Elderly populations have specific reactions and needs after a disaster. Many older adults, especially those who lack resources or have declining physical capacity, lose important support systems in the destroyed neighborhood. They may also have more difficulty in "navigating" the channels of the emergency system. This situation is compounded if older persons are poor, immigrants, or unskilled.
Specific problems of the elderly that aggravate the problems of coping after a disaster include:
• Relocation with family members where privacy, personal space, and daily routines are a source of stress;
• Difficulty with sleeping schedules and relying on sleep medication;
• Sense of disorganization or confusion due to loss of "cues" in daily activities.
The reaction of older individuals to a trauma will be influenced by the impact of what they saw, heard, felt, and smelled, as well as by memories of crises in their past. This revisitation of past events is not simply a product of regression or trigger reactions. It is essentially a normal attempt to ground one's reactions in the familiar.
GUIDELINES FOR HELPING OLDER PERSONS COPE WITH DISASTER
In working with elderly disaster survivors, mental health workers should place emphasis on restoring confidence and dignity. The following guidelines will help workers assist elderly survivors cope with the aftermath of a disaster:
Rebuild and reaffirm attachments and relationships: Nurturing and physical closeness is needed. Let older persons identify those to whom they want to be attached; however, do not assume family relations are friendly.
Consider their concern about safety: The elderly need to know they have options in making a choice about their safety. Evacuation is a highly controversial issue in disaster. Older adults may be less safe in evacuations than if they remain in their homes (if this is feasible).
Talk about the tragedy: Remember that older persons may be venting feelings about their lives, not about the immediate event. Do not attempt to prevent this venting, since validating past concerns is an important part of establishing trust in preparing to deal with current concerns. The elderly may also respond well to music and opportunities to paint or create art that communicates their reactions.
Anticipate communication lapses: In conversations, the elderly may go back and forth from the past to the present. Workers may be confused by an individual's discussion of past events or past relationships in terms of the present disaster experience. It is important to remember that the discussion may be entirely rational and logical from the perspective of the individual.
Understand that stress inhibits memory: If an older person forgets a name, place, or portion of an event, the worker should take great precautions to avoid placing pressure on the elderly person to remember.
Prepare for sporadic conversation: Workers should be prepared for the elderly to talk sporadically about the disaster, spending small segments of time concentrating on particular aspects of the traumatic experience as a method of defense.
Provide factual information: Older adults want factual information, but may be able to absorb the facts only in limited quantity. Often, they ask to have information about the disaster repeated a number of times. Eventually they will integrate it and gain better control over their emotions about the event.
Make short-term predictions: Specific times and places for changes should be made clear. It will help to delineate events on a calendar or clock so that the older person can more easily track the future. Workers should spend time addressing basic needs in a detailed way, such as who will help the older person, where the person will stay at night, where he/she will get clothes, and what property may be rescued from their destroyed homes.
Establish routines quickly: It is best to reinitiate old routines if possible, since routines are considered an anchor in aging.
Reassure about normal reactions: The worker should reassure the elderly that lapses of concentration, memory losses, physical ailments, and depression are normal reactions to the abnormal post-disaster situation that may have nothing to do with the aging process.
Reactions to Traumatic Events among Elderly Populations
• Fear of mortality
• Need for permanence
• Wish to reconnect with past and with friends
- Generally temporary state
- May be long-term regression of severe, chronic condition
- May move in and out of regressed state during relocation
• Multiple Losses
- Fear of relocation to unknown neighborhood
- Fear of losing their dignity
- Loss of hope for the future
- Loss of cherished mementos
• Need to integrate loss into context of life
• Disorientation as routine is interrupted
• Sense of denial as a normal defensive reaction to trauma
• Immediate fear response, followed by anger and frustration when unable to control a situation
• Physiological responses
- Sleep disturbances
- Appetite disturbances
- Crisis episodes