Supporting Older Adults After Disasters: A Compassionate Guide to Recovery
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Imagine you are 85 , 95 years old, and you've just survived a natural disaster like the wildfires in L. A. We heard countless stories like this, or a hurricane, or an earthquake.

Only to face the challenge. Of not only losing everything and grieving but recovering emotionally, psychologically, spiritually.

Some older adults are at greater risk and emotional vulnerability following a disaster, which we will talk about in this episode. Yet, there is significant research that suggests that older adults actually Have high rates of resilience and tend to return to their usual level of functioning and well being sooner and with fewer mental health and substance use problems after a disaster, than younger cohorts, and we Actually saw this during the COVID 19 pandemic as well, where older adults were more physically vulnerable to the impact of COVID 19 demonstrated high psychological resilience, and that tends to be the standard for older adults, following disasters and pandemics and epidemics.

So today I want to talk about what's typical for older adults after a traumatic event and when to be concerned. We'll also talk about some unique considerations for older adults because there are some older adults who are vulnerable after disasters, not because they lack resilience, but often because they face unique challenges that can complicate recovery, like chronic health conditions or dementia disorders. And we'll also talk about effective strategies to support older adults in the aftermath of a disaster.

During this episode, I'm going to be using the guide from SAMHSA called Helping Older Adults After Disaster. a guide to providing support.

So who am I to be giving you this information? I'm Dr. Regina Koepp. I'm a clinical geropsychologist and founder of the Center for Mental Health and Aging. I've also done extensive training in disaster mental health with the Disaster Mental Health Institute in South Dakota. My goal is to make sure that you have all of the tools that you need to meet the mental health needs of older adults.

So let's dive into the common psychological, cognitive, behavioral, and physical reactions that are common after a distressing event, a traumatic event, a natural disaster, car accident Within the first few days to four weeks after a disaster, distress is common, and this is true for everyone. And so are distress related reactions. Many people will feel better on their own over time without any professional mental Health or substance use support. Nevertheless, to many people, these distressing reactions are unusual and surprising, and they also might be very upsetting, but it's important to remember that these Distress reactions are an expected, typical, normal reaction to an abnormal event, and that's how we describe the distress that follows a traumatic event.

We say that the distress reactions are a normal response to an abnormal event. event. So let's review what some of the common emotional, cognitive, behavioral, physical reactions are for older adults.

So these are symptoms that you might notice or the older adult might describe to you. So here are the common emotional reactions following a traumatic event. Being anxious or fearful. Overwhelmed by sadness, grief, anger, guilt, like survivor's guilt. Why did I survive and they didn't? Feeling heroic, like they can do anything.

Maybe the adrenaline is pumping and they want to rush in and help. Maybe feeling disconnected, like they don't care about anyone or anything. Or, feeling numb. The feelings of disconnectedness and numbness. These are very common after a traumatic event, sort of disassociation that can happen, this is the psyche's way of dealing with trauma.

Then there are physical reactions that the older adult might describe or you might notice. Like more GI concerns, like stomach aches, or diarrhea, or headaches, or other physical pain for no clear reason, like aches, feeling very hungry or not hungry at all, so changes in appetite, sweating or having chills for no physical reason, having tremors or muscle twitches, this can be a result of the adrenaline in the system, or feeling jumpy and easily startled.

Here's what's tricky with older adults and This requires a lot of delicacy and fine tuning, which is. The majority of people, 65 and older, have at least one chronic health condition. And so it might be that during a particularly stressful time, the reserve in the body to navigate challenges decreases.

And so they might become more symptomatic with their chronic health condition. This can get very complicated if the person following a traumatic event is without medications. or necessary devices like oxygen, and so it might be that the person is having both a stress reaction and a physiological reaction related to their health condition, And this takes a lot of fine tuning to really understand, and you might need to consult with medical providers to clarify, does the person need additional medical care, or can the changes be attributed to the stress response to the traumatic event.

And it might be both. And that's what makes working with older adults a little bit more complicated and so very important. All right. So here are some common behavioral reactions to a traumatic event. And this could be that the older, again, that the older adult is describing this or that you're witnessing it.

And so maybe changes in sleep. Like difficulty falling asleep, staying asleep, or sleeping too much. Having increased or decreased energy levels. Feeling sad and crying a lot. Using substances, either like alcohol or tobacco, or even prescription medications to manage the intense emotions that are arising. Having outbursts of anger or irritability being short fused or having difficulty accepting help and wanting to be alone most of the time and withdraw from others and not wanting to talk with anybody. Here are some common cognitive reactions to a traumatic event for older adults, so having difficulty remembering things, difficulty concentrating, being more easily confused, disoriented, maybe not knowing what day of the week it is. Having trouble making decisions, kind of being stuck in a decision, having trouble talking about what happened, or listening to others talk about what happened.

