**Gerontology and Emergency Management:**

**Discovering Pertinent Themes and Functional Elements**

**Within the Two Disciplines**

Kathy Dreyer

Texas Institute for Research and Education on Aging

Center for Public Service

University of North Texas

P. O. Box 310919 -- TIREA

Denton, TX 76203-0919

kdreyer@pacs.unt.edu

# Abstract

In this chapter, the confluence of Gerontology and Emergency Management
is considered. Both disciplines have facets that are mutually
complimentary. The chapter illustrates the psychosocial issues,
practical considerations, and the applicability of gerontology within
emergency management, and vice versa. Other elements that provide
insights, such as future collaborations between the two fields of study,
are given consideration, as well as the overlapping features of other
disciplines such as public health, psychology, economics, and social
work. Potential means of expansion of collaboration between the two
disciplines that extends beyond typical natural disasters are also
explored.

# Introduction

At first blush, the nexus between gerontology and emergency management
may not automatically conjure much of an ostensible affiliation. After
all, the study of aging might not be generally associated with the
discipline of planning for extreme events such as natural disasters.
However, the coalescence of these two domains warrants examination
beyond what might automatically engender consideration at first: the
vulnerabilities that older adults may possess, in terms of their health
status, psychological issues, utilization of services, and financial
resources, placed in the context of preparing for and surviving the
aftermath of life-threatening, calamitous events. In truth, there have
been several connections between gerontology and emergency management;
there are also overlapping characteristics between these fields within
the domains of public health, psychology, social work and economics. It
is advantageous to combine gerontology and emergency management for the
mutual benefits each discipline dispenses, as well as to implement those
assets that have not been as widely employed, such as the strengths and
abilities of older adults to assist in the preparation for and the
aftermath of natural disasters.

**Adjuvant Benefits Involving Gerontology and Emergency Management**

The field of gerontology has provided many avenues of collaboration for
emergency management. Information about vulnerable populations and their
need for additional assistance in the advent and wake of natural
disasters is a starting point. Gerontology can offer perspectives on
those older adults with special needs (medications, mobility, physical
setting, monetary, ability to recover, and predisposition to stress).
This information can be extrapolated for use with vulnerable populations
such as disabled adults or individuals in frail or poor health. Also,
gerontology can provide information on the contingency plans that
long-term care facilities use in other emergency situations (coping with
power outages, distribution of medications, handling and storing food or
disposable products, evacuation procedures for those in wheelchairs or
who are unable to mobilize independently). The study of gerontology
offers multiple opportunities for providing beneficial insights into
assisting vulnerable populations before, during, and after a disaster;
however, the field can also serve to demonstrate the benefits of
employing the unique perspectives, strengths, and skills of older adults
who experienced disasters and survived. Other disciplines can provide
additional perspectives within the realms of gerontology and emergency
management, in terms of their relevance to vulnerability and disasters;
yet, the implementation of how older adults have made accommodations for
disaster-engendered losses is a technique that justifies additional
research. In other words, viewing and utilizing older adults as
survivors, not just victims, is an asset that gerontology can add to the
field of emergency management.

## Perspective on Vulnerability and Disasters

## [Public Health:]{.underline}

A primary consideration of older adults and their experience with
natural disasters is their ability to survive with a minimum of property
damage or personal injury. From this contemplation a central theme
emerges: older adults' ability to exit safely in the event of an
emergency. Older adults may be vulnerable in a number of ways. Their
physical condition or pathological factors can affect an older person's
ability to escape a disaster safely, thus making them more susceptible
to the effects of a natural disaster. As Eldar (1992) points out

