assisting older victims of disasters

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Assisting Older Victims ofDisastersBarbra L. Torgusen MSW, CATSM a & Jordan I.Kosberg PhD, ACSW aa University of Alabama , USAPublished online: 25 Sep 2008.

To cite this article: Barbra L. Torgusen MSW, CATSM & Jordan I. Kosberg PhD, ACSW(2006) Assisting Older Victims of Disasters, Journal of Gerontological Social Work,47:1-2, 27-44, DOI: 10.1300/J083v47n01_04

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Assisting Older Victims of Disasters:Roles and Responsibilities

for Social WorkersBarbra L. Torgusen, MSW, CATSM

Jordan I. Kosberg, PhD, ACSW

ABSTRACT. The tumultuous catastrophic tragedies of the Oklahomabombing in 1995 and September 11, 2001 attacks on the World TradeCenter and Pentagon have caused urgency for the profession of socialwork to be ready to respond to unexpected crises whether directed to anindividual, group, or nation. While there has always been the possibilityof tragedies in the U.S. caused by nature (so-called “acts of God”) or thespontaneous or planned acts of criminals or the deranged, the increasedawareness of catastrophes includes, as never before, disasters that areperpetrated by terrorist acts from within or outside of the U.S. The cre-ation of the Department of Homeland Security, in 2003, underscores theneed for awareness and for preparation on the part of the nation. Basedupon its skills and values, social workers have significant roles to play inthe face of potential and actual disasters; yet, gerontological socialworkers have additional responsibilities for addressing the needs ofolder persons. It is the purpose of this article to provide an overview ofissues to be considered by social workers, in general, and gerontologicalsocial workers, in particular, with regard to preparation for possible di-sasters and the consequences from such catastrophes that affect olderpersons. [Article copies available for a fee from The Haworth Document De-livery Service: 1-800-HAWORTH. E-mail address: <[email protected]> Website: <http://www.HaworthPress.com> © 2006 by The HaworthPress, Inc. All rights reserved.]

Barbra L. Torgusen and Jordan I. Kosberg are affiliated with the University of Ala-bama.

Journal of Gerontological Social Work, Vol. 47(1/2) 2006Available online at http://www.haworthpress.com/web/JGSW

© 2006 by The Haworth Press, Inc. All rights reserved.doi:10.1300/J083v47n01_04 27

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KEYWORDS. Gerontological social work, disasters, terrorism, olderpopulations, geriatric mental health workers, older victims, post-traumaticstress disorder (PTSD), disaster preparedness, emergency planning, disas-ter strategies, pet safety, staff preparedness, stress management, vicarioustraumatization, coping responses, crisis management education

BACKGROUND

Natural disasters have always existed. Such events include earth-quakes, hurricanes, tornadoes, floods, forest fires, volcanic disruptions,and mudslides and avalanches. Some of these events take place inde-pendent of human acts (e.g., hurricanes, earthquakes), while others maynot (e.g., forest fires, mudslides). Over the years, a number of articlesfocusing upon natural disasters have been written by and for socialworkers, including working with victims of earthquakes (Bolin & Stan-ford, 1998), floods (Curry et al., 2001), hurricanes (Prizzia & Helfand,2001). Although older populations were identified as high risk, alongwith other groups, these articles did not specifically focus upon olderpersons.

There have always been disasters caused directly or indirectly byhumans. Some disasters discussed in the literature were caused by in-advertent human acts, such as a bus accident (Cook, 1998), a MethylParathion disaster (Rehner et al., 2000), and asbestos exposure (Valli-anatos, 2001). While there might have been older victims of such di-sasters, they were not singled out for special discussion. There isgrowing concern about deliberate, and often premeditated, acts suchas mass murders, work place or school shootings, genocide, and ter-rorism whether by arms, bombings, biochemical, poisons, or otherforms of mass destruction. For example, Gerberding, Hughes, andKoplan (2002) have written about bio-terrorism preparedness and re-sponsibilities for clinical and public health agencies. Pfefferbaum(1996) discussed the mental health response to the Oklahoma Citybombing. Writing about consequences from terrorism in Israel, Yanay(1994) described various forms of assistance to civilian casualties ofhostile actions. In Points and Viewpoints in Social Work, Hong Kongsocial workers, Tsui and Cheung (2003), urged action by the profes-sion in the face of terrorism. Here, again, the authors of these articlesdid not directly focus upon older persons.

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IMPACT ON OLDER POPULATIONS

Past attention on the needs of older persons adversely affected by di-sasters had mainly focused upon the consequences of the subsequent re-location of older victims. For example, articles focused upon oldervictims of a tornado (Freidsam, 1962), urban renewal (Fried, 1963),earthquakes (Knight, Gatz, Heller, & Bengston, 2000), and a hurricaneinvolving the evacuation of many nursing home residents (Mangum,Kosberg, & McDonald, 1989). Especially characteristic of older vic-tims of such disasters were problems of spatial disorientation (loss of asense of belonging) and personal disorientation (loss of familiar personsand things).

