PREPARE: Personal Readiness, Emergency Packs and Recovery Essentials: Emergency Preparedness for Community-Dwelling Older Adults

Older adults, living within the community, are often left on their own to prepare for wide-spread disasters or emergencies. An abundant amount of emergency preparedness information is available; however, it is rarely tailored to older adults. The purpose of this project is to create awareness in the older adult population and provide information that is relevant at the community level. A questionnaire was utilized and distributed at two congregate meal sites with the purpose of collecting personal preparedness data. A seminar was subsequently presented that included a brief presentation, as well as, a visual demonstration of portable emergency packs. Local, county, state and federal resources tailored to older adults was also provided. The information provided was designed to encourage self-sufficiency and sustainability in a large-scale emergency.

1 "PREPARE" Personal Readiness, Emergency Packs and Recovery Essentials: Emergency Preparedness for Community-Dwelling Older Adults By Winnifred Howard Westwood Non-thesis project submitted in partial fulfillment of the requirements for the degree of Master of Science in Gerontology The University of Utah College of Nursing 04/27/2017 Supervisory Committee: Kara B. Dassel, PhD, Chair Linda S. Edelman, RN, PhD Michael Caserta, PhD 2 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS Table of Contents Abstract………………………………………………………………………………...3 Acknowledgements…………………………………………………………………….4 Introduction……………………………………………………………………………5 Project Purpose……………………………………………………………………...…6 Literature Review……………………………………………………………………...7 Methods………………………………………………………………………………...11 Materials and Supplies………………………………………………………………..13 Results………………………………………………………………………………….15 Discussion………………………………………………………………………………19 Limitations……………………………………………………………………………..20 Summary……………………………………………………………………………….21 3 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS Abstract Older adults, living within the community, are often left on their own to prepare for wide-spread disasters or emergencies. An abundant amount of emergency preparedness information is available; however, it is rarely tailored to older adults. The purpose of this project is to create awareness in the older adult population and provide information that is relevant at the community level. A questionnaire was utilized and distributed at two congregate meal sites with the purpose of collecting personal preparedness data. A seminar was subsequently presented that included a brief presentation, as well as, a visual demonstration of portable emergency packs. Local, county, state and federal resources tailored to older adults was also provided. The information provided was designed to encourage self-sufficiency and sustainability in a large-scale emergency. 4 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS Acknowledgements The road to my master's degree was filled with hope, inspiration and encouragement from so many sources. I know I did not make this journey alone. My husband and three boys were very much a part of my journey and I appreciate their patience and understanding when I was consumed with research and reports. They gave me hope that what I was embarking on had value. My parents gave me inspiration to always strive to be a little better each day. Unafraid to be older parents when I was born, they instilled in me the worth of an education and that age is just a number. I am so lucky to have called them mom and dad. I am also grateful for the encouragement to pursue a graduate degree from my late brother, Mark, who, like our parents, was an early proponent of lifelong learning. I am also grateful for my professors throughout this experience, especially Kara Dassel, GIP director and my committee chair. She gave me the opportunity to continue my education and pursue a dream 30 years after my last college life. She encouraged me to break big tasks down into smaller parts, thus allowing the process to flow easier. I have been blessed to have the love and support from so many wonderful role models, and for that I am eternally grateful. 5 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS "PREPARE" Personal Readiness, Emergency Packs and Recovery Essentials: Emergency Preparedness for Community-Dwelling Older Adults It's hard to find an area of the United States that is not subject to man-made or natural disasters. Hurricanes, earthquakes, floods, fire, terrorism, to name a few, are a significant concern, but they are especially devastating to vulnerable populations. Disasters, as described by the Department of Homeland Security are "an occurrence of a natural catastrophe, technological accident, or human-caused event that has resulted in severe property damage, deaths, and/or multiple injuries" (Gibson, 2006. p.73). The hurricanes of 2005 (i.e., Katrina and Rita), exposed many gaps in emergency planning, but especially highlighted inequities among vulnerable individuals. Vulnerable populations, which include older adults, are defined by the Centers for Disease Control and Prevention as: "People who cannot comfortably or safely access and use the standard resources offered in disaster preparedness, relief and recovery. They may include people with sensory impairments (blind, deaf, hard-of-hearing); cognitive disorders; mobility limitations; limited English or non-speaking as well as people who are geographically or culturally isolated, medically or chemically dependent, or homeless" (CDC.gov). The projected demographic changes of an older, more diverse community of adults (Crimmins, 2015), combined with the increase in disasters (Leaning & Guhr-Sapir, 2013), highlight an urgency to prepare older adults for emergencies. The premise for the "PREPARE" (Personal Readiness, Emergency Pack and Recovery