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The Impact of Natural Hazards on Older Adult Health: Lessons Learned From Hurricane Maria in Puerto Rico

Part of: Hurricanes Collection

Published online by Cambridge University Press:  02 November 2021

Elizabeth L. Andrade ,
Megan Jula ,
Carlos E. Rodriguez-Diaz ,
Lauren Lapointe ,
Mark C. Edberg ,
Maria I. Rivera  and
Carlos Santos-Burgoa Open the ORCID record for Carlos Santos-Burgoa [Opens in a new window]
Elizabeth L. Andrade*
Affiliation:
Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
Megan Jula
Affiliation:
Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
Carlos E. Rodriguez-Diaz
Affiliation:
Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
Lauren Lapointe
Affiliation:
Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
Mark C. Edberg
Affiliation:
Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
Maria I. Rivera
Affiliation:
Rivera Group, Washington, DC, USA
Carlos Santos-Burgoa
Affiliation:
Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
*
Corresponding author: Elizabeth Andrade, Email: elandrade@gwu.edu.
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Abstract

Objective:

With natural hazards increasing in frequency and severity and global population aging, preparedness efforts must evolve to address older adults’ risks in disasters. This study elucidates potential contributors to the elevated older adult mortality risk following Hurricane Maria in Puerto Rico through an examination of community stakeholder preparedness, response, and recovery experiences.

Methods:

In April 2018, qualitative interviews (n = 22) were conducted with stakeholders in 7 Puerto Rican municipalities. Interview transcripts were deductively and inductively coded and analyzed to identify salient topics and themes representing participant response patterns.

Results:

The hurricane’s detrimental impact on older adult health emerged as a prominent finding. Through 6 months post-hurricane, many older adults experienced unmet needs that contributed to declining physical and emotional health, inadequate non-communicable disease management, social isolation, financial strain, and excess morbidity and mortality. These needs were predominantly consequences of lengthy public service gaps, unsafe living conditions, interrupted health care, and the incongruence between preparedness and event severity.

Conclusions:

In a landscape of increasing natural hazard frequency and magnitude, a pattern of older adult risk has become increasingly clear. Study findings compel practitioners to engage in natural hazard preparedness planning, research, and policy-making that considers the multiple facets of older adult well-being.

Keywords

natural hazardsolder adult healthnon-communicable diseaseDisaster Planningcatastrophic disasters

Information

Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 17 , 2023 , e52
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

