Introduction
Recent disasters have shown that older adults are at increased risk of experiencing higher mortality and morbidity rates in a disaster event (Bolin and Klenow Reference Bolin and Klenow1988; Cutter, Boruff and Shirley Reference Cutter, Boruff and Shirley2003; Perry and Lindell Reference Perry and Lindell1997; World Health Organisation (WHO) 2008). Globally, there is a growing concern about the demographic challenges associated with an ageing population. In the context of increasing extreme weather-related events (Intergovernmental Panel on Climate Change Reference Field, Barros, Stocker, Qin, Dokken, Ebi, Mastrandrea, Mach, Plattner, Allen, Tignor and Midgley2012), this age group represents an important population to be considered when thinking about how to improve protection prior to a disaster event. To date, much of the preparedness research has focused on general adult populations and little differentiation has been given to age-specific differences. Ngo (Reference Ngo2001) argues that older adults living independently in the community must be recognised as an at-risk group prior to a disaster event. However, pre-disaster consultation and research with older adults over 65 years as active contributors to age-specific preparedness knowledge has not been widely undertaken (Tuohy, Stephens and Johnston, Reference Tuohy, Stephens and Johnston2014a). This paper draws on the narratives of the older adults who participated in a qualitative study which sought to explore older adults' understandings about disaster preparedness.
During the analysis of our interview data, we found that a bigger story about ageing was interwoven with older adults' accounts of disaster preparedness; their understandings about preparedness were linked to talk about maintaining independence. This paper provides a view of how a sample of older adults living in the community actively managed their independence in later life. Their meanings of being prepared for a disaster included wider cultural stories of contemporary ageing in the community.
Independence in later life may be seen as a relatively new focus for older people. In many Western countries, neo-liberal social policy on ageing has been influenced by concerns about the growing ageing population, and the anticipated burden of health and social welfare costs to government (Biggs Reference Biggs2001). Advances in medical care have further shaped a perception of ageing away from images of decline and dependency towards ageing policy that seeks to encourage active, healthy lifestyles (Katz and Laliberte-Rudman Reference Katz, Laliberte-Rudman and Katz2005; Smith et al. Reference Smith, Braunack-Mayer, Wittert and Warin2007). Petersen and Lupton (Reference Petersen and Lupton1996) argue that encouraging personal autonomy is a neo-liberal strategy aimed at reducing the role of the state, whereby citizens are encouraged to become more self-regulating, and conform to monitoring and taking responsibility for self-control of their body. Within social policy, the demands on older adults to maintain independence have been constructed to be both a personal and self-caring endeavour focusing on independence and health (Katz and Marshall Reference Katz and Marshall2003).
The possibilities to manage ageing therefore offer older adults new representations of old age (Gilleard and Higgs Reference Gilleard and Higgs2000). However, these contemporary concepts of ageing have created a paradigm that encourages personal autonomy and self-responsibility, which lead to practices such as self-reflection and risk management to achieve and maintain self-reliance (Katz and Marshall Reference Katz and Marshall2003; Rudman Reference Rudman2006). Self-reliance and independence, rather than reliance on others, have become cultural markers by which older adults increasingly define their lives (Minichiello, Brown and Kendig Reference Minichiello, Browne and Kendig2000; Smith et al. Reference Smith, Braunack-Mayer, Wittert and Warin2007). Thus, the value of being independent and self-reliant, and not becoming a burden to others, has become a moral imperative and marker of identity (Biggs Reference Biggs1997; Townsend, Godfrey and Denby Reference Townsend, Godfrey and Denby2006); and remaining independent in old age has become a socially valued achievement (Portacolone Reference Portacolone2011). As a consequence, older adults must pay greater attention to managing their independence in the community.
