The far northern coastline of the state of Queensland, Australia has a long history of cyclone-related losses, including the most recent one associated with Cyclones Larry (2006) and Yasi (2011). Most seriously impacted during these recent events were numerous isolated coastal hamlets characterized by smaller, aging populations, a lack of adequate health services and public transport, as well as a high socio-economic disadvantage.Reference Gurran, Blakeley and Squires 1 As climate-change scientists warn of significant increases in natural disasters, 2 national and international frameworks have been developed to help identify and mitigate the risks local communities face from natural hazards.Reference Guzman 3
As such, Australia developed a nationwide resilience-based strategy for disaster management, providing planning guidance to governments, communities, and individuals. 4 Acknowledging that emergency services are invariably stretched during a disaster, the strategy emphasizes the importance of individuals taking responsibility for their own disaster preparation, planning, prevention, and recovery, reinforcing the importance of self-reliance, shifting responsibility from the State and placing it squarely with the individual. This Neo-liberalist strategy states that all citizens must be fully aware of the risks they might face, have the capacity to mitigate risks by being adaptive and resourceful, and must be capable of undertaking physical, cognitive, and financial decisions and actions during pre-disaster preparation, impact, and reconstruction. Unfortunately, adopting this “self-help” approach is a challenging undertaking for many of the more vulnerable community members, including the elderly. 4
Yet, aging predictions estimating that Australia’s proportion of people over the age of 65 years will double by 2031, 5 along with government policies that encourage people to “age-in-place” by providing subsidized in-home community-based care services, raise serious concerns for emergency managers. Flooding, communication loss, and inaccessible transport links lead to serious disruptions in vital in-home care services, leaving many vulnerable people isolated for extended periods of time.Reference Woods, West and Buettner 6 Thus, although “self-reliance” is an expectation of policy-makers, an elderly person’s ability to remain self-reliant depends directly on support from family, friends, and in-home care organizations who collectively enable an older adult to both “age-in-place” and prepare, cope, and recover from a disaster.Reference Wiles, Leibing and Guberman 7 Given aging population predictions and those forecasting increases in the frequency and intensity of natural disasters, the objective of this qualitative, phenomenological research was to explore the disaster experience of older independent-living adults (65 years and older) in regional coastal hamlets in far north Queensland, Australia, as well as the views of local policy-makers and those who assist the elderly both on a day-to-day basis and during times of an emergency.
METHODS
Research was conducted in the region located between Cairns and Townsville on Australia’s far north Queensland coast, focusing on small hamlets identified in Figure 1. Following ethical approval, an array of snowballing techniques (media interviews and guest-speaker talks at community organizations) were utilized, which encouraged participation from senior respondents (SR) aged 65 years or older (N=36, 17 male and 19 female), emergency services officers (ESO; N=10, 9 State Emergency Offices and 1 Ambulance Officer), community health carers (CHC; N=7, 6 social workers and 1 community nurse), and local government disaster managers (DM; N=4, 2 officers from Cairns Regional Council and 2 from Cassowary Coast Council).
Figure 1 Study Sites, Far North Queensland, Australia.
All respondents participated in structured in-depth interviews (both face-to-face and over the telephone) or in focus groups, with SR also completing a self-administered questionnaire to collect information on demographics, including chronic health conditions and access to support. Focus groups and interviews ran for ~1 hour, directed by a question guide asking open-ended questions about past cyclone experiences and opinions regarding the future cyclone-coping capacity for elderly residents living independently. Interviews were digitally recorded and then transcribed verbatim by the first author.
A thematic analysis was conducted to identify the major issues and topics that emerged from the data. This process involved an iterative and inductive process of data immersion and interpretation, requiring transcripts to be read and re-read so as to identify common categories and themes.Reference Liamputtong and Ezzy 8 Data were manually coded, highlighting themes and sub-themes, which were grouped and labeled to better understand similarities and differences in the disaster experience for all participants. First, transcripts were examined for participants’ explanations, definitions, and experiences, specifically those associated with self-reliance and future challenges facing older people and emergency managers. Second, common and contrasting concepts were identified and grouped into common experiences and more aberrant experiences. Finally, the themes were reviewed, categorized, and labeled repeatedly until the process reached data saturation and no new themes emerged. The results purposely include specific quotes to enable the reader to understand and evaluate our thematic structures (Table 1).
Table 1 Respondents Responses
RESULTS
The thematic analysis identified differences between DMs’ expectations of the capacity of older adults to be “self-reliant” during a natural disaster and the opinions and experiences of SRs, as well as of ESOs and CHCs who care for them. Three key themes were drawn from the data and are presented below: expectations of self-reliance, identifying and locating vulnerable elderly, and future challenges.
Theme 1: Fulfilling Emergency Managements’ Expectation of Self-Reliance
Discrepancies were found between DMs’ expectations of older adults’ self-reliance and the experience of those on the ground. All DM respondents expected individuals, regardless of their age or physical ability, to ensure that they were self-reliant and prepared to take responsibility for the risks they lived with by identifying vulnerabilities and putting in place plans that mitigate future risks.
But SRs were concerned about their ability to cope with the physical strength required to adequately prepare, clean up, and rebuild their homes. They admitted requiring assistance to carry out these tasks, without which they felt they would have considered leaving their homes, a realization that upset many of the participants. Data from questionnaires revealed that nearly 40% of SRs did not understand what the “self-help” approach to emergency management meant for them. CHCs explained that many older residents were increasingly reliant on their services, because of diminishing social networks and reduced family support. Similarly, ESOs explained that older frail people were at risk during emergencies, especially during the preparation and clean-up phases when many attempted clean-up activities beyond their physical capabilities, often resulting in illness, injury, and exhaustion.
