C O R P O R A T I O N

Research Report

Improving Disaster Resilience Among Older Adults

Insights from Public Health Departments and Aging-in-Place Efforts

Regina A. Shih, Joie D. Acosta, Emily K. Chen, Eric G. Carbone,

Lea Xenakis, David M. Adamson, Anita Chandra

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Preface

Thisreportusesinterviewdatacollectedfrompublichealthdepartmentsandaging-in-placeefforts—specifically,fromcoordinatorsofage-friendlycommunitiesandvillageexecutivedirectors—toexplorehowcurrentaging-in-placeeffortscanbeharnessedtostrengthenthedisasterresilienceofolderadultsandwhichexistingprogramsornewcollaborationsamongpublichealthdepartmentsandtheseorganizationsshowpromiseforimprovingdisasterresilienceforolderpopulations.

Thecontentsofthisreportwillbeofparticularinteresttopoliticalleaders(e.g.,mayors’offices);emergencypreparedness,response,andmanagementstaff;healthdepartmentsatthelocal,state,andnationallevels;andleadersofage-friendlycommunitiesandvillages.

ThisresearchwassponsoredbytheCentersforDiseaseControlandPreventionthroughcontract200-2014-59627andconductedwithinRANDHealth.

AprofileofRANDHealth,abstractsofitspublications,andorderinginformationcanbefoundatwww.rand.org/health.

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Contents

Preface....................................................................................................................................iiiSummary..................................................................................................................................vAcknowledgments...................................................................................................................viBackground:OlderAdultsandDisasters..................................................................................1PurposeandMethods..............................................................................................................4VillageInterviews.................................................................................................................5AFCInterviews......................................................................................................................5PublicHealthDepartmentInterviews..................................................................................6

Results......................................................................................................................................6PrioritizingPreparedness.....................................................................................................6GapsinPreparednessActivities.........................................................................................10BarriersEncounteredbyStakeholders...............................................................................13SuggestedMetricstoTrackOlderAdultResilience............................................................14

InsightsforStakeholders........................................................................................................15RecommendationsforAFCs...............................................................................................15RecommendationsforVillages...........................................................................................16RecommendationsforPublicHealthDepartments............................................................17RecommendationsforResearchers...................................................................................18RecommendationsforPolicymakers..................................................................................18

References..............................................................................................................................20

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Summary

• Theincreasingfrequencyandintensityofweather-relatedandotherdisastereventscombinedwiththegrowingproportionsofolderadultspresentanewenvironmentinwhichpublichealthprogramsandpoliciesmustactivelypromotetheresilienceofolderadults.

• Preparednessprogramsconductedbypublichealthdepartmentsaredesignedtoreducemortalityandmorbidityand,consequently,willbecomeevenmorecritical,giventheincreasingproportionofolderadultsintheUnitedStates,largelyduetoagingbabyboomers.

• Interviewswithstakeholdersrevealedthatmostage-friendlycommunities(AFCs)andseniorvillagesdidnotplaceahighpriorityonpromotingdisasterpreparedness.Whilemostpublichealthdepartmentsweintervieweddidengageindisasterpreparednessandresilienceactivities,theywerenotnecessarilytailoredtoolderadults.

• AFCsandseniorvillageintervieweescitedolderadults’challengeswithcommunicationandlowprioritizationoftheneedtoplanfordisasters.Theseorganizationsalsoacknowledgedtheirlimitedawarenessofdisasterpreparednessandlackofdemandfromtheirconstituentstoprovideservicestohelptheircommunitiesbebetterprepared.

• Currentaging-in-placeeffortscanbeharnessedtostrengthenthedisasterresilienceofolderadults.Existingprogramsandnewcollaborationsbetweenpublichealthdepartmentsandtheseorganizationsshowpromiseforimprovingdisasterresilienceforolderpopulations.

• Theworkofpublichealthdepartmentsandaging-in-placeeffortsiscomplementary.Improvingtheeverydayengagementofolderadultswithfamily,friends,neighbors,andtrustedinstitutionssupportsotherorganizations’andagencies’preparednessworkbystrengtheninginformaltiesandbuildinginformationnetworks.Likewise,theworkofhelpingolderadultsbecomemoreresilienttodisastersprovidesanopportunityforolderadultstoengagewithothersandlearnskillsneededtoremainsafelylivingathomeastheyage.

• Aligningandextendingpublichealthdepartments’currentpreparednessactivitiestoincludeaging-in-placeeffortsandgreatertailoringofexistingpreparednessactivitiestotheneedsofolderadultscouldsignificantlyimprovetheirdisasterpreparednessandresilience.

• Forjurisdictionsthatdonothaveanexistingaging-in-placeeffort,publichealthdepartmentscanhelpinitiatethoseeffortsandworktoincorporatepreparednessactivitiesattheoutsetofnewlydevelopingaging-in-placeefforts.

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Acknowledgments

Thankyoutothevillages,age-friendlycommunities,andpublichealthdepartmentsthatparticipatedinthisstudy.WewouldalsoliketothankClaraAranibar,NinaRyan,andChanelSkinnerfortheirhelpinschedulingtheinterviews,aswellasourcolleaguesRodneyHarrellatAARP,NatalieGaluciaatVillagetoVillageNetwork,GailKohnandNickKushneratAge-FriendlyDC,andLauraBiesiadeckiandGeoffreyMwaunguluattheNationalAssociationforCountyandCityHealthOfficialsfortheirinputandtheirhelpwithrecruitinginterviewees.ThankstoJaimeMadriganofromRANDandJonathanAdrianofromtheEastCentralHealthDistrictinAugusta,Georgia,whoreviewedthisreportandprovidedideasandguidancethathavehelpedusarticulatethekeyfindingsandtheirimplications.Inaddition,wewouldliketothankAmyWolkin,theVulnerablePopulationsOfficerintheOfficeofPublicHealthPreparednessandResponseattheCentersforDiseaseControlandPreventionforherthoughtfulreviewofthereport.Finally,wewouldliketothanktheCentersforDiseaseControlandPreventionforfundingthestudythatmadethisworkpossible.

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Background:OlderAdultsandDisasters

Intensestormsandotheremergencieshavebecomemorefrequentandsevereinrecentyears—inpart,becauseofclimatechange(NationalOceanicandAtmosphericAdministration,NationalCentersforEnvironmentalInformation,2017;NationalAssociationofInsuranceCommissioners,CenterforInsurancePolicyandResearch,2017).Itisincreasinglyimportanttobuildresilientcommunities—thatis,communitiesthatcanrecoverfromdisastersandfromotherproblems,suchasviolenceandeconomicdownturns,andemergestrongerandbetterabletowithstandfutureadverseevents(Acosta,Chandra,andMadrigano,2017).Aresilientcommunity(Figure1)requiresstrongconnectionsatalllevels:betweenneighbors,betweenneighborhoodsandcommunityorganizations,andbetweenlocalgovernmentandnongovernmentalgroups(Chandraetal.,2011).

