Tag Archives: demographics

Aging in an Age of Climate Change: Part 4, by Janelle Christensen

  Janelle Christensen, data program analyst, Lake Worth campus       Janelle Christensen, PhD, MPH (AAGE member since 2006). Janelle’s research interests lie at the intersection of disaster management and aging studies, exploring how community dwelling families respond to emergency preparedness and disaster planning while simultaneously providing care for family members with Alzheimer’s disease.  She completed both PhD in Applied Biocultural Medical Anthropology and a Masters in Public Health (MPH) at the University of South Florida and has done Socio-legal research in intentional communities (Camphill Communities) based on the care of individuals with developmental disabilities in both Germany and the United States while completing her MA in Sociology of Law. Janelle is currently working as a Program Data Analyst for the Health Information program at Palm Beach State College.

 

home 3

Photo credit: Gaby Viteri Darczuk, 2011

Elders and caregivers living in the Lake Okeechobee, Florida area provide a microcosm of such vulnerability and provide both insight into the difference between federal and local county policies, and potential success stories. The areas surrounding Lake Okeechobee was the site of one of the most deadly hurricanes to strike the United States in 1928 resulting in at least 1,836 dead (though it is estimated that there were far more).19–21 This area remains second only to New Orleans in vulnerability to hurricanes.22 (Zora Neal Hurston’s novel, Their Eyes Were Watching God, was based on this hurricane in the Lake Okeechobee area). Even with repairs on the dike surrounding the Lake which began in 2011, the area remains at risk.23,24

I interviewed twenty people providing care to someone with Alzheimer’s disease in Palm Beach County, Florida. Five of these families lived on in on the banks of Lake Okeechobee. All of the caregivers interviewed in this area were over the age of 40 themselves and caring for an adult parent with Alzheimer’s disease (all over the age of 65) who currently lived with them. Three of the five caregivers I interviewed who lived on the banks of Lake Okeechobee occupied federally funded “HUD” housing.25 Though the HUD buildings in Florida are usually constructed out of cinderblock (structurally stronger than wood framed homes), these particular buildings are located in hurricane prone areas and do not have hurricane shutters. Caregivers were told that if they so desired, they could install hurricane shutters on their rented HUD apartments, however, due to the financial barriers of doing so, none of the caregivers interviewed had installed them (Note: low income is a requirement for living in HUD housing, which would also preclude home improvements to rented property).

The lack of shutters was a concern not only for protecting windows from the impact of flying objects during hurricanes, but for protecting the contents of a home after the storm. Caregivers reported that crime rates increased after the hurricanes in 2004-2005. Some families are reluctant to evacuate in the future because they fear the loss of their property to theft. Caregivers interviewed expressed concern over the escalation in crime after future hurricanes because the local economy had deteriorated since 2004-2005. Many may choose not to evacuate in the past (or at least not to evacuate a great distance) because they want to be able to return and protect their belongings from the anticipated looting that has followed hurricanes.

Pahokee City Hall

Photo credit: Gaby Viteri Darczuk

There were other reasons cited for staying closer to home when evacuating: Special Needs Shelters,26 which might have more specific accommodations for someone with Alzheimer’s disease, were further away (approximately an hour) and only allowed one caregiver to be present. If they evacuated to the local shelter (located in a Bell Glade high school), then they could remain with their extended families. It is important to note that most of the city of Belle Glade is also on the banks of Lake Okeechobee. If the eye of a hurricane were to pass directly over Lake Okeechobee as it presumably did in 1928, there would be catastrophic flooding to the area and likely render even this shelter unsafe.