Essentials) program is to close the gap that exists between available resources and vulnerable populations, specifically, older adults. PREPARE includes a seminar to educate older adults on basic emergency preparedness, provide 6 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS resources for recovery and additionally, demonstrate an emergency pack specifically targeted for older adults. The overall goal of this project is to encourage community-dwelling older adults to prepare for emergencies, and provide them with tangible and affordable resources to use during a time of crisis. Project Purpose Emergency preparedness information is all around us, but what is unknown is what specific steps older adults are taking to prepare for such events (e.g. action plan or purchase a kit). An abundant amount of information about emergency preparedness is available from federal, state and local resources, however, little is done at the local level to reach those in the community who could use this information. A program in California called, "The Great California ShakeOut," is held on the third Thursday of every October (calema.ca.gov). Millions of residents practice the "Drop, Cover, and Hold On" drill each fall. It is a valuable reminder of the hazards of living in an earthquake zone yet it is not tailored to older adults. A variety of other programs may also be available or sponsored by fire departments, and other community and faith-based organizations. The local adult center in my community, for example, holds an emergency preparedness seminar once each year in the spring. Moreover, there is a vast amount of information available online, too, however, many web-based resources for older adults are confusing and hard to navigate, and some were not functioning. Additionally, it is widely recommended that everyone have emergency kits at home, which can be put together or purchased ready-made. Commercial emergency packs, however, are not tailored for the older adult. Items such as a form to list medications, doctors, advance directives, POLST information, as well as, easy to 7 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS use and lite weight flashlights, pill boxes, etc., are not included in commercial packs. FEMA, AARP and the American Red Cross all recognize the need for older adults to be more prepared, especially after the disproportionate loss of life from the 2005 Hurricanes, however, it appears that many in the community go without this knowledge. Ideally, I would recommend four emergency kits: a home kit that includes a three-day food storage, a car kit, a portable pack and a bedside kit. Each kit is a valuable resource in case of an emergency, however, the focus of this project is on portable packs so I will only address items to that end. The purpose of this project is threefold: 1) identify the current level of emergency preparedness in a select group of community-dwelling older adults in Burbank, California, 2) prepare and present an educational program, based on survey results at a congregate meal site, and 3) create and display portable emergency packs that will benefit older adults during a time of crisis. The aim of this project is to encourage older adults, who live independently within the community, to take responsibility for their own safety. While my project is intended for community-dwelling older adults, it could be adaptable to other populations. The general timeline of this project was as follows: January- IRB approval from the Univeristy of Utah Institutional Review Board. February- Scheduled sessions at meal sites to distribute and collect survey information. March- Scheduled and presented educational session at congregate meal site. April- Finished written final project and and presentation. Literature Review 8 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS According to John Auerbach, associate director of the Centers for Disease Control and Prevention, "many older adults are at elevated risk in a natural or manmade disaster because of their special health needs, their social isolation, or their frailty" (CDC.gov, n.d.). The reality is that 80% of individuals aged 65 and above have at least one chronic health condition and nearly 50% have two or more (Aldrich, 2008). This results in a higher proportion of older adults needing hospitalization or nursing home placement following a disaster. Preparedness planning could eliminate extreme situations like this, or at least diminish the negative impact of a major disaster. At the least, proactive planning can empower and equip older adults to cope effectively in adverse conditions. Surprisingly, age-related issues as a vulnerability during disasters is a growing area of investigation. During the September 11, 2001 terrorist attack in New York, roughly 25,000 older adults lived within three blocks of the World Trade Center (Aldrich, 2008). Many older adults were left without electricity or a means to get food or medications. Also, frail older adults in need of service providers, whether formal or informal, were stranded until help could arrive. It was only after the disproportionate loss of life from the Hurricanes of 2005 in the older adult population that public health and other professionals took notice of the vulnerability of this cohort in wide-spread disasters (Aldrich, 2008). Research on preparedness shows people believe they are better prepared than they really are. Accordingly, nearly 40 percent of general population respondents to a government survey did not have disaster or emergency plans in place (SERVE.gov, n.d.). Alarmingly, a nationwide survey of older adults, found two thirds (66%) of the study population, of which the mean age was 70, did not have an emergency plan or had never participated in a disaster drill (Al-rousan, 9 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS 2014). Lessons learned from past disasters highlight the critical