So how do we know when to be concerned? So within the first For the first three days to four weeks following a traumatic event, these symptoms are expected and typical. If a person is experiencing nine or more distressing symptoms that I'll link to in the show notes this might meet criteria for acute stress disorder. This is not the same as post traumatic stress disorder, though it's related.

This is for the period between like three days following the traumatic event up to four weeks following the traumatic event. So it's in that early If a person is at an early stage following a traumatic event, when it becomes concerning is when a person meets criteria for a cluster of symptoms, at least nine symptoms that interfere with functioning.

I'm going to link to that in the show notes so that you have. a clear understanding of what acute stress disorder is and when it might benefit from treatment and also what post traumatic stress disorder is. And that gets diagnosed if the person meets criteria four weeks or beyond following the traumatic event.

And so it is typical in the days following a traumatic event that the person is experiencing a lot of distress. And there's a saying in disaster mental health, you know, often we want to jump in and help. And so that can be helpful when putting out a fire or when getting somebody to safety physically.

But when it comes to psychological support, there's a saying in disaster mental health that while In physical care, we might say, don't just stand there, do something. There's a saying in disaster mental health, especially in the early days, where we might want to intervene and tackle all the mental health concerns that are arising.

There's a saying, don't just do something, stand there. And I would modify that to say, don't, don't jump in to fix everything that, that's happening emotionally right away. Don't just do something. Be there. Be there with. the person. Don't let them be alone, but be there and hold space for them. This is especially critical in the first days where intervention might not be necessary or helpful.

Okay. But then of course, this is also what, what requires fine tuning is then when do we get concerned? And so I'm going to link in the show notes to what the diagnostic criteria is for acute stress disorder and post traumatic stress disorder and how to tell the two apart and when to intervene to provide care.

Okay, let's move on.

So there are some conditions for older adults that make some older adults, more vulnerable to the distress following traumatic event. And so I alluded to this earlier, but chronic health conditions can make older adults more vulnerable psychologically, physically, cognitively, to the impact of a traumatic event.

Like I mentioned, people 65 and older are more likely to have a chronic health condition and also more likely to have multiple chronic health conditions like heart disease, type 2 diabetes, or COPD, which is chronic obstructive pulmonary disease. So some chronic health conditions can make people who have them less able to respond to disaster warnings thereby putting them at greater risk of injury and more prone to difficult experiences during and after a disaster. So during the L. A. wildfires. Sadly, we saw examples of people who had physical disabilities like people with cerebral palsy or older adults with significant medical problems who stayed behind because they didn't want to be a burden on others and that led to their demise, which is heartbreaking.

And so one important thing to remember is the importance of preparation. Including for older adults, like making sure you have your hearing aids ready, glasses, medications, assistive, assistive devices, and so on, oxygen if, if possible, and and that you have a go bag. I have another article that I'll link to in the show notes with important resources for preparing for natural disaster. All of the information in that resource that I'm going to link to include, are tailored for older adults.

So let's go back to why chronic health conditions might make a person more vulnerable. Here are some examples. An older adult who has survived a stroke, for example, might be unable to stand in line for a long period of time to get assistive resources like water. Or to even carry the water back to their car or where they're staying and an older adult with a chronic health condition managed with the medication might run out of that medication.

Say you're in the wildfires and you have to evacuate and it's not safe to use oxygen if you're using oxygen for a medical problem. An older person with a special diet to manage hypertension or type 2 diabetes might not be able to eat the food. To keep their body healthy that's offered at a shelter, maybe the shelter does not accommodate wheelchairs and so on, or perhaps the person has a dementia disorder and is confused, can operate fine in their home with assistance, but maybe confused in understanding the directions required for evacuation.

And then of course there are conditions like hearing loss or visual impairment, or Challenges with managing activities of daily living, like grooming oneself or transportation that might make it difficult to navigate

community resources designed for evacuation, shelter and so on.

A survey done by crisis counseling, assistive and training program grants found that people with disabilities were more likely to report signs of distress after the disaster than those without disabilities.

Social isolation is another critical factor. Many older adults live alone and may not have a strong social connection. And so then it can be harder to access emotional or practical support after a disaster. So folks who prior to the disaster are experiencing social isolation might continue to have trouble following the disaster related to social isolation.

And here's the thing, there's a saying that healing happens in community. And so after a natural disaster, it's really important to stay in community. Even though your community might look different, it's really important to band together, and so older adults who are socially isolated may not be practiced at banding together and might struggle to do so, and so we'll talk in a little bit about How to help older adults with in different scenarios and let's not forget the financial challenges that many people or that many older adults following a natural disaster experience.