Figure1.BuildingBlocksofaResilientCommunity

Olderadults,definedforthisreportasadultsage65orolder,areespeciallyvulnerable

duringandafterdisasters(Beietal.,2013;Maliketal.,2017;Weisler,Barbee,andTownsend,2006).Forexample,halfofthedeathsfromHurricaneKatrinawereadultsage75andolder(Brunkard,Namulanda,andRatard,2008),and63percentofthedeathsafterthe1995heatwaveinChicagowereadultsage65orolder(Whitmanetal.,1997).Olderadultsaremorelikelythanothersinacommunitytobesociallyisolatedandhavemultiplechronicconditions,limitationsindailyactivities,decliningvisionandhearing,andphysicalandcognitivedisabilities

Individuals/familieshavetheknowledgetoprepareforandrespondtodisaster

Thereareenoughvolunteerstohelpinadisaster

Organizationsarereadyandpreparedtorespondandrecover

Therearestrongrelationshipsbetweenorganizations

Peoplecanrelyoneachother(neighbortoneighbor)

RESILIENTCOMMUNITIESRESILIENTCOMMUNITIES

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thathampertheirabilitytocommunicateabout,preparefor,andrespondtoanaturaldisaster(Levac,Toal-Sullivan,andO’Sullivan,2012;AldrichandBenson,2008).Asizablenumberofadultsage65orolder(aboutone-thirdofMedicareenrollees,orapproximately16millionnationally)livealone(Komisar,Feder,andKasper,2005).Disasterscanalsodisruptessentialservicesthatallowolderadultstoliveinthecommunity,suchasassistancefromfamilycaregiversandsocialserviceslikehome-deliveredmeals,choreservices,andpersonalcare(BensonandAldrich,2007).A2012surveyfoundthat15percentofU.S.adultsage50orolderwouldnotbeabletoevacuatetheirhomeswithouthelp,andhalfofthisgroupwouldneedhelpfromsomeoneoutsidethehousehold(NationalAssociationofAreaAgenciesonAging,NationalCouncilonAging,andUnitedHealthcare,2012).A2014surveyofadultsage50orolderfoundthat15percentofthesampleusedmedicaldevicesrequiringexternallysuppliedelectricity(Al-Rousan,Rubenstein,andWallace,2014).Thus,powerinterruptionscouldposeadversehealtheffectsforthisgroup.

Olderadultscanalsocontributeimportantassetstodisasterresponse.A2017qualitativestudyof17focusgroupswithat-riskindividualsfoundthatadultsage65oroldercontributetheirexperience,resources,andrelationship-buildingcapacitytopreparethemselvesandtosupportothersduringanemergency(Howard,Blakemore,andBevis,2017).Specifically,olderadultsbothgenerateandmobilizesocialcapitalatthelocallevelduringadisaster.

Yettherearecriticalgapsindisasterpreparednessforthisgroup.Althoughpreparednessguidelinesandresourcesexistforolderadults,the2014surveymentionedearlierfoundthattwo-thirdsofadultsage50orolderhadnoemergencyplan,hadneverparticipatedinanydisasterpreparednesseducationalprogram,andwerenotawareoftheavailabilityofrelevantresources(Al-Rousan,Rubenstein,andWallace,2014).Morethanathirdofrespondentslackedabasicsupplyoffood,water,ormedicalsuppliesincaseofemergency(Al-Rousan,Rubenstein,andWallace,2014).Adultsage65andolderwillmakeupnearly25percentoftheU.S.populationby2060(U.S.CensusBureau,2017).AstheU.S.populationagesandweathereventsbecomemoresevere,theneedtoaddressthevulnerabilityandleveragethestrengthsofolderAmericansindisasterswillgrow.

Publichealthandpreventionplanningandprogramsareneededtoidentifyolderadultsatelevatedriskintheeventofdisasters,addresstheirneeds,andleveragetheirstrengths(Al-Rousan,Rubenstein,andWallace,2014).Publichealthdepartmentsarethegovernmententityprimarilyresponsiblefordisaster-relatedpublichealthandsafety.However,publichealthdepartmentsareoftenfocusedontheentirecommunity,andeventheirtailoredprogramsmaybelimitedtoindividualswithfunctionallimitationsandmaynotnecessarilymeettheneedsofallolderadults.Onesetofresourcesforimprovingthedisasterresilienceofolderadultsmayalreadyexistincommunities:currenteffortstopromoteaginginplace.TheCentersforDiseaseControlandPrevention(CDC,2009)defineaginginplaceas"theabilitytoliveinone'sown

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homeandcommunitysafely,independently,andcomfortably,regardlessofage,income,orabilitylevel."A2015surveyfoundthat75percentofrespondentsage60orolderintendedtocontinuelivingintheircurrenthomefortheremainderoftheirlives,inlargepartdrivenbytheirdesiretobenearfamilyandfriends(NationalAssociationofAreaAgenciesonAging,NationalCouncilonAging,andUnitedHealthcare,2015).

TherearetwoprimarytypesofnationwideorganizationsthatpromoteaginginplaceintheUnitedStates(Greenfield,2012):

• Age-friendlycommunities(AFCs)aretypicallycollaborationsorpartnershipsbetweenorganizations(whichmayincludelocalgovernmentagenciesandcommunitygroups)thatpromotethesocialconnectednessofolderadultsacrossamunicipalorregionalarea(e.g.,citiesandcounties)andfacilitatetheirinclusionincommunitylife.TheWorldHealthOrganizationoverseestheGlobalNetworkforAge-FriendlyCitiesandCommunities.AARPoverseesanetworkofU.S.Age-FriendlyCities.

• Villagesaremembership-drivengrassrootsnonprofitorganizationsthatseektohelpolderadultsageinplacesuccessfullythroughanumberofprogramsandservices,suchashealtheducation,socialgatherings,accesstoalistofservicevendorswhohavebeenvetted,transportation,andbookkeeping.Villagesgenerallycoveraneighborhoodoracitybutinsomecasescancovermultipleadjacentcountiesinmoreruralareas.Villagesdifferbasedontheirsize,governancestructure,membershipcharacteristics,andregionalcoverage.TheVillagetoVillageNetworkisanationalnonprofitorganizationthatprovidesexpertguidance,resources,andsupporttohelpcommunitiesestablishandmaintainvillages.

Likeresilience,successfulaginginplaceemphasizesconnectedness.Forolderadultsinparticular,thismeansengagementwithcommunitylifeandneededservices.

