Older Adults and Disasters
Natural disasters are varied and are generally defined as events that have rapid and profound effects on the natural and social environment, causing significant financial loss, trauma, or death. Lethality and long-term consequences of natural disasters are worse for women, minorities, impoverished individuals, older adults, and other marginalized groups even in wealthier societies, depending on how disaster management occurs. Reference Walters and Gaillard1
Scholars point to numerous sources of stress for older adults in disaster situations. Older adults at large are more likely to be socially isolated. For older adults, chronic disease, as well as stress and anxiety from extreme weather events and disasters, can affect mental and cognitive health. Reference McDermott-Levy, Kolanowski and Fick2
Aging in Place and Disasters
Researchers have found that older rural Americans are typically long-time residents in their homes and desire to age in place. Aging in place is often assumed to be a positive experience Reference Anarde3; however, this does not hold true in the context of disasters where there is a lack of congruence between needs, supplies, and environment. An experience of forced relocation is 1 of the most stressful events that can occur in a person’s life, and many people may be willing to endure significant hardship to remain in their homes, Reference Henderson, Roberto and Kamo4 even if circumstances are sub-optimal or unsafe.
Hurricane Michael
In October 2018, Hurricane Michael was the strongest hurricane recorded to strike the Florida Panhandle, reaching a Category 5 strength. The household income, employment status, poverty status, and health insurance status of individuals 65 and older in Jackson County reflects what is typical for individuals experiencing social and economic hardship. Reference Smith and Trevelyan5
Federal Emergency Management Agency (FEMA) Information Data and Analysis reported that, after Hurricane Michael, there were 3309 survivors in Jackson County aged 65 and older who registered for financial assistance. 6 To align emergency management plans with the reality of the specific community and area being serviced, ie, to build a culture of preparedness, one must survey the population, assess the real needs of its residents, and identify groups that historically have been underserved. As emphasized, older adults are considered to be at higher risk of poor social and health outcomes due to mobility issues, chronic health conditions, fixed incomes, etc. Reference Bodstein, de Lima and de Barros7 According to Hirsch (2019), declining health and economic constraints can place older adults at increased risk of injury, death, and physical and psychological loss during and after disasters. Reference Hirsch8
Study Purpose
In this study, researchers endeavored to understand how adults aged 65 and older in Jackson County, Florida prepared for and coped with the effects of the disaster within the application of FEMA’s National Disaster Recovery Framework, which supports the recovery of states, tribes, territories, and local jurisdictions. Specifically, the study sought to answer the following questions: (1) What resources are available to individuals aged 65 and older in rural communities to prepare for a disaster? (2) What challenges do individuals aged 65 and older in rural communities face when experiencing a disaster? (3) What are the physical, social, emotional, and financial needs of individuals aged 65 and older in rural communities when a disaster strikes?
Methods
The interdisciplinary team for this project consisted of research experts from the United States, Canada, Ireland, Scotland, Sweden, and Brazil, representing disciplines including gerontology, disaster preparedness, social work, psychology, nursing, mental health, public health, community health, and public policy.
A cross-sectional survey method was used, where face-to-face surveys were administered as an interview to collect information from older adults (65+) in Jackson County, Florida, following the 2018 Hurricane Michael. The interdisciplinary team developed measures to administer face-to-face cross-sectional interviews for this exploratory study that were probing in nature to capture a descriptive profile of the residents, identify critical trends regarding disaster planning, and capture attitudes regarding disaster planning and concerns.
Study Recruitment
The ethics committee from the Federal Emergency Management Agency and the Florida Department of Health in Jackson County reviewed and approved the study, and written consent was obtained from the participants before participation. There were no monetary incentives used to recruit the participants. Members from the Department of Health at Jackson County acquired permission from 15 local organizations to conduct the survey with local study participants. Study participants were recruited from 1 of 12 locations in the county. A total of 139 interviews were included for analysis. A total of 14 surveys were removed due to incomplete information and survey respondent issues.