One caregiver was firm in evacuating for any hurricane threat, in large part because in addition to caring for her mother with Alzheimer’s disease, the caregiver also had a medical condition that qualified her for the Special Needs Shelter. This dyad evacuated for both Hurricanes Irene (2011) and Sandy (2012), even though the storms remained approximately 100 miles off the coast of Florida. Their experiences demonstrate the services that are available in Palm Beach County, should residents need them: before each storm, the county sent transportation to pick up both the caregiver and her mother and transport them to the Special Needs Shelter, where they could continue to receive necessary medical services. In addition, Palm Beach County coordinates with local Alzheimer’s care providers (i.e. Alzheimer’s Community Care) who provides specially trained volunteers to better address the needs of people with an Alzheimer’s disease or a related dementia during stressful disaster events. (Note: During 2011 and 2012, these dementia specific services were not deployed because the storms were not predicted to directly impact Florida). During the 2004-2005 hurricanes, this family was unable to return home after a hurricane due to the flooding in the area. The county and American Red Cross provided temporary housing in a skilled nursing facility where both the caregiver and her mother could receive care and necessary medical treatments. After the threat passed, and it was safe to do so, the county assisted in transporting them home.

The above example demonstrates a success story in service provision, coordination, and utilization. Palm Beach County has both the resources and the political impetus to provide these safety measures for its citizens. The same cannot be said for all of the counties that surround the shores of Lake Okeechobee.27 There can be a large variation in the availability of local resources and emergency management priorities from county to county. Furthermore, Lake Okeechobee has not received a direct hit from a hurricane in approximately 90 years, meaning the full capacity of even Palm Beach County to respond to a potential catastrophe has not been fully tested, especially as the intensity of hurricanes are predicted to increase as a result of warmer oceans.

The paradox facing many families is in an aging society is this: Those with the means to protect themselves in the event of a climate related disaster have less incentive to take the science behind climate change seriously than those who live at the margins, such as those who live below sea level in the 9th ward in New Orleans, Louisiana or elders living in HUD housing on the banks of Lake Okeechobee, Florida. However, those who are the most vulnerable often have the most difficulty prioritizing threats such as climate change; the threat of a stronger hurricane as a result of warmer oceans is much further from their thoughts than what they are going to eat and if they have enough medicine. For applied anthropologists (and others), advocating for policy that reduces emissions at the grass roots level is just one way to also advocate for the protection of vulnerable populations most likely to suffer during climate change induced disasters.

 

Pahokee FPL

Photo Credit: Gaby Viteri Darczuk

This entry was a continuation of the Aging in an Age of Climate Change series. To see the previous post, click HERE.

 

19. Barnes J. Florida Hurricane History. UNC Publishers; 2007:1–407.

20. Mykle R. Killer ’Cane: The Dealy Hurricane of 1928. Cooper Square Press; 2002:232.

21. Kleinberg E. Black Cloud: The Deadly Hurricane of 1928. New York, New York, USA: Carroll & Graf Publishers; 2003:283.

22. Leatherman S. 10 Most Vulnerable Areas to Hurricanes. Hurric Cent. 2006. Available at: http://www.hurricanecenter.com/hurricane-information/top-10-most-vulnerable-areas-to-hurricanes/. Accessed May 1, 2012.

23. Leatherman S, Zhang K, Xiao C. Lake Okeechobee, Florida: The next hurricane disaster? Water Resour Impact. 2007;9:5–7.

24. Morgan C. A Vulnerable Lake Okeechobee. Maimi Her. 2013. Available at: http://www.miamiherald.com/2013/09/20/3639411/a-vulnerable-lake-okeechobee.html.

25. U.S. Department of Housing and Urban Development (H.U.D.). 2014. Available at: http://portal.hud.gov/hudportal/HUD?src=/states/florida/offices.

26. Guidance on Planning for Personal Assistance Services in General Population Shelters. Fed Emerg Manag Agency. 2010:24. Available at: http://www.fema.gov/pdf/emergency/disasterhousing/guidance_plan_ps_gpops.pdf. Accessed February 2, 2011.