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References

Watts, N, Amann, M, Ayeb-Karlsson, S, et al. The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health. Lancet. 2018;391(10120):581-630. doi: 10.1016/S0140-6736(17)32464-9 CrossRefGoogle ScholarPubMed
Centre for Research on the Epidemiology of Disasters. Natural disasters 2019. 2020 https://www.preventionweb.net/publication/natural-disasters-2019-now-time-not-give. Accessed October 10, 2021.Google Scholar
World Health Organization. Older persons in emergencies: considerations for action and policy development. WHO. 2008. http://www.who.int/ageing/publications/Hutton_report_small.pdf. Accessed October 10, 2021.Google Scholar
Aldrich, N, Benson, WF. Disaster preparedness and the chronic disease needs of vulnerable older adults. Prev Chronic Dis. 2007;5(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2248769/. Accessed March 26, 2020.Google ScholarPubMed
Cloyd, E, Dyer, CB. Catastrophic events and older adults. Crit Care Nurs Clin North Am. 2010;22(4):501-513. doi: 10.1016/j.ccell.2010.10.003 CrossRefGoogle ScholarPubMed
McClelland, E, Amlôt, R, Rogers, MB, et al. Psychological and physical impacts of extreme events on older adults: implications for communications. Disaster Med Public Health Prep. 2017;11(1):127-134. doi: 10.1017/dmp.2016.118 CrossRefGoogle ScholarPubMed
Gamble, JL, Hurley, BJ, Schultz, PA, et al. Climate change and older Americans: state of the science. Environ Health Perspect. 2013;121(1):15-22. doi: 10.1289/ehp.1205223 CrossRefGoogle ScholarPubMed
Lilleston, R. Puerto Rico’s elderly left behind as others leave. AARP. 2017. https://www.aarp.org/home-family/friends-family/info-2017/hurricane-maria-elderly-fd.html. Accessed October 10, 2021.Google Scholar
U.S. Census Bureau. Puerto Rico, age and sex. 2010 American Community Survey 1-year estimates. 2010. https://data.census.gov/cedsci/table?q=Puerto%20Rico%20age&tid=ACSST1Y2010.S0101&hidePreview=false. Accessed November 2, 2020.Google Scholar
U.S. Census Bureau. Puerto Rico, age and sex. 2017 American Community Survey 1-year estimates. 2017. https://data.census.gov/cedsci/table?q=Puerto%20Rico%20age&tid=ACSST1Y2017.S0101&hidePreview=false. Accessed November 2, 2020.Google Scholar
Scott, M. Hurricane Maria’s devastation of Puerto Rico. National Oceanic and Atmospheric Administration. 2018. https://www.climate.gov/news-features/understanding-climate/hurricane-marias-devastation-puerto-rico. Accessed May 5, 2020.Google Scholar
National Weather Service. Major Hurricane Maria – September 20, 2017. n.d. https://www.weather.gov/sju/maria2017. Accessed May 5, 2020.Google Scholar
Lopez-Cardalda, G, Lugo-Alvarez, M, Mendez-Santacruz, S, et al. Learnings of the complete power grid destruction in Puerto Rico by Hurricane Maria. In: 2018 IEEE International Symposium on Technologies for Homeland Security (HST); 2018:1-6. doi: 10.1109/THS.2018.8574120 CrossRefGoogle Scholar
Rodríguez-Díaz, CE. Maria in Puerto Rico: natural disaster in a colonial archipelago. Am J Public Health. 2018;108(1):30-32. doi: 10.2105/AJPH.2017.304198 CrossRefGoogle Scholar
Farber, DA. Response and recovery after Maria: lessons for disaster law and policy. May 6, 2018. https://escholarship.org/uc/item/936195d5. Accessed May 5, 2020.Google Scholar
Román, MO, Stokes, EC, Shrestha, R, et al. Satellite-based assessment of electricity restoration efforts in Puerto Rico after Hurricane Maria. PLoS One. 2019;14(6):e0218883. doi: 10.1371/journal.pone.0218883 CrossRefGoogle ScholarPubMed
Zorrilla, CD. The view from Puerto Rico – Hurricane Maria and its aftermath. N Engl J Med. 2017;377(19):1801-1803. doi: 10.1056/NEJMp1713196 CrossRefGoogle ScholarPubMed