With regard to human-caused disasters adversely affecting older vic-tims, there have been articles written about terrorism and geriatric men-tal health workers (Cohen & Brown, 2003) and the need for action bygerontologists in the face of the threat of continued terrorism (Salerno &Nagy, 2002). Strug, Mason, and Heller (2003) have focused upon olderHispanics in New York City who were adversely affected by the eventsof September 11, 2001, the crash four months later of Flight 587 fromNew York bound for the Dominican Republic, and the anthrax scare.The article that, no doubt, had a far-reaching impact was by Lagnado(2001) who entitled her article on older persons affected by the tragedyin New York on September 11, 2001 in the Wall Street Journal: “Hid-den Victims: For Elderly Near WTC, A New World of Woe in Sept. 11Aftermath–Stranded at Home, Thousands Rely on Visiting Nurses toSustain Health, Hope–‘The Last to be Taken Away.’”

Finally, social workers know well that an older victim of a crime oraccident can face similar adversities as victims of large-scale disasters(who also suffer psychological trauma, social disruption, and personaland economic losses). Older persons are seen to face special challengesas a result of anticipation of, or as a result of, disasters. Averill and Beck(2000) have pointed out that, for older persons, Post-Traumatic StressDisorder (PTSD) results from distant as well as recent traumatic experi-ences.

GOVERNMENTAL RESPONSES

Tragedies occurring this century have magnified efforts at local,state, and national levels to better prepare citizens for the possibility ofall types of disasters. Some of these efforts target older persons. Under-

Barbra L. Torgusen and Jordan I. Kosberg 29

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standably, New York City has been especially active in preparing citi-zens for the possibility of disasters. Following September 11, 2001, theNew York State Emergency Management Office published Be Alert, BeReady . . . Be Prepared! A Guide to Individual Preparedness. The NewYork City Office of Emergency Management published an on-lineguide for emergency preparation, and initiated New York City AWARE,a program that focuses upon staff working in community service agen-cies. The City of New York, with the Department for the Aging (DFTA),has produced a Guide To Emergency Preparedness for Seniors andPeople with Disabilities that assists the creation of personal emergencyplans. DFTA has also established a website (http://www.ci.nyc.ny.us/html/dfta/html/prepared.html) that links older citizens to various agen-cies that can be contacted in the event of an emergency. In addition, theNew York City Office of Emergency Management has prepared a re-source, READY NEW YORK, which includes material on prepared-ness suggestions, and the New York City Department of Health andMental Hygiene has created websites on Public Health Emergency Pre-paredness and Terrorism and Mental Health.

As one example of state efforts to focus upon older persons, the Stateof Florida Department of Elder Affairs has created a comprehensive di-saster preparedness plan for older persons including the phone numbersof key state agencies responsible for planning and assistance. Disasterpreparation is not limited to large cities, or to urban states. In Alabama,the Department of Public Health’s Center for Emergency Preparednessseeks volunteers who are trained (and licensed) to assist others in disas-ters around the state, as well as distribute information on disaster pre-paredness.

At the National level, the Administration on Aging (AoA) has a Na-tional Disaster Preparedness and Response Office that coordinates ef-forts with State Emergency Management Agencies and the FederalEmergency Management Agency (FEMA) to respond to the specialneeds of older disaster victims. FEMA has prepared “Are You Ready:An In-Depth Guide to Citizen Preparedness.” Additionally, FEMA ap-proved Project Liberty, a $132 million crisis counseling grant, in May2002 (New York State Office of Mental Health, 2002). Project Libertyis a collaborative effort of New York State Office of Mental Health(OMH), local governments, and more than 100 provider agencies. Themission is to provide free crisis counseling services to persons, families,and groups most affected by the September 11th World Trade Center at-tack. The Department of Homeland Security has created a Ready Cam-paign and developed a Citizen Corps. Older persons are not always


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focused upon in these efforts, and there is the need to ensure that the in-formation reaches older persons. Gerontological social workers, whetherat local, state, or national levels, can be instrumental in such necessaryefforts.

RESPONSE BY SOCIAL WORK

“In addition to the development of a cadre of well-trained disasterprofessionals, NASW believes that social workers and social work stu-dents should acquire the specialized knowledge and methods requiredfor an effective response to trauma and critical incident stress debrief-ing.” Thus, declared a policy statement adopted by the NASW (2003)Delegate Assembly in 2002.

Social workers have always been seen as specially prepared forworking with the victims of loss and trauma, including those resultingfrom disasters. NASW has taken a proactive stance in positioning itselfto work with other groups involved in disaster planning. O’Neill (2001)noted that the American Red Cross (ARC) and NASW had developed aformal agreement that established close working relationships for thedelivery of mental health services for victims of disaster, rescue work-ers, military personnel and their families, and refugees. The pact calledfor a national network of ARC-trained, licensed or certified social work-ers to be “mobilized” in times of a disaster. This initiative supplementedthe NASW-ARC Disaster Mental Health Partnership to provide disastermental health services by social workers that exist at community, county,and state levels (Webb, 2000).

