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Module 4: The Elderly: A Vulnerable
Population in Disasters

The Vulnerable Elderly
Bhaskar, Herincx, and Bhaskar (2017) noted that socio-economic conditions, chronic
illness, and old age make senior citizens more vulnerable than other populations in
disaster situations. They are less able to react to emergencies, and during and after a
disaster, they likely to have little access to the healthcare resources they are
accustomed to and need to recover completely. Gershon, Portacolone, Nwankwo, Zhi,
Qureshi, and Raveis (2017) noted that elderly living in the community represent a very
vulnerable population, and as a result, this population is at high risk of death in
association with a disaster.

Maltais (2019) noted that the occurrence of a disaster would affect elderly people with
various disabilities disproportionately. Also, this researcher emphasized that elderly
persons are over-represented among the deceased as a result of disaster. For example,
those who died in the 2011 earthquake and tsunami in Japan were elderly over 70
years of age. By comparison, seniors represent only 25% of the population of Japan.

Ngo (2001) proposed that the terms geriatric and gerontological must be operationally
defined relative to responding to the needs of all seniors in the case of disasters. This is
particularly important with regard to persons 75 years of age and older who have
physical and/or cognitive disabilities. Relative to this notion, Maltais (2019) highlighted
that protecting elderly with disabilities takes on more salience in light of the increase of
disaster events in the past 40 that seem in one way or another related to climate.

Mitigation
Bonnan-White (2017) found that seniors in two independent living centers, primarily
females were more willing to accept evacuation orders from military, law enforcement
officials, and/or fire officials, as well as the order from the governor. They were least
likely to accept orders from neighbors, church leaders, or the media. With this
information, a human security framework suggests that utilizing this information with
respect to the behavior of seniors in preparing for evacuations might eliminate some of
the frustration that seniors and helping professionals alike experience in evacuating
seniors during in a disaster situation.

Bhaskar, Herincx, and Bhaskar (2017) suggest the use of the Emergency Vulnerability
Index (EVI) and Healthcare Emergency Accessibility Index (HEAI) to assess the risk to
frail elderly populations in areas where there could be a major disaster, i.e. New
Orleans. In conjunction with measures the Medicare and Medicaid Services’ Social
Vulnerability Index (SVI) and Risk Adjustment Factor (RAF) to measure needs in

emergency situations, it would be possible to know in what areas seniors over 65 years
of age are at most at risk and how to prepare for their needs in those emergency
situations. In this context, many elderly who reside in communities have made no plans
for disaster or emergency (Gershon et al., 2017).

Review CDC’s Social Vulnerability Index (SVI)

According to the Agency for Toxic Substances and Disease Registry, social vulnerability
refers to the resilience of communities when confronted by external stresses on human
health, stresses such as natural or human-caused disasters, or disease outbreaks.

The Geospatial Research, Analysis, and Services Program (GRASP) created and
maintains CDC’s Social Vulnerability Index. Check this factsheet (Links to an external
site.) for learn more about SVI.

Preparedness
Gershon et al. (2017) examined the preparedness of elderly citizens who received
home care in an urban community. The researchers found that 60% of participants in
the study had made no backup plans in case of emergency, 70% had no transportation
plan, and 44% had made no list of emergency contacts. Disabilities and resources were
barriers to citizens improving preparedness, as well as their lacking the cognitive
abilities that would motivate them to remove barriers. While many wanted training, many
were also homebound and reported being unable to participate in training.

By comparison, Nourozi, Saeli, Kankeh, Habibollah, Rezasoltani, and Fathi (2016)
conducted a quasi-experimental study to determine the extent to which elder persons
Iran can be educated and trained in preparedness for earthquake disaster. The
intervention for the experimental group included slideshows, group discussions, and
materials focused on preparedness for disaster. The researcher-prepared questionnaire
was developed to measure communication and environmental preparedness during and
after the disaster. Post test scores showed an increase in the preparedness of elderly
participants in experimental group relative to the control group that received no
intervention.

Response
Smith, Mozzer, Albanese, Paturas, and Gold (2017) highlighted the Senior Resiliency
Project in Rhode Island as a response to aid elderly persons in the case of disaster or
emergency. In this project, assessments of available resources were completed,
identifying specific sheltering practices in settings, and recognizing what energy might
be available. With these findings in place, facility employees and seniors were educated
and trained on what they will do in case of disaster events.

Kar (2016) made the point the many communities and states have emergency
management plans in place for those who reside in areas at risk of floods, tornadoes,
and hurricanes. However, he also noted that even though the elderly population is
clearly vulnerable in disaster situations, more often than not there are no specific plans

for this population, especially for those elderly with disabilities. Given the lack of
response to the needs of this vulnerable population, Kar (2016) recommended the need
to care for the elderly population at all phases of disaster response.