2017 Hurricane Season FEMA After-Action Report. 2017:65.0 https://www.fema.gov/sites/default/files/2020-08/fema_hurricane-season-after-action-report_2017.pdf. Accessed October 11, 2021.Google Scholar
Jonkman, SN, Maaskant, B, Boyd, E, Levitan, ML. Loss of life caused by the flooding of New Orleans after Hurricane Katrina: analysis of the relationship between flood characteristics and mortality. Risk Anal Int J. 2009;29(5):676-698.CrossRefGoogle ScholarPubMed
Cherniack, EP. The impact of natural disasters on the elderly. Am J Disaster Med. 2008;3(3):133-139.CrossRefGoogle ScholarPubMed
Adams, V, Kaufman, SR, Van Hattum, T, Moody, S. Aging disaster: mortality, vulnerability, and long-term recovery among Katrina survivors. Med Anthropol. 2011;30(3):247-270. doi: 10.1080/01459740.2011.560777 CrossRefGoogle ScholarPubMed
Ichiseki, H. Features of disaster-related deaths after the Great East Japan Earthquake. Lancet. 2013;381(9862):204. doi: 10.1016/S0140-6736(13)60091-4 CrossRefGoogle ScholarPubMed
Tanida, N. What happened to elderly people in the great Hanshin earthquake. BMJ. 1996;313(7065):1133-1135.CrossRefGoogle ScholarPubMed
Weisler, RH, Barbee, JG, Townsend, MH. Mental health and recovery in the Gulf Coast after Hurricanes Katrina and Rita. JAMA. 2006;296(5):585-588. doi: 10.1001/jama.296.5.585 CrossRefGoogle ScholarPubMed
Hall, N; Toner, JA, Mierswa, TM, Howe, JL. Geriatric mental health disaster and emergency preparedness. Springer Publishing Co: New York, New York; 2010.Google Scholar
Knowlton, K, Rotkin-Ellman, M. Preparing for climate change: Lessons for coastal cities from Hurricane Sandy. Natural Resources Defense Council April 2014;14-04-A. https://www.ndrc.org/sites/default/files/hurricane-sandy-coastal-flooding-report.pdf. Accessed October 11, 2021.Google Scholar
Wilson, JF. Health and the environment after Hurricane Katrina. Ann Intern Med. 2006;144(2):153-156.CrossRefGoogle ScholarPubMed
Baernholdt, M, Yan, G, Hinton, I, et al. Quality of life in rural and urban adults 65 years and older: findings from the National Health and Nutrition Examination Survey. J Rural Health. 2012;28(4):339-347. doi: 10.1111/j.1748-0361.2011.00403.x CrossRefGoogle Scholar
Glass, TA. Disasters and older adults: bringing a policy blindspot into the light. Public Policy Aging Rep. 2006;16(2):1-7. doi: 10.1093/ppar/16.2.1 CrossRefGoogle Scholar
Fernandez, LS, Byard, D, Lin, C-C, et al. Frail elderly as disaster victims: emergency management strategies. Prehosp Disaster Med. 2002;17(2):67-74. doi: 10.1017/s1049023x00000200 CrossRefGoogle ScholarPubMed
Dyer, C. Caring for seniors in a national emergency: can we do better? May 8, 2006. https://www.aging.senate.gov/hearings/caring-for-seniors-in-a-national-emergency-can-we-do-better.  Accessed October 11, 2021.Google Scholar
Santos-Burgoa, C, Sandberg, J, Suárez, E, et al. Differential and persistent risk of excess mortality from Hurricane Maria in Puerto Rico: a time-series analysis. Lancet Planet Health. 2018;2(11):e478-e488. doi: 10.1016/S2542-5196(18)30209-2 CrossRefGoogle ScholarPubMed
Santos-Burgoa, C, Sandberg, J, Andrade, EL, et al. Ascertainment of mortality after Hurricane Maria in Puerto Rico. George Washington University. 2018. https://publichealth.gwu.edu/sites/default/files/downloads/projects/PRstudy/Acertainment%20of%20the%20Estimated%20Excess%20Mortality%20from%20Hurricane%20Maria%20in%20Puerto%20Rico.pdf. Accessed October 11, 2021.Google Scholar
Andrade, E, Barrett, N, Edberg, M, et al. Mortality reporting and rumor generation: an assessment of crisis and emergency risk communication following Hurricane María in Puerto Rico. J Int Crisis Risk Commun Res. 2020;3(1). doi: 10.30658/jicrcr.3.1.2 CrossRefGoogle Scholar