Many older adults are living on a fixed income and maybe have just lost their home and all of their resources and fear that they don't have the time left in life to make up the financial loss that they've just endured. And maybe they're finally have paid off their home and are 85 years old and had a sense of security living in a home that they had paid off and we're looking forward to leaving that as a legacy for their children or grandchildren and now have nothing like this can be not only financially devastating to older adults, but existentially devastating as well.

So now that we know what some of the important considerations are with older adults, how do we provide support to older adults as mental health professionals, caregivers, or community members, supporting older adults after disaster? Here's how to provide support. support. First is to build trust and rapport to approach older adults with patience and empathy.

Don't rush them when they're telling their story. Take time to really listen to their experiences and validate their feelings.

An important experience after going through a trauma is to be able to tell your story. When people experience a traumatic event, it's Shattering. And so if I imagine sort of glass just shattering everywhere and part of the talking about the traumatic experience and how you're making sense of it afterwards is like putting those fragmented pieces of glass back together like a mosaic.

And so It's really important during this time to let the person tell their story and begin to put those fragments back together into a narrative. And so don't rush them, really listen, provide support, be empathetic, don't try to solve the problem straight away. Build trust and rapport, and you do this by listening by expressing empathy and compassion.

All right, then after listening, you help them access resources that they may need. Many older adults find disaster relief systems really overwhelming and confusing. I mean, don't we all? So it can be helpful to help the older clients that you're working with to navigate these services.

So to kind of break it down, help them understand what it all means, what they need to apply for, how to get access and so on. Another important strategy is to have very clear, Communication. If you are preparing or delivering messages about your program's services for disaster survivors, do so in multiple formats so that it's sure to reach the older adults that you want to reach. So this can be done like radio or TV or print materials and flyers and brochures and social media. Multiple formats, will make sure that people with sensory problems like visual impairment or hearing impairment can access this information. Also, good communication means that you prepare ahead of time before you meet with survivors. So consider your main messages, what points do you want to convey, so that you don't flood them with too much information.

Really just have clear information, what your program is, how people can access it. very much. And when they should use it. Another key ingredient, I mentioned this before, is social connection. As I mentioned before, there's a saying that we heal from trauma in community. Following a disaster or big catastrophic event, social connection is key. Isolation can be devastating to people, especially after a disaster. So it's really important to support older adults in reconnecting with their communities or joining group activities, reconnecting with friends, family, this because social bonds play a vital role in recovery.

And then finally, to monitor the person's well being and refer them to mental health care when needed. So like I said, I have an article in my show notes on the difference between acute stress disorder and post traumatic stress disorder. And so please go there and learn more about that. Mental health responses to catastrophic events do not only manifest as acute stress disorder or post traumatic stress disorder. People can also experience anxiety or depression or an increase in substance use problems. And so really taking the time to pay attention and monitor and express concern and refer is important.

And so, like I said, Link to the show notes for more information on mental health conditions among older adults. Referring older adults to the right mental health resources can make all the difference and mental health conditions among older adults are treatable.

So, one group that I want to talk about are older adults who live alone. And so, older adults who live alone, particularly those with disabilities, might rely on home health aids. Family members, friends and volunteers to help them prior to the catastrophic event or the natural disaster, and maybe they rely on them for their livelihood and activities of daily living like transportation or grooming or dressing or eating.

preparing meals. And so if you're working with an older adult who lives alone and has now been displaced, it can be really helpful to connect them with organizations and programs that can be helpful to reestablishing those supports. One good way to begin to prepare is by contacting your local area agency on aging. I'm going to link in the show notes, a brief one or two minute video I made on, on locating your Area Agency on Aging and what an Area Agency on Aging is, so link to the show notes to get access to that.

But essentially an Area Agency on Aging is a government funded program. It's almost in every community in the United States. States that has resources specifically for older adults. And so I will put a link to how to find your local area agency on aging, and also a link to a video to walk you through the steps of finding your local area agency on aging.

Another really important resource, perhaps one of the best, is SAMHSA's Disaster Distress Helpline. So this offers free and confidential support 24 7, and you can reach it at 1 800 985 5990. Again that's 1 800 985 5990.

The SAMHSA Disaster Distress Helpline and your local area agency on aging are valuable resources when it comes to connecting older adults to services in their communities following a disaster, so please use those resources. They can provide everything from emotional support to practical assistance and resources, ensuring older adults don't have to navigate recovery alone.

I have worked with older adults for more than 20 years and at times have heard from older adults More often than I would like to hear that they have reluctance in accepting or receiving help.

And so I want to talk a little bit on how to address reluctance with older adults when perhaps they do need support and resources but are reluctant to accept it because I don't want to take something away from somebody else. Maybe somebody else will need it more or I don't want to benefit from welfare or or I don't think I'm really that bad off. I've heard all of these as reasons that older adults are sort of reluctant to accept care. And so I want to address how to talk with older adults about that.

