
Expand age-friendly fitness centers in community centers and outdoor fitness stations in park areas.
Adopt Access Recreation practices and policies to increase awareness of outdoor recreation facilities and their level of accessibility so people can make more informed choices.
Promote PP&R programming in hospitals and clinics.

What Do Public Health Departments Do That Promotes Older Adults' Resilience?

Findings from our interviews provided a snapshot of how public health departments promote older adults' resilience. In most cases, public health departments do not explicitly conduct preparedness or resilience activities just for older adults, nor do they make this group a special focus of programming and planning. Public health department representatives describe their preparedness and resilience activities as having broad relevance that cuts across population groups and claim that these messages and activities do not require tailoring for older adults or other specific groups. For example, educational "lunch and learn" sessions on preparedness topics and medication-dispensing simulation exercises are noted as general-focus activities from which older adults might benefit but are not targeted specifically at older adults. Most interviewees challenge the idea that older adults are universally vulnerable and explain that many of their agencies focus on vulnerability factors (e.g., functional limitations, intellectual disabilities, medical needs, not speaking English) rather than populations defined by older age. Respondents acknowledge that while some vulnerability factors, especially around disability and medical needs, might be more common in older adults, there seems to be a resistance to using age as a proxy for vulnerability in and of itself. Figure 3.2 lists the most common types of activities that public health departments described as contributing to older adults' resilience. These activities are grouped by those done in partnership with older adults, those done in partnership with other organizations, and those done within the public health department.

Figure 3.2. Examples of Public Health Department Activities That Promote Older Adults' Resilience

With older adults in the community
Conduct outreach to older adults to recruit volunteers for disaster exercises, such as a medication-dispensing exercise.
With other organizations
Work with long-term care facilities or other residential facilities for older adults (e.g., senior housing) to help facilities plan for emergencies or to offer preparedness education activities with residents in conjunction with the facilities.
Partner or coordinate with other health departments, Area Agencies on Aging and similar organizations, Red Cross, and other nonprofit-type organizations (such as the Alzheimer's Association) in order to distribute their preparedness messages and programming broadly, including to organizations serving older adults.
Within the public health department
Develop messages and activities for vulnerable groups, such as individuals with functional limitations, intellectual disabilities, or medical needs or who do not speak English (which may include older adults with specific vulnerabilities).

What Are Public Health Departments and Groups That Support Aging in Place Doing Collaboratively to Promote Older Adults' Resilience?

Our interviews suggested that there is limited collaboration between these groups. However, Figure 3.3 summarizes some examples of activities that these groups are doing or that interviewees suggested as ways to improve their partnership. These are intended as examples and do not represent a comprehensive list of all possibilities.

Figure 3.3. Examples of Collaborative Activities to Promote Older Adults' Resilience

Collaborative Activities
Encourage older adults to sign up for emergency information systems (e.g., Smart 911, Code Red).
Partner to bring key health-promoting services to older adults (e.g., flu shots, inspections for issues that exacerbate respiratory illnesses).
Participate in preparedness planning to ensure that the needs of older adults are represented.
Develop/provide feedback on concise targeted educational materials for older adults.
Train or educate each other on specific areas of expertise (e.g., older adults, emergency preparedness).

Given their role as a public-private agency coordinating body, AFCs are well positioned to cultivate relationships between public health departments, villages, and emergency management agencies and amplify and support ongoing efforts—rather than duplicated effort—by leveraging existing programming and expanding dissemination of other agencies' work. These types of collaborative relationships are important for villages—especially for small to mid-size villages that lack the staffing capacity or resources to design their own preparedness educational materials or curriculum. While having local preparedness partnerships and strong programming around preparedness does not guarantee uptake by village members, our interviews showed a high interest among nearly all villages related to planning for or preventing health emergency events. Encouraging older adults to join or sign up for emergency information systems could ensure that first responders are aware of specific needs of older adults and are able to locate and support older adults when responding to a health emergency or to a disaster.

Village members may be more motivated and willing to put time into activities they perceive as having broad applicability or multiple benefits, beyond the disaster scenario that might be easier to ignore as unlikely. Villages can be a trusted broker to connect members to other services and information and, with partners, can develop messaging that draws connections between resilience dealing with everyday stress and health-related emergency preparedness and disaster resilience. This could include partnering to bring key health-promoting services to older adults. Public health departments can use flu clinics (at which flu shots are dispensed) as a way to test the processes they use to reach older adults with needed medication in the event of an infectious disease outbreak, in partnership with village members. Public health departments and AFC leadership could also coordinate to provide household inspections for issues that can exacerbate respiratory illnesses, such as asthma.

Because of their broad membership, AFCs are also well positioned as a forum for gathering agency input on disaster plans and educational materials developed by public health and emergency management agencies. Villages can also serve as a helpful place to gather input from older adults on the utility of materials and the feasibility of plans for communication and tracking systems for use with older adults.