Measures
The survey was developed to include 20 questions measuring demographic characteristics, living arrangements, types of informal and formal supports, use of 1 or more assistive devices, access to medications, chronic condition needs during the disaster, perceived mood postdisaster, perceived knowledge of disaster preparedness, and communication access during a disaster.
Statistical Analysis
Due to the exploratory nature of this study, descriptive statistical analysis was performed, including frequencies, cross-tabulations, and correlations. This analysis was followed by multivariate logistic and linear regressions examining the relationship between demographic information (age, gender, race, educational level, living and housing situation) and needs, concerns, and consequences of disaster. In a second set of models, educational level was replaced with income to examine the associations for this socioeconomic predictor. Due to small sample sizes, these results should be interpreted with caution.
Results
The sample characteristics of 139 participants are provided in Table 1. The mean age of the sample was 73.2 y (standard deviation [SD], 7.3; range, 61-92 y). Participants were predominantly female (73.4%), Black/African American (54.7%) or White (43.9%), and living alone (41%). Participants had diverse income levels and living and marital situations (Table 1). For example, one-quarter of respondents lived in a mobile home. Compared with the older population in Jackson County at large, the sample had a higher proportion of females and did not include any Hispanic individuals.
Table 1. Sample characteristics of the study (N = 139)
Note: *one person reported other, ** 4 individuals did not report income, they were included in lowest category+ *** only one person reported living on a farm.
The descriptive findings regarding resources, needs, barriers, concerns, and consequences of disaster situations for older adults who responded to the face-to-face survey interviews are summarized in Table 2. The results indicate a strong reliance of older adults on social networks when it comes to locating resources. Family, friends, and neighbors were the most likely first points of contact for assistance after a disaster. For the majority of respondents (n = 117; 84%), family, friends, and neighbors were also the most likely to help participants prepare for disasters. More than a half of the participants (54.7%) relied on only 1 source of support. There was substantial variation within this figure, however, with 10% of respondents reporting being unsure of whether they could secure aid in preparing for a disaster, and 35.3% reporting that they could secure aid and get help from 2 or more sources.
Table 2. Descriptive information regarding a) resources, b) needs, barriers & concerns, and c) consequences of disaster. Unless otherwise reported the values represent count and percentage
*includes those reporting decrease in mood more than a year ago (n = 6).
Despite its importance as a source of assistance, social networks played a comparatively minor role as a source of information during disasters. Respondents were asked to select 1 response identifying how they learned about disasters (health department, senior center, radio, TV, friends/neighbor, or church). The majority of respondents (88.5%) reported that they were likely to learn about emergencies from radio or television. Finally, there was substantial variation in respondents’ financial resources in case of evacuation. Nearly one-fifth of respondents could not or were unsure if they could pay for food and housing for even a single day in the event of an evacuation. More than one-third of the participants (n = 51; 36.7%) reported that they could only sustain costs for only 1-3 d.
Nearly half of the respondents (n = 61; 43.9%) reported requiring some form of assistance during the evacuation. The most common needs identified were associated with mobility, such as needing help with transportation (23%) or having a walker or cane (17.3%). Respondents were most likely to report arthritis, diabetes, and mobility issues as the health conditions most likely to affect their ability to evacuate (see Table 2). The number of initial concerns respondents reported when a disaster watch or warning was issued varied substantially. The mean number of selected concerns was 2.8 (SD, 2.0), with a range from 0 to 9. The most common concerns involved basic needs, including safety (60.4%), medicine (56.1%), shelter (36.0%), and food (33.1%). Approximately half of the participants reported a decrease in mood (n = 70; 51.1%) as a result of the hurricane.
The mental health of older adults in Jackson County after the hurricane appears to have worsened, with nearly half (46.8%) of participants stating a decline in mood. Only 38% of study participants indicated no change in their state of mind.
