ARCHIVED: Building a Global Framework to Address the Needs and Contributions of Older People in Emergencies – Priorities for action

 

12. Over the course of the Winnipeg Workshop participants identified best practices, gaps, and priorities for action through small group discussion. The outcomes of these deliberations are presented in the remaining sections of this report, combined into seven broad themes that are pertinent to emergency preparedness and seniors. The priorities for action address the need for governments and other stakeholders to change perceptions of older persons, to better identify and respond to the specific needs of older people, and to better identify and utilize the contributions of older people in emergency and disaster situations.

Theme 1: Public Education, Awareness and Communications

13. Past emergency situations have shown that before and during times of crisis there are often breakdowns in communications systems. At such times, little or inaccurate emergency information is transmitted to the public. Prior to an emergency, information about risks and how to prepare for an emergency may not be reaching particular segments of the population-for example, those who are isolated or those with low-literacy skills. Others may be disregarded by communications altogether. Older people, who are sometimes isolated and experience cognitive difficulties, may be at particular risk.

Considerations

14. There is a critical need to increase awareness and to strengthen public education about seniors and emergency preparedness, from prevention through preparedness and response, to recovery. This requires promoting wider understanding of the physical, social, environmental, and economic factors that contribute to the vulnerability of older people along with the promulgation of policies that support a vision of active/healthy ageing and resiliency of older people.

15. Communications are strengthened or compromised by a broad range of factors that have a significant impact on responsiveness to messaging. These factors include culture and personal beliefs, language and literacy skills, and past experience as well as geography, the policy environment, and resource levels. There is a need to address these factors and to strengthen capacities to update and disseminate clear and consistent communications with seniors and the public generally before, during, and following emergency situations.

16. Accurate and timely pre-disaster information is especially important and includes the development and tailoring of messages to influence older people, the public, donor organizations, and non-government organizations (NGOs), including humanitarian and aid agencies.

17. How messages are delivered is also significant. During an emergency, conventional public communications systems may be disrupted and there must be alternative emergency response systems in place; plain language must be used and messages must be clear, consistent and understandable.

18. Collaboration and partnerships also play a vital role in ensuring timely and accurate dissemination of emergency information. These partnerships should be interdisciplinary and multisectoral, linking all sectors and stakeholders, including civil society. It is particularly important that older people themselves are involved, advising on how best to reach them in emergency situations and how they want to receive messages.

19. Organizations can collaborate in delivering messages in creative and cost-effective ways. Community leaders, including those in the faith community, can play a particularly important role in conveying information to vulnerable populations.

20. The quality of information available for both planning and response purposes needs to be improved. To this end, emergency preparedness data needs to be disaggregated by age and gender to provide a more accurate picture of those who are the most vulnerable, service and programme needs, and the effectiveness of interventions. Further, there must be improved recording, tracking, sharing, and use of data among all stakeholders to contribute to the analysis of past emergency preparedness efforts and to enhance future capacities for response.

21. Priorities for Action

  1. Develop communications strategies and plans to heighten awareness and educate the public about seniors and emergency preparedness through developing universal key messages for the media, politicians, and other significant stakeholders.
  2. Develop interactive public education and awareness strategies for seniors that heighten their disaster awareness, strengthen their capacity to prepare for disasters and contribute to their own assistance and protection, and improve their ability to contribute directly to disaster recovery and response through self-help and mutual care.
  3. Ensure that emergency preparedness expertise and resources within communities are readily available and accessible to seniors and those engaged with older people. Resources should include best practice guidelines that are accessible through electronic means such as integrated web portals where this is practical but must also include alternative means to deliver resources and expertise that will remain operative during emergencies.
  4. Establish disaster education coalitions at the national and local levels that have the flexibility to include specific information geared to local needs and conditions. These coalitions should involve ageing networks, be inter-connected and be able to provide consistent and standard messages.
  5. Strengthen awareness and understanding among all people that older people who are poor are particularly vulnerable, especially in times of emergencies and disasters.
  6. Place special attention on educating young children about emergency preparedness to heighten their awareness and to develop knowledge, skills and resources to enable them to cope appropriately with and contribute to emergencies and disasters throughout all of the life stages.

