Introduction: This study compares self-reported Activities of Daily Living(ADL) and Instrumental Activities of Daily Living (IADL) status among elderly survivors ofthe 2003 Bam Earthquake before, two months after, and five years after the event, andexplores related determinants.

Methods: A two-stage cluster survey was conducted on 210 elderly survivorsin the earthquake-stricken area five years after the event.

Results: Both ADL and IADL scores decreased two months after earthquakecompared to prior status (p <0.001). No differences were observedbetween two months and five years after the event (p >0.05).Access to medical services were not related to level of ADL or IADL (p =0.52 and p = 0.74, respectively). Elderly survivors with lower functionalcapability in terms of ADL experienced more problems in access to relief items(p = 0.04), but no similar association was found for IADL(p = 0.26).

Conclusion: The Bam earthquake adversely affected functional capacity of theelderly. Disaster responders must take into account functional capacity of elders whenplanning for medical and relief operations.

Elders have long been recognised as among the most vulnerable people in disaster events. This paper reports a qualitative study of the self-perceived needs of older people in the aftermath of the Bam earthquake in Iran in 2003. A total of 56 people aged from 65 to 88 years were recruited to the study using purposive sampling, including 29 men and 27 women. Six focus group discussions and ten semi-structured individual interviews were conducted. Each focus group involved six to ten people from the cities of Bam and Baravat and their rural suburbs. Content analysis was used to analyse the transcribed data. The analysis identified four major themes among the informants' concerns: inappropriate service delivery, affronts to dignity, feeling insecure and emotional distress. A disaster-prone country like Iran needs to be appropriately prepared with culturally sensitive plans to meet the needs of those who suffer from their effects, not least older people. Emergency relief managers should note that for many older people in a disaster zone, customary forms of relief are neither required nor appropriate, and that their distinctive immediate and long-term needs should be assessed and met. Relief agencies need to be trained to be age-sensitive and should mainstream older people's rights in the planning and implementation of both the response and recovery phases of assistance.