Critical gerontology has drawn attention to the apparent simplicity but potentially damaging aspect of social policy about active ageing. The practical policy focus on ability to live independently in the community has primarily been on functional criteria such as physical and cognitive capability (Holstein and Minkler Reference Holstein and Minkler2003; Mack et al. Reference Mack, Salmoni., Viverais-Dressler, Porter and Garg1997). Critics point out that active engagement with life is problematic as a cultural image of ageing, because it primarily draws attention to health and physical activity (Holstein and Minkler Reference Holstein and Minkler2003). This critical perspective argues that maintaining functional health in old age represents a normative standard against which successful ageing is measured, which in turn influences older adults' choices and actions (Holstein and Minkler Reference Holstein and Minkler2003; Minichiello, Browne and Kendig Reference Minichiello, Browne and Kendig2000). Holstein and Minkler (Reference Holstein and Minkler2003) argue that this perspective ignores genetics, and the influences of social factors such as gender and income on health in later life. Yet, the preoccupation with healthy ageing and the prevention of ill health remains (Secker et al. Reference Secker, Hill, Villeneau and Parkman2003). Therefore, older adults manage their health needs within the cultural discourse of personal responsibility and independence in the community so as not to be seen as a social or financial burden. In this way, not only are the norms of ageing perpetuated but meaningful experiences of physiological, emotional and contextual adjustment and transition remain neglected (Holstein and Minkler Reference Holstein and Minkler2003). It is against this background of promoting independent ageing within the community that the context of older adults' concerns about their health can be understood.
Currently, 90 per cent of older Americans live at home (Peek Reference Peek, Phillips, Thomas, Fothergill and Blinn-Pike2010); and similarly in New Zealand, 90 per cent of adults over 65 years are expected to be living at home, of whom 28 per cent are predicted to be living alone by 2021 (Statistics New Zealand 2004). However, despite older adults ageing independently in the community, they are exposed to risks and vulnerabilities associated with the physical realities of ageing (Stephens, Breheny and Mansvelt Reference Stephens, Breheny and Mansvelt2014). The individualised nature of ageing can create personal and social vulnerabilities as older adults experience age-related decline such as disability and chronic disease and living alone (Katz and Laliberte-Rudman Reference Katz, Laliberte-Rudman and Katz2005; Portacolone Reference Portacolone2011; Smith et al. Reference Smith, Braunack-Mayer, Wittert and Warin2007). Loss of traditional forms of social assistance that previously could be relied upon can also become a challenge to older adults' ability to maintain independence (Lupton Reference Lupton2013). For example, family employment patterns (women in the workforce) and family relationships (divorce, remarriage, geographic spread) can impact on the availability of family networks as a resource for older adults to call on (Kemp and Denton Reference Kemp and Denton2003; Lupton Reference Lupton2013). Consequently, both declining health and reduced social assistance can threaten independence, which older adults must confront and manage.
In times of threat, such as a disaster, older adults experience a greater risk of negative outcomes, and attention to age-specific preparedness using a qualitative research approach has not been widely explored from the perspective of older adults (Tuohy, Stephens and Johnston Reference Tuohy, Stephens and Johnston2014a, Reference Tuohy, Stephens and Johnston2014b, forthcoming). Both personal and social vulnerability have been identified as factors linked to poorer outcomes, which in a disaster are likely to be exacerbated (Bolin Reference Bolin, Rodriguez, Quarantelli and Dynes2007; Tuohy and Stephens Reference Tuohy and Stephens2011). Consequently, older adults are more likely to experience higher morbidity and mortality rates (Cutter, Boruff and Shirley Reference Cutter, Boruff and Shirley2003; Perry and Lindell Reference Perry and Lindell1997; WHO 2008). For example, in the Kobe, Japan earthquake in 1995, more than 50 per cent of the casualties were older adults, but more than 90 per cent of subsequent deaths were older adults; in Hurricane Katrina in the United States of America, 71 per cent of the deaths in Louisiana were people aged over 60 years (WHO 2008). In the Chicago heatwave in 1995, the high death rate of older adults was related to physical decline and social isolation (Klinenberg Reference Klinenberg2002). The author also suggested socio-cultural norms of independence and the importance of self-sufficiency also contributed to the high death rate.