As had been pointed out, older persons, as disaster victims, have notalways been singled out for special attention. Rather, they have been in-cluded under the “umbrella” of special and vulnerable populations. In aguest editorial in the Medical Sciences section of the Journal of Geron-tology, Salerno and Nagy (2002), both from the National Institute onAging, urged immediate attention to the needs of older persons follow-ing acts of terrorism. Alluding to both physical and psychological con-sequences to older victims, whether directly or indirectly affected by anact of terrorism, they stated, “As health and aging professionals, thesafety, care, and reassurance of older persons must be gerontologists’priority” (p. M554). It is believed that gerontological social workers,too, must give priority to such groups of older persons.


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PROFESSIONAL ROLES AND RESPONSIBILITIES

The areas of disaster intervention for social workers, includingthose working with and for older persons, can be conceptualized to ex-ist in one of three areas of activity: (1) planning for disaster preven-tion, (2) procedures during a disaster, and (3) interventions followingdisaster. Each area has prodigious implications for social workers, ingeneral, and for gerontological social workers, in particular. The threeareas for action will be discussed independently; yet, in fact, they areinterrelated.

Disaster Prevention Planning

Disaster prevention activities have been developed to help agencystaff increase their awareness of what can and should be done to helptheir client/patient populations in the face of a disaster. Articles haveoutlined scenarios of activities to be undertaken when a disaster strikes(Peterson & Perry, 1999). One limitation of these disaster preventionscenarios is that they utilize “actors” to portray the victims of the disas-ter. While these efforts are important for education and training on di-saster preparedness, often there is insufficient attention to the needs ofolder populations in preparing for a possible disaster. Indeed, such pre-paredness should be extended to formal caregivers as well as older per-sons and their informal caregivers (family, friends, and neighbors).

The growing number of gerontological social workers will, hope-fully, lead to an increasing number of those who are educated andtrained to assist older persons in disaster preparedness. Older personsneed information on when, where, and how to evacuate, or how to re-main safe in their residence. Planning strategies for those who workwith both institutionalized and non-institutionalized individuals shouldinclude knowledge of older persons’ mental, cognitive, and physical ca-pabilities. Planned relocation of older physically or mentally impairedpersons necessitates a procedure for ensuring that their medications andneeded health care supplies accompany them during an evacuation.This attention to planning requires consideration of several special is-sues.

Respect for individuality. Preparing and planning for disaster preven-tion for older persons necessitates an awareness of the heterogeneity ofbackgrounds and variations in mental, physical, and cognitive abilities.Additionally, there will be differences in the ability to differentiate be-tween a disaster preparedness drill and an actual disaster event. Ethnic-


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ity and race, gender, language competence, and geographic locationalso have an impact on the desire, and on the opportunity, to participatein disaster preparedness. It should be realized that, for some older per-sons, the mere mention of possible adversities could result in anxietyand concern, and agency staff need to be made aware of such possibili-ties and to be educated in methods to help older persons cope with thesecircumstances.

It is also imperative that when staff members are preparing to educateand discuss disaster preparedness with older persons, they need to besensitive to the possibility that past experiences may result in emotion-ally challenging memories and discomfort (and, perhaps, revive post-traumatic stress). Thus, when approaching disaster preparedness for anolder person, a professional must be cognizant of the period and placewithin which that person, or that older population, has already lived.

Current cohorts of older persons have survived such events as air raiddrill, bombings, threats of nuclear war, World Wars I and II, the KoreanConflict, and the Vietnam War, among other conflicts (Averill & Beck,2000). Additionally, most likely older persons have already survivedother personal tragedies. Discussing disaster prevention, either fromnatural or human-made disasters, can cause fear, anger, helplessness,depression, secondary PTSD, and in some cases result in an increase insubstance abuse to quell these feelings (Kimerling, Clum, & Wolfe,2000). Secondary stress disorder can manifest itself in sleep distur-bances, nightmares, and an exaggerated sense of fear and anxiety.

On the other hand, advising an older person to be aware of strangers,know where the exit signs are, have first aid kits available, or “don’tpanic” may leave some older persons feeling as though they are beingtalked down to and treated as children. Good advice, in planning for di-sasters, needs to be supplemented by a genuine respect for older personsand their life experiences.

Concern for pets. Social workers need to remember that the appre-hension created when discussing disaster prevention with older personsis not only limited to the potential loss of one’s independence, home,and possessions, but also the safety and security of loved ones, includ-ing a pet or pets. The importance of a pet for an older person is wellknown and each older person needs to formulate plans for the safe shel-ter of a pet during a disaster. As known by many persons involved in di-saster planning and relief, some older persons will refuse to get out of“harm’s way” and leave their dwelling (home or apartment) in the faceof an impending disaster (i.e., hurricane, tornado), if their pet will re-main in jeopardy.


