How can I as a senior citizen plan for disasters?

Everyone shares some common ways we can prepare for disasters. Because of some physical, demographic, and other considerations, there are some special things to keep in mind for senior citizens. Here are some tips:

• Store plenty of water, at least 1 gallon per person per day, because dehydration is a serious health problem for older adults. Store at least 3 days worth. Use small containers with easily removable caps. Water in swimming pools and spas can be used for sanitation and personal hygiene.
• Have a three-day supply of nonperishable food, with consideration to your special dietary needs.
• Assemble a disaster first aid kit (PDF), being certain to include nonprescription medications that you use on an ongoing basis. Include a thorough personal medical history (PDF) or invest in some sort of electronic medical history device (PDF). If possible keep an extra pair of eyeglasses, hearing aid batteries and if you are in an electric wheelchair have a manual wheelchair available or extra batteries on hand.
• Have an emergency contact person (PDF) who lives in a different geographic area. Give that person a list of names, phone numbers / email addresses of people who should be contacted; or you can give your friends and family the name and phone number / email address of your contact person.
• Put your important papers in a safe place. These should include insurance policies, bank account and credit card information, Medicare and/or Medicaid cards, and living wills and powers of attorneys (PDF).
• Include in your disaster kit (PDF) some time passers such as board games, puzzles, books, paper and pens for letters and notes, envelopes and stamps, playing cards and some paperback books

Use the following checklist to get started:

• Assemble a disaster supplies kit (PDF).
• Arrange for someone to check on you.
• Plan and practice the best escape routes from your home.
• Plan for transportation if you need to evacuate to a Red Cross shelter.
• Find the safe places in your home for each type of emergency.
• Have a plan to signal the need for help.
• Post emergency phone numbers near the phone.
• If you have home health care service, plan ahead with your agency for emergency procedures.
• Teach those who may need to assist you in an emergency how to operate necessary equipment. Be sure they will be able to reach you.

Seniors with Alzheimer’s Disease have some special disaster-related needs, and this is a very helpful guide for helping them prepare and respond to disasters here.

Seniors with diabetes, bed-bound persons, and oxygen dependent persons need to assure that they have sufficient emergency supplies on-hand.

Web Links

This fact sheet on disaster preparedness from the American Red Cross’ prepared.org titled “What We Can Do to Save Our Lives” is “for seniors, written by seniors.” (PDF)

Traumatic Response, Depression, and Dementia in the Elderly

Mental health is a serious concern for elderly persons.  In fact, some studies show that elderly people are at greater risk of mental disorders and their complications than are younger people:  

• From 15 to 25 percent of elderly people in the United States suffer from significant symptoms of mental illness.
• The highest suicide rate in America is among those aged 65 and older. In 1985, this age group represented 12 percent of the total U.S. population, but accounted for 20 percent of suicides nationwide. That means close to 6,000 older Americans kill themselves each year.
• Worldwide, elderly people lead the World Health Organization's list of new cases of mental illness: 236 elderly people per 100,000 suffer from mental illness, compared to 93 per 100,000 for those aged 45 to 64, the next younger group.
• Severe organic mental disorders afflict one million elderly people in this country and another two million suffer from moderate organic disorders.

Many elderly persons do not seek or receive appropriate treatment, out of embarrassment or isolation or lack of physical or financial access to mental health care.  Additionally, elderly people, their loved ones and friends, and often their own doctors fail to recognize the symptoms of treatable mental illness in older people. They blame them on "old age" or think nothing can be done to alleviate the problem. As a result only 4 percent of the patients in community mental health centers are elderly, and only two percent of the patients seen in mental health private practitioners' offices or hospitals are elderly.

Here are some quick facts on disaster-related mental health in the elderly.

Pseudodementias
Elderly people may become forgetful, disoriented, or confused because they have developed a quickly reversible condition that is totally unrelated to dementia such as Alzheimer’s Disease. For example, medication interactions or overdoses, poor diet and other physical or mental problems cause symptoms that mimic dementia. Depression (see below) often resembles dementia in that its victims withdraw, cannot concentrate, and appear confused.
Causes of pseudementias such as malnutrition, medication or dietary changes, and stress are particularly relevant in a disaster, and any elderly person suddenly exhibiting mental changes should be diagnosed thoroughly for these influences rather than for a dementia-related disease process. 