Sandberg, J, Santos-Burgoa, C, Roess, A, et al. All over the place?: differences in and consistency of excess mortality estimates in Puerto Rico after Hurricane Maria. Epidemiology. 2019;30(4):549-552. doi: 10.1097/EDE.0000000000000970 CrossRefGoogle ScholarPubMed
Santos-Burgoa, C, Sandberg, J, Suárez, E, et al. Mortality risk within counterfactual models: Puerto Rico and Hurricane Maria – authors’ reply. Lancet Planet Health. 2019;3(5):e209. doi: 10.1016/S2542-5196(19)30020-8 CrossRefGoogle ScholarPubMed
Cruz-Cano, R, Mead, EL. Causes of excess deaths in Puerto Rico after Hurricane Maria: a time-series estimation. Am J Public Health. 2019;109(7):1050-1052. doi: 10.2105/AJPH.2019.305015 CrossRefGoogle Scholar
Bernard, R. Research methods in anthropology: qualitative and quantitative approaches. 5th ed. Altamira Press: Walnut Creek, CA; 2011.Google Scholar
Maxwell, J. Designing a qualitative study. In: Bickman, L and Rog, DJ, eds. The SAGE Handbook of Applied Social Research Methods. Thousand Oaks, CA: SAGE; 2009:214-253. doi: 10.4135/9781483348858.n7 CrossRefGoogle Scholar
2017 Infrastructure Report Card. American Society of Civil Engineers. 2017. https://www.infrastructurereportcard.org/. Accessed December 15, 2020.Google Scholar
Failure to act: electric infrastructure investment gaps in a rapidly changing environment. EBP U.S. 2020. https://www.asce.org/uploadedFiles/Issues_and_Advocacy/Infrastructure/Content_Pieces/Failure-to-Act-Energy2020-Final.pdf. Accessed December 15, 2020.Google Scholar
Semega, J, Kollar, M, Shrider, EA, Creamer, JF. Income and poverty in the United States: 2019. Suitland, MD: U.S. Census Bureau; 2020.Google Scholar
Henderson, TL, Roberto, KA, Kamo, Y. Older adults’ responses to Hurricane Katrina: daily hassles and coping strategies. J Appl Gerontol. 2009;epub. doi: 10.1177/0733464809334287 Google Scholar
Hung, WW, Ross, JS, Boockvar, KS, Siu, AL. Recent trends in chronic disease, impairment and disability among older adults in the United States. BMC Geriatr. 2011;11:47. doi: 10.1186/1471-2318-11-47 CrossRefGoogle ScholarPubMed
Peterson, L, Brown, LM. Disaster Planning for community-dwelling older adults: strengths, weaknesses, and interventions. In: Cefalu, CA, ed., Disaster Preparedness for Seniors: A Comprehensive Guide for Healthcare Professionals. Springer Publishing Co: New York, New York; 2014:21-30. doi: 10.1007/978-1-4939-0665-9_3 Google Scholar
Kluss, T. Seniors particularly vulnerable in Sandy’s aftermath. The Gerontological Society of America. 2012. https://www.eurekalert.org/news-releases/803952. Accessed October 11, 2021.Google Scholar
Kopp, JB, Ball, LK, Cohen, A, et al. Kidney patient care in disasters: emergency planning for patients and dialysis facilities. Clin J Am Soc Nephrol. 2007;2(4):825-838. doi: 10.2215/CJN.01220307 CrossRefGoogle ScholarPubMed
Krousel-Wood, M, Islam, T, Muntner, P, et al. Medication adherence in older clinic patients with hypertension after Hurricane Katrina: implications for clinical practice and disaster management. Am J Med Sci. 2008;336(2):99-104. doi: 10.1097/MAJ.0b013e318180f14f CrossRefGoogle ScholarPubMed
Ngo Ehren, B. When disasters and age collide: reviewing vulnerability of the elderly. Nat Hazards Rev. 2001;2(2):80-89. doi: 10.1061/(ASCE)1527-6988(2001)2:2(80)Google Scholar
Mitani, S, Kako, M, Mayner, L. Medical relief for the 2011 Japan earthquake: a nursing account. Nurs Health Sci. 2014;16(1):26-30. doi: 10.1111/nhs.12112 CrossRefGoogle ScholarPubMed
Bell, SA, Horowitz, J, Iwashyna, TJ. Health Outcomes after disaster for older adults with chronic disease: a systematic review. Gerontologist. 2020;60(7):e535-e547. doi: 10.1093/geront/gnz123 CrossRefGoogle Scholar
