Abstract:
Climate change and disasters present mounting health risks to the U.S. population, especially for adults ages 65 and older. Generally, across all age groups, older adults are the least prepared and the most at-risk during all phases of a disaster (e.g., mitigation; preparedness; response; recovery), and, have the highest rate of disaster-related deaths. This article identifies vulnerabilities of older adults to climate change and disasters, including those related to chronic health conditions, disabilities, and depleted social networks. It then discusses two critical resources that can reduce older adult vulnerability, including individual and community emergency preparedness and increased social support.
Key Words:
climate change, disasters, health risks, emergency preparedness, social support
Such acute natural disasters such as hurricanes, floods, heat waves, and wildfires, as well as gradual-onset environmental events like sea level rise and coastal erosion, are growing in frequency and severity across the United States (National Oceanic and Atmospheric Administration [NOAA], Centers for Environmental Information [(NCEI], 2020). In 2020, U.S. disasters caused $95 million in damage, which was nearly double the 2019 figure and the third-highest losses reported since 2010 (Flavelle, 2021).
The last four years have been particularly devastating, as the United States has seen several catastrophic disasters, including Hurricanes Harvey (2017), Maria (2017), and Michael (2018); extreme flooding in the Gulf and Mid-West regions (2019); a record number of named Atlantic storms (2020); heat wave deaths in Arizona that soared to new highs (2020); and wildfires that have swept through California with unprecedented regularity. Climate change is accelerating the severity of many of these disasters.
Average land and ocean surface temperatures continue to rise, with 2020 ranking as the second hottest year on record (NOAA, 2021). These rising surface temperatures have been linked to more droughts, increased intensity of storms, increased wind speeds in tropical storms, and now are understood to place areas at risk that are not typically subjected to powerful flooding, waves, and currents. Warming temperatures also increase the spread of vector-borne illnesses like West Nile and Lyme disease, as these conditions allow mosquitoes and ticks to be present for longer seasons.
These trends leave little doubt that climate change and natural disasters are emerging as critical public health challenges, as they present a mounting risk to the health and well-being of the U.S. population (Frumkin and Jackson, 2020). We have witnessed firsthand how these events can have direct and indirect impacts on human health, including physical trauma, acute disease, and emotional distress, as well as contribute to increases in the morbidity and mortality associated with chronic and infectious disease (Giorgadze et al., 2011; Shoaf and Rottman, 2000).
Climate change and disasters also threaten access to clean air, safe drinking water, nutritious food, and proper shelter. For those who have lived through catastrophic disasters, these events can be extremely disruptive and it can take months—if not years—to regain a sense of normalcy. However, climate change and natural disasters are not equal opportunity threats. Climate impacts and disasters exacerbate existing inequalities related to race and ethnicity, gender, socioeconomic status, and age. Such impacts are felt greatest by the most socially vulnerable, especially adults ages 65 and older.
Older Adult Vulnerability to Natural Disasters and Climate Change
The health and well-being of older adults is disproportionately affected by disasters and climate-related events due, in some cases, to chronic health conditions, cognitive limitations, and depleted social networks (Balbus and Malina, 2009; Bei et al., 2013; Cherry et al., 2015; Pillemer and Filiberto, 2017). Disasters can cause those with chronic health conditions to experience disruptions to their medical care, as well as challenges securing needed medication or critical equipment like oxygen. Power outages, in particular, can be extremely disruptive to regular treatment for conditions like chronic kidney disease, which is nearly 40 percent more common in adults ages 65 and older than in adults ages 45 to 64.
Following Hurricane Sandy (2012), widespread power outages across New York and New Jersey disrupted hospital and dialysis facilities for weeks, which led to increased emergency department visits, hospitalizations, and an increase in kidney patient death rates (Kelman et al., 2015).
Similarly, Puerto Rico’s power outages blanketed 80 percent of the island following Hurricane Maria, which left only three major hospitals functioning in the days after the storm. The nearly 5,000 patients who relied on dialysis prior to Maria remained in very tenuous circumstances for the eleven months it took to restore power to the island.