Depression
Depression, considered the most common mental disorder, afflicts up to five percent of people aged 65 and older.   This disease is characterized by a deep sense of sadness, lessened energy and motivation, loss of pleasure in usual activities, and changes in appetite and sleep patterns.
Although trauma-related stress is a normal disaster response, elderly persons who exhibit the above symptoms for more than two weeks following a disaster should receive additional evaluation to make certain that they are not developing depression.

Dementias
Dementia, which is characterized by confusion, memory loss, and disorientation, is not an inevitable part of growing old. In fact, only 15 percent of older Americans suffer from this condition. Of that number, an estimated 60 percent suffer from Alzheimer's disease, a progressive mental deterioration for which no cause or cure has been found.  Detailed information on caring for persons with dementia in disasters is included elsewhere on this website.

Elderly persons can respond to and even grow from disaster experiences in many of the same ways as can younger persons.  Attention to these mental health considerations can be important in facilitating their disaster recovery.
Some of this fact sheet is based on information found at this site. (pdf)

 

Resilience and the Elderly

Senior citizens today are a sturdy, reliable generation.  They have proven time and again the ability to survive everything from the Great Depression to world wars and the threat of nuclear holocaust.   They are survivors.

These survival qualities, known as resilience, refer to the ability to “bounce back” from life problems in a way that makes people stronger.  Resilience in the elderly seems to involve some similar influences as it does in younger people, and also some important differences. 

Resiliency conditions take place along three dimensions of our experience: I AM, I CAN, and I HAVE. This fact sheet will discuss each of these as it relates to disaster recovery in the elderly.

I AM refers to personal characteristics such as self-esteem, confidence, and recognition of personal strengths and assets.  Unlike the young, elderly persons have a lifetime of experience in confronting and surviving the difficulties of life, and in their response to disaster they can remember and draw on this history of survival and character-building.

I CAN as an element of resiliency refers to recognition of not just self-esteem but self efficacy, which means the ability to DO and PERFORM survival- and recovery-related tasks.  Although they may not possess the physical strength or stamina of younger people, elderly persons often have talents of wisdom and perseverance and perspective that they can bring to the disaster experience.

I HAVE refers to the supports around each of us that promote resilience.  These supports are like the airbags in our cars that even when we crash can keep us from being wounded too seriously.  For elderly persons these support systems might include access  to service agencies, relationships with others, and participation in community resources.

In summary, elderly persons are perhaps uniquely suited, through a lifetime of confronting and working through struggles, to endure and recover from disasters.  Some additional information on resilience if found elsewhereon this website.

  

Disaster Preparedness for the Elderly:  A checklist

Elsewhere on this website you can find an overview of general disaster preparedness as it relates to persons who are elderly.  Following is a checklist that elderly persons may use to enhance their disaster preparedness:

Use the following checklist to get started:

• Assemble a disaster supplies kit (PDF).
• Arrange for someone to check on you.
• Plan and practice the best escape routes from your home.
• Plan for transportation if you need to evacuate to a Red Cross shelter.
• Find the safe places in your home for each type of emergency.
• Have a plan to signal the need for help.
• Post emergency phone numbers near the phone.
• If you have home health care service, plan ahead with your agency for emergency procedures.
• Teach those who may need to assist you in an emergency how to operate necessary equipment. Be sure they will be able to reach you.
• Consider special needs such as Alzheimer’s Disease (link to Alzheimer’s Association Safe Return Program pdf found on General Public FS, tab Special Needs) and other dementias, discussed elsewhere on this website.
• Consider special medical needs (link to This website pdf under disaster response found on General Public FS, tab Special Needs) such as diabetes, oxygen-dependence, and lack of mobility, as they may relate to disaster preparedness.

 

Web Links

Tips for Senior Adults is another helpful computer file with some senior-specific disaster planning tips.

 

Elderly Persons and Coping With Disasters

Coping refers to the process of not merely surviving a disaster, but managing and making meaning of it in a way that allows us not merely to survive but to grow.  Coping is a process that each person moves through differently, and it may also be a process that is somewhat different for elderly persons than for younger ones.  Here are some things to keep in mind about coping as it relates to disasters: 