Thacker, MTF, Lee, R, Sabogal, RI, Henderson, A. Overview of deaths associated with natural events, United States, 1979-2004. Disasters. 2008;32(2):303-315. doi: 10.1111/j.1467-7717.2008.01041.x CrossRefGoogle ScholarPubMed
Walsh, J, Gibson, A, Brown, LM. Peace of mind’s price tag: the psychological costs of financial stressors on older adults postdisaster. Transl Issues Psychol Sci. 2016;2(4):408-417. doi: 10.1037/tps0000089 CrossRefGoogle Scholar
Department of Homeland Security. Hurricane Maria statistics progress update. November 7, 2017. https://www.dhs.gov/photo/hurricane-maria-statistics-progress-update. Accessed March 31, 2020.Google Scholar
Pascual, OS. Hurricane Maria’s death toll in Puerto Rico is higher than official count, experts say. Miami Herald. 2017. https://www.miamiherald.com/news/weather/hurricane/article175955031.html. Accessed May 7, 2020.Google Scholar
The Weather Channel. Puerto Rico power fully restored 18 months after Hurricane Maria wiped out the grid. https://weather.com/news/news/2019-03-21-puerto-rico-power-restored-hurricane-maria. Published March 21, 2019. Accessed March 31, 2020.Google Scholar
Niles, S, Contreras, S. Social vulnerability and the role of Puerto Rico’s healthcare workers after Hurricane Maria. Natural Hazards Center. 2019. https://hazards.colorado.edu/quick-response-report/social-vulnerability-and-the-role-of-puerto-ricos-healthcare-workers-after-hurricane-maria. Accessed October 11, 2021.Google Scholar
U.S. Census Bureau. Puerto Rico, relationships by household type (including living alone) for the population 65 years and over. 2017 American Community Survey 5-year estimates. https://data.census.gov. Accessed November 1, 2020.Google Scholar
Bei, B, Bryant, C, Gilson, K-M, et al. A prospective study of the impact of floods on the mental and physical health of older adults. Aging Ment Health. 2013;17(8):992-1002. doi: 10.1080/13607863.2013.799119 CrossRefGoogle ScholarPubMed
Cherry, KE. Disasters and long-term recovery: introduction to a special issue. Curr Psychol. 2015;34(3):492-493. doi: 10.1007/s12144-015-9369-z CrossRefGoogle Scholar
Heid, AR, Christman, Z, Pruchno, R, et al. Vulnerable, but why? Post-traumatic stress symptoms in older adults exposed to Hurricane Sandy. Disaster Med Public Health Prep. 2016;10(3):362-370. doi: 10.1017/dmp.2016.15 CrossRefGoogle ScholarPubMed
Jia, Z, Tian, W, Liu, W, et al. Are the elderly more vulnerable to psychological impact of natural disaster? A population-based survey of adult survivors of the 2008 Sichuan earthquake. BMC Public Health. 2010;10(1):172. doi: 10.1186/1471-2458-10-172 CrossRefGoogle ScholarPubMed
Kun, P, Tong, X, Liu, Y, et al. What are the determinants of post-traumatic stress disorder: age, gender, ethnicity or other? Evidence from 2008 Wenchuan earthquake. Public Health. 2013;127(7):644-652. doi: 10.1016/j.puhe.2013.04.018 CrossRefGoogle ScholarPubMed
Parker, G, Lie, D, Siskind, DJ, et al. Mental health implications for older adults after natural disasters – a systematic review and meta-analysis. Int Psychogeriatr. 2016;28(1):11-20. doi: 10.1017/S1041610215001210 CrossRefGoogle ScholarPubMed
Viswanathan, KP, Bass, R, Wijetunge, G, Altevogt, BM. Rural mass casualty preparedness and response: the Institute of Medicine’s Forum on Medical and Public Health Preparedness for Catastrophic Events. Disaster Med Public Health Prep. 2012;6(3):297-302. doi: 10.1001/dmp.2012.38 CrossRefGoogle ScholarPubMed
Al-rousan, TM, Rubenstein, LM, Wallace, RB. Preparedness for natural disasters among older US adults: a nationwide survey. Am J Public Health. 2014;104(3):506-511. doi: 10.2105/AJPH.2013.301559 CrossRefGoogle ScholarPubMed