Thefollowinglistsummarizestherationaleforfocusingonolderadults’preparednessandourhypothesisthataging-in-placeeffortsmayserveasresourcestopublichealthdepartmentstobolsterthedisasterresilienceofolderadults(Keim,2008):

1. TheU.S.populationisagingrapidly,inpartbecauseoftheagingbabyboomercohorts.2. Intensestormsandotheremergencieshavebecomemorefrequentandsevereover

time,andolderadultstendtoliveinareasmorepronetodisasters.3. ThemajorityofolderadultsintheUnitedStatesareunpreparedforanemergency,and

manyaresociallyisolatedorarenotabletoreceiveorrespondtomessagestypicallyemployedbypublichealthdepartments.

4. Olderadultsarevulnerableandhavespecificneedsinthefaceofanemergencythatarenotfullycoveredbymostpublichealthdepartments’preparednessactivities.

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5. Emergencypreparednessprogramsaredesignedtoreducemortalityandmorbidity,whichwillbecomeevenmorecritical,giventheagingU.S.population.

6. Aging-in-placeeffortsmaybeanationalresourcetosupportdisasterresilienceofolderadults.

PurposeandMethods

Thepurposeofthisstudyistoidentifythekeycomponentstohelppublichealthdepartments,whicharechargedwithgeneralpreparednessefforts,andaging-in-placeefforts,whichstrengthengeneralresilienceamongolderadults,tobetteraligntheiractivitiesandrelationshipswitheachothertofillthegapsinresilienceofolderadultstodisasters(seeFigure2).Wesoughttoanswertwomainquestions:(1)CancurrentAFCandvillageeffortstopromoteaginginplacebeharnessedtostrengthenthedisasterresilienceofolderadults?(2)Whichexistingprogramsornewcollaborationsamongpublichealthdepartmentsandaging-in-placeorganizationsshowpromiseforimprovingdisasterresilienceforolderpopulations?Figure2.Aging-in-PlaceInitiativesandPublicHealthDepartmentsRarelyCollaboratetoBolsterPreparednessSpecifictoOlderAdults

Aging-in-placeinitiatives

SocialsupportDailyquality-of-life

needs

PublichealthdepartmentsGeneral

preparednessGeneralhealth

resilience

Currentgapisinconductingpreparedness

tailoredtoolderadults

In2016,aresearchteamconductedkeyinformantinterviewswiththreegroupsofstakeholders—publichealthdepartmentstaff,AFCleaders,andvillageexecutivedirectors—withthreegoalsinmind:

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• Improveunderstandingofwhatpublichealthdepartments,AFCs,andvillagesarecurrentlydoingtoaddressdisasterresilienceinolderpopulations.

• Identifypromisingavenuesforimprovingcurrenteffortsorlaunchingnewones,includingprograms,partnerships,andcollaborations.

• Gatherrecommendationsforusefulmetricsofresilienceinolderadults.

Asemistructuredprotocolwasestablishedtoguidetheinterviewswiththesestakeholders.Itincludedquestionsaboutthegreatestneedsaroundhelpingolderadultspreparefordisasters;thetypesofresilienceactivitiesengagedinbytheirorganizations,bothgenerallyandforolderadults;othertypesofolderadult–focusedprogrammingconductedbytheirorganizations;wholeadsresilienceactivitiesforolderadultsintheirserviceareas;awarenessofandcollaborationwithotherolderadult–servingandresilience-focusedorganizationsandagenciesintheirregions;andideasforhowtoassessprogressaroundemergencypreparednessandresilienceforolderadults.Whilethisqualitativeresearchsoughttoreachsaturationofinformationwithineachstakeholdergroup,itisimportanttonotethattheseresultsarenotrepresentativeofallviewpointsforeachstakeholdergroup.Allinformantsgaveverbalconsenttoparticipate,andthemethodswereapprovedbytheRANDCorporation’sHumanSubjectsProtectionCommitteeandtheFederalOfficeofManagementandBudget.

VillageInterviews

Weinterviewed16villageleadersfromtheapproximately175villagesthatwereoperatinginearly2016whenwebeganrecruitinginterviewees.Inmostcases,theintervieweewastheexecutivedirector.WerecruitedtheseexecutivedirectorswiththehelpoftheVillagetoVillageNetwork,amember-basedorganizationofvillagesacrosstheUnitedStateswithanationalstaffthatprovidesguidance,resources,andsupporttohelpcommunitiesestablishandmaintaintheirvillages.OurrecruitmentstrategywastolocatevillagesrepresentingdiversityinsizeandgeographicregionacrosstheUnitedStates.Thevillagesinoursamplewereformedbetween2008and2015andhadbeeninexistenceforanaverageof5.5years.

AFCInterviews

Beforewebeganrecruitingintervieweesin2016,therewere26AFCswithcompletedactionplans.WiththehelpoftheAARPPublicPolicyInstitute,werecruitedleadersfromtenAFCs,representinganevendistributionacrossallU.S.geographicregionsandruralorurbanstatus.Weinterviewedthesetenleaders,whoweregenerallyrepresentativesofthecoordinatingbodiesofaparticularAFC.Mostrespondentswereemployedbylocal

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governments,butafewrespondentshadprimaryrolesatacademicinstitutions,communityfoundations,orothertypesofcommunity-engagedorganizations.

PublicHealthDepartmentInterviews

WithassistancefromtheNationalAssociationforCountyandCityHealthOfficials,werecruited11staffmembersfrompublichealthdepartments.These11intervieweeswereprimarilyresponsibleforimplementingemergencypreparednessandresilienceactivities.OursamplerepresentedanevendistributionacrossallU.S.geographicregionsandruralorurbanstatus,withalldepartmentslocatedinareasthathadanAFCinthesamejurisdiction.Inthecaseofacountypublichealthdepartment,thecitylocatedwithinthecountywiththepublichealthdepartmenthadanAFC.Inmostcases,participantswereemergencypreparednesscoordinators.TheintentofselectingpublichealthdepartmentsinanareathathadanexistingAFCwastoidentifywhetherexistingentitieswereawareoftheircounterparts’activitiesandhowtheycouldbebetteraligned.Totheextentthatpublichealthdepartmentsarecapableandcangetleadershipbuy-in,theycanserveaskeystakeholdersforinitiatingthedevelopmentofanAFCorvillage.Thisreportdescribeshowpublichealthdepartments,AFCs,andvillagescanencouragealignmentofkeygoals,complementaryactivities,andsharingofinformationtoincreasepreparednessofolderadultsattheoutsetofanewlydevelopingaging-in-placeeffort.

Interviewswereledbyamemberoftheresearchteam,withanotherteammembertakingdetailednotes.Interviewswerealsoaudio-recorded.Recordingswerereferredtoforclarificationofthewrittennotesandtoconfirmverbatimquotes,asneeded.

Onceinterviewswerecomplete,tworesearchersindependentlyreviewedandsummarizedinterviewthemesforeachgroup.Leadresearchersontheproject,bothofwhomparticipatedinconductinginterviews,thenreviewedthesummaryofthemes,verifyingmajorthemesandsuggestingclarificationorexpansionofkeypointswhenneeded.Themeswerethenrefinedandexpandediterativelybytheresearchteam.