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While disaster planning can result in shelters for older persons livingin “high risk” geographic areas (such as living in homes at sea levelclose to an open body of water or at the base of steep hills or mountains),taking pets into shelters that will house their owners is seldom possible.The ARC does not, for health and safety reasons, allow non-certifiedcompanion pets (that is, non-service pets) into evacuation shelters dur-ing disasters. However, knowing that there is a shelter where a pet canbe placed during a possible disaster can provide peace of mind and asense of security for the older person, and will increase the possibilitythat the older person will go to a safe place in an emergency situation.

However, as shelters for pets are not always available, the ARC gen-erally recommends that individuals with pets identify a predeterminedlocation in the home where the pet can be safely placed during a disaster(such as a bathroom or utility room). Further, they suggest that each petis fitted with a collar and tag. When the pet is left in the home during adisaster, the ARC recommends that the owner place a placard on thedoor of the residence indicating the type and number of pets inside thedwelling. This will add to easing the mind of the older person as theyplan for a possible disaster.

Staff preparedness. Social workers need to anticipate, and plan for,not only the needs of the older patients, clients, or program participants,but also the needs of agency, program, or institutional staff. For exam-ple, assessing the experiences learned after Hurricane Elena threatenedthe St. Petersburg, FL area in 1991, that lead to the largest relocation ofinstitutionalized older persons in U.S. history, Mangum, Kosberg, andMcDonald (1989) found that staff within institutional and congregatesettings–responsible for the relocation of older persons into shelters–had genuine concerns about the safety of their own family members,home, and pets. Such concerns are understandable. Although responsi-ble for the care of the older residents, staff members have been found toleave their “charges” to ensure the safety of loved ones, possessions,and their dwellings. This possibility of unauthorized departures fromthe job by worried staff must be addressed in advance.

During a presentation about the September 11th attack, directors oftwo agencies involved with caregiving to institutionalized older personsdiscussed their management of staff concerns (Torgusen, 2002). Bothindicated that members of their staff were torn between the guidingprinciples of the patient care and their own personal responsibilities forloved ones at home. Additionally, as these two agencies were located inrural areas, difficulties with communication, distance from home, and


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uncertainty in ascertaining the safety and security of family membersand pets added to the emotionality and urgency of the moment.

The Columbia Center for Public Health Preparedness conducted a pi-lot training program for school health nurses and included questions re-garding disaster preparedness (Qureshi, Merrill, Gershon, & Calero-Brekheimer, 2002). Of significance was the finding that 90% of thenurses reported one barrier to report for duty in the event of a disaster:caregiving responsibilities for a child or older relative. Worries abouttransportation and personal health were next in importance. Such find-ings suggest that it is necessary to identify, address, and resolve poten-tial challenges faced by a disaster workforce during emergencies.

Interventions During a Disaster

Social workers need to consider activities taking place during, orshortly after, a disaster that will provide assistance to those affected bythe disaster. Pfefferbaum (1996) has written about organizing mentalhealth services following the Oklahoma City bombing of the Alfred P.Murrah Federal Building in 1995. The American Academy of Expertsin Traumatic Stress, Inc. has disseminated information on an ongoingbasis dealing with topics related to helping victims of disasters. Topicsinclude stages of acute traumatic stress management; strategies forEmergency Responders working with traumatized individuals, workingwith those who provide assistance to victims of catastrophes, and themanagement of Emergency Responders’ own responses of trauma.

During a disaster, whether caused by nature or human hands, thereare needs for safe and secure social settings for older persons, sheltersfor their pets, transportation for those being vacated from institutionalsettings to safe locations, and transportation for those living in the com-munity who do not have transportation. Older persons residing in NewYork during the September 11th attack were told to evacuate theirhomes, leaving behind pets and familiar surroundings, not knowing ifthey would ever be able to return or what they might face once they didreturn. Similarly, while living in the Miami area, the second author per-sonally knew of many older persons living in apartment buildings nearthe Atlantic Ocean who could not vacate their apartments in the face ofan incoming hurricane. Although they were required to leave theirdwellings and go to higher grounds, some of these individuals had notransportation, others had pets they refused to leave, others had no oneto stay with in a safer part of town, and others feared that their apart-


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ments would be broken into if they left. For whatever the reason, theseindividuals remained extremely vulnerable.