> elderly persons may have locomotor, sensory or cognitive impairments
> restricting their activities. Some impairments-such as those of sight
> or hearing- may limit them in perceiving warnings and emergency
> instructions; others will reduce their ability to carry out
> recommended self-protected actions (getting under tables during an
> earthquake or tornado-shaking) or their speed and agility in leaving a
> room or building (in a fire). When a disaster occurs, even without
> collapse or major damage, buildings and their surroundings may become
> unsafe and previously innocuous elements of the interior environment
> can become dangerous and result in injuries from broken glass, falling
> electrical fixtures, moving equipment and furniture. Elderly persons
> with functional limitations will face greater risks in this changed
> environment than able bodied and younger individuals (355).
>
> Obviously there is a need to assist those older adults with limited
> functional capacity and chronic impairments; however, not all older
> adults have physical or health-related difficulties. According to a
> report from the National Center for Health Statistics (2004), 76% of
> non-Hispanic white, 59% of non-Hispanic black, and 63% of Hispanic
> adults, aged 65 and older, reported having health that is good to
> excellent. The report also demonstrates that among adults aged 65 to
> 74, 80% of non-Hispanic white, 62% of non-Hispanic black, and 65% of
> Hispanic origin indicate their health as good to excellent. The same
> report found that among those aged 65 and older; the majority does not
> indicate a problem with hearing or seeing. Only 47% of men and 30% of
> women in this age group reported trouble hearing; 16% of men and 19%
> of women in this age group indicated trouble seeing. These results may
> suggest that the majority of older adults would be capable of escaping
> and surviving a disaster.

The surroundings in which older adults live require assessment for
potential evacuation routes and exits. Those who live alone require
additional attention and support, in regard to evacuating safely, or at
least having a plan in case of a disaster. Older adults, who reside in
continuing care retirement communities, assisted living facilities, or
nursing homes, should be able to rely on the administration of their
facility to provide information and direction as to the proper
procedures for escaping a disaster. Additionally, the facility should
have contingency plans in place to allow for the secure departure of
older adults who require additional assistance to exit the facility. In
this case, emergency management planners would have an interest in the
procedures and preparation plans utilized, for older adults residing
alone, and those within a retirement or long term care facility.

Emergency management personnel responding to disaster situations must be
especially careful with those older adults suffering from a variety of
ailments who require assistance with keeping track of medications or
other items mandatory for maintaining their health. Personnel must also
be able to communicate effectively with individuals suffering from
visual and auditory impairments, in addition to the emotional response
that is bound to occur when a person's home and belongings are damaged
or destroyed. The field of emergency management can certainly provide
strategies and guidelines for assisting older adults who need help
planning for disasters, especially those who have physical impairments
or cognitive challenges, as well as those who live alone. There is some
information available about emergency procedures relative to older
adults living independently at home who may have mobility limitations,
physical difficulties, or visual impairments (American Red Cross 2004,
United States Administration on Aging 1995), to say nothing of the
condition of their home environment, and its ability to provide a quick
exit in an emergency. These factors can certainly influence a person's
ability to respond to a disaster.

Secondly, with advancing age, changes in health status occur. Lung
capacity is reduced, which can be problematic in the event of dust and
particles in the air after a disaster. A change in hearing is also
common as people age. The effect of hearing deficits can impair older
adults' ability to hear certain tones or discern announcements given in
an area with substantial background noise, which can prevent them from
responding to emergency sirens. Another change accompanying aging is
that of smell. There may be an inability for older adults to detect
spoiled food and, inadvertently consume it (United States Administration
on Aging, 1).

Susceptibility to illnesses is another component. Older adults may be
more prone to the after-effects of a natural disaster. Tanida (1996)
states that after the 1995 earthquake in Hanshin, "many elderly people
caught diseases such as 'shelter pneumonia' because of the unhealthy
environment and dehydration" (1134). In the event of non-functioning air
conditioning or heating units after a disaster, older adults may not be
able to perceive the changes in temperature. This can result in
hyper/hypothermia. The field of public health could assist both
gerontology and emergency management professionals by assisting planning
efforts to minimize the effects of disasters, especially those related
to environmental hazards.