The exploratory multivariate analyses showed that those older individuals were less likely to rely on formal help when preparing for (odds ratio [OR], 0.89; 95% confidence interval [CI]: 0.78-1.01) and recovering from a disaster. Predictably, older individuals, (OR 1.02; 95% CI: 0.96-1.08), African Americans/Blacks (OR 1.30; 95% CI: 0.58-2.88), as well as those living alone, (OR 2.90; 95% CI: 1.14-7.4) reported greater need for assistance. African Americans/Blacks tended to report lower knowledge about emergency kits (OR 0.40; 95% CI: 0.15-1.02), lower ability to cover costs in case of evacuation, and had a higher predicted mean number of concerns when a warning was issued (Figure 1). Thus, they are an essential group to focus on. Another at-risk group seemed to be those living in mobile homes. They reported having access to less help after a disaster and had a smaller total number of resources (Figure 1) they could draw on in disaster situations.
Figure 1. Figures of predicted mean number of (left) resources after disaster by housing type and (right) concerns when watch is issued by race. Multivariate analyses were adjusted for age, gender, race (left) and education, living situation, and dwelling (right).
Discussion
The findings presented in this report indicate that older individuals rely mainly on family and friends and less on social services and institutional help for disaster preparedness and recovery. This is consistent with previous findings Reference Kim and Zakour9 and is a significant predictor for how rural older adults prepare for disaster-related emergencies. The study findings also revealed that individuals aged 65 and older lack disaster preparedness and are disproportionately affected when a national disaster strikes. The analysis identified lack of transportation as a key challenge for older adults during an emergency evacuation situation.
Most participants indicated concerns about access to their medications or the challenges of finding food. Of equal importance are older adults’ wide range of physical, social, emotional, and financial needs when a disaster strikes.
There is a close link between poverty and disasters; in this study, nearly half of the participants had an income of less than $1041 monthly, equivalent to the federal poverty level. There is also a direct link between poverty and literacy. This study revealed that some of the study respondents had literacy deficiencies, making it challenging for them to access disaster preparedness materials. These findings align with previous studies that suggest a gap between population literacy and the level of education required to read most disaster preparedness materials. Reference So, Franks and Cree10
Limitations
There are several limitations in applying the findings from this pilot study. Only those organizations that were already engaged in disaster relief work were likely to respond to the project team’s request for assistance in recruiting respondents. The sample size was also relatively small and homogeneous in terms of geographic location and race, which limits the ability to generalize the study findings to more diverse populations.
Conclusion
This study shows that many older adults face obstacles in preparing for and responding to disasters. The high percentage of survivors in these counties (Figure 2) who are aged 65 and over suggests the counties consider supporting the construction of accessible housing in preparation for future disasters. It is crucial for federal, local, and state government, as well as community organizations, and trusted relief agencies for national disasters to work together to help older adults prepare for and recover from disaster-related catastrophic events.
Figure 2. Percentage of population over 65 y of age – designated counties for individual assistance.
Acknowledgments
We thank survey participants for their time and for providing valuable information. This work is a part of a collaborative partnership with FEMA Interagency Recovery Coordination, Florida A&M University, and a team of International Scholars in support of the Florida Health Department in Jackson County. We acknowledge the FEMA Joint Field Office Management Team for DR-4399-FL Hurricane Michael: Thomas J. Dargan, Federal Coordinating Officer; Leda Khoury, Federal Disaster Recovery Coordinator; and Jeffrey L. Coleman, Deputy Disaster Recovery Coordinator.
Survey Implementation Team
Federal Emergency Management Agency: Patricia A. Fletcher, Principal Investigator and Kiarah Turner, Research Assistant. Florida A&M University Cooperative Extension: Vonda Richardson, Administrator; Dreamal L. Worthen; Kimberly Davis, Eunice Stevenson, and Summer Kilpatrick. Florida Department of Health at Jackson County: Sandy K. Martin, Administrator, Katrice Davis, Mary Beth Gurganus, Karen Edwards, and Natalie Johnson.
