Disaster impact and response: overcoming the thousand natural shocks

Emotional Resilience of Older Adults during COVID-19: A Systematic Review of Studies of Stress and Well-Being

OBJECTIVES

To examine post-traumatic stress, depression, anxiety, and well-being in older adults under quarantine.

METHODS

A systematic review of CINAHL, Ovid EBM Reviews, Ovid Embase, Ovid Medline, Ovid PsycINFO, Scopus, and Web of Science from 2000 to 2020 was conducted. Keywords included coronavirus, epidemic, quarantine, stress, mental health, and similar terms. Included studies enrolled participants under quarantine, quantitatively measured mental health or well-being, and characterized outcomes by age.

RESULTS

Of 894 initial results, 20 studies met the criteria and were included. Studies comprise 106,553 participants from eight countries, ages 6-100, two epidemics (COVID-19, SARS), and 27 assessment tools. One study found greater distress in older adults relative to younger adults, one found no significant differences, and 18 found lower negative outcomes in older participants in at least one metric.

CONCLUSIONS

Older adults in this review generally have lower stress and less negative emotions under quarantine than younger adults. It is unknown how this compares to pre-pandemic measures. More representative and longitudinal studies are needed to measure the impact of quarantine on the mental health of older adults.

CLINICAL IMPLICATIONS

As existing scales may not capture the full extent of pandemic psychological effects on older adults, clinicians must vigilantly monitor older adults' mental health.

Disaster impacts on cost and utilization of Medicare

Background

To estimate changes in the cost and utilization of Medicare among beneficiaries over age 65 who have been impacted by a natural disaster, we merged publically available county-level Medicare claims for the years 2008–2012 with Federal Emergency Management Agency (FEMA) data related to disasters in each U.S. County from 2007 to 2012.

Methods

Fixed-effects generalized linear models were used to calculate change in per capita costs standardized by region and utilization per 1000 beneficiaries at the county level. Aggregate county demographic characteristics of Medicare participants were included as predictors of change in county-level utilization and cost. FEMA data was used to determine counties that experienced no, some, high, and extreme hazard exposure. FEMA data was merged with claims data to create a balanced panel dataset from 2008 to 2012.

Results

In general, both cost and utilization of Medicare services were higher in counties with more hazard exposure. However, utilization of home health services was lower in counties with more hazard exposure.

Conclusions

Additional research using individual-level data is needed to address limitations and determine the impacts of the substitution of services (e.g., inpatient rehabilitation for home health) that may be occurring in disaster affected areas during the post-disaster period.

To flee, or not to flee, that is the question for older asylum seekers

As psychiatrists, we assess, diagnose, and manage psychiatric problems in older adults. We also have an important role as their advocates and in promoting positive attitudes toward this group. Only in the 1950s was there increasing recognition that older age did not necessarily equate to senility, that treatment of psychiatric disorders in this group was possible, and could have good outcomes (Roth, 1955). There is, however, still an undercurrent of pervasive negative attitudes toward the elderly, and their psychiatric needs continue to be marginalized, with less attention from the media, funding bodies, and even from our medical and surgical colleagues (Pensonet al., 2004).

Risk factors for PTSD after Typhoon Morakot among elderly people in Taiwanese aboriginal communities

BACKGROUND

This study aimed to investigate the risk factors associated with post-traumatic stress disorder (PTSD) symptoms in a mid- and old-age population who experienced Typhoon Morakot in Taiwan.

METHODS

One hundred and twenty people, who were mostly Taiwanese aboriginal people aged 55 years and above, were invited to participate in this study. PTSD symptoms were assessed using the PTSD Symptom Scale (PSS-I). Information regarding demographic characteristics, relocation, personal injury, family death, property damage, and self-perceived health was collected.

RESULTS

29.2% of study participants presented significant PTSD symptomatology during the previous month. Development of PTSD symptomatology after the disaster was significantly associated with being female (OR 3.63, 95% CI = 1.11-11.88), experiencing relocation (OR 5.64, 95% CI = 1.60-19.88), and having poorer self-perceived health (OR 4.24, 95% CI = 1.53-11.78) after controlling for age, education, personal injury, family death, and property damage. Further, by adding depression into the analysis, we found the risk factors were being female (OR 4.66, 95% CI = 1.16-18.80), experiencing relocation (OR 27.91, 95% CI = 3.74-229.80), family death (OR 67.62, 95% CI = 2.85-1063.68), and poorer self-perceived health (OR 28.69, 95% CI = 4.52-182.06).

CONCLUSION

Nearly 30% of the elderly people studied who experienced Typhoon Morakot developed significant PTSD symptomatology. The risk factors for PTSD symptoms were female gender, poorer self-perceived health, relocation, family death, and depression. The elderly people who were relocated by governmental programs were more likely to develop PTSD symptomatology after experiencing trauma. Resettlement and rehabilitation programs after a disaster need to be more concerned with their psychological effects on victims.