• Remember that what you are feeling and how you are behaving is normal under the circumstances.   Be patient with yourself in your journey toward healing from the disaster and its consequences. 
• Physical reactions to a disaster are normal.  These reactions, known as stress are good because they help us function effectively in the urgency of the disaster.  It is only when the stress lingers and grows after the disaster, something known as Post-Traumatic Stress Disorder, that there is more concern.  
• Acknowledging feelings is important in recovery.  Many elderly persons have learned not to complain and to be private in their experience.  Speaking about your experience, though, can help you in your healing.  Sharing your experiences with other disaster victims can help you to understand that you are not alone.
• Asking for what you need often helps in healing, too.  It is not “selfish,” for example, to ask for a blanket or for water or for a shoulder to cry on.  It is also healthy and appropriate to ask for and accept help from community programs.  Older adults should be encouraged to ask for any type of help needed, such as financial, emotional, and medical assistance. Many of you have spent your lifetimes in the service of others, and disasters are times to let others be of service to you. 
• Focusing on your strengths and abilities will help.  This process, known as resilience, is important in disaster recovery.   What qualities do you, and maybe only you, possess and bring to the disaster experience? Becoming involved in the disaster recovery process and helping others to heal can be beneficial to the older adults own recovery.
• You each recover and heal at your own pace.  Again, be patient with yourself.

Older adults are a generation of survivors and with the proper support will become even stronger and more capable of facing future challenges.

Some of this fact sheet is excerpted from this site.

This 1-page article provided by SAMHSA titled A Guide For Older Adults explains what can help the elderly during and after a disaster.

  

Elderly Persons With Dementia and Disaster Response

Dementias such as Alzheimer ’s disease, although relatively rare in the elderly, are nevertheless an important influence on response to disasters.  We have included information on this website on disaster preparedness and person with dementia.  This brief fact sheet is intended to focus on disaster response for persons with dementia and their caregivers.

If You Know a Disaster is About to Occur

• Get yourself and the person with Alzheimer’s to a safe place. 
• Alert others (friends, family, medical personnel) to the fact that you are changing locations, and give them your contact information. Contact them as regularly as you can as you move.
• Be sure there are people other than the primary caregiver who have copies of the person with dementia’s medical history, medications and physician information. 
• Purchase extra medications.

If Relocation is Necessary
In an emergency, people with dementia and their caregivers may find themselves uprooted or displaced to alternative living arrangements. Extra care and attention must be made to ensure the health and safety of the people with dementia in such environments. The change of location, plus unfamiliar noises and activities, may cause them increased stress and confusion. And, certain behaviors of persons with
Alzheimer’s may confuse or alarm others.  Try to:

• Be calm and supportive, letting the person with dementia “borrow” from your sense of stability and perspective
• Remain flexible, patient and calm - a person with dementia will respond to the tone you set.
• Restate and respond to the emotion being expressed by the person with dementia. Ask, “Are you feeling frightened?”  Sometimes physical contact, such as offering a hand or a hug, is helpful.
• Not  leave the person with dementia alone. Don’t ask a stranger to watch the person.

Even within a difficult space such as a shelter, try to create a stable and calm environment through: 

• Trying to spend extra time with the person to help him or her adjust to the new environment.
• As much as possible, trying to maintain daily routines.
• Using simple sentences and explanation, and diverting attention to new and familiar topics and activities as necessary.  For example, a caregiver might say, “I know you want to go home. For now, we need to stay here. Let’s see if we can get some lunch.”
• As appropriate, inform people around you that the person has memory loss.
• Limit news media exposure to the disaster.

Take care of your loved one and yourself

• Ensure proper nutrition and hydration for both yourself and for the person with dementia.
• Make it a priority to find a doctor and pharmacy.
• Find a good listener – seek spiritual support.

Some of this information is based on the guidelines provided by FEMA at this site.

FEMA provided this 3-page article titled Caring for Someone with Dementia in a Disaster which explores several topics including what to do if you know a disaster is about to occur, preparations to make in advance and tips if you are relocated due to the disaster.

Additional information on caring for persons with cognitive impairment during disasters may be found here.

This 3-page article provided by the American Association of Homes and Services for the Aging offers information pertaining to the handling of cogitatively impaired individuals during a Pandemic/Epidemic or Disaster.