Strategies. It is imperative that specific strategies be available for useby social workers when dealing with older persons during disasters. Af-ter ascertaining whether medical intervention is necessary, Lerner andShelton (2001a) suggested a “three D” strategy: distraction, disruption,and diffusion. Distractions involve redirecting and refocusing a personhaving gone through a disaster, including the introduction of a diver-sionary topic. Once this is accomplished, support and normalization of aperson’s reactions can occur. Disruption can most effectively be accom-plished by establishing eye contact with the individual on his or herlevel, speaking in a calm and clear tone, and giving one specific com-mand, such as, “Mr. Jones, I want you to take a deep breath.” Repeatwith increasing tone and volume until the individual follows the com-mand, and then lower the voice and calmly give further directions andsupport. The third component of this strategy, diffusion, is an interac-tion mimicking the individual’s voice rate and tone. Gradually slow thetone, pace, and rate until he or she is calm and can be moved from thesituation.

Professional strategies necessitate detachment, empathic communi-cation, support provision, and maintaining an awareness of an individ-ual’s physical and mental reactions. If necessary, counselors who are–themselves–undergoing stress while working with others, should re-move themselves from the area, debrief the experience with anothercounselor if available, or put their thoughts in writing.

Professionals should be trained to understand, recognize, evaluate,and manage the response to disasters by those employed in programs,services, and facilities for older persons. As previously mentioned, staffmembers have their own worries and for those who are assisting olderclients, patients, or residents during a disaster this means they mustmake their personal concerns of secondary importance. Working withindividuals who are in acute emotional distress requires an intensitythat, for the professional, is both mentally and physically challenging. Itis necessary for staff members to consider their state of readiness to behelpful to clients or patients who are “in crisis,” prior to engaging themin the helping process.

• Social workers in disaster situations are exposed to tumultuousevents. There are times when a social worker will identify with anindividual or with some aspect of the disaster. For example, afterarriving in Washington, DC, the senior author had the responsibil-


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ity of providing support to family members of those killed at thePentagon on September 11. Thus, she needed to be supportive andprofessional, while feeling–herself–the overwhelming physicaland psychological impact that these events had on her personallife. Indeed, Cunningham (2004) has written about “vicarioustraumatization” that can adversely affect professionals workingwith victims of disasters, as well as social work students being ex-posed to material on trauma in the classroom.

Interventions Following a Disaster

Disasters can include financial misfortune, family deaths, damage ordestruction of one’s dwelling, and serious illness or injury, among manypossible adversities. Additionally, there are normative challenges fac-ing older persons as a result of the aging process that require adaptationsor coping responses (Hooyman & Kiyak, 2002) following a catastro-phe. Early intervention is necessary to reduce the harmful psychologicaland emotional effects of both natural and human-made disasters (NIMH,2002; FEMA, 2003). Social workers, educated in crisis management,are uniquely aware of the need to examine past traumatic experiences offear, loss, anger, and grief that older persons may have experienced (andmaking them especially vulnerable to PTSD).

Strategies with older persons. Schnurr, Spiro, Vielhauer, Findler,and Hamblen (2002) suggested that experiencing a disaster may precip-itate PTSD. The symptoms may include recurring concerns about finan-cial stability, health, living independently, relocation and isolation, andbasic survival; grief over loss of loved ones and loss of valued andmeaningful possessions. Further, there will be continued, exaggeratedfear and anxiety about personal safety and the physical safety of lovedones, sleep disturbances, the need to repeatedly talk about events andfeelings associated with the disaster, and need to helpful in communitydisaster recovery efforts.

A Training Manual has been published; through an interagencyagreement between the FEMA and the Center for Mental Health Ser-vices (CMHS), Substance Abuse and Mental Health Services Adminis-tration; that discusses specific responses of older persons to the after-math of disasters. Identified are the following considerations:

• Older persons are often slower to register for disaster assistance,and once they are registered, may not follow through and completethe necessary applications to obtain assistance.


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• Older persons may be at higher nutritional risk in the aftermath of adisaster and may forget to take necessary medications.

• Older persons are often targeted by fraudulent contractors and “conmen” that follow disasters and financially exploit disaster victims.

• Older persons may be susceptible to physical and mental abuse asfamily stresses increases in later stages of the disaster.

• Older persons are less likely than younger generations to use formalaid sources such as the Federal Emergency Management Agency(FEMA) or the Red Cross.

• Older persons have slower economic recovery.• Older persons suffer a pattern of neglect in receiving social sup-

port after a natural disaster.• Older persons have more health problems after disasters.• Older persons do not necessarily comply with disaster warnings.

The ailments of older persons could worsen in a disaster situation.These include, but are not limited to, heart disease, cancer, stroke, ar-thritis, poor vision and hearing, depression, and dementia. It is also ofparamount importance that precautions prevent new or further injuriesfrom falling during and following relocation.

Due to physical and mental impairments, exacerbated by advancedage, older persons can have difficulty obtaining necessary assistance.They may have limited incomes, inability to read or speak English, andfew if any family members or friends to provide needed help, or feartraveling to the source of assistance.