The effort to alleviate the consequences of natural disasters is the
first step in assisting older adults to effectively cope with disasters
and remain as physically healthy as possible. Ollenburger and Tobin
(1999) indicate that "individuals in poor health and who have difficulty
getting around are restricted in the actions they can take to mitigate
hazard losses, which can lead to higher stress levels" (66). In addition
to preserving physical health, maintenance of older adults' mental
health is of crucial importance, given the elements of preparing for and
surviving the aftermath of a disaster. There are many components of
mental health and vulnerability that are unique to older adults, which
compels the use of psychology and its expertise.

## [Psychology]{.underline}

Older adults can be extraordinarily vulnerable to the effects of a
natural disaster, in terms of psychological response. As Langer (2004)
illustrates,

> most older people will inevitably suffer multiple losses. Some will
> need to learn the roles and responsibilities of becoming widows or
> widowers. Other losses might include loss of mobility or independence.
> Older adults who develop health problems will necessarily have to
> adjust from an unrestricted lifestyle to one with greater
> confinements. As individuals experience a diminution in control and an
> inability to solve their problems independently, fear -- such as fear
> of the onset of additional health problems, of living alone, or of
> becoming a crime victim-can become a major concern. How each person
> copes with these life changes will often depend on individual
> differences as well as the "modus operandi" that has been the vehicle
> for overcoming crises in the past (277).

Given the accumulation of other losses, another loss, especially one of
this nature, can be more traumatic and devastating. After the Hanshin
earthquake in 1995, "suicide by elderly victims occurred at a rate of
almost once a month. In addition, some elderly people were found dead in
a ditch, presumably because they were lost in a new territory" (Tanida,
1996, 1134). Healthy psychological responses to disasters are important
to surviving a disaster, and all of the losses intrinsic to it. Oriol
(1999) points out "apathy or helpless stoicism may be among the likely
reactions, based largely on the attitude that they will never be able to
recover or replace losses ranging from property damage to death of
friends or family" (28). Being able to safely evacuate a home
environment would certainly improve a person's response to a natural
disaster; not knowing how to escape or where the safest place in the
home is to survive when a disaster strikes can certainly result in
psychological trauma, and can affect the ability to cope with additional
losses or in the event of extensive damages to the home environment. The
natural state of an older adult's home is also a factor to consider. The
home environment should be evaluated for its potential evacuation
routes, safety, and ability to withstand impending damage. The safety of
the older adult to remain in the home environment is a factor,
especially if he/she does not want to leave.

Another significant factor in extenuating losses involves an older
adult's financial resources. Langer (2004) notes that "economic status
is a powerful determinant of an elderly person's ability to cope;
intelligence and education also play a considerable role, as does an
individuals' degree of physical and mental health" (278). As such, the
realm of economics provides insights into surviving a natural disaster.

## [Economics]{.underline}

Another potential vulnerability is the financial status of older adults
who may not have the means to rebuild or recover from the effects of a
disaster that destroys their home and belongings. Those who are already
in dire financial straits can suffer more than economic losses. In the
devastating 1995 Hanshin earthquake, Tanida (1996) illustrates that "77%
of victims were crushed to death, and a greater proportion of elderly
people died from burns or penetrating injuries. Many of the elderly
people lived in inexpensive old wooden houses of their own or in
tenements" (1133). To make matters worse, according to Tanida, "elderly
people tended to sleep in ground floor rooms, which were especially
prone to collapse in this earthquake" (1133). There were over 6,000
deaths caused by the quake, and "about half of the deaths were people
aged 60 and older" (Hirayama, 115). In terms of ability to rebuild and
recover from the devastation caused by this earthquake, those older
adults who survived faced enormous obstacles. Many of those directly
affected could not rebuild for financial reasons, and Hirayama (2000)
states "a problem in the disaster area is not the shortage of loans but
the lack of credit among the elderly victims" (125).