need to be prepared. Planning will not be enough, though. Disaster preparedness, to be successful for older adults, must be accessible, easy to understand, economical and practiced. Unfortunately, disasters are occurring more regularly and are becoming more severe. Leaning and Guhr-Sapir, reported in 2013 that natural disasters steadily increased over the last twenty years, more specifically, a threefold increase occurred between the years between 2000 and 2009 as compared to 1980 through 1989. Moreover, during President Obama's term in office, he declared a record number of federally designated natural disasters in his presidency (Al-rousan et al., 2014). Furthermore, natural disasters are predicted to increase and intensify because global temperatures are climbing (Leaning & Guha-Sapir, 2013). The community of older adults is increasing, as well. Each day our older adult population (65 and over) grows by 10,000 individuals (NCOA.org). A survey by the U.S. Department of Health and Human Services found that between the years 2004 and 2014, the population of individuals age 60 and over increased by 32.5% (AoA, 2015). The older population is surging globally as well. It is predicted that 20% of the world's population will be 85 and over by the year 2055 (Crimmins, 2015). Moreover, the proportion of centenarians (people age 100 and over) is growing even faster. Globally, in 1990 there were 2.9 centenarians per 10,000 adults 65 and over. That number is estimated to rise to 23.6 centenarians by 2050 (Stepler, 2016). The "graying of America," is a consequence of the Baby Boom generation, those individuals born between 1946 and 1964. This cohort has shaped society at every life stage they have passed through (Sugar, 2014). Not only are there a growing number of older adults, but they are living longer as well. 10 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS Another pressing need for preparedness is the reality that many older adults are geographically isolated from family and friends. With the aging population predicted to outnumber children under the age of 15 by the year 2045 (Connelly, 2014), older adults will increasingly be living alone when an emergency or disaster occurs. The mobility of many young families, especially in rural Midwest states, has also forced "aging-in-place" on many adults age 65 and up who are unable or unwilling to move. Additionally, improved health and finances is a double-edge sword, allowing many older adults to choose to live independently in their own home (Stepler, 2016). The years between 1900 and 1990 saw a fivefold increase in older adults who live alone, from 6% to 29%. Additionally, more women are living alone (Stepler, 2016). Further statistics show that 27 percent of women ages 65-74 lived alone in 2014, however, that number jumps to 42 percent in the 75-84 age group and 56 percent among women 85 and over (prb.org, 2016). Disaster and emergency situations pose a significant health risk for older adults as many have physical and/or cognitive limitations. While it is true that we are living longer and healthier, it is also true that we are living with multiple chronic conditions for a longer period of time (Sugar, 2014). But even "healthy" older adults can experience vulnerabilities when faced with a disruption due to disaster or emergency situations. Normal physiologic changes can make reaction time slower, compromise vision, and reduce optimal hearing (Ham, 2014). Of the roughly 1,300 people who died in Hurricane Katrina in 2005, for example, more than 70 percent were older adults (CDC, n.d.). Furthermore, the median age of the 465 individuals that died in the 1995 Midwest heatwave was 75 years (Aldrich, 2008). The prevalence of multiple health problems makes older adults more likely than younger populations to suffer from chronic 11 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS illnesses, use multiple medications, be home-bound, and live alone or in isolated regions (Gibson, 2006). Chronic illnesses such as heart disease, hypertension and arthritis are common in older adults and affect response time (Ham, 2014). Based on age-related health issues (Aldrich, 2008), the aging of America (Crimmins, 2015), and the desire to live independently in their own homes (Stepler, 2016), there is a need to recognize and address emergency preparedness in the older adult population. Therefore, the overall goal of this project is to encourage communitydwelling older adults to prepare for emergencies, and provide them with tangible and affordable resources to use during a time of crisis. Methods Participants were recruited through two of the three congregate meal sites located at adult centers in the community of Burbank, California. These sites were chosen for convenience and target population sampling. A flyer was distributed at two adult centers located in Burbank, California (Appendix A) announcing a "Free Emergency Preparedness Seminar." Questionnaires (Appendix B) were distributed during lunch at the two congregate meal sites and the following week a seminar was presented based on results from the survey. The location for the presentation was based on convenience and suitability to present PowerPoint slides. These sites were also chosen because many independent, assisted and skilled nursing facilities typically have their own disaster/emergency protocols in place based on federal guidelines. The congregate meal sites collectively serve a maximum of 200 meals each day five days a week. These congregate meal sites serve people age 60 and above, however, individuals ages 55-59 as well as younger visiting family members are also welcome. With approval from the nutrition director, the survey was administered only once at each congregate meal site chosen. A total of 41 actual responses were 12 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS collected. Participants were given a self-administered questionnaire with fifteen questions broken down into two parts. Questions were self-explanatory and required no more than 10-15 minutes to complete. Part one asked general demographic items to assess age, marital status, sex, education level, income, source of income and living arrangement. Part two ascertained perception of readiness, concern about disasters, interest in being better prepared and whether participants have a portable pack at home. Two questions were formatted in a Likert scale of 1 5, where 1 is the least concerned or prepared and 5 represents the most concern or prepared. Sample questions asked: 1). To what extent are you concerned about disasters/emergencies? Scale of 1-5 2). To what extent do you feel prepared for emergencies/disasters? Scale of 1-5 Other questions were in a yes/no or open format. 