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The Psychological Impact of a Disaster on Older Adults
and How Being a Good Advocate Can Help

The Administration on Aging understands the heavy impact that being the victim of a disaster can have on older adults. As a result, AoA developed guidelines to help local aging services providers both understand the potential for problems specific to seniors and to help providers be successful advocates to help them. To follow is information provided by AoA for your use. Please note that aging services provider staff members are referred to as "advocates".

Overview

Disaster Related Problems vs. Pre-Existing Problems

Common Problems An Advocate Might See With Older Adults

Using a Low-Key Approach to Help Victims

Understanding the Role of Disaster Assistance Advocate

The Grief Response - for People and for Possessions

Traumatic Stress - What It Is, How to Help

Overview
It is important to understand that the victims of a disaster (whatever their age) have suffered an intense emotional experience. As a result, the victims may well require anywhere from a few days to several months merely to sort out the details of what has happened. This does not mean that the victims are ignorant or incompetent. Rather, it means that they have been overwhelmed by their experience, and they are attempting to make some sense out of it in regard to the way they understand the world.

Perhaps it would be helpful to point out that if a hundred people undergo exactly the same experience, they may well describe that experience in a hundred different ways. Police long have recognized this fact as being a problem in getting different people to describe what they saw when they witnessed a crime.

Another way to look at this matter - the way some sociologists look at it - is to say that reality is socially constructed. This means that people think about events, talk about them with other people, and compare these events to their previous knowledge, in an effort to make sense out of them. In this process, each person involved may come up with a slightly different "definition of the situation" - or a slightly different conclusion as to what has happened, and what it means.

Several responses can be expected in such a situation. One response may be the adoption of the attitude that there is no hope for the future. This may be related to the attitude that things are so horrible that they can never be put back in order, or it may be related to the attitude that there is no use in trying to put things back in order because another disaster probably will come along and ruin it again.

Another response, and the one that has allowed humans to bounce back after problems for thousands of years, probably will be that the disaster was only a "freak" occurrence, something that likely never will happen to the victims again. People who adopt this attitude probably will want to get on with the job of cleaning up, fixing up, and returning life to normal.

Disaster Related Problems vs. Pre-Existing Problems
Any of the responses suggested above may be found in the older adult population, just as they may be found among any other group.

But the problems may be worse among older adults because of some condition that already existed before the disaster. Older adults may already have significant problems, such as housing, financial, health, medications, drugs, alcohol or family. Any of these problems is only compounded by the disaster. This adds to the confusion that the advocate may have to help the victim sort out.

The advocate may have to distinguish problems related to the disaster from problems that already existed. The advocate must watch for evidence that the victims of a disaster already had problems that needed attention. These may be social work, or something else. If pre-existing problems are identified, they must also be dealt with - but those problems should be delegated to others who have responsibility for these concerns. In a situation like this, the advocate should rely on the professional staff of the Aging Agency for guidance in referring the non-disaster problems to other persons and agencies who have responsibility in these areas. When this task is accomplished, the advocate can then make better progress in helping with the disaster-related problems.

It is vital that the advocate learn to recognize the difference between these problems which are related to the disaster and those problems which are not. It also is important for the advocate to understand that some clients will attempt to establish dependency relationships, or other kinds of relationships, with the advocate. These would demand more time than the advocate will be able to give. The advocate is responsible for caring for many people in a rather specific way, and must not become overly involved with any single case.

Advocates must work to achieve a reasonable balance between the job of being an advocate and the desire to respond to the needs that some victims will have for friendship. While it is true that warmth and friendliness are characteristics that an advocate should have and use, it is also true that these aspects of personality cannot be exercised as fully as some people would like.

Filling the needs of some victims for the companionship and friendship of individuals as important as they may be - will prevent the advocate from reaching those victims who have more immediate needs directly related to the disaster.