  

Disaster Preparedness and Persons with Dementia

Dementia refers to physical changes in the brain causes loss of memory and other mental abilities, severe enough to interfere with daily living.    The best known example of dementia is Alzheimer’s disease.  Although dementia is not a common or inevitable part of aging (only 15 percent of older Americans suffer from this condition the needs of persons with dementia (and their caregivers) present important disaster-related mental health challenges. 
Here are some quick preparedness guidelines:

• Consider registering with the Alzheimer’s Association Safe Return Program.  This is an identification and support program that provides assistance for a person with Alzheimer’s who wanders off and becomes lost, either locally or far from home, and registration may be particularly helpful in the event of a disaster.
• If you are already registered in Safe Return, make sure personal contact information, medicines needed and doctor information are updated with the program.
• Prepare an emergency kit in a watertight container and stored in an easily accessible location.  In addition to standard items, dementia-related preparedness needs might include:

• Easy-on flotation devices, such as “water wings” or floating armbands
• Easy on/off clothes (a couple of sets)
• Velcro shoes/sneakers
• Back-up eyeglasses
• Incontinence products
• Wipes
• Lotion (good for soothing the person)
• Pillow, toy or something else to hug
• Favorite items or foods, liquid meals
• Supplies of non-perishable medication
• Extra identification items for the person, such as an ID bracelet or clothing tags
• Copies of legal documents, such as power of attorney
• Copies of medical documents that indicate the person’s condition and current medications
• Copies of insurance and Social Security cards
• Zip-lock bags to hold medications and documents
• Physician’s name, address and phone numbers
• Alzheimer’s Association phone number and address and Safe Return phone number
• Recent picture of the person with dementia

Consider preparing a “What You Should Know About (name)” fact sheet for the person with dementia to bring to a shelter or other emergency disaster center. Information on the form could include:

• What the person with dementia likes to be called
• Cultural background
• Names of family and friends
• Past hobbies and interests
• Sleep habits
• What upsets them
• What calms them down
• Typical patterns of behavior
• Normal daily structure and routines
• Eating and drinking patterns and abilities

This information could assist both the person with dementia and his or her caregivers.

• Educate yourself about the specific ways that persons with dementia may experience and respond to traumatic events such as disasters.

Parts of this fact sheet are based on a very helpful FEMA document found here. (pdf) 

 

After the Disaster: Now what?

Although people of all ages have similar struggles in recovery from disaster, there are some special considerations for the elderly.   Here are some tips to help you in your recovery.

• Remember that recovery is a process, not an event.  You will probably go through phases of recovery, including:
1. Denial  (pretending nothing ever happened)
2. Anger (finding someone or something to blame)
3. Bargaining (imagining that there is some way to erase the disaster or protect against further trauma)
4. Depression (feeling numb and sad as the full experience begins to sink in)
5. Acceptance (integrating the experience of the disaster within your life experience as a whole)

Remember that this process takes time, and that you can be patient with yourself as you take the journey of recovery.

• Anticipate and be on the look-out for signs of stress.  An optimal amount of stress is good as it helps us function, but too much stress can lead to health-problems and psychological concerns.

In older adults some disaster stress reactions may be experienced immediately, while others may appear months later.

• Focus on maintaining close relationships.  Some people who survive a disaster experience a strong desire to withdraw from others. They may withdraw even from those to whom they are the closest. Overcoming the tendency to isolate ones self takes real strength and discipline, of the sort that many elderly persons are already skilled at through a lifetime of doing the necessary but difficult thing.

A few ways to break the isolation barrier are to:

• TALK: It takes courage to reveal what you are thinking and feeling to someone else. Talking can be very comforting and healing.  

• ASK FOR HELP: Research shows that people who ask for help come through disasters stronger and healthier than those who view seeking help as a weakness.  Perhaps some short-term counseling (insert internal link here) may help you make sense of the experience of the disaster, and rather than be a sign of weakness this is a sign of strength.

• BE WITH PEOPLE: Stay involved with your religious or spiritual or civic communities and with any elder-specific services that are available in your area.

• Invest in self-care.  Now is the time to take care of yourself, to sleep and eat and listen to music and try to resume your ordinary activities as you are able and as circumstances permit. You have survived a disaster. That doesn't mean your life is over or that you don't deserve to be happy again. Do something good for yourself.

Portions of this fact sheet are excerpted from this site.

This 1-page article from the University of Nebraska titled Special Concerns of Older Adults Following a Disaster provides information concerning how to emotionally recover after a disaster.

  

Preparedness and Elderly Persons

Elderly persons are a diverse group.  Some are in good health but aren't quite as agile as younger persons.  Some have hearing or vision problems, and others might use a cane or a wheelchair.  Some have family nearby, and some live alone.  Some have considerable financial resources and others are more limited.  Whatever the situation, though, elderly persons can, and need to, be prepared for disasters in ways that take into consideration their physical, demographic, and other needs.  Preparation for disasters, regardless of our age, can help minimize its effects. 