1). Do you have an emergency/disaster plan, whether written or otherwise in place? Yes, No, Why or why not? 2). Are you interested in being better prepared for emergencies/disasters? Yes, No, Why or why not? 3). Do you have a portable emergency pack?" Yes, No, Why or why not? 4). Are you responsible for the safety of others (in addition to yourself) in the event of a disaster or emergency? Yes, No, If so, for whom (state relationship). Two questions were open-ended and asked about: 1). How much are you willing to pay for a ready-made emergency pack tailored 13 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS for older adults? 2). Is there anything else you would like to add that has not already been covered? Survey results provided tangible evidence of a high level of concern about disasters (79%), and demonstrated an interest in being better prepared (66.7%). Results also showed a desire for a variety of handouts so information was provided from local, county, state and national resources. The educational portion of PREPARE incorporated recommendations based on survey results, as well as recommendations from FEMA, AARP, the American Red Cross and local resources. This seminar was designed to briefly address emergency preparedness planning and was presented with a PowerPoint, and later augmented with a visual demonstration of a portable back pack. The presentation was brief (about 15 minutes), and there was an additional 10 minutes after the presentation for portable pack demonstrations with time for questions afterwards. Ample handouts, some in large print formats, were provided representing federal, state, local and community-based organizations. The purpose was to provide information on types of disasters, impact on infrastructure, reducing impact of hazard thru mitigation (e.g., securing heavy furniture, awareness of utility shut-off, securing pictures). Home preparedness tips included information on how to create a three-day emergency kit, portable emergency pack, the importance of having a smaller version by their bed and suggested items for a car kit. Lastly, the importance of creating an individual/family plan was addressed with the benefits of practicing before an emergency to identify any problems. Information was presented in an easyto-understand PowerPoint format with an accompanying handout. Additionally, a resource sheet was available to further assist in preparedness planning. 14 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS Materials Pre-made emergency packs are readily available from numerous companies and at a variety of price points, however, a pack suitable for older adults would take a good amount of time to put together. Most packs contain the same basic emergency essentials, generic enough to be acceptable by many consumers. However, for individuals with functional limitations, choices are limited or non-existent. Items that are easy to use such as, portable packs that are light weight, flashlights that are easy to use and maintain, and a form to store critical emergency information such as contacts, current medications, doctors. POLST and Advanced Directive forms should also be included. The main goal of the emergency packs was to create a portable pack that is sensitive to the needs of older adults. The importance of a functional portable pack cannot be overstated in an emergency. An additional benefit is it provides a centralized location to store important information that can follow the older adult in case of evacuation. The cost for a ready-made pack can range anywhere from $20 for a very basic portable pack, to well over $100. The pack I displayed at my emergency preparedness seminar contained 20 items and cost about $30 (as a wholesale price) to put together. I also wanted the pack to be mobile and light weight to allow for easy transportation so that factored into the products chosen (the final sample weighed 6 lbs). Below is a list of the items included. It is not meant to be exhaustive. Other items could be added to individualize packs to specific needs. Items such as eye glasses, extra medications, hearing devices and denture needs could enhance usability. Digital assets are also important to store and should be included in emergency preparedness protocols. 