Lerner and Shelton (2001b) discuss stages of PTSD management thatinclude such activities as the need for the professional to assess dangersthe client sees for him or herself and others, and how the event physi-cally and perceptually impacts upon the client. There is a need to evalu-ate the client’s level of alertness, and obvious medical needs, and toobserve and identify those individuals affected by the client’s trauma. Aformal caregiver (such as a social worker) begins to develop a rapportwith the client and assures the client’s safety (if possible).

The client is encouraged to relate the experience and then to discussbehavioral and/or physiological responses. The professional empa-thizes with the client and seeks to normalize feelings, validate and edu-cate, and prepare the client for the future by reviewing the traumaticevent, bringing the client to the present, discuss the near future, and pro-vide necessary referrals. While such considerations pertain to those ofany age; in fact, the advanced age or frail condition of an individual af-fects the relationship between the worker and older client, and the abil-


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ity to effectively assist the older victim of a disaster. The use of therapyanimals, primarily dogs, has been found beneficial for providing bothphysical and emotional relief during times of extreme stress, as well forfamilies of victims of a disaster (Harpaz, 2001).

Staff debriefing. Additionally, there is the possibility that social work-ers assisting those who have gone through a disaster will, themselves,face secondary PTSD. Indeed, it is a possibility that the professional willhave been personally affected by the disaster. Such a situation is dis-cussed in the Trauma Response Info-sheet, “How Can Emergency Re-sponders Manage Their Own Response to a Traumatic Event?” (Lerner &Shelton, 2001c).

Good intentions on the part of therapists do not seem to always suf-fice in helping post-traumatic victims, and Coghlan (2002) entitled hisarticle, “Counseling can add to the Trauma.” While a one-on-one “de-briefing” of a recent traumatic event might be beneficial, Coghlan foundthat this was not always the case. However, group counseling that in-cludes those having experienced a common situation in a structured set-ting has been found to result in consistently positive results. Thus, socialwork practitioners need to be aware of research findings and practiceexperience, as well as have the desire to help disaster victims.

PROFESSIONAL IMPERATIVES

Social workers–especially gerontological social workers–need to beprepared for work with older persons who have been (or who might be)victims of disasters, as well as all citizens. There are important roles forsocial workers to play at local, state, and national levels in the formationand implementation of organized efforts to better prepare older personsfor the possibilities of disasters. The following are suggestions and ex-amples of efforts in assisting individuals consider and prepare for thepossibility of disasters, whether acts of nature or acts of human beings.

Public Awareness

There is a need to make all citizens sensitive to the possibility of di-sasters and to engage in anticipatory planning. While, on one hand, thiswill heighten awareness, causing some anxiety, such efforts providesome comfort to others in pointing out–in advance–things that can bedone and resources that will be available to assist them before, during,and after a crisis. The mass media can reach all citizens, including older


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persons. Yet, it is believed, a more targeted approach is necessary to ed-ucate older persons. Such targeting can provide education in settingswhere the older persons are most comfortable, where they dwell, andplaces they frequent: senior citizen housing, retirement communitiesand senior centers, shopping malls, etc.

Education and Training

Of course, there is a need to raise awareness in the classroom for so-cial work students. A cadre of social worker educators can train othersfrom around the country to educate social work students on disasterplanning and interventions for all citizens, and for older persons, in par-ticular. Such efforts may result in students seeking advanced training indisaster preparation and interventions, prior to their graduation. Re-cently, there has been a call for “Infusing and Teaching CurriculumContent on Bioterrorism and Emergency Preparedness for the Aging”(Johnson, 2005). Additionally, students should be exposed to researchfindings and practice experiences concerning the quantity and quality ofpreventive and interventive efforts, so that they will be aware of bestpractice methods in working on behalf of disaster victims.

While crisis work in catastrophes is not seen to be a concentrated areafor social work preparation, there is the possibility that social workerswill be professionally (and possibly personally) interested in preparingthemselves for work with populations affected by disasters. Cunn-ingham (2004) has pointed out the students in courses focusing uponhelp for trauma victims might, themselves, face “vicarious traumaticexperiences.”

Telecommunication Mechanisms

For some forms of adversity, there are available systems that help in-dividuals during or after a disaster and catastrophe. As an example, ski-ers can increase the possibility that they will be found shortly after amajor avalanche by having a device that gives their location to rescuers.Older persons, especially if impaired, can have built into their housingunit emergency pull-strings or other devices to alert others that they arein jeopardy. While such mechanisms do not preclude the occurrence ofcatastrophic events, they might provide some relief to the anxiety asso-ciated with times of tumultuous crises. Accordingly, social workers canencourage older persons, and others, to plan for the inclusion of suchmechanisms where they live dwell or congregate.


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Plannng Efforts

As evidenced by the efforts in New York City and the State ofFlorida, planning can, and should, take place prior to the occurrence of adisaster. Such efforts should focus on older persons living independ-ently in their own homes and those living within particular health or so-cial settings. Hospitals and other forms of health care settings arerequired to have periodic evacuation drills. These “dry runs” benefitboth patients and staff alike. There is a similar need for such drills inprogram and services for older persons, as well in their residential set-tings. It is imperative that social workers take the initiative in suchemergency planning, and for gerontological social workers to ensurethat attention is directed to the special needs of older persons.