27. Map of Florida. Map-of-Florida.net. Available at: http://www.map-of-florida.net/florida/.

Aging in an Age of Climate Change: Part 3, by Janelle Christensen

 

Janelle Christensen, data program analyst, Lake Worth campus  Janelle Christensen, PhD, MPH (AAGE member since 2006). Janelle’s research interests lie at the intersection of disaster management and aging studies, exploring how community dwelling families respond to emergency preparedness and disaster planning while simultaneously providing care for family members with Alzheimer’s disease.  She completed both PhD in Applied Biocultural Medical Anthropology and a Masters in Public Health (MPH) at the University of South Florida and has done Socio-legal research in intentional communities (Camphill Communities) based on the care of individuals with developmental disabilities in both Germany and the United States while completing her MA in Sociology of Law. Janelle is currently working as a Program Data Analyst for the Health Information program at Palm Beach State College.

 

When Hurricane Katrina struck New Orleans1 in 2005, the death tolls were overwhelmingly among those over 65 years of age.2 Many were frail elders who were not prioritized during hospital evacuations.3 Others died in their homes, alone. Many were separated from families and stranded as the area struggled to rebuild.4

I am an anthropologists who has worked with aging populations in hurricane prone areas, specifically individuals with Alzheimer’s disease and related dementias and their caregivers in South Florida.5,6 For many anthropologists, climate change is not an abstract concept that may or may not affect humanity in the far off future. When models show that a warming climate and warmer oceans fuel more powerful hurricanes 7,8 and one lives in a coastal area, as I do, climate change is not far away. As Crate and Nuttall (2009) poignantly explain,9 climate change has an immediate impact on many groups around the globe, from the Sahara to the Arctic. As people living at the margins of society, or at the margins of habitable land, struggle to adapt to the symptoms of a disrupted climate, their stories are documented in the field notes and writings of anthropologists who work with these groups. To the people contending with the results of a changing climate, it is not a hypothetical: climate change is real, immediate, and personal. Likewise, when one works with and cares about the very people who are likely to be considered among the most expendable 3,10 should an inevitable hurricane hit one’s area, there is cause for concern.

In 2012, Hurricane Sandy struck New York and New Jersey. While the death toll was much lower than in Louisiana and Mississippi during Hurricane Katrina, of those who died as a direct or indirect result of Hurricane Sandy, most were over the age of 60.11 Decisions made by governors, hospital and nursing home administrators, and private citizens all played a role in the disproportionate death tolls during both Hurricane Katrina and Hurricane Sandy.1

To many, this is not surprising. As Fjord (2007) points out, the sick, disabled, and elderly are “the expected dead”.12 While elders might be cared for well enough under normal circumstances, all too often during a disaster, many of the most vulnerable are deprioritized. During Hurricane Katrina, buses that had been contracted for nursing home evacuations were commandeered by Federal agencies for other purposes.1314 Nursing homes were not often regarded as essential facilities and therefore, are not prioritized for power restoration after a storm.15At least two hospitals in New Orleans (Memorial Hospital and Lindy Boggs) did not evacuate many of the patients who needed the most intensive care. 10,16 Though neonates were evacuated after the storm and the ambulatory could be evacuated by boat when the hospital flooded, those who were elderly were left to die in the oppressive heat to which the elderly are particularly vulnerable. At both of these hospitals, morphine was administered in potentially lethal doses to many of the elderly patients (though charges of homicide were later dropped).3

Sheri Fink describes the challenging ethics that accompanied the allocation of scarce medical resources before Hurricane Sandy hit New York in her book 5 Days at Memorial. She notes that many of the lessons supposedly learned during Hurricane Katrina had failed to translate to prepared hospitals in New York as the storm approached.10 Generators were still located in flood-prone basements. Administrators and staff met to decide who should be kept on the limited number of electrically powered respirators should there be a prolonged loss of power. The protocol for deciding who is the most worthy of life-saving equipment and procedures is rarely established and clear. The allocation goals are supposedly to serve the “greatest good” but, as Fink asks, “what does the “greatest good” mean when it comes to medicine? Is it the number of lives saved? Years of life saved? Best ‘quality’ years of life saved? Or something else?”3 These questions hint at another: Should the younger populations be prioritized before the elderly? In answer to this, Fink cites a response from a woman participating in a focus group.