ResultsPrioritizingPreparedness

WhatStakeholdersAreDoing

Overall,wefoundthatmostAFCsdidnotplaceahighpriorityonpromotingdisasterpreparedness.Althoughvillagesdidpromotedisasterpreparednessactivities,mostofthesefocusedonbuildingsocialcohesionandsupportoronpreparingforhealth-relatedemergencies.Publichealthstaffgenerallyreportedthatresilience-buildingprogramsforolderadultswerelimitedornonexistentintheiragencies.Theyexpressedtheviewthattheirmission

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waspreparednessforallagegroupsinthegeneralpopulationandthatolder-adultprogramingtypicallyfellunderthejurisdictionofanotheragency,suchasastateorlocalDepartmentofAging.Someoftheirworktargetedvulnerablepopulationsorindividualswithfunctionallimitations,whichmayincludesomebutnotallolderadults.

Villages

Themajorityofvillageswereengagedinatleastoneactivityaimedatimprovingolderadults’resilience.Theactivitiesvaried,basedontheneedsofthevillagemembers,butcanbegroupedintothreegeneralapproaches:

• information-sharingandoutreach,whichincludedprovidingbrochuresonpreparedness,callingmembersduringandafterdisasters,andremindingmembersaboutchangingsmokedetectorbatteries

• improvingcommunicationwithfirstresponders,includinghelpenrollinginsmart911registriestomakerespondersawareofmembers’needs,hostinginformationsessionsfromlocalemergencyresponders,andmedicalalertsystems

• assessmentandplanning,includinghomesafetyinspections(e.g.,forfiresafety),supportforemergencyplanning,andsupportforadvancecareplanningconversations—thatis,wishesincaseofdeathoranincapacitatinghealthevent.

Abouthalfofthevillageleadersinoursamplenotedthattheirvillageengagedinsomekindofemergencyplanning.Theseactivitiesare,asnoted,focusedmostlyonpreparingforhouseholdemergencies,suchasfiresorhealthcrises.However,severalvillagerespondentsdrewconnectionsbetweenpreparingfordisastersandpreparingforhealth-relatedemergenciesasakeycomponentofsupportforaginginplace,sinceolderadultstendedtoplaceahigherpriorityonpreparingforhealth-relatedemergencies.Thevillageintervieweesalsonotedthatdespitetheseactivities,manyoftheirmemberswouldstillbehighlyvulnerableintheeventofnaturaldisaster.

Inpartnershipsandcollaborations,villagesweremorelikelytoworkwithnonprofits,suchasseniorcenters,thanwithgovernmentagencies.Manysawthepotentialvalueofpartneringwithpublichealthdepartments,thoughsomeexpressedtheoppositeview—thattheydidnotviewpublichealthpartnershipsasworthwhilebecausethevillagelackedthestafftimetomaintainapartnership,didnotknowhowapartnershipwouldbenefittheirwork,orwereconcernedthatpartneringwithgovernmentagenciesmightbringwithitregulationsthatwouldrestricttheactivitiesofthevillage.

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AFCs

Ingeneral,AFCswerelessengagedthanvillagesinactivitiesthatfocusedexplicitlyondisasterresilience.Unlikevillages,whichare“bottom-up”membershiporganizationscreatedtoaddresstheneedsoftheirmembers,AFCsaremore“topdown”;theiractivitiescenteronthemodelsetforthbytheWorldHealthOrganizationandAARP,whichidentifieseightdomains:thebuiltenvironment,transport,housing,socialparticipation,respectandsocialinclusion,civicparticipationandemployment,communication,andcommunitysupportandhealthservices(WorldHealthOrganization,2017).

Noneofthesedomainsexplicitlyaddressdisasterresilienceorpreparedness,andmostAFCrespondentsdidnotseeaclearintersectionbetweenthesedomainsanddisasterpreparedness.OfthetenAFCrespondents,onlythreewereengagedinresilienceactivities.ThesethreeAFCrespondentsexpressedtheviewthatpreparednesswasanextensionoftheirworkonneighborhoodcohesionandsocialengagement.TheleaderofoneoftheseAFCsarticulatedtheviewpointthatimprovingtheeverydayengagementofolderadultswithfamily,friends,neighbors,andtrustedinstitutionssupportedotherorganizations’andagencies’preparednessworkbystrengtheninginformaltiesandbuildinginformationnetworks.EachofthesethreeAFCleadersobservedthattheiractivitieswerefillingaroleinhelpingtolinkcommunitypreparednessingeneralwiththespecificneedsofolderadultsandthatbridgingthisgap—ratherthandeliveringanyspecificservices—maybethebestwaytosupportolder-adultpreparedness.

AFCsthatusedacommunity-engagedstrategytosetprioritieswerelesslikelytofocusonresilienceanddisasterpreparednessbecausethesearetypicallyoflessimmediateinteresttoolderadultsthanthedailyquality-of-lifeissuesaddressedintheeightdomains.Incontrast,AFCsthatwereformallyaffiliatedwithmultiplecityagenciesorissue-specificorganizationstypicallyhadmorediverseagendasthatleftmoreroomforconsideringresilienceanddisasterpreparednessinsomeform.

Intermsofpartnershipsandcollaborations,AFCsarealmostentirelycollaborativeefforts,ofteninvolvingcommunityleadersandrepresentativesofcityorlocalgovernmentagencies,whichinsomecasesincludedpublichealthdepartments.MostoftheAFCsinoursamplewerestaffedbyacombinationofgovernmentemployees(whoseparticipationwaspartoftheirjobs),communityleaders,interns,andvolunteers.

PublicHealthDepartments

Allofthepublichealthdepartmentsinoursamplewereengagedinpreparednessplanningandeducation.Inmostcases,theplanningfocusedonpreparingforhealthemergenciesorthe

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health-specificpieceofadisasterevent,suchasrapidmedicationdispensingorcontaininginfectiousdiseases.Mostpublichealthdepartmentsdidnothaveobjectivesorprogramsspecifictoolderadults.Asnotedearlier,theytypicallydidnotperceiveprogrammingforolderadultstobe“intheirlane.”However,somehadprogramsfocusedonindividualswithfunctionallimitations(alsocalledat-riskorvulnerablepopulations).Somealsohadprogramsrelatedtochronicdiseasepreventionandmanagement(e.g.,depressionanddiabetes),aswellasreductionofhealthrisks,suchastobaccouseandfallprevention.Alloftheseissuesdisproportionatelyaffectolderadults.Manypublichealthdepartmentleadersfeltthattheirprogramshadbroadrelevancetoolderadultsand,therefore,feltthattheymettheneedsofolderadultsadequately.

Withrespecttopartneringactivities,allofthepublichealthdepartmentsinoursampledescribedextensivecollaborationandcoordinationwithothermunicipalagencies.Somepartneredwithareaagenciesfocusedonagingtodisseminateinformationabouthealthpromotionprogramsforolderadults.Othersparticipatedinlargerregionalcoalitionstopromotehealthandwellnessgoalsthatwerepartofabroaderstrategicplan.