Additionally, more than a third of all older adults report one or more disabilities, which can range from communication (seeing, hearing, speaking), mental functioning (Alzheimer’s disease and other dementias), and physical functioning (limited or no ability to walk, climb stairs, or lift or grasp objects). Disabilities place older adults at double the risk of a disaster-related injury or death; make them less likely to evacuate; and increase their recovery time (Gershon, 2020).
Power outages can be extremely disruptive to treatment for conditions like chronic kidney disease, which is nearly 40 percent more common in adults ages 65 and older.
Older adults with physical disabilities, lower levels of educational attainment, and fixed or limited income are most vulnerable to the effects of disasters due to their limited preparedness for emergencies (Al-Rousan, Rubenstein, and Wallace, 2014). The unique and stressful challenges presented to older adults with disabilities during a disaster can extend to their caregivers. Caregivers for those with Alzheimer’s disease and related dementias are often told to maintain routines and limit exposure to new environments to minimize behavioral symptoms (i.e., agitation, aggression, depression, anxiety); however, evacuation or displacement due to a disaster can exacerbate these behavioral symptoms and present new challenges for caregivers of this population (Gibson, Walsh, and Brown, 2018).
Such risks are compounded by the size and strengths of older people’s networks. The thinning or absent social networks of many older adults mean that they have limited support from friends and family, and often live alone. Nearly a third of U.S. residents older than age 65 live alone, and as people age, they are even more likely to live alone—by age 75, more than half of women live alone (Institute on Aging, 2021).
Adults ages 65 and older who live alone are much more likely to be poor (16.7 percent) than older adults who live with families (5.7 percent). The highest poverty rates were experienced by older Hispanic women living alone, as 37.2 percent faced poverty (Administration on Aging, 2018). Older adults who live alone can experience a sense of instability and insecurity, and are left by themselves to sort out complex disaster response and recovery operations.
Heat waves are especially dangerous for older adults who live alone or are socially isolated, which are the leading risk factors related to heat wave deaths. Most of the deaths from the 1995 heat wave that struck Chicago and killed more than 700 people over a four-day period were attributed to older adults who lived alone (Klinenberg, 2015). Over the past five years, heat has been linked to more than 1,500 deaths in Arizona alone, with many more people being hospitalized due to heat-related illnesses. Heat waves can be especially dangerous for lower-income older adults who do not own air conditioners, have limited financial resources to continuously operate them, or do not live in communities with access to cooling centers. Climate change is expected to produce heat waves that are longer, more intense, and more frequent, which will only further threaten the lives of isolated older adults, as well as present challenges for states with large older adult populations such as Arizona.
Despite their vulnerability to disasters and climate-related events, older adults often experience less mental health distress than do other age groups. Research in New Jersey following Hurricane Sandy found that older adults were more likely to report that they had recovered despite higher levels of exposure to the storm (Merdjanoff et al., 2019). Additional studies have found that older adults are more psychologically resilient to disasters than are younger adults. This can be attributed to the inoculation hypothesis, which says that the accumulation of traumatic or challenging life experiences can provide older adults with better coping abilities than younger age groups when faced with disaster exposure. Such findings suggest that while older adults may be particularly vulnerable to the disaster itself, their life experiences may provide them with the tools to “bounce back.”
It is important to acknowledge that age alone does not distinguish the risk that disasters and climate change pose to older adults. There are critical intersections with social characteristics such as race and ethnicity, socioeconomic status, disability, and gender that can increase or decrease such vulnerability. Historical redlining of minority neighborhoods continues to expose black and lower-income individuals and families to more deleterious effects of global warming. Researchers found the redlined neighborhoods were more heavily impacted by extreme health events than other neighborhoods in more than 100 U.S. cities (Wilson, 2020). Many historically redlined urban communities have sizeable older populations.
With this understanding, it is important to note that, generally, across all age groups, older adults are the least prepared for disasters, are the most at-risk during all phases of a disaster (e.g., mitigation; preparedness; response; recovery), and, have the highest rate of disaster-related deaths (Brown and Walsh, 2018).