15 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS Prices listed are estimates for wholesale cost only and not indicative of actual retail costs. - Back Pack $5.00 - Emergency Poncho (Rain and Body Warmth) $.50 - Bright Colored Safety Vest $1.00 - Work and Non-Latex Gloves $2.00 - AM/FM Radio $4.00 - 2 LED Flashlights and Extra Batteries $6.00 - Mask $.50 - Basic First Aid Kit $2.00 - 30 Min Lite Stick $.50 - Water $.50 - Snack $.50 - Preparedness Guide $1.00 - Quake Hold $1.00 - Scissors $.50 - Small Pill Container $.25 - Eye Protection $1.50 - Whistle $.50 - Duct Tape $1.00 - Emergency Information in Waterproof Package $.25 Results The seminar was intended to be a brief overview of disaster preparedness. The actual 16 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS seminar lasted only about fifteen minutes and consisted of a brief PowerPoint, a follow-along handout (Appendix D), a visual demonstration of a portable back pack and a smaller bedside pack. Interest in the items in the emergency packs added an additional ten minutes. Comments from those in attendance were very positive and appreciative. Participants especially liked that the brochures were organized and representative of federal, state, local and community resources. Many were also very interested in the items in the pack and asked, "where can I get a back pack" like the one demonstrated. Other comments were positive about the large-print brochures provided and that most were available in Spanish. Those in attendance also liked that I had included a form for important contacts and that I included information regarding disasters and pets. According to the director, the seminar was attended by almost double the average number of individuals who typically show up for lunch. A codebook was created to analyze survey responses (Appendix C). There were 41 responses with an average age of 73 years (see Table 1). Over half of participants were male. The vast majority of the respondents, were college graduates or had attended college. Half of participants reported being single or widowed. About one fourth were divorced or separated and nearly seventy-five percent reported Social Security as a main source of income. Others reported current employment or retirement savings as an income source. More than half lived alone and a quarter lived with family. Most of respondents reported wanting to be better prepared with half already owning a portable pack. The survey results showed nearly eighty percent being concerned about disasters/emergencies however, results from the question: "To what extent do you feel prepared for disasters/emergencies?" displayed a normal distribution of responses with most showing some concern while others were or were not. Overall, no one 17 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS indicated a level of high death anxiety. Responses to what they would be willing to pay for a portable pack, about forty percent said it depended on what the pack contained, however, one fourth were willing to pay $5-$50, one fifth indicated they would pay $75-$100, while an equal percentage was not interested in a pack at all. Respondents indicating no concern for preparing for disasters indicated they were already prepared because, "I worked for FEMA," "I live in my van," "My preparedness is my glock gun," and "if somethings going to happen, it's going to happen." Table 1. Survey Responses. Survey Item Mean (SD)/Percentage Age 73.4 years (S.D.=9.3) Male 56.1 % Education Less than High School 5.0% High School or GED 7.5% Some college 37.5% College graduate/post grad 50.0% Marital Status Single 27.5% Divorced 30.0% Married 15.0% Widowed 27.5% 18 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS Annual Income $42,000 or less 70.6% $42,000-$125,000 26.5% $125,000 + 2.9% Primary Income Source Social Security 74.4% Employment 5.1% Retirement savings 17.9% Other 2.6% Living arrangement Lives alone 56.4% Lives with spouse 15.4% Lives with family 25.6% Other 2.6% Shows concern about disasters 79.0% Feels prepared 43.2% Has a disaster plan 52.5% Wants to be better prepared 66.7% Has a portable pack 52.5% Is responsible for others 32.4% Willing to pay for a go-pack 19 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS $5-$25 21.3% $40-$50 3.6% $75-$100 17.9% Not interested 17.9% Depends on contents 39.3% Discussion Emergency preparedness is not an age-limited concern, it is universal in scope. The reality of man-made and natural disasters increasing in the future (Leaning & Guhr-Sapir, 2013) magnifies the pressing need to prepare before, not after an event. The aging demographic, and the fact that most federal aid is available only after a presidential declaration (FEMA.gov, 2016), (Appendix E), presents challenges for local communities to initially take care of their own. Older adults, who are living longer (Stepler, 2016), and with multiple chronic conditions, are more likely to be affected by disasters (Aldrich, 2008). Many older adults choose to live independently leaving them more vulnerable and potentially alone for several days. Health and isolation issues only exacerbate the need for assistance in surviving, coping and rebuilding following a large-scale disaster. The population of older adults is projected to increase to one out of every five people in the United States by the year 2050 (Crimmins, 2015), and the projected decline in large families, thus, the pool of available relatives to help in times of crisis will be smaller. To further illustrate this, in 2010 there were seven family members for every individual 80 years and older. By the year 2050 there will only be three (Winakur, 2015). Additionally, local communities benefit by 20 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS being proactive by acknowledging and addressing the diversity within their borders. The increase in natural and man-made emergencies, and the desire to age in place creates a precarious scenario. The importance of including older adults in emergency preparedness plans cannot be overstated. Communities should be concerned about planning for emergencies and communicating those plans to their citizens who are living alone. Limitations There are a few limitations with this study, one of which is the small number of responses. The responses, (N = 41), is a relatively small response number to ascertain a true indication of readiness; however, even with a small sample size, enough information was submitted to ascertain a level of need for emergency and disaster preparedness in the older adult population residing in my community. The convenient sample limited the generalization of this project. Recruitment was limited to participants from congregate meal sites