Learning Preparedness From Older People in Japan: The Great Hanshin-Awaji Earthquake

The Great Hanshin-Awaji Earthquake which struck Kobe and the Hyogo prefecture in Japan on January 17, 1995 left 6,533 dead, 43,792 injured, and 510,000 homes damaged or destroyed. The greatest proportion of people who died in that disaster was the elderly. But older people have also made a lasting contribution to building safer communities, and are now part of the Disaster Reduction Museum in Kobe, Japan, where volunteer older persons narrate and share their stories of survival and resilience.

"Eight years after the Great Hanshin-Awaji Earthquake, elderly people in the Nagata district, which was badly affected by the disaster, started conducting storytelling for groups of students on school trips. Elementary and junior high students have no experience of the Great Hanshin-Awaji Earthquake or, if they did experience it, it was when they were very young and they have no memory of the event. Children from outside the region were also included and told what actually happened in Nagata district in the Great Hanshin-Awaji Earthquake, how people coped, how they felt then and how they feel now. Through these storytelling activities, children who have not experienced major earthquakes learn how powerful they can be, and are motivated to think about the necessity of preparing for disaster and ways of coping if one occurs."

Source: Hutton, D. Older People in Emergencies: A Framing Document for Policy and Program Development. Draft Version 3 prepared for the World Health Organization. 2006.


Theme 2: Strategies to Integrate Seniors' Contribution in Emergencies

22. It is important to recognize the capacities and contributions that seniors make both in their daily lives and in emergency situations. Yet older people are generally excluded from emergency planning and programmes. Genuinely engaging older people in emergencies can help ensure that their distinct needs are identified and integrated into assessment, programming and evaluation. In addition, it can provide critical assistance and support in mitigating the impact of crises for individuals and families as well as facilitating recovery and rehabilitation for entire communities.

Considerations

23. In disasters and crises, older people provide essential support to families such as the ongoing nurturing and care of children and income support. Within their communities they can provide valuable leadership in relief and rehabilitation projects where they often take lead roles in the mobilization of human and financial resources. The contribution of older women is often particularly important in the caring and support of children and orphans including securing and preparing nutritious food and maintaining shelter.

24. Older people need to be integrally involved in all stages of emergency preparedness. This engagement needs to include collective planning for the mitigation of disasters, locating and identifying those who are the most vulnerable in emergencies, determining levels of individual and community needs, and the development of community-based solutions for recovery and the restoration of livelihoods.

25. Income generation is an especially important function and high priority for older people following disasters. Experience suggests that seniors often play an especially important role in maintaining and/or restoring financial stability within their families and within their communities.

26. Priorities for Action

  1. Develop plans and strategies to engage seniors in community-wide emergency planning processes and in all stages of emergency management.
  2. Create inclusive community dialogue processes that build on the foundation of NGOs where people often congregate naturally in communities to reach older people who are vulnerable and to provide needed assistance and protection. These organizations should include faith-based organizations, humanitarian aid organizations, and other civil society organizations.
  3. Develop emergency management procedures that include the direct involvement of older persons in locating seniors in emergencies and disasters, identifying those who are the most vulnerable, assessing and addressing individual and community needs, and participating in post-emergency impact assessments and evaluations.
  4. Develop a surge capacity for emergency preparedness initiatives in communities that includes the use of retired professionals and professionals-in-training, the natural leaders within communities of older people, and older volunteers.
  5. Harness and strengthen political will to build supportive environments that promote and strengthen older people's involvement and contribution before, during, and after emergencies and disasters.

Working With and Learning From Older People: The Lebanon Crisis

In 2006, the Israel-Lebanon conflict broke out in Lebanon and northern Israel.  Over a 33-day period in July and August, more than 1,000 Lebanese civilians were killed and close to 5,000 wounded. Nearly one million were displaced from their homes. In response to this crisis, the Makassed Philanthropic Association in Beirut opened ten schools in Beirut to meet the basic health and humanitarian needs of over 3,500 displaced persons. Older people played an important role in making this a success.