A considerable body of research has focused on disaster preparedness and factors that influence individuals to prepare (Lindell and Perry Reference Lindell and Perry2000; Solberg, Rossetto and Joffe Reference Solberg, Rossetto and Joffe2010). However, this research has been oriented towards quantitative methodologies such as questionnaires and surveys to assess influences on risk perceptions and their relationship to preparedness to predict influences on individual behaviour (e.g. Heller et al. Reference Heller, Alexander, Gatz, Knight and Rose2005; Lindell and Perry Reference Lindell and Perry2000; Spittal et al. Reference Spittal, McClure, Siegert and Walkey2008). In general, this research has tended to ignore the social context of the individual and assume risk perceptions are appraised, and rationalised, and that recommended actions … would be initiated by individuals (Wisner, Blaikie, Cannon and Davis, 2004). Furthermore, preparedness research has not clearly focused on older adults and their perspectives (Gibson and Hayunga, 2006; Ngo, Reference Ngo2001; Peek, Reference Peek, Phillips, Thomas, Fothergill and Blinn-Pike2010; Heller et al. Reference Heller, Alexander, Gatz, Knight and Rose2005).
Bearing in mind the social influences that have shaped how older adults in the community are expected to age independently, autonomously and responsibly, with particular attention to managing bodily ageing, this paper now draws attention to how accounts about disaster preparedness became a collective and bigger story about personal preparedness and social circumstances. Both personal and social factors framed how independence was managed in old age and provided a perspective from which to understand influences on disaster preparedness.
Method
This study used a narrative approach, which is sensitive to social context, subjectivities and meanings, and provides rich detail and broader understandings about human experience (see Riessman Reference Riessman2008). The narrative approach enables the telling of stories, which present and transmit social norms and cultural representations, and provide a map about our social world (Bruner Reference Bruner2004; Pollner and Stein Reference Pollner and Stein1996). Furthermore, stories can also re-conceptualise and re-present unfamiliar narratives about social practices and disseminate knowledge (Pollner and Stein Reference Pollner and Stein1996). In this way, asking older adults about disaster preparedness, a subject that has received very little research attention from a qualitative perspective, provides contextually sensitive expressions of everyday social life. Hence, broader understandings from independent older adults about how their lives are socially situated provides an important perspective that extends the concept of preparedness.
The participants
Older adults may be vulnerable and marginalised in their communities. For this research, older adults living in the community who were more likely to be vulnerable because of declining health, and increasing frailty, and who might experience reduced community connectedness through loss of social networks due to ill health, reduced mobility and death of same-age networks were recruited. These factors have been identified to have an adverse influence on disaster outcomes in older adults (Fernandez et al. Reference Fernandez, Byard, Lin, Benson and Barbera2002; Oriol Reference Oriol1999; Powell, Plouffe and Gorr Reference Powell, Plouffe and Gorr2009). We sought the help of a home support agency as a way of identifying and accessing vulnerable older adults living in the community. The receipt of task specific care assistance assistance to remain independent in the home is often an indicator vulnerablity. The receipt of assistance for task-specific home help for one or two hours per week is an indicator that an older adult is experiencing difficulties living independently in the community. Receiving formal help assists with maintenance of ongoing independence in the community, and for some, it delays moving to assisted living and institutional care, where assistance is available 24 hours per day. Although this care agency was supportive of our research, no formal preparedness assistance or education had been offered by this organisation to their clients prior to or during the research project. Ethical considerations also informed our rationale for using a home support agency for recruitment of participants, as we did not want to recruit anonymously from the community without knowing that there was a level of organisational support that older adults could call on in case participation in the research project caused distress and concern about the nature of disaster preparedness and response. We also wanted to interview more frail older adults where possible, which was achieved, and the median age of the sample was over 80 years.
The agency's clients were a mixture of fee-paying and welfare-funded older adults. The agency distributed the research information letter and invitation to participate to their male and female clients; participant replies were posted to the researcher. The agency manager undertook three mailouts and the response rate was 41 per cent.