Inaddition,mostpublichealthleadersdescribedcollaborationswithnongovernmentalgroupsandcommunityorganizations,suchashospitalsystems,churches,andcharities(e.g.,theRedCrossandCatholicCharities).Theirmotivationforthesepartnershipswastouselocalnetworksandcommunicationchannelstodeliverpublichealthmessagesandtoconducteducationandoutreach.Oneadditionaltypeofengagementwitholderadultsthatafewpublichealthdepartmentsmentionedwasoutreachtoolderadultstorecruitvolunteersfordisasterexercises,suchasamedication-dispensingexerciseduringapublichealthemergency.Onepublichealthleaderalludedtothefactthatthisvolunteeropportunityforolderadultsengagespeopleinapracticalwaywhileprovidinganopportunityforpreparednesseducationmoregenerally.Thisisjustoneexampleofhowolderadultsareanassetforbolsteringcommunityresilience.

Somepublichealthleadersexpressedinterestinpartneringorcoordinatingwithnonprofitorganizationsandothergovernmentagenciestoconductoutreachdirectedtoolderadultpopulations,thoughnonecurrentlydidso.Abouthalfofpublichealthdepartmentsworkedwithlong-termcarefacilitiesorotherresidentialfacilitiesforolderadultstohelpthosefacilitiesplanforemergencies.AnynursinghomeacceptingMedicareorMedicaidisrequiredbylawtohaveanemergencyplan(CDC,2012a),andallpublichealthdepartmentsappearedproactivelyengagedwiththesesitestodevelopplansforevacuationorshelteringinplaceandconductededucationactivitieswithresidentsinconjunctionwiththefacilities.MostpublichealthleadersindicatedtheywereawareofalocalAFC,butonlytworeportedinteractingwithAFCleadershiponpreparednessactivities.Veryfewpublichealthleadersreportedbeingawareofvillagesintheircommunity,andnonereportedinteractingwiththemonpreparednessactivities.Ofthe

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11publichealthleadersweinterviewed,sevenwerefromcommunitieswithoneormorevillages.Inseveralcases,thepublichealthdepartmentleadersdidnotlooktotheAFCorvillageforcollaborationbecauseanothergovernmentagencywastaskedwithfocusingonolderadult–focusedprogramming(althoughnotrelatedtopreparednessactivities),and,therefore,thosepublichealthdepartmentsdidnotconsiderthemselvestobetheagenciesthatwoulddirectlypartnerwiththeAFCsorvillages.Similarly,villageleadersandAFCsdidnotviewpublichealthdepartmentsasaprimarypartnerforolderadult–focusedprogramming.However,therewasstrongagreementamongpublichealthleadersthattheirdepartmentalmissionshadsignificantoverlapwiththoseofAFCs,suchthatapotentialcollaborationwitheithertypeoforganizationwouldbewellalignedwithagencygoals.

RecapofKeyFindingsonStakeholderActivities

AFCsandvillagesfocusedonsuccessfulaginginplace,helpingolderadultsfunctioninandstayconnectedtotheircommunities.Many,especiallyvillages,wereengagedinprogramsdirectlyrelevanttodisasterpreparedness,althoughtheydidnotviewtheseprogramsasahighpriority.Publichealthdepartmentsfocusedondisasterpreparedness,aswellaspreventingandmanagingchronicdiseaseamongthelocalpopulation,buttheydidnothaveprogramstargetedspecificallytoolderadults.Publichealthdepartmentsdidhaveprogramsforindividualswithfunctionallimitations(whichcanencompasssomeolderadults,butnotall),butpublichealthleadersdidnotviewprogrammingforallolderadultsastheirresponsibility.

GapsinPreparednessActivities

WeexploredAFC,village,andpublichealthdepartmentviewsofhowwelltheirpreparedness-relatedactivitiesalignedwiththegreatestneedsthatolderadultsface.Allacknowledgedongoinggapsinthisalignment.

AFCs

AFCsacknowledgedgapsbetweenthegreatestneedsofolderadultsandtheavailableservicesorsupportforpreparedness.AFCrespondentsidentifiedseveralareasofpreparednessneedsforolderadults,includingchallengesrelatedtocommunication,connectedness,andindividualplanning(e.g.,lackofplanningaroundspecifichealthneeds,medicationmanagement,lackoftransportation,andmedicalneeds).

MostAFCrespondentssuggestedthatcertainneedsaremorecommonamongolderadultsduringadisasterresponse.Forexample,transportationorhealthneedsareparamountforolderadultsand,ifleftunaddressed,canpreventolderadultsfrombeingresilientfollowinga

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disaster.Providingorobtainingappropriatetransportationforpeoplewithfunctionaldisabilities(e.g.,dialysisornonemergencymedicaltransport)maypresentmajorchallengesintheeventthatevacuationisnecessary.Similarly,olderadultswhousemedicalequipmentorsupplies(suchassupplementaloxygen),relyonhomecareservices,orneedmedicationsmayexperiencehealthcaredisruptionsduetolossofpower,interruptionofservices,orinabilitytogettoanopenpharmacy.Thiscouldcreateaserioussituationthatcompoundsthewideremergencyeventinagivenlocation.Accordingtorespondents,understandingtheseuniqueneedsandplanningforthem—onthepartofindividuals,publichealthdepartments,andfirstresponders—isanareaofgreatneed.

Theabilityofmunicipalitiesorfirstresponderstotrackvulnerableand/orisolatedindividualswasalsoidentifiedasagap.Afewrespondentsraisedthecorollaryoffunctionaldisabilityregistriesthatarekeptbysomecities,buttheycitedchallengesrelatedtogettingpeoplesignedupfortheseregistriesandmaintainingtheminawaythatwouldbeusefulduringanemergency.TheissueofcommunicationandtrackingofvulnerableolderadultsrelatedtooneAFCrespondent’sbeliefthatdevelopingsocialcohesionwasoneofthegreatestpreparednessneedsofolderadults.Inthisrespondent’sview,olderpeoplearemorelikelytobevulnerable,isolated,andcautiousandtoneedtrustworthyrelationshipswithneighbors,friends,organizations,orotherswhocanreachthemorbereachedouttoinanemergency.

AfewAFCsalsocitedthereadinessoffirstrespondersandemergencymanagementpersonnelasanareaofneedforolderadultsandpeoplewithdisabilities.Respondentsbelievedthatemergencyserviceswerenotalwaysmindfuloforequippedtoaddresstheuniqueneedsoftheolderadultsintheircommunitiesandthatfurthereducationandtrainingwasneeded.