Common Problems an Advocate Might See With Older Adults
It is impossible to generalize about older people, just as it is impossible to generalize about younger people. This means that - as we have suggested repeatedly - different people will respond to the same event in different ways. But it also means that not all older people hear poorly, or have any other impairment. Yet it still is useful to know that there are certain tendencies that advocates should watch for, so that they may best help disaster victims.

If the advocate has these tendencies clearly in mind, he or she can then compare each victim to this list and see if any of these tendencies apply to this specific victim. If a victim is found to have one or more of these tendencies, then the advocate should be aware that the special efforts must be taken to address these problems so that disaster assistance can more easily be provided.

To follow are some of the most common problems in functioning:

• Communication Deficits
  The ability to hear and see well tends to decrease with age, and older persons often require a higher level of stimulation for communication. For example, more than half of all men over the age of 65, and a third of all women over 65, have been found by researchers to have some hearing loss. This may make the physical event of a disaster more threatening to the older person, and it may make it harder for the advocate to communicate with the victim.
  
  
• Learning Impairment
  The ability of older persons to learn may be diminished - especially when they are exposed to new information for only a short time. Therefore you should exercise patience when you seek to explain programs or obtain information you need to fill out forms. Some individuals may take more time to understand the meaning and intent of your questions and explanations.
  
  
• Problem-Solving Deficiencies
  Research has shown that some older people have difficulty in figuring out ways to solve problems. One result of this is that they often prefer to do things in their usual ways and are reluctant to adopt new ways of doing things. You may get more understanding, and a better response, if you exercise great patience in explaining alternative strategies for solving problems.
  
  
• Slow Memory Function
  Older persons may require more time to retrieve and organize information from their memory. You should provide plenty of time for victims to remember as you seek to learn about things that have been lost, or things which may be needed.
  
  
• Limited Formal Education
  The generation of Americans now identified as "senior citizens" generally has had less formal education than you have received. The average person over age 65 today may only have completed the 9th or IOth grade. This varies from one state to another, and from one region to another. This is important to understand because you should recognize that the formal education of many victims, as well as their life experience, has not acquainted the victims with the complexity of government responses to social problems. You should not assume that the victims are aware of all available disaster programs. You should be prepared to explain why such programs exist, how they work, and what they may mean to the victim.
  
  
• Psychological Depression
  The most common psychological problem among older persons (especially those over the age of 70 or 75) is depression. The symptoms may be sadness, lack of interest, pessimism, and difficulty in making decisions all of which may be made worse by the trauma of a disaster. The advocate cannot be solely concerned with repair of physical damage to the victim's property. The advocate should attempt to use whatever resources the victim needs - including aid in overcoming emotional or psychological problems - as well as physical and economic assistance. Depression may come and go, and it may be brought on by a distressing event in life. The repeated visits of the advocate may serve to identify changes over time that would not be observed on a single visit. The advocate must be careful not to impose his or her values on the situation. Things that an outsider may view as trivial concerns may be extremely significant for the older person and may produce emotional distress that will lead to social isolation. This may increase needs for the services of the advocate.
  
  
• Different Values
  The present group of older Americans grew up at a time when the most cherished values in American society were independence and self-reliance. They were teenagers and young adults before Social Security and most of the present public assistance systems were developed. As a result, many members of the aging population have very negative views of these programs because they think their independence and self-reliance will be diminished. Part of the job of the advocate may be to help these people overcome their doubts about the appropriateness of participating in government disaster programs.
  
  
• Welfare Stigma
  In other disaster situations, it has been found that some older people refuse help from federal programs because they view such assistance as "welfare". Among many people in the United States -- and especially older people -- being identified as "being on welfare" is very objectionable, and suggests that the person is lazy and not willing to work. For people who value independence and reliance this is a real stigma. It is important to convey to disaster victims that the programs you are suggesting to them are not welfare programs. You may need to explain to the victims that the aid they are being offered is nothing more than a return of some of the federal tax dollars they have paid over the years. If this explanation is rejected, you may need to seek help from your supervisor in devising ways to distinguish between disaster assistance programs and so-called "welfare".