Theme 2: Identifying and Locating the Vulnerable Elderly
Despite disaster coordination and response being the responsibility of DMs, each stated that identifying those most at risk was not their task. DMs concurred that they could identify the areas that were at risk from storm surges, but that it was not possible to identify who resided in those areas, nor was it possible to know if those residents were in need of any form of assistance. Surprisingly DMs did not regard the elderly as a vulnerable group as they felt the elderly had strong social and family networks. DMs also felt older adults were better positioned to deal with cyclones than younger members of their community because of their past cyclone experiences. In contrast, both CHCs and ESOs viewed the elderly as a vulnerable group, concerned that the location of many older adults in need of assistance was unknown.
Theme 3: Future Challenges for Disaster Management Authorities
All DM respondents agreed that the most pressing issue in relation to an aging population was the issue of evacuation. Reduced mobility, along with a declining sense of community and reduced social networks (due to outmigration following 2 cyclones) meant DMs feared the elderly would become increasingly reliant on the support of authorities—support that was not necessarily available. Looking to the future, SRs acknowledged that mobility and a loss of physical ability were their major challenges, particularly with respect to the immense task of cleaning up once the cyclone had passed.
ESOs were concerned that DMs did not classify the elderly as high priority, and advocated the creation of a register to identify elderly citizens residing alone, to ensure that those who were most vulnerable were identified and checked-up on during a disaster. CHCs consistently reiterated concerns about the impact of societal changes (an expectation that all citizens used the Internet for cyclone preparatory information) and budget cuts on service delivery to older residents. CHCs were also concerned about the impact of two major cyclone events on their communities, explaining that many residents were increasingly fearful of the annual onset of cyclone season.
DISCUSSION
This study provides an insight into the effects of successive natural disasters on older adults residing in remote coastal Australian communities. Despite government policies emphasizing self-reliance, these results illustrate that some SRs are concerned regarding their ability to remain self-supporting without a future guarantee of physical assistance, medical support, community care, and disaster funding; a view shared by those who care for them.
Yet, Australian emergency managers continue to expect all individuals to be self-reliant, relying on communities to work together to manage the risks that confront them, 4 views supported by the DMs interviewed for this study. However, results from this research found that such expectations could not be met by remote coastal hamlets recovering from successive disasters. Figure 2 represents the effects of an aging population on community capacity and natural-hazard resilience in remote coastal hamlets. It is clear that the diminishing health and financial capacity of individuals compromises the overall health and financial capacity of the entire community, leading to an overall diminished community capacity, which impacts not only the ability to prepare and recover from intense hazards, but also the community’s ability to remain self-reliant.
Figure 2 Features of Coastal Hamlets and the Effect of an Aging Population on Natural-Hazard Community Resilience and the Capacity to Implement the Self-Help Approach to Disaster Emergency Management.
The importance of regarding the elderly as among the most vulnerable during the pre- and post-stages of a cyclone is well documented. Statistics revealing the mortality rates of the elderly following recent natural disasters are explained by deteriorating health, reduced mobility, sensory, and cognitive capacities, as well as fewer economic resources.Reference Cherry, Galea and Su 9 The opinions of ESOs and CHCs interviewed for this study confirm these findings, with several explaining the high dependency many older people have on in situ care. It therefore follows that if an elderly person requires in situ support to live day-to-day, then there is a reasonable chance that this individual will be unable to care for him- or herself if these services are disrupted following a natural hazard, nor would they have the capacity to prepare for, or clean up after, a catastrophic event without assistance.
Of most concern was the issue of interpretation. Despite disaster authorities interpreting “self-reliant” to mean that all citizens are equally aware of the risks they face and possessing the capacity to undertake actions to reduce those risks, CHCs claimed that older adults interpret “self-reliant” to mean having the financial capacity to afford in situ health and community care. The term confused SRs when placed in the context of cyclone preparation and recovery, with many admitting they had no knowledge of authority expectations. However, most SRs felt more confident in their cyclone-recovery ability if they were assured of financial and physical assistance in the future. CHCs confirmed these views explaining that the elderly were reluctant to ask family and friends for assistance because of personal pride and a fear of appearing unable to remain independent. This stoicism, which the literature highlights is prevalent amongst the elderly in rural settings,Reference Davis and Bartlett 10 was blamed for the injuries older people often sustained during the clean-up phase of a cyclone, as they attempted activities beyond their physical capabilities.
Clearly, much more research is needed to explore what contributes to an older person’s decision to age-in-place in vulnerable coastal communities, for such decisions need to consider the issues associated with limited services, natural-hazard risks and safety, as well as address the importance of social networks and understanding emergency management expectations. Disaster planners must consider strategies that both identify the whereabouts of the most vulnerable and address the risks associated with the increasing number of elderly people residing alone in these communities. Finally, disaster planning should encompass strategies that assist affected communities to economically recover from the impacts of future hazards, because the forced outmigration of those who were charged with caring for the elderly within the community has dire consequences on both the individuals left behind and the community as a whole.
Acknowledgments
This paper was submitted as part of the special section on Caring for Older Adults in Disasters, Disaster Med Public Health Preparedness. 2017;11:25-152.
