By Geralyn Magan
In a new book about climate justice, two LTSS Center researchers recommend strategies for keeping older adults safe during weather emergencies.
After Hurricane Katrina slammed into the City of New Orleans in 2005, the nation learned an important and devastating lesson: older adults are highly vulnerable to the physical and mental health effects of extreme weather.
Katrina found New Orleans residents, public officials, first responders, community agencies, and healthcare providers woefully unprepared for its impact. Tragically, older adults paid the price, suffering the highest mortality rate of any age group impacted by the storm.
Despite these adverse outcomes, we’ve made little progress over the past two decades in understanding and mitigating the effects of climate-related disasters on older adults, according to Climate Justice and Public Health, a new book from the University of Massachusetts Press.
“Nearly every natural disaster since (Katrina) has continued to demonstrate that older adults are disproportionately susceptible to disaster-related harm,” according to the book’s chapter on the impact of climate change on older adults.
Authors of that chapter include Natasha Bryant and Robyn Stone of the LeadingAge LTSS Center at UMass Boston; Caitlin Connelly, a Gerontology PhD student at the University of Massachusetts Boston; and Kathrin Boerner, a professor of prevention and rehabilitation research at the University of Oldenburg, Germany.
CLIMATE CHANGE AND OLDER ADULTS
Connelly, Boerner, Bryant, and Stone argue that natural disasters like floods, hurricanes, wildfires, and extreme heat are particularly challenging for people over age 65, who are more likely to live with chronic conditions, functional limitations, and social isolation.
Physical impairments may limit older adults’ ability to evacuate their homes, and cognitive impairment can interfere with information processing and decision-making, they write. Maintaining continuity of care throughout a disaster can be particularly challenging for older adults who rely on durable medical equipment, ventilators, and dialysis. Insufficient financial resources present many challenges: during heat waves, for example, older adults with low incomes may not have air conditioning or may be reluctant to use it due to cost.
A national infrastructure has been created to protect all citizens, including older adults, from the effects of climate-related disasters. Public health departments, for example, are responsible for ensuring health and safety during these events. The Older Americans Act requires State Units on Aging and local Area Agencies on Aging (AAA) to develop emergency preparedness plans for their communities. The federal Emergency Preparedness Rule requires Medicare/Medicaid providers, including nursing homes and providers of home and community-based services (HCBS), to develop and test disaster plans and train employees on disaster preparedness.
Yet, the authors maintain that the nation’s emergency-response infrastructure doesn’t address all the challenges that older people face during climate-related events. Public health departments don’t necessarily focus on older adults when they plan and develop programs; federal regulations have been weakened in recent years; and staff at community-based organizations report that they lack the training to formulate adequate preparation and response plans.
RECOMMENDATIONS FOR FILLING THE GAPS
The authors recommend several strategies for addressing current gaps in efforts to prepare for, respond to, and recover from climate-related disasters. Here are a few:
Communications: Older adults must make quick decisions during climate disasters, including whether to evacuate or ride out an emergency at home. These older adults report that their choices are often influenced by people they trust, including faith leaders, social workers, case managers, medical care professionals, and frontline professionals. Communities should rely on these trusted voices to transmit storm-related communications to the older adults they serve, including those who do not speak English.
LTSS Providers: Providers of long-term services and supports (LTSS) play a significant role in helping older adults navigate climate disasters. For example, the authors recommend that HCBS providers train homecare aides to serve as first responders who can assist clients before, during, and after disasters. Nursing homes should train staff to provide mental health services during and after a disaster when those services are often interrupted. Providers, including those not required to comply with the federal Emergency Preparedness Rule, would benefit from emergency preparedness training and should incorporate this training into their disaster plans.
Evacuation and Relocation: Evacuation and relocation can be traumatic, and shelters designed for the general population may not meet the medical needs of older people. States could mandate that localities establish and operate special-needs shelters, separate from other shelters, that would accommodate and care for specific at-risk populations, including older adults with multiple chronic conditions.
Cross-Sector Collaboration: Many of the current weaknesses in disaster planning and response could be addressed by increasing cross-sector collaboration among public health departments, policymakers, AAAs, LTSS providers, frontline professionals, family caregivers, and community residents. This collaboration could be encouraged if states require the development of partnerships between older adult-serving agencies and government agencies.
FUTURE RESEARCH DIRECTIONS
The authors outline three areas of future research addressing climate change and older adults:
- Focus on HCBS recipients. Researchers should examine how climate change impacts the health of older adults who use HCBS and how those impacts differ from the impacts experienced by the older population at large or older adults living in nursing homes.
- Examine racial and ethnic populations at greatest risk. Understanding climate change-related health disparities will help policymakers, public health officials, and service providers better predict, prepare for, and target resources to vulnerable groups.
- Look beyond acute weather events like hurricanes. Researchers should also consider the impact of more common climate-related occurrences like worsening air quality, wildfires, and longer-term high-heat periods.