Elsewhere on this website you will find detailed information about disaster preparedness.  Here are some specific preparedness considerations for persons who are elderly:  

• Store plenty of water, at least 1 gallon per person per day, because dehydration is a serious health problem for older adults. Store at least 3 days worth. Use small containers with easily removable caps. Water in swimming pools and spas can be used for sanitation and personal hygiene.
• Have a three-day supply of nonperishable food, with consideration to your special dietary needs.
• Assemble a disaster first aid kit (PDF), being certain to include nonprescription medications that you use on an ongoing basis. Include a thorough personal medical history (PDF) or invest in some sort of electronic medical history device (PDF). If possible keep an extra pair of eyeglasses, hearing aid batteries and, if you use an electric wheelchair, make sure there is a manual wheelchair available or extra batteries on hand.
• Have an emergency contact person (PDF) who lives in a different geographic area. Give that person a list of names, phone numbers / email addresses of people who should be contacted; or you can give your friends and family the name and phone number / email address of your contact person.
• Put your important papers in a safe place. These should include insurance policies, bank account and credit card information, Medicare and/or Medicaid cards, and living wills and powers of attorneys (PDF).
• Include in your disaster kit (PDF) some time passers such as board games, puzzles, books, paper and pens for letters and notes, envelopes and stamps, playing cards and some paperback books

These suggestions will help you feel better prepared in the event of a disaster.

Web Links

The University of Florida provided this 2-page article titled Disaster Planning Tips for Senior Adults, which explores disaster planning topics for the elderly including water, food, first aid kits, non-prescription drugs, contacts, important papers, time passers, medical needs, people with special needs, emotional support/stress-reduction and evacuation or movement to a shelter.

This fact sheet on disaster preparedness from the American Red Cross’ prepared.org titled “What We Can Do to Save Our Lives” is “for seniors, written by seniors.”

 

Managing Disaster Stress-Related Responses in the Elderly

Although it is normal for those experiencing disasters to have a traumatic stress response, excessive reactions may also occur when a situation overloads the mental ability of the person to act appropriately.   These excessive stress responses may cause a person to become very agitated or angry, to seek to find someone to blame, or even to strike out at others physically.  Here are some guidelines to avoid such responses in elderly persons including elderly persons with dementia.

1. Preparation and Prevention

Potential causes of excessive responses are over-stimulation, inadequate attention, pain, fear, hunger, and misunderstanding or misinterpreting the events in the environment.  Disruptions of routine tend to be exaggerated in times of disaster, and knowing this we can make necessary adjustment to minimize traumatic response.

2. Responding to Stress in Others

Understanding another person’s feelings is necessary before we can respond to them.  Often by the time we have truly understood no additional response is necessary.   Here are some helpful listening and understanding principles:

• Appreciating that the person under stress may be responding not just to these circumstances, but to the way that the present situation is reminding them of something in the past.
• Speaking in a calm, low-pitched voice.
• Avoiding the use of force or physical restraint whenever necessary.  Reassurance and guidance and redirection are always less stress-inducing than force.
• Validating the other’s experience.  Focus on the feelings, not only the content of what the person is saying.  Sometimes the emotions being expressed are more important than what is being said. Look for the feelings behind the words.

There are also some environmental and behavioral ways to minimize disaster-related stress:

• Try to reduce excess stimulation.  Turning down the volume on the television or the radio, or closing the curtains, can often promote calm even in disaster circumstances.
• Demonstrate and teach relaxed breathing strategies
• Listening to familiar music or recordings, or looking at familiar pictures, can often convey a sense of consistency and calm.
• Short exercise breaks, even something as simple as taking a walk around a shelter or doing some mild stretching, can also help prevent excessive reactions to stress. 
• Regular verbal and written cueing (“We’re going to the shelter now,” “There has been a tornado, but now we are safe,” “The lights are off because there is no electricity, but we have candles”), without infantilizing or “talking down,” can often help. 
• Even in the midst of a shelter or other difficult disaster environment, seeking to provide and maintain a consistent routine (teeth brushing, meal and sleep times) can help minimize stress.
• Use of familiar transitional or “comfort” objects, such as pillows or photographs or even items of clothing, can also minimize stress.

With appropriate prevention and some adjustments in our environment, we can maintain mental health in the face of disasters.

Some of this information is adapted and modified from the helpful guidelines at this site.