Older adults frequently live in and relocate to states that are susceptible to various natural disasters and climate-induced events, such as hurricanes (Florida, Louisiana, Texas), heat waves (Illinois), wildfires (California), and flooding (North Carolina, South Carolina, New Jersey) (Baggaley, 2017; Himes and Kilduff, 2019). One quarter of the 52 million Americans who are ages 65 or older live in the disaster-prone states of California, Florida, and Texas (Himes and Kilduff, 2019).
Despite their vulnerability to climate-related events, older adults often experience less mental health distress than do other age groups.
In addition to the damage and destruction disasters generate, the incidence of these events is necessitating massive evacuations, which are extremely disruptive to older adults and can place them at higher risk of physical and mental health impacts. In October 2016, more than 2.5 million people were ordered to evacuate in Florida, Georgia, North Carolina, and South Carolina due to Hurricane Matthew, which was the tenth most destructive storm in U.S. history (Editors, 2016).
As the size of the older adult population continues to substantially expand in all of these high-risk states, more of this vulnerable age group will be at heightened risk of disaster exposure, which could be deleterious to their health and well-being. It has become imperative to identify, develop, and invest in critical resources to combat the mounting risk that climate change poses to this vulnerable population.
Needed Resources to Reduce Older Adult Disaster Vulnerability
There are two predominate resources that can mitigate older adult disaster vulnerability. First is a focus on advanced planning for future disasters and increasing emergency preparedness at the individual and community levels. Building a culture of preparedness, which is a focus of the Federal Emergency Management Agency, involves increasing homeowner, renter, flood, and wind insurance rates; enhancing community mitigation efforts; and ensuring a continuity of operations so that essential services and agencies are able to function despite emergencies.
Preparedness also involves increasing individual and community capacity for adaptation. Individual adaptation is influenced by social support and psychological resilience—two resources known to buffer against the effects of disaster exposure—while community adaptation is affected by the type, timing, and level of support received after a disaster. These efforts cannot be a one-size-fits-all approach. Preparedness messaging must be targeted to the most salient factors of the populations most vulnerable to disasters and climate change. This means preparedness messaging and direct outreach not just for older adults, but specifically for older adults with disabilities, those of lower-income, and those with limited social support.
In our research on community-dwelling older adults living in coastal Louisiana, initial findings suggest that older adults need specific resources to age in areas that are prone to disasters and climate change. These include informal social support from their family (specifically, adult children), formal social support from community organizations like senior centers, and strong community ties. Social support—the giving and receiving of emotional or instrumental help—can increase psychological resilience to disasters but also supports improved physical and psychological health, which makes it a critical resource for aging more generally.
Following the Great East Japan Earthquake and Tsunami (2011), researchers found that older survivors with high levels of social support were at a significantly lower risk of developing depressive symptoms, even after adjusting for demographic and disaster exposure variables (Sasaki et al., 2019). Previous findings also suggest that older adults with higher levels of social support are more likely to be prepared for disasters and emergencies (Kim and Zakour, 2017), which creates an added incentive to increasing social support efforts for older adults.
Interventions to Address Older Adult Vulnerability to Disasters
Emergency preparedness is particularly important for older adults and an effective, low-cost intervention to reduce vulnerability. This involves working with friends, family, and neighbors to develop an emergency plan that targets specific needs, including essential medical care or means of evacuation. Older adults can begin by designating a contact person who will check on them during a disaster and develop a plan to maintain communication with their contact in the event of an emergency.
Additionally, older adults can create an Emergency Supply Kit that contains a list of important contacts (i.e., family, friends, doctors), health-related items (i.e., medical supplies, medication, glasses), and critical documents secured in a waterproof bag (i.e., list of medications, power-of-attorney documents, copies of photo ID and medical insurance cards). This kit should also include enough basic supplies (i.e., food, water, flashlight with extra batteries, cash, seasonally appropriate clothing) to last for at least three days. For older adults, it might be important to identify a bag that has wheels and is easy enough to move. Older adults and their caregivers should revisit this kit every six months to ensure that all items are up-to-date.