At the 'Ali Bin Abi Taleb' school in Beirut, the life of the displaced remained quite cheerful, in spite of the adversities of war. This school had welcomed about 185 displaced [people] of all ages: infants, children, women, older people, and few young men. Every morning, the chores were distributed. Social workers from the Makassed Association would take the children to the courtyard and organize various activities for them: storytelling, 'face painting', drawing lessons, reading.  The younger women were assigned the duty of cleaning the premises on a rotating basis. The older ladies were asked to cook for the groups. All these activities would end by noontime. After a much needed rest, the displaced would spend their afternoons together, walking around the surrounding streets, some buying needed items. The older men would sit in one of the corners discussing the political situation, with varying levels of optimism. The older ladies would rally around the children and tell them stories about life in the village in yesteryears.

This organization and delegation of tasks in that school was soon adopted in other centers. Older people have provided a significant level of support for the displaced children and the worried younger mothers. Older people provided supervision, care and guidance."

Source: Hutton, D. Older People in Emergencies: A Framing Document for Policy and Program Development. Draft Version 3 prepared for the World Health Organization. 2006.


Theme 3: Ensuring Access to Essential Services and Protection

27. In disasters, those who are the most vulnerable need access to a broad spectrum of life-saving and life-sustaining essential services. These include emergency shelter, fuel, food and nutrition, transportation, and health services. Yet older people are often overlooked in emergency management activities, partly because it is assumed that their care and well-being will be maintained by their families and communities. For example, older people are rarely included in nutritional assessments, decisions about food requirements, or in food programme design, yet they have specific nutritional needs. Moreover, seniors have often been excluded from capacity-building and livelihood projects, placing them at increased risk of destitution and marginalization. Finally, the isolation and subjugation of older people, and especially women, places them at particular risk of neglect, abuse and violence.

Considerations

28. Humanitarian organizations and other NGOs involved in emergency preparedness often address older people's needs within the framework of vulnerable people generally and do not have specific expertise to address the unique needs and circumstances of seniors. At the same time, donor organizations tend to spend comparatively little money on programmes designed specifically to address older people in emergencies (Wells, 2005).

29. Few legal instruments address older people as a distinct vulnerable group while humanitarian policies and practices relate to older people in different ways and to different degrees: some practice codes and guidelines do specifically address the needs of older people in emergencies (for example, the Guidelines for best practice [HAI & UNHCR, 2003]). Nevertheless, legal instruments and policy frameworks remain very important vehicles for raising awareness of the importance of assisting older people in emergencies, promoting the development and use of accepted standards to assess progress and performance, and ensuring protection for the vulnerable.

30. In the context of legal instruments and frameworks, it is also important to develop broad action plans to ensure that essential services and protections are in place. These plans need to involve older people in all stages of emergency management, to build emergency issues directly into institutional policies and be mainstreamed into existing programmes, and incorporate an intergenerational approach which takes into account the needs and contributions of different age groups and builds on mutual support strategies.

31. Special effort is needed to locate and identify those older people who are the most vulnerable in an emergency as they often experience structural barriers and even discrimination in accessing basic services and assistance. It is also important to engage older people directly in assessing their needs, setting priorities, and determining appropriate responses as some research suggests that there may be discrepancies between older people's perception of their needs and the perceptions of aid and relief organizations (for example, the 1999 study of humanitarian agency practices [Wells, 2005]).

32. When communities and resources are stressed under emergency conditions, older people are especially vulnerable to violence and abuse and are in particular need of protection. This is especially the case of women whose vulnerability is often heightened in disasters and conflicts. Elder abuse takes many forms including discrimination, physical and psychological abuse, financial abuse, and violation of land and property rights.