The study was conducted in 2012 and is based on 16 interviews with older adults aged between 65 and 90 years (median age 84 years): seven men (four were widowed, one man's wife was in care for Alzheimer's disease, another had a disabled wife who was not present during the interview, and one man whose partner was at work); five women, all were widows; and four married couples. This resulted in 12 interviews with individuals and four with couples. Participants were living across a range of high-, middle- and lower-income suburbs, and while most participants paid for their home-help services (household cleaning and shopping), two received welfare assistance. All lived in the community except one couple who had very recently moved to a villa in the grounds of a retirement complex.
Participants were interviewed about their views on disaster preparedness. The interviews were undertaken throughout the region of Wellington, New Zealand by the first author. At the conclusion of the interview, participants were offered a civil defence preparedness booklet and the interviewer answered any questions raised by participants about disaster preparedness. The interviews were audio-recorded, transcribed, and returned to participants for checking and release. Participants gave consent for their information to be published with the knowledge that their personal names and other identifying information would be anonymised by the use of pseudonyms and removal of any identifying details.
Ethical approval for the procedures was gained from Massey University Human Ethics Committee. No participants were distressed during the interview.
Data analysis
The analysis of narrative accounts attended to meanings of talk about ‘being prepared’ in the context of age-related threats and challenges of living independently in the community. The interview recordings were transcribed and analysed by the first author and the transcripts were read many times to develop an understanding of the data. Recurrent patterns of meaning were identified within the data-set and coded (Braun and Clarke Reference Braun and Clarke2006). Thematic analysis assisted in the interpretive and insightful process of analysing and making sense of the data-set, as meanings are created from the context of events, subjectivities and stories told (Boyatzis Reference Boyatzis1998; Braun and Clarke Reference Braun and Clarke2006). To assist in managing the data-set and to develop a basic coding scheme for interpretation of thematic patterns, the transcriptions were transferred on to a database using the software program Atlas. ti (Scientific Software Development, GmbH) after the method of Friese (Reference Friese2012). The key themes were identified whereby the analysis sought to give voice to older adults' subjective meanings together with the influence of social context on those meanings.
Results and discussion
Initially, participants talked about aspects of conventional disaster preparedness, which included assembling survival items and knowledge about protective actions to take. However, the narrative approach of the study allowed for stories about preparedness in later life to be told. In this way, the individual autobiographical narratives became bigger life stories (Phoenix and Sparkes Reference Phoenix and Sparkes2009), which were socially and culturally located.
Asking about disaster preparedness enabled a new story of preparedness to be told; one that was highly relevant to older adults in the community. Older adults' disaster preparedness became stories about age-specific preparedness, which focused on health and social relationships. Throughout the interviews, older adults discussed their age-specific needs, which were related to physical decline and personal adjustment to old age. They discussed their medical health and their reduced mobility in the context of the need to be prepared for such changes in later life. Older adults also talked about personal challenges and adaptation. In sum, their ‘bigger’ life stories were about how they responded to managing independence in the community. This paper illustrates how concerns about managing age-related independence within a New Zealand context shaped understandings about being prepared.
Health concerns
Preparedness for declining health was talked about within the day-to-day management of independence. Len, aged 65 years, was unable to walk without physical aids. In the following extract, he appraised his reduced functional mobility:
You actually think through situations, whereas once upon a time you wouldn't have, I'd automatically think I would cope, but it is just like walking. I have to work out instinctively and know where the next hand holder is … and I wouldn't have thought that way five years ago, ten years ago … you get a real shock and you're suddenly helpless.
Another participant, Ron, aged 90 years, who lived with his wife, assessed his risk of falling to be very high. His mobility was now a threat to his independence and needed to be managed. Consequently, he was very careful when walking, and always relied on his walking frame. Preparedness to manage his personal risks, which he associated with physical decline, was addressed by doing the recommended physiotherapy exercises to try to strengthen his muscles to get them ‘back into a state of fitness'.