Living with a Chronic Disabling Illness and Then Some: Data from the 1998 Ice Storm

This study examined the impact of the 1998 Canadian ice storm on the physical and psychological health of older adults (age > 55 years) living with a chronic physical illness, namely osteoarthritis and/or osteoporosis. Although disasters are relatively rare, they are a useful means of examining the impact of a single stressor on a group of individuals. Specifically, we took advantage of a natural experiment to compare the responses of a group of 59 ice storm victims to those of 55 matched controls living outside the ice storm area. Data on disability, pain, self-reported health, helplessness, depression, and independence were assessed prior to the ice storm and approximately 17 months later. Older adults who reported greater helplessness and lost independence prior to the storm reported significantly greater ice storm stress and rumination and were more likely to report that the storm affected their condition. In addition, participants exposed to the ice storm reported significant changes in disability and pain nearly a year and a half later, compared to matched controls. These results suggest that older adults with chronic physical illness may be particularly vulnerable when faced with additional stressful events.

Current psychopathology in previously assaulted older adults

Older adult women age 55+ years (N = 549) were interviewed as part of a population-based epidemiological research study of lifetime experiences with physical and sexual assault and current mental health problems. Although overall rates of psychopathology were low, producing very small cells for comparison, women who reported experiencing physical assault an average of 28 years previously were more likely to present with past year substance abuse, depression, and avoidance and reexperiencing symptoms of posttraumatic stress disorder (PTSD) than those with no previous physical or sexual assault. Women who reported experiencing sexual assault an average of 50 years previously were more likely to present with autonomic arousal and avoidance symptoms of PTSD than those with no prior sexual assault. The aforementioned findings should be considered with caution, however, as sample cell sizes were minimal for all but the PTSD symptom subtypes. Mental health service implications for older adults are discussed.

Posttraumatic stress disorder in older adults: a conceptual review

Issues that are salient in understanding posttraumatic stress disorder (PTSD) in older adults are examined in this review. Although this issue has received scattered attention in the literature since introduction of the diagnosis of PTSD to the Diagnostic and Statistical Manual (DSM) in 1980, it is clear that numerous conceptual and defining questions exist in our understanding of the aftermath of trauma exposure in older adults. In approaching this issue, studies pertaining to diagnostic status as well as broader dimensions of psychosocial functioning are examined. Concerns that are unique to older adults are highlighted throughout, with particular attention to areas where additional research is warranted.

Aged citizens in the warning phase of disasters: re-examining the evidence

While there is a strong consistent empirical literature on older citizens in the recovery period of disasters, there is much less research on how the elderly respond to disaster warnings. Furthermore, there are conflicting findings among these studies, some characterizing the elderly as noncompliant and less likely to cooperate with authorities, while others find the elderly no less responsive than other age groups. The current article reviews the literature in this area and tries to sort out conflicting findings in terms of the timing of the research and methodological considerations. Data are analyzed from nine disasters-representing flood events, volcanic eruptions, and hazardous materials emergencies-which show citizens over sixty-five years old no less likely to comply with disaster warnings.

Correlates of war-induced stress responses among late middle-aged and elderly Israelis

Over a period of six weeks in the winter of 1991, Israel was exposed to hostile enemy actions unlike any others in its history. In the Gulf War, civilians were front-line targets for Scud missiles which fell in the heart of the country's most heavily populated areas. One hundred and sixty-four late middle-aged and elderly Israelis were interviewed with respect to their emotional and behavioral reactions. Subjective health, gender, and attribution of meaning were the most significant variables, explaining most of the variance in the two measures of response. Satisfaction with informal network effectiveness was a relatively strong predictor of change in the affective distress variable. Degree of religious commitment and chronological age were weak but significant predictors of affective distress and social interaction distress respectively. Location of residence in relation to the missile impact zone was of no significance in explaining variance in the dependent measures. The findings are discussed in light of the uniquely subjective, interpretive context of stress phenomena, and the need to identify those variables that explain individual differences among older adults in their responses to stress.

Response of the elderly to disaster: an age-stratified analysis

This article analyzes the effects of chronological age of disaster victims on their responses to stress effects of natural disasters. Previous research is reviewed and major findings of that research are noted. Findings regarding disaster losses, physical impacts, aid utilization patterns, kinship relations, relative deprivation, social-psychological impacts, neglect of elderly disaster victims, and differential recovery rates by age are retested on new data. Data described herein were gathered using survey techniques in two disaster stricken communities in Texas. Elderly victims' responses to the tornadoes are compared to a nonelderly (under sixty years of age) group to assess differences. Findings of previous research were, in many instances, supported although certain divergences between the current findings and preceding findings are noted, particularly in rates of recovery.