It is also essential that older adults create an evacuation plan and decide where they will go. For community-dwelling older adults, this might involve identifying friends or family they could stay with, as well as efficient evacuation routes and means of transport. For those who live in an assisted living community, they should familiarize themselves with whatever planning is in place and ask questions in advance. Creating an evacuation plan, including escape routes and meeting places, can help older adults assess physical limitations that might impede evacuation and help them to identify resources—even within their community—that can assist with their evacuation. The City of New Orleans has partnered with the Smoothie King Center (NBA arena) to create a central location for the City-Assisted Evacuation Plan. Any resident who needs help evacuating during a disaster due to transportation, financial, or medical needs can be picked up at one of seventeen spots around the city, including four at senior centers, and will be taken to the Smoothie King Center for evacuation.
Second, to combat the effects of a warming planet and climate-related disasters, there must be investment not just in physical infrastructure but also in social infrastructure. In 2020, Congress allocated $806 billion for environmental programs to address biodiversity protection, sustainable forestry, renewable energy, and adaptation (Thwaites, 2020).
COVID-19 has demonstrated how woefully unprepared we are as a nation to handle extreme disruption and widespread social stressors like disasters.
While there is little debate that we need further investment in physical infrastructure to combat climate change, policymakers continue to underinvest and overlook the importance of social infrastructure. Social infrastructure shapes and encourages social interactions, leads to healthier, safer, more equitable, and less polarized communities, and can reduce the vulnerability of certain populations to disruptive disasters. Investing in social infrastructure (i.e., libraries, green space, public space that encourages interaction) can also build community preparedness, social cohesion, and collective efficacy, which are critical in reducing the mental and physical health effects of climate change and disasters.
Investing in these relationships prior to a disaster striking can provide the foundation for effective response and recovery that limits the damaging impact of these events, and simultaneously limit the growing disparities between those who suffer most from disasters. For older adult populations, especially those that are lower income and live alone, investing in resources that increase social support and build social cohesion can limit their vulnerability to disaster and also enhance recovery.
Conclusion
By 2034, 21 percent of the population (78 million) will be ages 65 and older, and for the first time in U.S. history, older adults will outnumber children (Vespa, 2018). As the older adult population continues to expand in high-risk states such as California, Florida, and Texas, the number of people at heightened risk of disaster exposure will increase and the burden to prepare for and respond to climatological-related disasters will place enormous pressure on local and state public health and emergency management programs.
Unfortunately, if the COVID-19 pandemic has revealed anything, it has demonstrated how woefully unprepared we are as a nation to handle extreme disruption and widespread social stressors like disasters. While major investment is needed to bolster the reach of public health and emergency management agencies to mitigate the impacts of disasters on vulnerable populations like older adults, we must also recognize the importance of increasing disaster preparedness and building social support. Investing in the structural and behavioral resources that older adults need in order for them to prepare and recover, especially when we know what is on the horizon, is our best way to limit their vulnerability to such events.
One of the greatest looming challenges is to close the gap between older and younger adults regarding concerns about climate change. A 2018 survey revealed that while 70 percent of adults ages 18 to 34 are worried about global warming, only 56 percent of adults ages 55 and older shared the same sentiment (Reinhart, 2018). Meanwhile, the health consequences that climate change and disasters pose for older adults are indisputable and too great to ignore. Increasing awareness among older adults so they fully understand the threats presented by climate change and disasters can ease efforts to increase preparedness and mitigation in this population. This includes action by governments, local authorities, and trusted community brokers to build awareness around the specific threats that climate change and disaster pose to older adult communities to promote individual and community preparedness efforts. This also means greater structural change, including investment in social infrastructure, to build social cohesion and increase social support in places that are most at-risk. Only by investing in behavioral and structural change can we truly reduce the vulnerability of older adults to disasters and climate change.
Alexis Merdjanoff, PhD, is a clinical assistant professor in Social and Behavioral Sciences at New York University’s College of Global Public Health.
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