Ashida, S, Zhu, X, Robinson, EL, Schroer, A. Disaster preparedness networks in rural Midwest communities: organizational roles, collaborations, and support for older residents. J Gerontol Soc Work. 2018;61(7):735-750. doi: 10.1080/01634372.2018.1474157 CrossRefGoogle ScholarPubMed
Bethel, JW, Foreman, AN, Burke, SC. Disaster preparedness among medically vulnerable populations. Am J Prev Med. 2011;40(2):139-143. doi: 10.1016/j.amepre.2010.10.020 CrossRefGoogle ScholarPubMed
Boscarino, JA, Adams, RE, Figley, CR, et al. Fear of terrorism and preparedness in New York City 2 years after the attacks: implications for disaster planning and research. J Public Health Manag Pract. 2006;12(6):505-513.CrossRefGoogle ScholarPubMed
Christensen, JJ, Richey, ED, Castañeda, H. Seeking safety: predictors of hurricane evacuation of community-dwelling families affected by Alzheimer’s disease or a related disorder in South Florida. Am J Alzheimers Dis Dementiasr. 2013;28(7):682-692. doi: 10.1177/1533317513500837 CrossRefGoogle ScholarPubMed
Cox, K, Kim, B. Race and income disparities in disaster preparedness in old age. J Gerontol Soc Work. 2018;61(7):719-734. doi: 10.1080/01634372.2018.1489929 CrossRefGoogle ScholarPubMed
Duggan, S, Deeny, P, Spelman, R, Vitale, CT. Perceptions of older people on disaster response and preparedness. Int J Older People Nurs. 2010;5(1):71-76. doi: 10.1111/j.1748-3743.2009.00203.x CrossRefGoogle ScholarPubMed
Eisenman, DP, Zhou, Q, Ong, M, et al. Variations in disaster preparedness by mental health, perceived general health, and disability status. Disaster Med Public Health Prep. 2009;3(1):33-41. doi: 10.1097/DMP.0b013e318193be89 CrossRefGoogle ScholarPubMed
Fox, MH, White, GW, Rooney, C, Rowland, JL. Disaster preparedness and response for persons with mobility impairments: results from the University of Kansas Nobody Left Behind Study. J Disabil Policy Stud. 2007;17(4):196-205. doi: 10.1177/10442073070170040201 CrossRefGoogle Scholar
Kim, H, Zakour, M. Disaster preparedness among older adults: social support, community participation, and demographic characteristics. J Soc Serv Res. 2017;43(4):498-509. doi: 10.1080/01488376.2017.1321081 CrossRefGoogle Scholar
Murphy, ST, Cody, M, Frank, LB, et al. Predictors of emergency preparedness and compliance. Disaster Med Public Health Prep. 2009;epub. doi: 10.1097/DMP.0b013e3181a9c6c5 CrossRefGoogle ScholarPubMed
Pietrzak, RH, Southwick, SM, Tracy, M, et al. Posttraumatic stress disorder, depression, and perceived needs for psychological care in older persons affected by Hurricane Ike. J Affect Disord. 2012;138(1-2):96-103. doi: 10.1016/j.jad.2011.12.018 CrossRefGoogle ScholarPubMed
Ticehurst, S, Webster, RA, Carr, VJ, Lewin, TJ. The psychosocial impact of an earthquake on the elderly. Int J Geriatr Psychiatry. 1996;11(11):943-951. doi:10.1002/(SICI)1099-1166(199611)11:11<943::AID-GPS412>3.0.CO;2-B3.0.CO;2-B>CrossRefGoogle Scholar
Wang, C. Bracing for hurricanes: a qualitative analysis of the extent and level of preparedness among older adults. Gerontologist. 2018;58(1):57-67. doi: 10.1093/geront/gnx187 CrossRefGoogle ScholarPubMed
Kim, Y-C, Kang, J. Communication, neighbourhood belonging and household hurricane preparedness. Disasters. 2010;34(2):470-488. doi: 10.1111/j.1467-7717.2009.01138.x CrossRefGoogle ScholarPubMed
Killian, TS, Moon, ZK, McNeill, C, et al. Emergency preparedness of persons over 50 years old: further results from the Health and Retirement Study. Disaster Med Public Health Prep. 2017;11(1):80-89. doi: 10.1017/dmp.2016.162 CrossRefGoogle ScholarPubMed
Gershon, RR, Portacolone, E, Nwankwo, EM, et al. Psychosocial influences on disaster preparedness in San Francisco recipients of home care. J Urban Health. 2017;94(5):606-618. doi: 10.1007/s11524-016-0104-3 CrossRefGoogle Scholar
