PTSD: National Center for PTSD
Impact of Disaster on Older Adults
The Impact of Disaster on Older Adults
Research has been mixed about whether older adults are at higher risk for post-traumatic psychopathology. Normative aging suggest older adults may be at lesser risk because they have had a lifetime to develop coping abilities. However, with chronological aging comes health decline and other factors that may leave older adults more vulnerable during and after a disaster.
What Are the Risk and Protective Factors Associated with Aging?
Brown, Rothman, and Norris (2007) reported that chronological age is a poor predictor of the need for mental health care services following a disaster. They argue that the most important factors for the use of post-disaster services include the individual’s pre-disaster health status, social networks, and the availability of health-sustaining resources (1). Many older adults are quite resilient in the face of disasters, and older adults may be an under-recognized source of resilience and response in time of crisis (2-4).
However, about 80% of older adults have at least one chronic condition that makes them more vulnerable than those without a chronic health problem during a disaster. These chronic conditions, combined with the physiological, sensory, and cognitive changes experienced as part of aging, may result in frail older adults having special needs during emergencies (5).
A meta-analytic review found that older adults were 2.11 times more likely to experience PTSD symptoms and 1.73 times more likely to develop adjustment disorder when exposed to natural disasters as compared to younger adults (6). A recent longitudinal study found that while age alone was not a significant predictor of psychological outcomes, older individuals with low income, low social support, and high levels of solitary religious participation are at greater risk; and, perceived social support seemed to be the key factor in terms of positive mental health outcomes (7).
Other related risk factors may play a role in increased incidence of PTSD, such as prior exposure to extreme traumatic stressors, difficulty re-establishing income and savings, institutionalization, cognitive limitations, female gender, and lack of or loss of social support (1,6,8). Another longitudinal study of recently affected older adults found that the majority (78.7%) had low/no PTSD symptoms across all assessment points; 16.0% had chronic, clinically significant symptoms; and 5.3% had a delayed onset course of clinically significant symptoms. Those with chronic and delayed symptoms were more likely to have greater severity of disaster exposure, and greater number of traumas and stressors since this disaster. Having some college or higher education was protective, reporting a negative association with the chronic and delayed symptom trajectory (9).
What Are Recommended Strategies for Working with Older Adults Following Disaster?
In order to best serve older adults following disaster, advocates for this demographic should participate in community-wide emergency preparedness. Having professionals from diverse fields working and training in these coalitions will produce the best outcomes.
Recommended strategies when assisting older adults post-disaster include (1,6,8-10):
- Minimizing disruption to disability and health services on which older people rely
- Designing shelters that are accessible for older persons
- Creating contact systems that enable checks on the well-being of older adults
- Developing triage systems that allow rapid reconnection with family and provision of basic needs
- Using community mapping data to identify areas where many older adults live
- Establishing continued monitoring and timely intervention for disaster-affected older persons, particularly those with lower levels of education, disaster-related physical injury or illness, high level of community disruption, and financial distress
- Fostering organizational linkages
- Bolstering social support across individuals, families, and communities at large
- Providing financial resources for older adults who do not have the funds to manage post-disaster expenses
Provision of mental health services for older adults may require special efforts to address systematic and personal barriers to treatment. Elderly individuals may be less likely to admit to feeling overwhelmed or distressed. The stigma of mental health treatment and the belief that only the mentally ill require such treatment may hinder effective provision of services.
Educating older adults about the nature of reactions to disaster and mental health treatment, informing them about community resources, and identifying lessons learned and potentially positive outcomes may be helpful. Any interventions should take into account travel, mobility, cognitive, and stamina limitations (1,8,11).
- Brown, L., Rothman, M., & Norris, F. (2007). Issues in mental health care for older adults after disasters. Generations, 4, 21-26.
- Siskind, D. J., Sawyer, E., Lee, I., Lie, D. C., Martin-Kahn, M., Farrington, J., Crompton, D., & Kisely, S. (2016). The mental health of older persons after human-induced disasters: A systematic review and meta-analysis of epidemiological data. American Journal of Geriatric Psychiatry, 24, 379-388. doi:10.1016/j.jagp.2015.12.010
- Davey, J. A., & Neale, J. (2013). Earthquake preparedness in an ageing society: Learning from the experience of the Canterbury Earthquakes. Retrieved from https://www.eqc.govt.nz/research/research-papers/earthquake-preparedness-ageing-society
- Trumbo, C., Lueck, M., Marlatt, H., & Peek, L. (2011). The effect of proximity to Hurricanes Katrina and Rita on subsequent hurricane outlook and optimistic bias. Risk Analysis, 31, 1907-1918. doi:10.1111/j.1539-6924.2011.01622.x
- Aldrich, N., & Benson, W. F. (2008). Disaster preparedness and the chronic disease needs of vulnerable older adults. Preventing Chronic Disease, 5, A27. Retrieved from http://www.cdc.gov/pcd/issues/2008/jan/07_0135.htm
- Parker, G., Lie, D., Siskind, D. J., & Martin-Kahn, M. (2015). Mental health implications for older adults after natural disasters – a systematic review and meta-analysis. International Psychogeriatrics, 28, 11-20. doi:10.1017/S1041610215001210
- Cherry, K. E., Sampson, L., Nezat, P. F., Cacamo, A., Marks, L. D., & Galea, S. (2015). Long-term psychological outcomes in older adults after disaster: Relationships to religiosity and social support. Aging & Mental Health, 19, 430-443. doi:10.1080/13607863.2014.941325
- Claver, M., Dobalian, A., Fickel, J. J., Ricci, K. A., & Mallers, M. H. (2013). Comprehensive care for vulnerable elderly Veterans during disasters. Archives of Gerontology and Geriatrics, 56, 205-213. doi:10.1016/j.archger.2012.07.010
- Pietrzak, R. H., Van Ness, P. H., Fried, T. R., Galea, S., & Norris, F. H. (2013). Trajectories of posttraumatic stress symptomatology in older persons affected by a large-magnitude disaster. Journal of Psychiatric Research, 47, 520-526. doi:10.1016/j.jpsychires.2012.12.005
- Johnson, H. L., Ling, C. G., & McBee, E. C. (2015). Multi-disciplinary care for the elderly in disasters: An integrative review. Prehospital and Disaster Medicine, 30, 72-79. doi:10.1017/S1049023X14001241
- Stanko, K. E., Cherry, K. E., Ryker, K. S., Mughal, F., Marks, L. D., Brown, J. S., Gendusa, P. F., Sullivan, M. C., Bruner, J., Welsh, D. A., Su, L. J., & Jazwinski, S. M. (2015). Looking for the silver lining: Benefit finding after Hurricanes Katrina and Rita in middle0aged, older, and oldest-old adults. Current Psychology, 34, 564-575. doi:10.1007/s12144-015-9366-2