Recovery
Li, Aida, Hikichi, Kondo, and Kawachi (2019) examine association with post-disaster
depression and PTSD with mortality after the 2011 earthquake and tsunami. In a
sample of 8567 Japanese with a 60% response rate, the researchers found that
depression was significantly associated with depression post-disaster while PTSD was
not associated with mortality. The findings suggest the need for mental health services
that include in-person therapy, i.e. cognitive behavioral therapy (CBT) and
psychopharmacology that may be needed to enhance the cognition of some elderly
person so that CBT can be most effective.

Yotsui, Campbell, and Honma (2016) found that older people provided support for peers
din recovering the 2011 earthquake in Japan. The researchers found that elderly
Japanese who lost all their possessions and homes in the earthquake entered a
temporary housing situation. As participants in a social welfare program focused on
social and community support among displaced elderly person, each elderly person
made two visits each day to support other seniors in the community. While the visits
helped others who were isolated, it helped the elderly visitors reestablish their social
identities as well, and thus, was empowering.

Social Work Response
Based on the literature highlighted in this lesson, there are several implications for
social workers interested in enhancing emergency management systems for this
particular vulnerable population. At the meso level, social workers could be involved in
conducting research at the local level using reliable instruments to determine the extent
to which the elderly populations are at risk in certain areas. Social workers can play a
key role at both the meso and micro levels of practice in helping elderly populations
become better prepared for disaster themselves, as well as “helping the helpers”
understand that this population has exceptional needs in order to be prepared for
disaster situations. At the macro level, social workers should definitely take on an
advocacy role to ensure that federal, state, and local agencies address the unique
needs of elderly persons in disaster situations. Despite the term “vulnerable population”
being assigned to the elderly population, the needs of these citizens are generally not
met in disaster situations.

Practice Exercise

Elderly and Vulnerability in Disasters

Select the correct answer(s) for the multiple choice questions below.

1. Elderly persons are underrepresented in the death toll after a disaster.

a.True

B. False
a. Feedback: The correct response is (b). In fact, elderly persons are

overrepresented in the death toll after a disaster due to health and mobility
factors.

2. Which of the following ae instruments might be used to assess the risk to elderly
in the community if a disaster occurs?

. Emergency Vulnerability Index (EVI)
a. Healthcare Emergency Accessibility Index (HEAI)
b. Medicare and Medicaid Services’ Social Vulnerability Index
c. All of the above
d. None of the above

Feedback: The answer to this question is (d). All of three measures would be
helpful in assessing the risk to the elderly in a community if a disaster occurs.

3. In terms of preparedness for a disaster or emergency, what percentage of
citizens who received home care in one city had a back-up plan for disaster
and/or emergency?

. 60%

50%

40%

none of the above

a. Feedback: The answer to this question is (c). Sixty percent of the citizens had
no back-up plan for disaster or emergency.

4. Elderly persons can be support to their peers in following a disaster.
. True
a. False

b. Feedback: This is true as was seen in the 2011 earthquake in Japan, which
has implications for how social workers might facilitate and utilize support
groups for elderly populations.

5. Which of the following disorders is associated with mortality among the elderly
following a disaster?

. Depression
a. PTSD
b. both depression and PTSD

c. Feedback: The answer is more (a) because depression is most associated with
mortality after a disaster event.

Summary
This lesson examined the elderly as a vulnerable population in disaster situations. The
mitigation for preparedness shows that we need to know more about how the needs of
elderly populations can be addressed in disaster situations. In terms of preparedness,
research seems to focus on how elderly persons can improve their preparedness. This
brings into question the extent to which society as a whole should be more responsible
for planning how to address the unique needs of this “vulnerable” population in disaster
situations.

References
Bhaskar, Herincx, & Bhaskar, (2017). Geographical information system for elderly population for

emergency preparedness. Paper presented at the Southern California Conference on
Undergraduate Education in Pomona, California on November 18, 2017.

Bonnan-White, J. (2017). Independent-living senior communities in disaster: Self-efficacy and
trust in responding agencies. Journal of Homeland Security and Emergency, 14(2).

Gershon, R., Portacolone, E., Nwankwo, E., Zhi, Q., Qureshi, K., & Raveis, V. (2017).
Psychosocial influence on disaster preparedness in San Francisco recipients of home
care. Journal of Urban Health, 94(12), 606-618.

Kar, N. (2016). Care of older persons during and after disasters: Meeting the challenge. Journal of
Geriatric Care and Research, 3(1), 7-12.

Li, X., Aida, J., Hikichi, H., Kondo, K., & Kawachi, I. (2019). Association of post-disaster
depression and posttraumatic stress disorder with mortality among older disaster
survivors of the 2011 Great East Japan Earthquake and Tsunami. JAMA Netw Open,
2(12):e1917550.

Maltais, D. (2019). Elderly people with disabilities and natural disasters: The vulnerability of
seniors and post trauma. HSOA Journal of Gerontology and Geriatric Medicine, 5, 2-7.

Ngo, E. (2001). When disasters and age collide: Reviewing vulnerability of the elderly. Natural
Hazards, 2.

Yotsui, M., Campbell, C. & Honma, T. (2016). Collective action by older people in natural
disasters: The Great East Japan Earthquake. Aging & Society, 36(5), 1052-1082.

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