For Nell, aged 86 years, even going shopping was assessed as a potential threat to independence. Therefore, an evaluation of everyday routines and their attendant risks was also considered to be necessary to anticipate and plan for. Nell identified the importance of managing her husband's chronic health condition (diabetes), and stressed the need to prepare for unexpected health threats before they left the house:
Whenever we go out anywhere, even just going down to the shops he always takes his insulin with him … because anything can happen … like a car can knock you over on the street, or anything else, kids on skateboards can send you flying, and land you up in hospital.
Many participants identified the importance of supportive technologies to assist in maintaining their independence. Cell phones and medical alarms were identified as being important aids for managing future health threats such as heart attacks and strokes. One couple in their late eighties had pre-programmed emergency contact numbers (ICE, In Case of Emergencies), which they had learnt about when attending a cell phone course for seniors. Consequently, the couple had phone numbers for the chemist, doctor and family contacts on their cell phones.
Increasing frailty and the desire to maintain control over managing independent status was a further expression of preparedness. Fred and Joan, in their late eighties, had recently moved to a townhouse within the grounds of a retirement complex. In the following excerpt, the couple talk about their need for greater personal care because of declining health:
Joan: We wanted to stay in our own home didn't we?
Fred: Yes…
Joan: We were very happy there, but Fred has advanced prostate cancer, and ah both of us are in our eighties, and we are very well aware that something could happen to … well like my problem with my heart three weeks ago. I wasn't aware that it was in as bad a state as it was, and we ah just have to be prepared for anything to happen … so ah I feel it's wise to think ahead and be prepared to make the sacrifice necessary. Let expedience take precedence over nostalgia.
The centrality of health concerns was an important focus for older adults in our sample. They constructed preparedness to be reflexive and an ongoing endeavour used to maintain independence. Petersen and Lupton (Reference Petersen and Lupton1996: ix) argue that within the Western world, ‘health status and vulnerability of the body’ has now become an individual responsibility. This suggests that the independent self must calculate and evaluate risks in an ongoing way. In this theme, health needs were characterised by personal regulation and self-responsibility. Older adults utilised the concept of preparedness to assist them to anticipate risks and adapt to change. Yet preparedness was also interpreted to be a reflective embodied process about understanding decline and finitude. Responding to health conditions in old age was an active response to managing independence; and reflected the dominant view that ageing was defined in terms of one's health status (Holstein and Minkler Reference Holstein and Minkler2003). The stories were also bigger social stories about social norms of independence, and the endeavours of participants to live by these social understandings. Managing an ageing and vulnerable body illustrated how older adults increasingly adopted and prioritised preparedness strategies to monitor their everyday health to assist with remaining independent older adults within their communities.
Preparing for death
Rita, an 82-year-old widow, told a story that provides a very clear illustration of the way in which participants interpreted norms of independence, while preparation was not for survival but rather for death. In answering questions about her preparedness for disaster, Rita first showed that she was determined to adapt to being old, despite her difficulties in remaining mobile. Rita's desire to be independent in the community was steadfast. Thus, as an older adult she wanted to remain self-reliant and responsible.
From my point of view, having had a life that was extremely healthy – didn't have to think about my health, suffered what turned out to be a twisted muscle in a leg when I was gardening, and ahm badly diagnosed, I thought it would go away. It has left me with years of walking badly for the first time in my life and getting up out of chairs, I can do it, but it is slow and my main aim is to remain as independent as possible, I am taking osteopathy and various things to improve, but one's physical ability for the first time in my life is a consideration…
The outstanding difficulty is the lack of strength and the lack of speed, you're not doing what you used to do and you have taken time to adjust to this period of your life … my neighbour when he saw that I was struggling with my gardening leg and struggling to get it right again lent me a walking stick … and I now find that I've got to train myself to give it up if I possibly can, but while I'm doing that I notice that my feet are much slower, the knees don't turn me round as quickly and all of that is going to be a hindrance to yourself or anyone else trying to assist you [in a disaster] and therefore as I say, I feel as much as anything, as much as attending to your physical environment and your physical health, you'd better work on your philosophy of life and death.