Local and Regional Coalitions of Professionals

Social work should be represented in coalitions that are engaged inemergency planning activities. Indeed, social workers should be initia-tors of such efforts, where and when they do not exist. As social workershave the skills and commitment for action on behalf of groups at high-risk, social work professionals should be on the forefront of such coali-tion-building efforts.

CONCLUSION

Social workers, among others from the helping professions, can learnfrom the experiences of victims of past disasters (such as the Oklahomabombing, the September 11th attacks, floods, earthquakes) or those forwhom the possibility of disaster is a way of life (such as the daily expe-riences of Israelis). Also, there is a need to learn from professionalgroups that are often the first in contact with victims of disasters, such asEmergency Medical System staff, ARC workers, FEMA, or critical oremergency care nurses.

Older persons can benefit from social work assistance in all threephases of disaster intervention: prior to, during, and following a disas-ter. By implementing lessons learned about human behavior in theclassroom and experiences in their careers, social workers are unsur-passed in their ability to serve vulnerable populations. Social work edu-cation can assist students to anticipate, and act in the face of, both


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natural and human-made tragedies for all citizens, including the specialneeds of older persons.

This article advocates for greater social work attention to disasterpreparation and planning efforts on behalf of older persons. Clearly,there are no parts of the country that can escape the potential of eithernatural or human-caused disasters. There is ample evidence of the se-verity of disasters upon older persons, and social workers have manypotential roles in disaster preparedness and interventions. It seems quiteimportant that social work educators and practitioners take the lead inthe development of sensitive and well-trained professionals who areprepared to meet the needs of older persons who are threatened by thefear of possible disasters as well as the tumultuous consequences of ac-tual disasters.

REFERENCES

Averill, P. M., & Beck, J. G. (2000). Posttraumatic stress disorder in older adults: Aconceptual review. Journal of Anxiety Disorders 14(2), 133-156.

Bolin, R., & Stanford, S. (1998). The Northridge earthquake: Community-based ap-proaches to unmet recovery needs. Disasters 22(1), 21-38.

Coghlan, A. (2002). Counselling can add to the trauma. New Scientist 178(2401), 3-5.Cohen, D., & Brown, L. M. (2003). Terrorism and older persons: Websites for geriat-

ric mental health professionals (Editorial). Journal of Mental Health 9(3), 139-143.Cook, J. J. (1998). Multiple accident: Would our disaster plan be up to the challenge?

Nursing, http://www.springnet.com.Cunningham, M. (2004). Teaching social workers about trauma: Reducing the risks

of vicarious traumatization in the classroom. Journal of Social Work Education40(2), 305-317.

Curry, M. D., Larsen, P. G., Mansfield, C. J., & Leonardo, K. D. (2001). Impacts of aflood disaster on an ambulatory pediatric clinic population. Clinical Pediatrics(40), 571-574.

Federal Emergency Management Agency (2003). On-line: www.fema.gov/library/prepandprev.shtm

Freidsam, H. J. (1962). Reactions of older persons to disaster-caused losses: A hy-pothesis of relative deprivation. In C. Tibbitts & W. Donahue (Eds.), Social andPsychological Aspects of Aging, New York: Columbia University Press, pp. 632-639.

Fried, M. (1963). Grieving for a lost home. In L. Duhl (Ed.), The Urban Condition,New York: Basic Books, pp. 151-171.

Gerberding, J. L., Hughes, J. M., & Koplan, J. P. (2002). Bioterrorism preparednessand response: Clinicians and public health agencies as essential partners. Journalof the American Medical Association 287(2), 898-901.

Harpaz, B.J. (October 28, 2001). At center for terrorist attack victims, they pat thedogs and feel better. The Associated Press. On-line: http://www.therapet-inc.com.


Dow

nloa

ded

by [

Uni

vers

ity o

f T

asm

ania

] at

20:

39 2

7 N

ovem

ber

2014

Hooyman, N. R., & Kiyak, H. A. (2005). Social Gerontology: A Multidisciplinary Per-spective (7th edition). Boston: Allyn and Bacon.

Johnson, A. (2005). Infusing and teaching curriculum content on bioterrorism andemergency preparedness for the aging. Newsletter of the Association for Gerontol-ogy in Higher Education, 28(3), 11.

Kimerling, R., Clum, G. A., & Wolfe, J. (2000). Relationships among trauma expo-sure, chronic posttraumatic stress disorder symptoms, and self-reported health inwomen: Replication and extension. Journal of Traumatic Stress, 13(1), 115-128.

Knight, B. G., Gatz, M., Heller, K., & Bengston, V. L. (2000). Age and emotional re-sponse to the Northridge earthquake: A longitudinal analysis. Psychology and Ag-ing 15(4), 627-634.