and included mostly ablebodied older adults. A vast number of community-dwelling older adults do not participate in local nutrition programs for a variety of reasons: by choice or physical inability. Further, my questionnaire was distributed to English-speaking participants only. Additionally, most of the respondents had some college or had graduated from college, which is not indicative of a diverse population. Therefore, the participant pool is not representative of the general older adult population. Future projects should focus on exploring a greater variety of sites to include older adults from diverse educational and ethnic backgrounds. Potential ideas to reach community-dwelling older adults to provide emergency preparedness assistance could involve creating a registry. Targeting this population, especially the frailest, would allow communities and first responders to focus on doing "the greatest good 21 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS for the greatest number," (Burbankcert.org, n.d.). Possible registries could include fire departments, Meals on Wheels recipients and adult center participants. Independent living facilities could also be a registry source and could benefit by augmenting their own protocols with residents capable of self-sustainability during a time of crisis. Summary Our demographics are changing to an older and more diverse nation. A nation where with the majority of older adults want to stay in their own home. However, an often overlooked "gap" in this scenario is the vulnerability of this cohort during a time of crisis, particularly in larger cities. Aging -in-place, instead of the once desired move to a warmer climate "retirement" community, has placed a greater number of older adults in the community. Isolation from families is an additional problem and is becoming more commonplace. As a result, many in the 65 and over population are often left on their own. This new norm is creating an independent older adult population that may not be equipped to handle adverse situations. Normal age-related health issues of the older adult affect response time and decision making, and could be detrimental in a large-scale disaster. As many older adults are disproportionately affected by man-made or natural disasters (Aldrich, 2008), it is imperative for local communities to recognize the need to take care of this vulnerable group. Local stakeholders would benefit by being proactive in this approach. Emergency planning, though, goes beyond kits and packs. Proper planning begins with educating individuals about their abilities and limitations, as well as recognizing potential hazards in their environments. Developing a network of contacts, getting involved, learning what your community has in place for disasters, and practicing emergency procedures can help lessen 22 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS the impact of a major emergency. Insuring that caregivers, formal or non-formal, are part of the planning, is critical. Most importantly, is for older adults, families and communities to recognize the need for everyone to be prepared. Disasters and emergency situations rarely give warning, and following a large-scale crisis, we may be on our own for a few days or longer. The overarching goal of this project was to highlight the need to include older adults in emergency preparedness discussions and planning. Communities will be better prepared if they are inclusive of all their citizens. However, the more immediate, and personal goal, was to create awareness in my local community, encourage self-sufficiency, and hopefully, help older adults be better prepared to survive a major disaster. This was done by identifying the level of preparedness in a group of community-dwelling older adults, preparing and presenting an educational seminar, providing information from a variety of local, county, state, and federal sources, and demonstrating portable emergency packs. Through these efforts, I believe the goals of this project were met. 23 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS References Aldrich. 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New England Journal of Medicine, 369(19),1836-42. doi: 10.1056/NEJMra1109877. National Council on Aging, (n.d.) The United States of aging survey. Retrieved from https://www.ncoa.org/news/resources-for-reporters/usoa-survey/ Mather, M. (2016). Fact Sheet: Aging in the United States. Retrieved from http://www.prb.org/publications/media-guides/2016/aging-unitedstaes. Putting Down Roots in Earthquake Country (n.d.). Retrieved from http://www.calema.ca.gov. Stepler, R. (2016). World's centenarian population projected to grow eightfold by 2050. Retrieved from http://www.pewresearch.org/fact-tank/2016/04/21/worlds-centenarianpopulation-projected-to-grow-eightfold-by-2050/ft_16=04-20_centenarian_us. Sugar, J. A., Riekse, R. J., Holstege, H., & Faber, M. A. (2014). Introduction to Aging: A Positive Interdisciplinary Approach. New York, NY: Springer Publishing Company. U.S Department of Health and Human Services. (2015). Profile of older Americans. Retrieved from www.aoa.acl.gov/Aging Statistics/Profile. WHCOA. (2015). The White House Conference on Aging. Retrieved from https://whitehouseconferenceonaging.gov/ 25 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS Winkaur, J. (2015). Caregiver woes in the Medicare system: A tale of two patients. Family caregiving in the new normal. doi: http://dx.doi.org/10.1016/B978-0-12-4170469.00004-0. Elsevier Inc. 26 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS APPENDIX A Older Adults are More Vulnerable to Natural and Man-Made Disasters Free Emergency Preparedness Seminar Tailored to adults 55 and over Free Handouts, Resource Guides & Portable Emergency Pack Demonstration McCambridge Nutrition Site Friday March 3, 2017 If you would like to stay for lunch Please call 818.238.5365 27 