Rita's bigger story was about preparedness for managing declining physical health in order to maintain her independence in the community, but she had a more overarching concern which she moves towards at the end of her narrative. As much as she is working on maintaining physical capacity (training herself to walk again without a stick), Rita knows that this will not help in an emergency situation and her more important preparation task is preparing philosophically for death.
Helen described this preparation more succinctly. Rather than work towards preparation for death as the climax of her account, this was at the forefront of her mind:
Oh I suppose at my age … you see at my age we're really more thinking about preparedness for death than anything else, and our own deaths, not general death you know and that sort of thing crops into your mind much more and ah you know, thinking of how we would cope if you sort of had a stroke on your own. So with that in mind I've got one of these help phone things you know.
Helen, a widow aged 78 years, was concerned about her recent hospitalisation for a seizure, and the implications it had for her to stay independent in the community. She could no longer drive, relied on family to take her shopping and had invested in a medical alarm. But for Helen, preparation was based on her immediate concerns about the manner of her own death.
These two accounts exemplified how preparedness with regards to functional health (e.g. Rita) and chronic health conditions (e.g. Helen) were linked to considerations about their own death. Cicirelli (Reference Cicirelli2006) suggests older adults' views about death change as their health declines and they sense themselves to be closer to death. Results from a longitudinal study of older adults over 85 years, conducted in San Francisco over a six-year period, found that as older adults' health declined, many had considered and made preparations for death, such as writing a will, planning funeral arrangements and other practical tasks (Johnson and Barer Reference Johnson and Barer1997). Furthermore, older adults in the study were increasingly aware of their finitude and were philosophically accepting and prepared for their end of life (Johnson and Barer Reference Johnson and Barer1997). In the context of preparations for disasters and survival, personal meanings of death emerged as a central concern. Our study suggests that at some point older adults will consider health problems and loss of spouse and others to signal life is drawing closer to an end. Preparedness for end of life therefore becomes a more global and over-riding concern. Therefore, preparing for a disaster and preparing for survival takes on different meanings for some older adults living independently in the community.
Social preparedness
Many in the study also expressed a second story: that of social preparedness to support independence. Older adults talked about a range of relational situations where preparedness was storied as a response to lifecourse events and situations now being faced. Their challenges reflected the dynamic interpersonal complexity of managing ageing in the community and were reflections of contemporary socio-cultural norms of independence.
Nine older adults in this study were widowed, and many talked about the death of their spouse and their adjustment to living alone. Being prepared was linked to maintaining independence and re-evaluating their everyday challenges in the context of living alone. In the following excerpt Jim, aged 88 years, had assessed his risks now that he was alone, and deliberately undertook preparedness actions that enabled his family to have easy entry to his house in case of a future health emergency:
Well, I am on my own now, my wife died late last year, so I've got different things to think about … if I have a heart attack you know, can my sons and daughters get into the house? That's why I take the key out at night now, other than breaking windows and that type of thing. I try and anticipate what could happen.
Jim recognised his social vulnerability, and ensuring his family had access to his house was one practical measure that gave him confidence now he was living alone. Similarly, Jean, aged in her late seventies, also linked preparedness to the experience of being alone ‘because it is just myself suddenly to look after’, making decisions on her own without her husband to share discussion with was something to which she was now adjusting. Another participant, Rita, aged 82 years, illustrated meanings about being on her own with regards to how she evaluated needing assistance with her car: ‘and I suddenly thought well I am helpless without this assistance now’, and subsequently re-evaluated the importance of being mindful of the value of maintaining her breakdown car insurance because she was now on her own.