To help disseminate these tracking systems, educational efforts may be needed to help older adults recognize their assets and vulnerabilities and identify areas in which they need assistance. Public health departments could provide training or education to village members on how to assess their assets and vulnerabilities and on available programs to improve communication with first responders about their needs. Similarly, AFCs' regular assessment of community and health services for older adults could provide useful information to inform public health departments' plans and villages' services. AFCs can provide a brief presentation tailored to the interests of public health departments and villages to further their partnership.

Ideally, public health departments, villages, and AFCs are working together seamlessly to advance their shared goal of building a community in which older adults can be happy, healthy, and safe in their homes. A strong partnership between these three groups means that they recognize each other's value, are regularly sharing information and resources, and are continually improving their own efforts and their shared efforts through input and engagement with each other and the older adults in their community.

How Can My Group Improve Older Adults' Resilience?

Use Worksheets 3.1, 3.2, and 3.3 to identify the activities that your group is already doing independently and in collaboration with other groups in your community, as well as activities that might be of interest in the short or long term. For each activity, select whether you are doing it now (Now) or whether it is something your group would like to plan to do in the short term (ST), long term (LT), or never (N). Taking some of these simple steps can help improve the resilience of older adults in your community.

Before implementing any activities, be sure to explore whether these activities might already be occurring in your community. This will help your group find the right partners and avoid any duplication of efforts.

Take the activities that you indicated your group would like to do in the short or long term and use Worksheet 3.4 to plan more details about how your group might accomplish these activities. There are spaces to include activities that your group can do on its own, as well as activities that can be done in collaboration with others.

Tools Used in This Step

Worksheet 3.1. Age-Friendly Communities Activity Self-Assessment and Planning

Worksheet 3.1. Age-Friendly Communities Activity Self-Assessment and Planning

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Instructions

  1. In the "Activity" column, list the activities that your group would like to accomplish in the short and long term.
  2. Indicate the time frame in which you are planning on completing these activities in the "Dates (Time Frame) for Completion" column.
  3. Identify the person(s) and organization(s) responsible for the activity and the source of any resources that will be needed (for example, "We will get volunteers from the local village") in the "Who Is Responsible" and "Where Will We Get Any Resources We Need?" columns, respectively.
  4. When the activity is complete, fill in the "Date Completed" column.

Worksheet 3.2. Villages Activity Self-Assessment and Planning

Worksheet 3.2. Villages Activity Self-Assessment and Planning

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Instructions

  1. In the "Activity" column, list the activities that your group would like to accomplish in the short and long term.
  2. Indicate the time frame in which you are planning on completing these activities in the "Dates (Time Frame) for Completion" column.
  3. Identify the person(s) and organization(s) responsible for the activity and the source of any resources that will be needed (for example, "We will get volunteers from the local village") in the "Who Is Responsible" and "Where Will We Get Any Resources We Need?" columns, respectively.
  4. When the activity is complete, fill in the "Date Completed" column.

Worksheet 3.3. Public Health Department Activity Self-Assessment and Planning

Worksheet 3.3. Public Health Department Activity Self-Assessment and Planning

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Instructions

  1. In the "Activity" column, list the activities that your group would like to accomplish in the short and long term.
  2. Indicate the time frame in which you are planning on completing these activities in the "Dates (Time Frame) for Completion" column.
  3. Identify the person(s) and organization(s) responsible for the activity and the source of any resources that will be needed (for example, "We will get volunteers from the local village") in the "Who Is Responsible" and "Where Will We Get Any Resources We Need?" columns, respectively.
  4. When the activity is complete, fill in the "Date Completed" column.

Worksheet 3.4. Plan for Short-Term and Long-Term Resilience Activities

Worksheet 3.4. Plan for Short-Term and Long-Term Resilience Activities

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Instructions

  1. In the "Activity" column, list the activities that your group would like to accomplish in the short and long term.
  2. Indicate the time frame in which you are planning on completing these activities in the "Dates (Time Frame) for Completion" column.
  3. Identify the person(s) and organization(s) responsible for the activity and the source of any resources that will be needed (for example, "We will get volunteers from the local village") in the "Who Is Responsible" and "Where Will We Get Any Resources We Need?" columns, respectively.
  4. When the activity is complete, fill in the "Date Completed" column.
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Summary

This Step provided guidance about the types of activities that villages, AFCs, and public health departments are already doing or could do to promote resilience on their own and in collaboration with each other (Table 3.1, Table 3.2, Figure 3.1, Figure 3.2, Figure 3.3). Now that you have completed this Step, you should have identified present and future activities for your group (Worksheet 3.1, Worksheet 3.2, Worksheet 3.3) and developed a plan for how to tackle these activities in the short term and long term (Worksheet 3.4). Step Four will help you to asess whether your efforts to promote older adults' resilience have had the desired effects.

Up Next:

Step 04. Evaluating and Improving

This step provides guidance on how to conduct an evaluation of your efforts, measure outcomes, and use these results to improve ongoing work.

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