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS APPENDIX B Consent Cover Letter "PREPARE" Personal Readiness, Emergency Packs and Recovery Essentials: Emergency Preparedness for Community-Dwelling Older Adults The purpose of this research study is to determine the level of emergency readiness in community-dwelling adults age 55 and over. We are doing this study because older adults are disproportionately affected by natural and man-made disasters. It is important for older adults to be self-sufficient when a large-scale emergency occurs as service agencies will be in highest demand and may not be able to respond for several days. The survey will be completed anonymously and no personal information will be recorded. The only people who will be viewing the collected data will be those who are a member of the research team. There are no foreseen risks or benefits that are associated with participation in this study. If you have any questions complaints or if you feel you have been harmed by this research please contact Dr. Kara Dassel, Director of the Gerontology Interdisciplinary Program at the University of Utah by phone at [phone] or by email [e-mail]. Contact the Institutional Review Board (IRB) if you have questions regarding your rights as a research participant. Also, contact the IRB if you have questions, complaints or concerns which you do not feel you can discuss with the investigator. The University of Utah IRB may be reached by phone at [phone] or by e-mail at [e-mail]. It should take 10-15 minutes to complete the questionnaire. Participation in this study is voluntary. You can choose not to take part. You can choose not to finish the questionnaire or omit any question you prefer not to answer without penalty or loss of benefits. By returning this questionnaire, you are giving your consent to participate. Thank you for taking the time to complete the survey. Your answers will help assist in the preparation of an emergency preparedness seminar for older adults. 28 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS Disaster Preparedness Questionnaire The purpose of this survey is to explore the level of emergency preparedness in individuals age 55 and over. Your participation is entirely voluntary and no identities will be recorded. You can also choose to not finish the questionnaire or omit any question you prefer not to answer. Your responses to this brief survey will provide valuable feedback regarding personal preparedness in our local community. Thank you in advance for your willingness to participate in this disaster preparedness survey. Sincerely, Winnifred Westwood Masters Candidate (Gerontology) University of Utah Begin Survey Part 1 Please circle only one answer 1. What is your gender? (1) Male (2) Female 2. What is your age? _________ 29 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS 3. What is your level of formal education? (1) Less than High School Graduate (2) High School Graduate (3) Some College or Vocational School (4) College Graduate (5) Post College Graduate 4. What is your marital status? (1) Married/cohabiting relationship (2) Single (never married) (3) Widowed (4) Divorced/separated 5. What is your yearly household income? (1) Less than $42,000 (2) $42,000-$125,000 (3) Greater than $125,000 6. What is your current source of income? (1) Social Security (2) Employment (3) Retirement/savings 30 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS (4) Other, please specify: _______________________ 7. What is your current living arrangement? (1) Live alone (2) Live with spouse (3) Live with family (4) Other: ________________________ Part 2 8. To what extent are you concerned about disasters/emergencies? (Please circle below where 1 = not at all and 5 = very concerned) 1 9. 2 3 4 5 To what extent do you feel prepared for disasters/emergencies? (Please circle below where 1= not prepared and 5 = very prepared) 1 2 3 4 5 10. Do you have a disaster/emergency plan, whether written or otherwise? (1) Yes (2) No Why or why not?_____________________________________________ 11. Are you interested in being better prepared for disasters/emergencies? (1)Yes (2) No Why or why not?_____________________________________________ 12. Do you have a portable emergency pack available in your home? (1)Yes (2) No Why or why not?_____________________________________________ 31 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS 13. Are you responsible for the safety of others (in addition to yourself) in a disaster or emergency? (1) Yes (2) No the event of If so, for whom are you responsible? He/She is my (state relationship) ________________________________ 14. How much would you be willing to pay for a ready-made emergency pack that is tailored to older adults? _________________________________ 15. Is there anything else you would like to add that has not already been covered?_________________________________________________________ ________________________________________________________________ ________________________________________________________________ _______________________________________________________________ You have completed the questionnaire. Thank you for your participation! 