Social preparedness was also associated with a sense of disconnectedness to neighbours, and highlighted factors that extend beyond health, which can support independence. The following excerpt illustrated how being independent and alone in the community was an isolating experience, in terms of having people to call on in times of need. Jim, aged 89 years, had been widowed two years, and had no close family alive:
I don't know the person next to where I live. The only person I know is the person who lives next door here, and yet it's not an everyday conversation, it's not an everyday meet, it's once a month perhaps hello from where I am in my bedroom, I can see her putting the washing out, I tap on the window, hello, and that's about all you know, there's no afternoon teas or morning teas or come in for a cup of tea, or anything, nothing like that.
In the following excerpt, Helen, aged 78 years, did not have contact with her neighbours, and had limited support from her son, whom she did not like to bother unnecessarily. In response to the interviewer asking how she would cope with unexpected demands, she replied:
Helen: I don't know, you see the older you get the less confidence you have, and when you are losing your mobility and things like that you lose an awful lot of confidence…
I: When you said, as you get older you lose your confidence, is there an example you can give me?
Helen: Oh well you see, well it's just a lack of mobility, I've had several broken bones and each time that slows you up a bit more and … well, I'm not allowed to drive for a year since I had this seizure.
Helen constructed her independence as now being more difficult. Factors that support independence were problematic: isolation in the community, reduced social support and physical decline all contributed to her loss of confidence and her ability to cope with unexpected demands.
Older adults also made personal assessments regarding their need for further assistance to manage their independence. In the following excerpt, Joan and Fred, aged in their late eighties, linked preparedness to reappraising their personal and social needs in later life:
Joan: That's one of the persuasive points I think about moving into a [retirement] village, we've got friends who say no I'd never want to go into one of those places, but I think it can be very short sighted, and ah not knowing what's going to happen today or tomorrow, ahm you're unprepared if you are just in a house on your own … unless you've got lots of things in place ready to communicate. We wanted to stay in our own home, didn't we?
Fred: Yes…
Social preparedness was also storied to be an important factor that supported independence in the community. Numerous participants gave examples of how neighbours were available to offer help, and the confidence they had in knowing assistance would be available:
Joe: Yes we don't have a car now, ah we are completed ah grounded so, mmm … yeah … so it's quite awkward really but ah we can still get around here around the place, around the section and in the garden…
Nell: our neighbours are very good…
Joe: yeah that's another important thing…
Nell: The lady next door, she will take us anywhere where we want to go and she usually ah contacts us nearly every morning to see if we've got any medical appointments or if we want to go shopping or anything.
Joe: She's lovely, yeah and people across the road, there are several in the street that ah we know.
Similarly, one couple, aged 88 and 90 years, identified sources of social support for independence, which included each other, relatives and neighbours. In the following story spontaneous assistance, which had been given to help carry in a heater, was interpreted as social preparedness, because help was available when it was needed:
Ron: And neighbours if they're fit and well would help, I am sure they would. I was impressed over this thing yesterday [assistance to carry heater into house] how much spare capacity we had in the way of human material…
I: To help you with the heater?
Liz: Yes.
Ron: Yes, to help us with the heater…
Liz: And once they had got it in, in the big box, shall we get it out of the box? The fellow who helped Ron, who was the first one on the scene, you see he's never been in the house before and the very fact of having neighbours in your house, they know where Ron might be in his chair you know, that he's not down in his study.
Concerns about managing independence in old age shaped understandings of being prepared. Older adults in our study were making assessments about how they would cope on their own and assessing their social preparedness, which reflected norms of independence and personal responsibility. This theme can be interpreted to reflect contemporary age-specific social expectations and cultural representations, which encourage decreased dependency by older adults on public welfare systems. Kemp and Denton (Reference Kemp and Denton2003: 757) urge consideration of social constructions of independence, which represents a shift from ‘collective to individual responsibility’, because many older adults will not remain independent, despite expectations of individual responsibility. Independence in later life is generally perceived as a required condition to enjoy life through feelings of being in control and not being a burden to others (Portacolone Reference Portacolone2011). However, fear of being a burden can shape how older adults experience their lives, both in material and emotional ways (Kemp and Denton Reference Kemp and Denton2003). This theme situates preparedness as a strategy that assists adaptation to being independent on one's own. However as Plath (Reference Plath2008) suggests, older adults' independence can be negatively experienced, because reduced financial, personal and social resources can contribute to neglect, isolation and reduced safety. The influence of personal and social vulnerability, and its negative consequences on older adults in disasters (Cutter, Boruff and Shirley Reference Cutter, Boruff and Shirley2003; Klinenberg Reference Klinenberg2002; Tuohy and Stephens Reference Tuohy and Stephens2011; WHO 2008), provides a specific context to Plath's view.