33. Ageing networks can be very effectively integrated into the delivery of essential services and protection.

34. Priorities for Action

  1. Engage and empower older people through the strict observance of international law and through supporting and implementing policies and practices to provide essential services, assistance, and protection to seniors in emergencies and disasters.

Addressing Older Peoples Needs in West Darfur

Since violence erupted in Darfur in 2003, over 2 million people have been displaced and almost 300,000 have died from disease and starvation. It has been estimated that about 8% of those now living in camps are older people, half of whom live alone. A 2004 assessment carried out by the HelpAge International found that 45% of these displacees lacked adequate shelter and 61% were suffering from untreated chronic diseases.

In response to the crisis, HelpAge International has been carrying out programming in seven camps in Sudan.  The implemented activities have been key in not only reducing the suffering of older people, but raising their social standing in their communities.

  • Older people's committees were established to represent the needs and rights of older people, to act as a point of reference for other humanitarian organizations, and to coordinate outreach services to more vulnerable people.
  • A network of community health workers was established in each of the camps to provide outreach and basic care to older people.
  • A system of donkey-cart ambulances was set up to transport older people to medical appointments.
  • In partnership with the World Food Programme, supplementary food baskets were distributed to older people at risk of malnutrition or caring for several dependents.
  • In one camp, a social nutrition centre was implemented to provide freshly cooked meals to vulnerable older people three times weekly.
  • Social activity centres were established to allow older people to gather together, share news and stories, and make traditional handicrafts as one way to rebuild their sense of community.
  • To increase older people's self-sufficiency, HelpAge International supported a shoe-making cooperative, a bakery, livestock regeneration, and distributed seeds and tool kits for household gardens.

Source: Hutton, D. Older People in Emergencies: A Framing Document for Policy and Program Development. Draft Version 3 prepared for the World Health Organization. 2006.


Theme 4: Continuity of Health Services

35. Emergency situations can make it very difficult for older people to manage pre-existing illnesses and chronic conditions.  Home support and care arrangements may be interrupted, essential medical equipment like oxygen generators or ventilators can become inoperable, and health facilities may be damaged or overwhelmed with disaster-related acute injuries and with those who are unable to cope with pre-existing health conditions or whose health conditions have been amplified as a result of the disaster. These problems may be particularly pronounced in rural/remote settings where access to all forms of health care is often more limited than in urban settings.

Considerations

36. Health is one of the primary concerns of older people in emergencies, alongside material security. Good health is a pillar of active and healthy ageing, contributing to seniors' capacity to maintain a livelihood, remain independent, and exercise control over their lives. In times of emergency maintaining health and well-being can be compromised as the challenges associated with normal ageing such as reduced mobility, sensory and cognitive capacities are compounded by such additional challenges as the risk of malnutrition, chronic disease management and disabilities, and coping with trauma and threats to mental health.

37. People need to understand better how to plan for and manage their health in emergency situations. This includes ensuring adequate supplies of medications and access to emergency health care and equipment. However, it is also important that health providers, especially primary care providers, and those responsible for emergency management measures are aware of the health needs of vulnerable seniors: that they know the impact of disasters on heightened health risks, that they are able to identify and treat vulnerable seniors in crisis, and that they have access to appropriate protocols and standards of intervention and care.

38. Evidence suggests that some older people may be more resilient than younger people in emergencies because they can draw on broad life experiences. Yet at the same time it is clear that the loss, displacement, and trauma associated with emergencies can act as cumulative and interactive stressors and that this can have very detrimental effects on the health and well-being of older people. Accordingly, there is a need to understand better and address the mental health needs of seniors-beginning with the development of improved ways to assess and identify those who are particularly traumatized and following through with multi-disciplinary teams of caregivers to ensure a variety of response options. A key challenge for health interventions is that older people may conceal their vulnerabilities out of fear of being marginalized and isolated by family, responders, and their communities.