32 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS APPENDIX C Disaster Preparedness Questionnaire The purpose of this survey is to explore the level of emergency preparedness in individuals age 55 and over. Your participation is entirely voluntary and no identities will be recorded. You can also choose to not finish the questionnaire or omit any question you prefer not to answer. Your responses to this brief survey will provide valuable feedback regarding personal preparedness in our local community. Thank you in advance for your willingness to participate in this disaster preparedness survey. Sincerely, Winnifred Westwood Masters Candidate (Gerontology) University of Utah Begin Survey Part 1 Please circle only one answer GENDER 1. What is your gender? (1) Male (2) Female 33 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS AGE 2. What is your age? ENTER AGE EDUC 3. What is your level of formal education? (1) Less than High School Graduate (2) High School Graduate (3) Some College or Vocational School (4) College Graduate (5) Post College Graduate MARITAL 4. What is your marital status? (1) Married/cohabiting relationship (2) Single (never married) (3) Widowed (4) Divorced/separated 34 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS INCOME 5. What is your yearly household income? (1) Less than $42,000 (2) 42,000-$125,000 (3) Greater than $125,000 SOURCE 6. What is your current source of income? (1) Social Security (2) Employment (3) Retirement/savings (4) Other, please specify: ENTER COMMENTS LIVINGARR 7. What is your current living arrangement? (1) Live alone (2) Live with spouse (3)Live with family (4) Other: ENTER COMMNENTS 35 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS Part 2 CONCERNED 8. To what extent are you concerned about disasters/emergencies? (Please circle below where 1 = not at all and 5 = very concerned) (1) (2) (3) (4) (5) FEELPREPARED 9. To what extent do you feel prepared for disasters/emergencies? (Please circle below where 1= not prepared and 5 = very prepared) (1) (2) (3) (4) (5) HAVEPLAN 10. Do you have a disaster/emergency plan, whether written or otherwise? (1) Yes (2) No Why or why not? ENTER COMMENTS BETTERPREPARED 11. Are you interested in being better prepared for disasters/emergencies? (1)Yes (2) No Why or why not? ENTER COMMENTS 36 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS HAVEPORTABLEPACK 12. Do you have a portable emergency pack available in your home? (1)Yes (2) No Why or why not? ENTER COMMENTS RESPONSIBLEFOROTHERS 13. Are you responsible for the safety of others (in addition to yourself) in the event of a disaster or emergency? (1) Yes (2) No If so, for whom are you responsible? He/She is my (state relationship) ENTER COMMNENTS WILLINGTOPAY 14. How much would you be willing to pay for a ready-made emergency pack that is tailored to older adults? ENTER COMMENTS ADDITIONALCOMMENTS 15. Is there anything else you would like to add that has not already been covered? ENTER COMMENTS You have completed the questionnaire. Thank you for your participation! 37 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS APPENDIX D STEPS TO PREPARE FOR EMERGENCIES Disaster Preparedness Seminar 3/3/17 McCambridge Nutrition Site Create a master plan tailored to your living situation, local risk factors and health abilities __________________________________________________________ __________________________________________________________ Kits for your car, bedside, a portable "Go-Bag" and a 3-day home kit ____________________________________________________ ____________________________________________________ ____________________________________________________ Learn what your community offers, stay connected. __________________________________________________________ __________________________________________________________ __________________________________________________________ Learn CPR, join a CERT program, know your neighbors __________________________________________________________ __________________________________________________________ __________________________________________________________ 38 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS RESOURCES FOR PREPAREDNESS AND RECOVERY: FEDERAL: www.ready.gov www.fema.org [phone] STATE: www.caloes.ca www.shakeout.org [phone] COUNTY: www.espfocus.org Current Disaster Info [phone] 211 LOCAL: Burbank: www.readyburbank.org Burbank City website: www.burbankca.gov BWP: Power disruption Free Sandbags: Disaster Preparedness Info: [phone] [phone] [phone] OTHER USEFUL SITES: American Red Cross: www.redcross.org/prepare AARP: www.aarp.org LA Department of Public Social Services: www.ladpss.org U.S. Department of Veteran's Affairs: www.va.gov Centers for Disease Control www.emergency.cdc.gov California Poison Control: www.calpoison.org Pet Preparedness: www.avma.org/disaster Caltrans Highway Info: www.dot.ca.gov Eldercare: www.eldercare.org (866)-613-3777 [phone] [phone] [phone] [phone] [phone] [phone] 39 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS APPENDIX E 40 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS 41 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS 42 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS 43 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS TABLE DISPLAY AT BURBANK NUTRITION SITE Organized into: federal, state, county and local 44 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS 45 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS 46 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS 47 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS 48 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS 49 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS 50 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS 51 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS 52 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS 53 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS Portable back pack displayed at seminar Also adaptable as a car kit Bright Colored Safety Vest Work and Non-Latex Gloves AM/FM Radio 2 LED Flashlights Extra Batteries Mask Basic First Aid Kit 30 Min Lite Stick Water Snack Note Book and Pen "Quake Hold" Scissors Small Pill Container Eye Protection (googles) Whistle Duct Tape Emergency Information in Waterproof Package 54 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS Examples of smaller packs Contain essentials to keep next to bedside Flash lite Note pad Whistle Eye glasses Emergency contacts Gloves Handwipes 55 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS 56 Running head: EMERGENCY PREPAREDNESS FOR OLDER ADULTS