Villages

Villageleadersnotedthattoofewmemberswereeducatedortookaction,whichwassometimesbasedonmembers’failuretoprioritizeortakeseriouslythepotentialbenefitsofpreparedness.Consequently,villageleadersnotedthattheirabilitytopromotepreparednessamongtheirmemberswaslimited,basedonthelackofinterestorwillingnesstoengage.

Arelatedchallengeforvillagemembers,discussedmoregenerallyinthecontextofserviceprovision,isthatmanymembers’needsaredynamic;asmembersdealwithacutehealtheventsandsubsequentrecoveryorfacemoresteadydeclinesinhealth,theirneedsandimpairmentswillchange.Thisrelatestopreparednessandresiliencebecause,inlightofthefluctuatingmedicalneedsofvillagemembers,gapsinpreparingforthosemedicalneedswillhavetobecontinuallyassessedandreassessed.

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PublicHealthDepartments

Publichealthrespondentscitedseveralreasonsthatolderadultsmaybemorevulnerableintheeventofanemergency.Respondentsfocusedonolderadults’healthandmedicalneeds,includingmedication,medicalequipment,andfunctionallimitations;socialisolation—thatis,beingmorelikelytolivealoneandlesslikelytoknowneighbors;andlackofawarenessandpreparednessforemergencies.Lackofknowledgeaboutpreparednessandlackofreadinesswereviewedasproblemsforolderadults,butrespondentsnotedthatthischallengeisalsowidespreadinthegeneralpopulation.Nevertheless,olderadultsmightbelessawareofpreparednessguidelinesandrecommendationsforemergencyresponse;lesslikelytomakeaplanandbuildakit;andlessabletoactivateanemergencyplanwhenneeded,suchasevacuatingorgoingtoashelter.Mostrespondentsdescribedolderadultsasgenerallylackingthetechnologicalskillsneededtouseacellphoneorcomputertofollownewsorsocialmediaupdatesduringanemergency;thisputsolderadultsatriskofbeingdisconnectedfromemergencyresponseinformation.Anotherspecialneedofolderadultswithregardtoemergencyresponseistransportation;whenwalkingtoashelterisnotfeasibleforanurbanresident,orifanindividualnolongerdrives,lackoftransportationislikelytoposeaseriouschallengetotimelyevacuation.

Publichealthleadersalsopointedtogapsinthenationalpolicyandlegalframeworkintendedtoprotectolderadultsaspartofemergencypreparedness.MostofthepoliciesthatguideU.S.disasterpreparedness,response,andrecovery(e.g.,theNationalResponseFramework,theNationalDisasterRecoveryFramework,theHomelandSecurityAct,theStaffordAct)donotspecificallyaddressplanning,preparedness,orresilienceofolderadults(CDC,2012a).OneexceptionisthePandemicandAll-HazardsPreparednessAct,whichfocusesonpublichealthandmedicalpreparednessandresponseandprovidesgrantstostrengthenstateandlocalpublichealthsecurityinfrastructure.ThispolicypermitstheSecretaryofHealthandHumanServicestorequirethosereceivinggrantstoincludethestate-levelagencyresponsibleforaging-relatedissuesintheirpreparednessplans(CDC,2012b).Acomplementarypolicy,theOlderAmericansAct,requiresstateandlocalareaagenciesthataddressagingtoengageinpreparednessplanning.Eachagencyisrequiredtodevelopapreparednessplanforhowitwillcoordinatewithprivate,nonprofit,andgovernmentdisasterresponseagencies.Inaddition,stateagenciesonagingarerequiredtobeinvolvedinthedevelopment,revision,andimplementationoftheirstate’spublichealthemergencypreparednessandresponseplan.Muchlikethepublichealthpolicy,thisrequirementforpreparednessplanningistiedtograntfundingforthesestateandlocalagingagencies(CDC,2012b).

Despitetheserequirements,ourfindingshighlightthelackofasingleleadagencyresponsibleforpreparingorprotectingolderadultsduringadisaster.Formostofthepublic

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healthdepartmentsinoursample,thepublichealthleaderwasnotassignedthisresponsibility.Infact,fewlocationshadanyagencyordepartmentspecificallyaddressingolderadults’preparednessorresilience;rather,thefocuswasonvulnerablepopulations,inwhicholderadultswereoftenoverrepresented(e.g.,thosewithfunctionaldisabilities),butwhichwerenotdefinedinanage-specificway.

Respondentsfromthelargerpublichealthdepartmentsinoursamplealsopointedtogapsandlimitationsininteragencycollaborationaroundemergencypreparednessandmanagement.Respondentsnotedhowcollaborationwithmanyotheragenciesworkingonpreparednessplanningrequiredthemattimestolimittheirownplansandscope.Forexample,somerespondentsexplainedtheirlackofprogrammingandoutreachtoolderadultsbythefactthatanotheragencyordepartmentwastheleadagencyforolderadult–focusedservices,and,therefore,theydidnotperceiveaneedtoaddressthispopulation.

BarriersEncounteredbyStakeholders

Weaskedthosestakeholderswhoexpressedinterestinpreparednessactivitiesforolderadultsaboutbarrierstoincludingthemintheirprogramportfolios.Theypointedtothreetypesofbarriers:

• limitedknowledgeorawarenessoftheproblem,includingtheperceptionthatdisasterpreparednessforolderadultswasoutsidetheirorganizationalmissionorscope

• lackofdemandfromconstituents• resourceconstraints.

LimitedKnowledgeorAwareness

Abarriercommonlycitedbystakeholderswaslimitedawarenessorknowledge.Insomecases,stakeholders,particularlyAFCandvillageleaders,werenotawarethatdisasterpreparednessforolderadultswasitsownfieldofactivityorhadonlypassingacquaintancewiththespecificissues.Inothercases,stakeholdersdidnotseealignmentbetweentheseactivitiesandthegoalsandmissionsoftheirorganizations.Whilestakeholdersgenerallyunderstoodthevalueofresilienceforolderadults,theyoftenperceivedthatotherorganizationswereresponsibleforthis.Publichealthdepartmentsperceivedthatagenciesforagingplayedthisrole.ManyAFCandvillageleadersfeltthatotherorganizationswerealreadydoingthisworkintheirlocalarea.

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LackofDemandfromConstituents

Invillages,theconstituentsaretheolderadultmembers;inAFCs,theconstituentsareorganizationalleaderswhocommittoimprovingcommunityconditionsinapredefinedsetofdomainsdevelopedbytheWorldHealthOrganizationandAARP.Althoughtheseconstituentsareslightlydifferent,theprioritiesforAFCandvillageconstituentsaresimilartoeachotherbecausethefocusisonagingolderadults,whereaspublichealthdepartmentsfocusonemergencypreparednessmostlywithoutcustomizationtoolderadults.AFCsandvillagesprioritizedsocialengagementissuesandsocialservicesforolderadultsinlargepartbecauseconstituentsinAFCsandvillageswerefocusedonday-to-dayproblemsandimprovingoverallqualityoflife.AFCandvillageleadersbelievedthattheirconstituenciesdidnotnecessarilyseethevalueofhelpingthemtobemoreresilienttodisastersbecausetheywerenotasvisibleasquality-of-lifeissues,nordidtheyseepossibleconnectionsbetweenthoseeffortsandhelpingthembecomemoreresilientindailylife.