Like Americans of all ages, older adults might be unfamiliar with government services. For which they're eligible, particularly after a disaster, some older adults also might be concerned that if they accept help, that means that they'll be taking that help away from other people who might need it more.

Older adults might be reluctant to admit that they need that help or have distress or mental health concerns and because of stigma that. Stigma, which disproportionately impacts older adults, especially related to mental health concerns.

So, to help older adults accept help, you might point out, depending on the funding for your program, that the older person's taxes have helped to pay for the assistance that's being offered. So, in a sense, they have contributed to the assistance that they're getting. If an older adult thinks that accepting help will mean taking services away from those with a greater need, you could make them aware that many programs require that community needs be measured after disaster and services then get planned to meet those needs.

So if If we're not clear about who needs the services, programs won't get the funding that they need to provide the services. And then if you talk about options for mental health care and substance use care, avoid using clinical language. Often when I'm training graduate students or even Licensed mental health providers, especially those who are trained in more manualized styles of psychotherapy.

I'll encourage them to be a little more conversational and a little less prescriptive and psychoeducational. And so first, we invite them, again, to build that rapport and trust before offering psychoeducation. And then once that trust and rapport is built, and there's some conversation and, and collaboration happening between you and the older person, then to offer some psychoeducation and support, but really to avoid clinical language.

The clinical language might reinforce the concerns that the person has about stigma. And so I think a conversational style that connotes respect and dignity, and autonomy.

So in working with older adults, it's also can be so helpful to focus on their strengths and empower them to take steps to improve their lives after the disaster. Older adults are incredibly resilient. There's a saying that older adults are competent in managing crises because they've experienced so many of them throughout their lives. And so this could be a time where you draw on their past experiences. How did you get through a hardship like this in the past? Who did you turn to for support? Who was there for you?

This can get tricky if people in their life have died. And so now they are all alone when before they would rely on a partner or a family member. to help them. And so you might need to brainstorm with them. Who else could take that place? Who could be in the place of support? And if you're a mental health provider, that person might be you.

Here is a four step process that might be helpful to you in providing support to older adults. One, is to talk with older adults about what they need. To really get curious and to pay attention, to listen intently to what they say they need. Number two is to ask questions to prompt older adults to think about how they've addressed similar issues or needs in the past. When you got lonely, who did you turn to? When you wanted to get your mind off problems or feel better? What did you do?

Three is to really listen to their responses. Don't bulldoze them and start problem solving straight away. Really listen and reflect back to them what you heard. Four is to provide guidance. You can do this by helping people come up with ways to address their needs that might work in a post disaster environment, like could you check with someone from your church or synagogue about whether they're having services again, and in what format?

Did you know that the Senior Center is offering a support group for disaster survivors? You might want to let Older adults know that it's common for disaster survivors to show the signs of distress that we talked about at the beginning of this episode.

And remind them that asking for help takes a tremendous amount of strength and courage. Older adults also might be living with grandchildren or caring for grandchildren. So if you're working with older adults, it can be helpful to have resources for all stages of life at the ready so that you have them to offer.

This is really important, sometimes new traumatic events bring up old traumatic events, and sometimes the system can get flooded psychologically, spiritually, emotionally, and sometimes when that happens, a person might have more thoughts of harming themselves or somebody else.

And if this is the case, it's really important not to dismiss this. It's really important that you get that person care and support. And you can do that by calling 988 It's 988, which is a national crisis hotline. Again, that's 988. It's like 911, but for mental health emergencies. So please use that if you're concerned, or if an older adult is describing concern about a loved one, encourage them to use 988 to get guidance to help them with their loved one.

And finally, if you're supporting older adults following a natural disaster or another type of catastrophic event, it's really important that you take care of yourself. I love this quote that says, " the expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet". It is critical if you're supporting older adults navigating distress following a traumatic event that you take care of yourself too.

That you take a break, that you shore up your internal resources. Because your health and wellness is just as important as everybody else's.

So let's recap. Supporting older adults after disasters requires us to recognize their unique challenges and resiliency. To provide tailored support and connect them with social supports and resources. Doing, Doing this will help set them up for a better recovery. And like I said, there's a saying that healing happens in community, and I am honored to be in community with you. My goal is to make sure that you have all of the resources that you need to meet the mental health needs of older adults. And so I put together a free guide called the Trauma Informed Care Guide with Older Adults. You can download that at www.mentalhealthandaging.com/tic for Trauma Informed Care. Again, that's www.mentalhealthandaging.com/tic.

Remember it is only with your help that we will meet the mental health needs of older adults. So thank you for being here and doing your part.