Lagnado, L. (2001). Hidden victims: For elderly near WTC, a new world of woe inSept. 11 aftermath–Stranded at home, thousands rely on visiting nurses to sustainhealth, hope–“the last to be taken away.” Wall Street Journal, Dec. 12, 2001, A1.

Lerner, M. D., & Shelton, R. D. (2001a). The 10 Stages of Acute Traumatic StressManagement (ATSM): A Brief Summary Reprinted from Acute Traumatic StressManagement by The American Academy of Experts in Traumatic Stress, Inc.

Lerner, M. D., & Shelton, R. D. (2001b). How can Emergency responders managetheir own response to a traumatic event? A Brief Summary Reprinted from AcuteTraumatic Stress Management by the American Academy of Experts in TraumaticStress, Inc.

Lerner, M. D., & Shelton, R. D. (2001c). How Can Emergency Responders Managetheir Own Response to a Traumatic Event? Reprinted from Acute Traumatic StressManagement by The American Academy of Experts in Traumatic Stress, Inc.

Mangum, W. P., Kosberg, J. I., & McDonald, P. (1989). Hurricane Elena and PinellasCounty, FL: Some lessons learned from the largest evacuation of nursing homepatients in history. The Gerontologist 29(3), 388-392.

National Association of Social Workers (2003). Social Work Speaks: NASW PolicyStatements, 2003-2006 (6th Edition). Washington: DC: NASW.

National Institutes of Mental Health (2002). On-line: www.nimh.nih.gov/research/massviolence.pdf

New York State Emergency Management Office (2003). On-line: http://www.nysemo.state.ny.us/BePrepared.pdf

New York State Office of Mental Health (2002). On-line: http://www.omh.state.ny.us/omhweb/omhq/q0902/LibertyGrant.html

O’Neill, J. V. (2001). Red Cross, NASW have pact. http://www.socialworkers.org/pubs/news/2001/11/pact.htm

Peterson, D. M., & Perry, R. W. (1999). The impacts of disaster exercises on partici-pants. Disaster Prevention and Management, 8(4), 241-254.

Pfefferbaum, B. (1996). The Oklahoma City Bombing: Organizing the MentalHealth Response. The American Academy of Experts in Traumatic Stress, Inc.http://www.aaets.org/arts/art5.htm

Prizzia, R., & Helfand, G. (2001). Emergency preparedness and disaster manage-ment in Hawaii. Disaster Prevention and Management 10(3), 173-182.


Dow

nloa

ded

by [

Uni

vers

ity o

f T

asm

ania

] at

20:

39 2

7 N

ovem

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2014

Qureshi, K. A., Merrill, J. A., Gershon, R. R. M., & Calero-Breckheimer, A. (2002).Emergency preparedness training for public health nurses: A pilot study. Journalof Urban Health, 79, 413-416

Rehner, T. A. et al. (2000). Depression among victims of South Mississippi’s MethylParathion disaster. Health and Social Work, February, 33-40.

Salerno, J. A., & Nagy, C. (2002). Terrorism and aging. Journal of Gerontology: Med-ical Sciences, 57A(9), M552-M554.

Schnurr, P. P., Spiro, A., Vielhauer, M. J., Findler, M. N., & Hamblen, J. L. (2002).Trauma in the lives of older men: Findings from the Normative Aging Study.Journal of Clinical Geropsychology 8, 3, 175-187.

Strug, D. L., Mason, S. E., & Heller, F. E. (2003). An exploratory study of the impactof the Year of 9/11 on Older Hispanic Immigrants in New York City. Journal ofGerontological Social Work 42(2), 77-99.

Torgusen, B. L. (2002). America attacked: Strategies for rural social workers Sep-tember 11, 2001. Presented at the 27th National Institute on Social Work and Hu-man Services in Rural Areas Social Work & the Rural Context: Strategies thatEmpower. Frostburg, MD, July 2002.

Tsui, M-S. Y., & Cheung, F. C. H. (2003). Dealing with terrorism: What social work-ers should and can do. Points & Viewpoints. Social Work, 48(4), 556-557.

Vallianatos, C. (2001). Mitigating stress of asbestos exposure: Groups led by socialworkers offer support and act as a clearinghouse. NASW NEWS, January.http://www.socialworkers.org/pubs/news/2001/01/asbestos.htm

Webb, R. A. (2000). Partners in Disaster Mental Health. http://www.socialworkers.org/practice/health/redcross.asp

Yanay, U. (1994). Assistance to civilian casualties of hostile actions. Social Security(Israeli Journal of Welfare and Social Security Studies), 3, 137-163.

MANUSCRIPT RECEIVED: 09/08/04MANUSCRIPT REVISED: 04/19/05

MANUSCRIPT ACCEPTED: 05/31/05


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assisting older victims of disasters

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