ResourceConstraints

ResourceconstraintswereabarrierforAFCsandvillages.ManyAFCshadminimaldedicatedstaffandhadtoprioritizeactivitiesandprograms.Asnoted,theyoftendidnotperceivepreparednessasapriority.Villageleaderswhoseorganizationsdidnotengageinpreparednessactivitiestypicallyhadevenless“bandwidth”fortakingtheseon.Villagesalsonotedlimitationsintheirabilitytoprovidehigh-qualitypreparednesssupport,asthesmalldedicatedstaffandvolunteersgenerallydidnothaveexpertiseinpreparednesseducation.

SuggestedMetricstoTrackOlderAdultResilience

Wealsoaskedourintervieweeswhattypeofmetricwouldbeimportanttoassessinordertomeasureortrackwhetherolderadultsinanareaweremoreresilientovertime.Respondentsfocusedmainlyonindividuals’preparednessknowledgeandwhattangiblestepshavebeentaken.Forexample,theysuggestedmeasuringthenumberofpeoplewhohavedevelopedaplan,includingknowingwhomtocallinanemergencyorwheretogoforinformation,andhavephonenumbersoftheirfamilymembersorcaregiverswrittendown.

Othersuggestionsincluded

• conductingfocusgroupsamongolderadultswithdiversefunctionalstatusandserviceagenciestargetingolderadultpopulationstoassesstheneedsandinterestsofolderadultsaroundpreparedness

• evaluatingthepenetrationofoutreacheffortsanduptakeofinformationandactivities

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• trackinghealthserviceutilization,suchasemergencyroomvisits,overtimetounderstandtheimpactoftargetedpreparednessactivitiesonhealthcrisesduringanemergency(thisrespondentexpectedimprovedpreparednesstoaverthealthcrisesintheeventofadisaster)

• atthehigherleveloforganizationalpreparedness,assessinghowmanysupportiveserviceagencies,suchasnursinghomevisitingprograms,haveresponseplans,communicationsplans,andcontinuity-of-operationsplansinplacetoassistolderadultsduringanemergency.

InsightsforStakeholders

TheinterviewssupportedourhypothesesthattheactivitiesofAFCs,villages,andpublichealthdepartmentsaresupportiveofeachother:Publichealthdepartments’effortstobuildresiliencetodisastersamongolderadultswillhelpthemageinplacemoresuccessfully,andtheworkofvillagesandAFCstobettermanagechronicdiseaseandreducesocialisolationcanhelpmakeolderadultsmoreresilienttodisasters.TherecognitionofthealignmentandextensionoftheseeffortstoexpandcurrentpreparednessactivitiesforAFCsandvillagesandmoretailoringofexistingpreparednessactivitiesamongpublichealthdepartmentstoolderadultscouldsignificantlyimprovethepreparednessandresilienceofolderadults.Althoughthefindingsfromthesequalitativeinterviewsarenotrepresentativeofallvillages,AFCs,andpublichealthdepartments,weoffersomerecommendationsfornextstepstoimproveolderadults’disasterpreparednessandresilience,basedonthedatawecollectedwithinthislimitedsamplerecruitedfromtheentirepopulationofthesethreestakeholdergroupsacrosstheUnitedStates.

RecommendationsforAFCs

• AFCsarepublic-privatepartnerships,withrepresentationfromlocalgovernmentandcommunitymembers.Theyarewellpositionedtoprovideleadershipincultivatingpositiverelationshipsbetweenolderadults,publichealthdepartments,andemergencymanagementagencies.

• Theycanalsofacilitateimprovedcommunicationandoutreachbypublichealthdepartmentstoolderadults.

• Morebroadly,AFCscanamplifyandsupportotheragencies’work—ratherthanduplicatetheireffort—byleveragingexistingprogrammingandexpandingdisseminationofthework.

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• SomeAFCsfelttheneedtofocusoneverydayquality-of-lifeissuesorbasic-needsissuesinordertomaintainvalueintheeyesofendusers,sponsors,andpartners.AFCleadersnotedthattheseconstituentsmaynotperceivetherelevanceofpreparednesstoqualityoflifeormakingcitiesmorelivableforolderadults.WesuggestthatAFCscouldhonetheirmessagingaroundresilience,perhapslinkingitmorebroadlytootherhealth-relatedandquality-of-lifeissues,inordertoincreasethesalienceofdisasterpreparednessforolderadultsasastrandoftheAFCs’work.

• Inaddition,AARPandtheWorldHealthOrganizationcouldalsoconsidermoreexplicitlylinkingpreparednessandresiliencetooneoftheeightlivabilitydomainsintheirframework—oraddinganinthdomainfocusedontheseissues.Likewise,preparednesspermeatesmany,ifnotall,ofthedomains,suchassocialparticipation,communicationandinformation,communityandhealthservices,andtransportation.Socialcohesioncanimproveimmediatesupportsavailabletoolderadults,information-sharingiscriticalintheeventofanemergency,andbuildingcontingenciesintransportationneedsisparamounttofacilitateaccesstomedicationsandmedicalservices,suchasdialysis,inthecaseofaninterruptionofpowerorservices.

RecommendationsforVillages

• Villagescancultivaterelationshipswithlocalresourcesthatpromoteemergencypreparedness(publichealth,emergencymanagement,andfirstresponders).Thisisimportantforvillages—especiallyforsmalltomid-sizevillagesthatlackthestaffingcapacityorresourcestodesigntheirownpreparednesseducationalmaterialsorcurriculum.Smallvillagesandthosewithresourceconstraintswereabletooffersomepreparednessprogrammingorguidancetotheirmemberswhentherewerelocalresourcesinthecommunity.

• Incaseswherelocalresourcesarelacking,thenationalVillagetoVillageNetworkresourcesmightoffertechnicalassistancebyprovidinginformationonthetypesofentitiesthatconductpreparednessandideasforhowvillageleaderscanmakeconnections,aswellasprovidingnationalpreparednessandresilienceresourcestailoredforolderadults.

• Havinglocalpreparednesspartnershipsandstrongprogrammingaroundpreparednessdoesnotguaranteeuptakebyvillagemembers;lackofmemberinterestand/orperceivedneedwasnotedasabarriertodoingeffectivepreparednesswork.