Using a Low-Key Approach to Help Victims
Advocates are not expected to force disaster programs on the victims. Nor should any approach be adopted which tends to "push" the victims into any action. Advocates should keep in mind that they are dealing with adults, and not assume that all older persons have lost their ability to think and function.

Training will help advocates to overcome barriers to communication which may be the cause of a person's reluctance to accept service. The advocate should recognize that a hearing deficiency, or the perception of all government assistance as welfare, may be the reason that the victim does not readily accept assistance. If this turns out to be the case, then the advocate is expected to identify this factor, and develop a way to deal with it in a helping fashion.

If at first the advocate finds the victim unwilling to cooperate, it might be well for the advocate to leave a written message about who he or she is, and why the visit was made. The advocate then can withdraw and move on to visit with another victim. After some thought is given to the reluctant victim's case, the advocate may be better prepared to try again to approach him or her in a way that is more understandable to the victim. As indicated before, it may take several visits with the same victim before the advocate earns the required degree of acceptance to help the victim obtain needed aid. It is the repeated demonstration of interest and concern in the victim that is more likely to break down resistance than any "hard-sell" approach.

Understanding the Role of Disaster Assistance Advocate
Once the advocate does gain acceptance from the victim, and it is allowed to explain the availability of assistance, the advocate may be asked for advice about what the victim should do. If these questions relate directly to the programs that the advocate is trained to deal with then the advocate should be able to respond rather easily.

But it also is reasonable to expect that once you are accepted in an advice-giving role, the victim may call on you for advice about things which lie beyond your specific competence or outside the scope of your job. When such situations arise, you must keep in mind that no one is an expert on all things. Therefore you should feel no sense of failure if you cannot answer the question that is asked. This is the reason that the aging network is funded to hire experts in a variety of areas to assist older adults. The job of the advocate is not to know all the answers, but the advocate is expected to know where to obtain reliable information for victims.

An important service that has been offered in past disasters, through the aging network, has been the service of professional damage appraisers. They have been used to help victims of disasters get full value from their property damage insurance.

In some disasters, attorneys have been hired with public money to provide limited advice to victims.

Other kinds of advice may be obtained from a variety of sources. Some of these are regular public agencies which already exist.

It is the job of the disaster advocate to keep in mind that he or she needs to turn to others for specific, expert advice on many questions.

The advocate, then, should use careful judgment when asked questions by victims. If the advocate does not have real knowledge sufficient to answer the question correctly, then the advocate should explain to the victim that the advice of a specialist is needed, and explain how this may be arranged. Frequently the advocate will need to refer such a question to the supervisor in order to obtain expert assistance.

It is not the job of the advocate to be all things to all people. Instead, the advocate is intended to be one who facilitates - one who sees that the proper resources are brought to bear at the proper time.

Intervening in the lives of other persons is a large responsibility that may have important and long-lasting effects. Thus it is more desirable for the advocate to admit that he or she does not know the answer to a particular question than to give the wrong answer. A good advocate will not merely decline to answer the question, but will indicate to the victim that efforts will be made to obtain the answer from an appropriate source and transmit the information to the victim later. This should be followed up later, so your credibility is maintained.

Help for the Disaster Advocate
As an advocate, coming into contact with so much devastation can take a toll. In order to best help others, you must make sure that your needs are met. The effects of a disaster can be long-lasting and the resulting trauma can reverberate even with those not directly affected by the disaster.

The Centers for Disease Control and Prevention have put together information on general strategies for promoting mental health and resilience that have been developed by various organizations based on experiences in prior disasters. While each individual is affected differently by a disaster, certain groups may share common experiences.

Mental Health Assistance for Responders

Mental Health Resources for Health Professionals

Information for States and Planners

Educational Flyers for Handing Out on Violence and Stress