Pekovic, V, Seff, L, Rothman, MB. Planning for and responding to special needs of elders in natural disasters. Generations. 2007;31(4):37-41.Google Scholar
Oliver, C. Catastrophic disaster planning and response. CRC Press: Boca Raton, FL; 2010.Google Scholar
Kim, S, Kulkarni, PA, Rajan, M, et al. Hurricane Sandy (New Jersey): mortality rates in the following month and quarter. Am J Public Health. 2017;107(8):1304-1307. doi: 10.2105/AJPH.2017.303826 CrossRefGoogle ScholarPubMed
Gibson, MJ, Hayunga, M. We can do better: lessons learned for protecting older persons in disasters. AARP. 2006. https://assets.aarp.org/rgcenter/il/better.pdf. Accessed December 15, 2020.Google Scholar
Baylor College of Medicine. Recommendations for best practices in the management of elderly disaster victims. https://www.bcm.edu/pdf/bestpractices.pdf. n.d. Accessed December 15, 2020.Google Scholar
Centers for Disease Control and Prevention. Identifying vulnerable older adults and legal options for increasing their protection during all-hazards emergencies: a cross-sector guide for states and communities. 2012. https://www.cdc.gov/cpr/documents/aging.pdf. Accessed October 11, 2021.Google Scholar
Centers for Disease Control and Prevention. Emergency preparedness for older adults. 2018. https://www.cdc.gov/aging/pdf/disaster_planning_goal.pdf. Accessed December 15, 2020.Google Scholar
American Psychological Association. Older adults and disasters: how to be prepared and assist others. n.d. https://www.apa.org/pi/aging/resources/older-adults-disasters.pdf. Accessed December 15, 2020.Google Scholar
Chandra, A, Acosta, J, Stern, S, et al. Building community resilience to disasters. RAND Health. 2018. https://www.rand.org/content/dam/rand/pubs/technical_reports/2011/RAND_TR915.pdf. Accessed October 11, 2021.Google Scholar
U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. HHS EmPOWER program executive summary: shaping decisions to protect health in an emergency. 2020. https://empowerprogram.hhs.gov/Program-Executive-Summary.pdf. Accessed December 15, 2020.Google Scholar
Shih, RA, Acosta, JD, Chen, EK, et al. Improving disaster resilience among older adults. Rand Health Q. 2018;8(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075802/. Accessed March 31, 2020.Google ScholarPubMed
Kusmaul, N, Gibson, A, Leedahl, SN. Gerontological social work roles in disaster preparedness and response. J Gerontol Soc Work. 2018;61(7):692-696. doi: 10.1080/01634372.2018.1510455 CrossRefGoogle ScholarPubMed
U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. Addressing the needs of older adults in disasters. https://www.train.org/main/course/1093802/. n.d. Accessed December 15, 2020.Google Scholar
Gibson, A, Walsh, J, Brown, LM. Disaster mental health services review of care for older persons after disasters. Disaster Med Public Health Prep. 2018;12(3):366-372. doi: 10.1017/dmp.2017.60 CrossRefGoogle ScholarPubMed
Foley, K. Workforce updates 2018. Presented at the: American Geriatrics Society (AGS) 2018 Annual Scientific Meeting. Orlando, FL: American Geriatrics Society; 2018.Google Scholar
Health Resources and Services Administration. National and regional projections of supply and demand for geriatricians: 2013-2015. 2017. https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/GeriatricsReport51817.pdf. Accessed December 15, 2020.Google Scholar
Committee on Best Practices for Assessing Mortality and Significant Morbidity Following Large-Scale Disasters, Board on Health Sciences Policy, Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine. In: MacKenzie EJ, Wollek SH, Yost OC, Cork DL, eds., A Framework for Assessing Mortality and Morbidity After Large-Scale Disasters. Washington, DC: National Academies Press; 2020:25863. doi: 10.17226/25863 CrossRefGoogle Scholar