Typically, retired older adults are living on fixed incomes, and do not
have financial means to replace belongings in the event they are
destroyed. In particular, older women are especially vulnerable to the
effects of financial loss, as they are more likely to be without a
pension, especially since they may not have worked for pay during their
young adult life. Also, they usually live longer than their male
counterparts, suggesting they need more financial resources for
survival. Women may suffer more financial devastation if their house is
destroyed from the effects of a natural disaster. Ollenburger and Tobin
(1999) indicate

> the economics of aging place many women in extremely vulnerable
> positions which influences their ability to cope with the unexpected
> consequences of natural disasters. This economic vulnerability of
> women, who may be the sole support for themselves and/or for their
> children, had been described as the feminization of poverty.
> Consequently, natural disasters can perpetuate the poverty trap for
> women as demonstrated by some of the recent research looking at women
> and other marginalized groups in hazardous areas (66).

Another part of the problem is that older adults who experience losses
of any kind may downplay or their difficulties due to the level of
distress caused by having to admit a problem exists. A failure to handle
their problem independently makes them reluctant to acknowledge help is
needed (Langer 2004). The devastation caused by a disaster, financially
speaking, leads to an examination of what services are available and,
more importantly, used, by those in greatest need after a natural
disaster strikes.

# [Social Work]{.underline}

An analysis of the utilization of services designed to assist victims of
natural disasters yields unsatisfactory results. For example, in the
aftermath of the Hanshin earthquake, Tanida (1996) points out that
"elderly people tended not to proclaim their problems unless they were
questioned specifically. Thus, the superficial survey by the medical
teams failed to notice the problems of elderly people in shelters"
(1134). Additionally, as Tanida continues, those who provided care for
the older adults were also victimized by the disaster and rendered
unable to offer their usual services. Unfortunately, the situation was
exacerbated to the extent that those older adults were receiving little,
if not inadequate, care for an extended period of time (Ibid, 1135).

The viewpoint that older adults do not seek care after disasters is
supported by Langer (2004), who states, "the at-risk elderly do not
usually self-refer. If they receive help, it is typically because
someone else obtained it for them" (278). There are many reasons for a
low utilization rate of services by older adults trying to recover from
the effects of a natural disaster. Langer (2004) further explains that

> American culture places a high premium on independence and
> self-reliance, and, as a result, people feel uncomfortable when they
> need to ask for assistance. For the current cohort of older adults who
> survived such hardships as the Depression, this admission might be
> difficult. Maintaining independence is one of the most frequently
> occurring life themes. Many older people worry that they will lose
> their independence and their value in society through reliance on a
> fixed income or through a loss to maintain their own home (279).
>
> Another difficult aspect of utilization of services involves forced
> relocation and its relevance to social work. Sanders, Bowie, and Bowie
> (2003) suggest "geriatric social workers are often a frontline service
> for older adults who have experienced a forced relocation following a
> natural disaster. Additionally, the social work profession is involved
> in the long term problems that forced relocation can cause for older
> adults" (25). Forced relocation is especially traumatic for older
> adults who rely on informal care for support, such as African
> Americans. A lifetime spent developing a support system within a
> community, can be abolished in the event a person has to move to
> another location in order to have a home. For those whose experience
> with the health care system raises suspicion and distrust, the change
> in their home is even more problematic.
>
> In light of the health, psychological, economic, and service
> utilization issues, there are many prospects for the field of
> emergency management to converge with gerontology to improve not only
> how older adults experience, survive, and move beyond natural
> disasters, but how they can and will help others coping with the same
> event.

**Recommendations for Emergency Management**

First and foremost, the field of emergency management could support
gerontology in an effort to apply practical guidelines for older adults
in the event of natural disasters. A guide or directions for preparing
for the advent or aftermath of an emergency could be developed
collaboratively, and could involve public health professionals,
especially in the case of long-term care facilities. Saliba, Buchanan
and Kington note that "nursing facilities often are overlooked as a
health resource and generally are not incorporated into disaster-relief
plans" 1436. To exacerbate this problem, nursing homes may experience an
overload in capacity of residents in the event that hospitals are
damaged by a disaster and hospital personnel attempt to transfer their
patients to the safety of a facility (Ibid, 1438). Again, social workers
frequently encounter this scenario as they attempt to assist older
adults in their quest for assistance. Given the fact that public health,
social work, emergency management, and gerontology professionals have a
stake in this situation, it is only natural that these disciplines work
together to address and resolve this critical situation.