Portacolone (Reference Portacolone2011: 808) argues that the desire for independence is now a form of self-regulation that fosters personal control, and that a reduced institutional presence conveys ‘an ideology of freedom’ which requires individual initiative for further assistance. However, old age presents many challenges that may become a threat to independence, which must be personally managed. A study by Mack et al. (Reference Mack, Salmoni., Viverais-Dressler, Porter and Garg1997) on older adults' perceived risks to independence found personal health problems were of highest concern, which this study has also elucidated.
Age-related change in later life has been conceptualised to be a dynamic balance between negotiating resource loss and gain. Resource loss, such as declining functional ability, may influence how older adults consider and reappraise their personal and social resources in order to support and maintain independent living. From this perspective, adjusting and adapting to change can assist everyday function in later life (Baltes and Lang Reference Baltes and Lang1997; Lang, Rieckmann and Baltes Reference Lang, Rieckmann and Baltes2002). Baltes and Baltes (Reference Baltes, Baltes, Baltes and Baltes1990) have suggested that the maintenance of everyday function involves three adaptive processes, which positively contribute to enabling independent living. Their model of selective optimisation with compensation (SOC) proposed that as older adults seek adaptive and successful ageing, they may reduce activities (selection); spend more time and energy on specific tasks or priorities (optimisation); and use new ways of reaching a goal (compensation). In understanding the role of preparedness, older adults were selecting ways of adapting to their changed levels of personal and social resources, which included thinking about preparedness for end of life.
Our findings suggest that preparedness was a fundamental part of older adults' everyday experience, and was consequently a practice which was actively used to address health and independence. The centrality of preparedness within older adults' day-to-day lives has provided a more detailed map about ageing in an independent world and presents narratives about social practices concerned with adapting and managing age-related change. Any significant change in everyday circumstances of older adults lives has the potential to threaten independence. Consequently, many older adults must frequently re-evaluate, adjust and develop compensatory ways of reaching goals to maximise quality of life. In this way, anticipating and managing age-related challenges situates the concept of disaster preparedness within a broader framework of age-specific preparedness as older adults evaluate and prioritise goals and strategies to maintain independence and wellbeing.
Conclusion
Preparedness in the context of ageing is an adaptive concept that extends beyond disasters. Our findings suggest that older adults' meanings of preparedness were linked to managing physical health needs and social resources within the community to support preparedness in the context of old age. Health concerns informed preparedness, which was associated with anticipating health decline and the need for assistance. Examples of preparedness included actions such as purchasing medical health alarms, carrying medication when going out and using a walking frame to prevent falls. Social preparedness was concerned with levels of assistance from family and neighbours, which could additionally support independence.
Older adults in our study monitored their activities which were influenced by health concerns; and they focused their priorities on maintaining independence and autonomy. Understanding the primary goals of older adults, and how they are accomplished, is an area of relevance in the context of preparedness and ageing. Therefore, future research to extend understandings about the socio-cultural role of preparedness and how best to complement preparedness practices would assist older adults to remain autonomous, independent and integrated in their communities; and ultimately improve outcomes in a disaster context.
It is highly relevant for disciplines such as health, gerontology and emergency management to work collaboratively and consider the bigger story of ageing in the community. Situating emergency preparedness goals within a health perspective is likely to be more cogent for older adults, and taking a multidisciplinary perspective has the potential to improve significantly disaster outcomes for older adults.