• However,ourinterviewsshowedahighinterestamongnearlyallvillages—andtheirmembers—relatedtoplanningfororpreventinghealthemergencyevents,andnearlyallvillagesofferedservicesrelatedtopreparingforhealthevents(e.g.,medicalalert

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systemsandtheVialofLifeandFileofLifeprograms,whichaskparticipantstogathernecessarymedicationsandhealthinformationincaseofemergency).Thus,onecriticalwaytoincreasethesalienceofpreparednessactivitiestovillagesandtheirmembersisforadvocatesinthesecommunitiestofocusoncoreresilienceactivities.Theseareactivitiesthatcutacrossavarietyofhealthandmedicalstressesandemergencies,naturalandman-madedisasters,economicandsocialthreats,andstressesthatarepresenteverydayandnotjustduringalarge-scaledisaster—suchashavingalistofcontacts,documentationofhealthinformation,extrasuppliesonhand,andawaytocommunicatewithoutpower.Focusingontheseactivitiescouldmotivatepeoplewhoaremorecomfortablefocusingonday-to-dayquality-of-lifeissuesandstresses,ratherthanonpreparingforaneventthatmayormaynotoccur(e.g.,ahurricane).Villagemembersmaybemoremotivatedandwillingtoputtimeintotheseactivitiesiftheyperceivethemashavingbroadapplicabilityormultiplebenefitsbeyondthedisasterscenariothatmightbeeasiertoignoreasunlikely.

• Villagesneedtolearnmoreaboutplayinganeffectiveroleinpreparednessfortheirmembers.Severalvillageleadersseemedintimidatedbytheideaofsupportingpreparednessfortheirmembersbecauseoflackoftrainingorknowledgeortheinabilitytoprovidecomprehensiveservices.

• Villagesmayneedtobecoachedintounderstandingtheuniqueroleandvaluetheycanaddtopreparednessforolderadultsintheircommunities—namely,thatvillagescanbeatrustedbrokertoconnectmemberstootherservicesandinformation.Villagescanalsoworkwithpartnerstodevelopmessagingthatdrawsconnectionsbetweenresiliencedealingwitheverydaystressandhealth-relatedemergencypreparednessanddisasterresilience.

RecommendationsforPublicHealthDepartments

• Publichealthdepartmentsneedtobeabletoreacholderadultswhomightbesociallyisolatedandhavelimitedcommunicationorinformationchannels.Theycouldconsidertesting“reverse911”systemsthatenableemergencymanagementorotherauthoritiestodistributerecordedinformationtonon-cellularhometelephonenumbersthroughautomatedcallingandpromoting“opt-in”registries,inwhicholderadultscouldelecttomakefirstrespondersoremergencymanagementagenciesawareoftheirlocationandtheirneedssothattheycouldbelocatedandsupportedintheaftermathofanemergency.

• Publichealthdepartmentscouldconductorparticipateinresearchtoidentifybestpracticesrelatedtothesetypesofcommunicationandtrackingsystemsandhelp

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disseminatethisinformationacrossAFCs,villages,andnationalnetworksofpublichealthdepartments.Tohelpdisseminatethesetrackingsystems,educationaleffortsmaybeneededtohelpolderadultsrecognizetheirassetsandvulnerabilities.Successfuldisseminationcouldspurcollaborationaroundthedevelopmentorenhancementofthesetypesofsystemsinotherlocations.Forexample,followingHurricaneKatrina,a2014studyinNewOrleanshighlightedpublichealtheffortstouseMedicaredatatoidentifyindividualswhouseelectricity-dependentmedicalequipmentinanefforttoimprovetheirdisasterpreparedness(DeSalvoetal.,2014).ThisspurredtheU.S.DepartmentofHealthandHumanServicestocreatetheemPOWERmapforhospitals,firstresponders,electriccompanies,andcommunitymemberstofindMedicarebeneficiarieswithelectricity-dependentequipmentwhomaybevulnerabletoprolongedpoweroutages(U.S.DepartmentofHealthandHumanServices,2016).

• Healthandsocialservicesagenciesthathavecontactwitholderadults,suchashomecare,dialysiscenters,nursinghomes,andhospicecare,couldplayalargerroleinhelpingtheiruserspreparefordisasters.Theseagenciesshouldalsosetupcontinuity-of-operationsplanssothatthevitalmedicalornutritionalservicestheyprovidetheirclientsarenotdisruptedintheeventofanemergency.Healthcarecoalitionswerealsocitedascollaborativeorganizationsthatcanassistwithpreparednessforolderadults.ThesecoalitionsaredefinedbytheU.S.DepartmentofHealthandHumanServicesasamultiagencynetworkofhealthcareorganizationsandpublic-andprivate-sectorpartnersthatassistwithpreparedness,response,recovery,andmitigationactivitiesrelatedtohealthcareorganizationdisasteroperations(U.S.DepartmentofHealthandHumanServices,undated).

RecommendationsforResearchers

Researchintoeffectivepreparednesspracticesforolderadultsisstilldevelopingasafield.Moreevaluationofexistingpracticesisneededtoidentifypromisingpractices,and,ultimately,evidence-basedpractices,forimprovingpreparednessandresilienceamongolderadults.

Inaddition,researchersneedtocontinuetotrackbarriersandprogresstowardaddressinggapsidentifiedinthisreport.

RecommendationsforPolicymakers

Giventheremaininggapsinpreparednessactivitiesforolderadultsandthelackofplansoradesignatedentitytoaddressthesegaps,policymakersatalllevelsofgovernment,particularlyatthestateandcommunitylevels,needtoagreeonaleadentitythatisaccountableforolder

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adults’protectionandresilience.Currentfundingmechanismsforpublichealthdepartmentsdictatetheprioritizationofdeliverablesthat,inmostcases,donotrequiretailoringservicestoolderadults.Currentpoliciesthatneedtobeaddressedincludeconsiderationofolderadults’uniqueneedsinrespondingtodisasterandsubsequentrecovery.Governmentcouldalsoagreeonastandarddefinitionoftheseneeds,whichdifferfromtheneedsofvulnerablepopulationsatlarge,especiallybecauseofolderadults’highlevelofsocialisolation.BecauseAFCsandvillagesplayanimportantroleinhelpingolderadultsbolstertheirresilience,publichealthdepartmentsandothergovernmentleaderswithinjurisdictionsthatdonothaveanaging-in-placeeffortcanhelpanAFCorvillagebuildconnectionswiththoseorganizationstomoreformallyincorporatepreparednessofolderadultsattheoutset.

Giventheabilityofolderadultstogenerateandmobilizesocialcapitalafteradisaster,currentpolicyshouldalsoacknowledgethemasanasset.Engagingolderadultsinpreparednesseducationandimprovingtheirsocialcohesioncouldimprovenotonlytheirpreparednessbutalsotheirgeneralwell-being,providingsynergisticeffectsforbothpublichealthdepartmentsandaging-in-placeefforts.Experienceovertimewillsuggestadditionalspecificwaysthatolderadultscanbeleveragedasassets.GiventhechangingdemographiclandscapeoftheU.S.population,thebolsteringofolderadultpreparednessisakeywaytobuildcommunityresilience.

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