The discipline of emergency management could provide the impetus for the
gerontological field to focus more energy on assisting older adults
before, during, and after events such as these. Most of the
gerontological literature and research appears to be directed at the
psychosocial effects of natural disasters on older adults, but there is
little, if any, information provided on how to prepare for an event.
There is no doubt that natural disasters can be traumatic, devastating,
and tragic, especially for older adults. Concentrating more information
as to how best to prepare beforehand would go a great way in helping to
mitigate the effects of such an episode.

Also, the field of gerontology would certainly help the emergency
management discipline address the unique effects a natural disaster can
impose on older adults. The unique health, psychological, economic, and
service-related issues facing older adults before, during, and after a
natural disaster, could be mitigated through the collaboration of
gerontology and emergency management professionals to address those
issues.

Finally, older adults who have coped with natural disasters and the
losses inherent to them can certainly provide insights into how to help
other elders survive these events. By working with these individuals,
emergency management professionals can determine the most effective and
beneficial means to assist those older adults in need of assistance when
disasters occur.

## Future Areas of Investigation

A realm in which gerontology would benefit from the field of emergency
management is the handling of disasters that affect older adults more
frequently. Extreme temperatures, both hot and cold, have a significant
impact on older adults, as the ability to perceive changes in
temperature decreases with age. The heat wave that occurred in Chicago
1995 provides a stark reminder of how vulnerable older adults that live
alone can be (Klinenberg, 2002).

Also, the prevention of fires in the home, particularly in older adults'
homes would be useful. According to the United States Fire
Administration (2001), fires and burns are the sixth leading cause of
death among older adults, who are also "far more likely than the rest of
the population to die or be injured in a fire" (4). The health hazards
posed by this type of emergency, to say nothing of the financial and
emotional costs, are worthy of consideration. In any case, the
classification of what constitutes a disaster can be expanded to include
droughts, freezing temperatures, and fires. These scenarios can have a
psychological and financial effect on older adults, as well as affecting
their health, and usually generates a need for assistance, similar to
other natural catastrophes.

Although these calamities typically do not generate as much attention or
publicity as a hurricane, tornado, or earthquake, older adults are still
at risk. The efforts of gerontology and emergency management experts
could certainly provide much needed solutions to these and other
dangerous situations. Despite the importance of assisting older adults
after calamitous events, it is critical to also understand the unique
strengths, talents, abilities, and resources that older adults possess,
and not simply believe they are only victims of natural disasters.
Maintaining a balance between identifying the singular needs of older
adults after a natural disaster has occurred and meeting those needs,
while also realizing the strengths and abilities of these older adults
for their potential to assist in the aftermath of a natural disaster, is
imperative.

Most importantly, older adults can also be recruited for their expertise
from experiencing disasters in the past. Additionally, there are many
older adults who volunteer for the American Red Cross; in fact,
"sixty-five percent of American Red Cross volunteers are age fifty-five
or above" (Oriol, 1999: 31). Based on the willingness of older adults to
volunteer, not to mention their experience with disasters, it seems
quite natural to deploy them into service after a disaster. Older adults
offer strength, familiarity, and assurance to other older adults,
especially if they have previously experienced and survived a natural
disaster. By their nature, older adults are survivors. As the Project
COPE (1992) "Voices of Wisdom: Seniors Cope with Disaster" Videotape so
eloquently stated:

> Senior citizens today are a sturdy, reliable generation. We've proven
> time and again our ability to survive everything from the Great
> Depression to world wars and the threat of nuclear holocaust. We've
> lived through droughts, floods, and all sorts of other natural
> disasters. We've given birth, supported our families, and stood by our
> loved ones through personal and financial losses. We are proud, tough,
> and resilient.
>
> The discipline of emergency management can provide the field of
> gerontology with an opportunity to promote one of the country's best
> natural resources -- older adults -- to assist others after a natural
> disaster.