39. Business continuity plans (BCPs) need to be developed and standardized to some degree within and across all stages of the health delivery system, including primary care, clinics and hospitals, and home and long-term care facilities.1For example, necessary medical services and treatments (e.g. dialysis and medications) must continue to flow throughout a response to a disaster. These plans must address standards of care and best practices around such matters as strategies for triage, and access to medical information and records; continuity of care and access to interdisciplinary care teams; and periodic simulations, testing and evaluation.

40. The sharing of important information in the form of medical health records-and electronic health networks-may be disrupted in disasters by electrical failure. It is critical to develop information-sharing alternatives which ensure that health information follows the patient while continuing to respect privacy considerations.

41. As governments are invariably over-extended in times of emergency and humanitarian and other relief agencies under-resourced, communities and civil society organizations play an important role in maintaining links between seniors and important health services. This support may range from complementing the supportive and connecting roles normally played by families and friends through to advocacy and outreach roles with and on behalf of older people.

42. Priorities for Action

  1. Develop business continuity plans for care providers and public and private suppliers that extend across the full spectrum of the health care system, from primary care to palliative care arrangements and that are periodically tested and upgraded to take account of changing health needs and capacities within communities. For example, BCPs need to be mindful of personalized emergency plans in place in catchment areas where older people reside; they need to include the creation of multidisciplinary teams that can provide seamless care and assistance in emergency situations, and they need to include regular emergency alert simulations to ensure their effectiveness in times of actual emergency and disaster.
  2. Establish and maintain ageing networks that include the participation of older people themselves and that connect the emergency management community directly with health planners, policy makers, researchers, and providers.
  3. Conduct periodic and systematic environmental scans to prioritize issues and identify best practices in health emergency management for older people.
  4. Develop guidelines and templates to articulate minimal health services and care requirements in emergency and disaster situations.
  5. Develop plans for home support and home care services, involving the active participation of older people. These plans should assess needs and develop alternative support and care arrangements before crises occur along with detailed emergency evacuation plans.
  6. Support qualitative and quantitative research on seniors' mental health needs in emergency situations that will lead to practical applications and guide interventions for health service and care providers and practitioners.
  7. Invest in health promotion and population and public health policies and programmes that recognize active and healthy ageing as the primary strategy for building resiliency and contributing to improved quality of life for older people generally, and for strengthening seniors' capacity to prepare for, cope with, and respond to the effects of emergencies and disasters.

LESSON FROM FRANCE: THE 2003 HEAT WAVE

The 2003 heat wave in Europe killed more than 30,000 [ ... ]. In France, where temperatures reached 40 degrees Celsius and higher, thousands of older people succumbed in rest homes and care facilities. Although the country had one of the most sophisticated health systems in the world, it did not have an extreme heat plan and suffered from "a lack of preparation, shortage of cooling equipment in nursing homes and hospital facilities, and [a] lack of any clearly defined roles for agencies involved" [ ... ]. This was compounded by funding and personnel shortages in many rest homes, which prevented adequate monitoring and care of more vulnerable residents. Among the elderly who died in their own residences, many living alone in inexpensive top floors of buildings where it was the hottest, common causes included a failure by authorities to identify those elderly at risk, to communicate to them ways to cope with the heat, and to provide life saving interventions like bottled water, ice packs, and cooling equipment.

In the wake of the heat wave, France undertook major reforms to protect older people. This included funding to equip retirement homes with air conditioning as well as to ensure adequate staffing. District councils were also made responsible for establishing registries of people at risk, and response guidelines for hospitals and voluntary aid workers were developed and implemented [ ... ].

Source: Hutton, D. Older People in Emergencies: A Framing Document for Policy and Program Development. Draft Version 3 prepared for the World Health Organization. 2006.


1 Business continuity planning is a proactive planning process that ensures critical services or products are delivered during a disruption. A Business Continuity Plan (BCP) includes plans, measures and arrangements to ensure the continuous delivery of critical services or products which permit the organization to recover its facility, data, and assets along with the identification of the necessary resources to support business continuity, including personnel, information, equipment, financial allocations, legal counsel, infrastructure protection and accommodations (Public Safety Canada, 2005).

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