**REFERENCES**

American Red Cross. Disaster Preparedness for Seniors by Seniors.
Retrieved on November 8, 2004 from
(<http://www.redcross.org/services/disaster/0,1082,0_9_,00.html>)

Childers, C. (2003). Age and Disaster Vulnerability*.* In Federal
Emergency Management Agency, Higher Education Project's Social
*Vulnerability Approach to Disasters* Retrieved January 26, 2005, from:
<http://training.fema.gov/emiweb/edu/completeCourses.asp>

Drabek, T.E. (1999). Understanding disaster warning responses. *Social
Science Journal*, 36 (3): 515-523.

Eldar, R. (1992). The needs of elderly persons in natural disasters:
observations and recommendations. *Disasters*, 16(4): 355-358.

Hirayama, Y. (2000). Collapse and reconstruction: housing recovery
policy in Kobe after the Hanshin great earthquake. *Housing Studies*, 15
(1): 111-128.

Kelly, J. I. How to develop a disaster action plan for older, distant
relatives. *AARP Bulletin,* May 2003. Retrieved on November 8, 2004 from
(<http://www.aarp.org/bulletin/yourlife/Articles/0505_sidebar_11.html>)

Kilijanek, T. S., & Drabek, T.E. (1979). Assessing long-term impacts of
a natural disaster: a focus on the elderly. *The Gerontologist*, 19 (6):
555 -- 566.

Klinenberg, E. (2002). *Heat wave: a social autopsy of disaster in
Chicago*. Chicago: University of Chicago Press.

Langer, N. (2004). Natural disasters that reveal cracks in our social
foundation. *Educational Gerontology*, 30: 275 -- 285.

National Center for Health Statistics. *Health, United States, 2004*.
Hyattsville, MD. 2004.

Ollenburger, J.C., & Tobin, G.A. (1999). Women, aging, and post-disaster
stress: risk factors. *International Journal of Mass Emergencies and
Disasters*, 17 (1): 65 -- 78.

Oriol, W. (1999). Psychosocial issues for older adults in disasters.
Retrieved September 30, 2005 from
<http://media.shs.net/ken/pdf/SMA99-3323/99-821.pdf>

Poulshock, S. W., & Cohen, E.S. (1975). The elderly in the aftermath of
a disaster. *The Gerontologist*, 15 (4): 357 -- 361.

Project COPE. "Voices of Wisdom Videotape and Brochure." Ventura County,
California, 1992.

Saliba, D., Buchanan, J., & Kington, R.S. (2004). Function and response
of nursing facilities during community disaster. *Research and
Practice*, 94 (8): 1436 -- 1441.

Sanders, S., Bowie, S.L., and Bowie, Y.D. (2003). Lessons learned on
forced relocation of older adults: the impact of Hurricane Andrew on
health, mental health, and social support of public housing residents.
*Journal of Gerontological Social Work*, 40 (4): 23 -- 35.

Shoaf, K. L., Sareen, H.R., Nguyen, L.H., & Bourque, L.B. (1998).
Injuries as a result of California earthquakes in the past decade.
*Disasters*, 22 (3): 218 -- 215.

Tanida, N. (1996). What happened to elderly people in the great Hanshin
earthquake. *British Medical Journal*, 313 (7065): 1133 -- 1135.

Ticehurst, S., Webster, R.A., Carr, V.J., & Lewin, T.J. (1996). The
psychosocial impact of an earthquake on the elderly. *International
Journal of Geriatric Psychiatry*: 11: 943-951.

Tyler, K. A., & Hoyt, D.R. (2000). The effects of an acute stressor on
depressive symptoms among older adults. *Research on Aging*, 22 (2): 143
-- 164.

United States Administration on Aging, & the Kansas Department on Aging.
Emergency preparedness manual for the aging network. March 1995.

U. S. Fire Administration. Older Adults and Fires. Volume 1, Issue 5;
December 2001

Vogt, B.M. (1991). Issues in nursing home evacuations. *International
Journal of Mass Emergencies and Disasters*, 9 (2): 247 -- 265.