If a significant generation, if the senior citizens were cut in half that would alter our society. That means that, you know, just like you definitely don’t want your child to die, people don’t want to be grandmother-less, people don’t want to be grandfather-less… So, I am just a little concerned about the aftermath of just giving it to the youngest person.”3

Anthropologists such as Anthony Oliver-Smith and Susanne Hoffman have long argued that disasters act as spotlights that shine on societies’ collective values.17,18 Recent hurricanes have forced us to ask, “To what extent do our elders matter to us in the United States?” Certainly, not all people over the age of 65 are frail and ill. Many are strong and healthy. Others are wealthy and can purchase assistance if needed. However, for those that are unable to simply get in a car and evacuate, who rely on others to assist them with their wellbeing, and have few resources, how do we ensure that they are not left behind? How do we resist the mechanisms in place that seem to deprioritize those with the most lived experience because they are the most inconvenient to serve during a disaster?

(In the next post of this series Janelle will look at how these questions can help us understand the lives of older people in the Lake Okeechobee region of Florida, where she conducted ethnographic research)

1. A Failure of Initiative: Select Bipartisan Committee to Investigate the Preparation for and Response to Hurricane Katrina. Washington, D.C.; 2006:1–379.

2. Brunkard J, Namulanda G, Ratard R. Research Hurricane Katrina Deaths, Louisiana, 2005. Disaster Med Public Health Prep. 2008:1–9.

3. Fink S. Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital. New York, New York: Crown; 2013:576.

4. Adams V, Kaufman SR, Hattum T Van, Moody S. Aging Disaster: Mortality, Vulnerability, and Long-Term Recovery Among Katrina Survivors. Med Anthropol Q. 2011;30(3):247–270. doi:10.1080/01459740.2011.560777.Aging.

5. Christensen JJ. Hurricane Preparedness of Community-Dwelling Dementia Caregivers in South Florida by. 2012:1–354.

6. Christensen JJ, Richey ED, Heide Castañeda. Predictors of Hurricane Evacuation of Community-Dwelling Families Affected by Alzheimer’s. Am J Alzheimers Dis Other Demen. 2013.

7. Trenberth K. Warmer Oceans, Stronger Hurricanes: Evidence is mounting that global warming enhances a cyclone’s damaging winds and flooding rains. Sci Am Mag. 2007;297(1):44–51.

8. Emanuel K. Increasing destructiveness of tropical cyclones over the past 30 years. Nature. 2005;436(7051):686–8. doi:10.1038/nature03906.

9. Crate SA, Nuttall M. Introduction. In: Crate SA, Nuttall M, eds. Anthropology and Climate Change: From Encounters to Actions. Walnut Creek, California: Left Coast Press; 2009:9–38.

10. Fink SL. Rationing Medical Care: Health Officials Struggle With Setting Standards. ProPublica. December 21, 2009.

11. Deaths Associated with Hurricane Sandy October–November 2012. Morb Mortal Wkly Rep. 2013;62(20):393–397.

12. Fjord L. Disasters , Race , and Disability : [ Un ] Seen Through the Political Lens on Katrina. J Race Policy. 2007;3(1):46–66.

13. Hurricane Summit Proceedings. 2006:100. Available at: http://www.ahcancal.org/facility_operations/disaster_planning/Documents/HurricaneSummitHartfordReport.pdf.

14. Caring for Vulnerable Elders During a Disaster : National Findings of the 2007 Nursing Home Hurricane Summit. 2007:1–62.

15. Hyer K, Brown LM, Christensen JJ, Thomas KS. Weathering the storm: challenges to nurses providing care to nursing home residents during hurricanes. Appl Nurs Res. 2009;22(4):e9–e14. doi:10.1016/j.apnr.2008.11.001.

16. Gray B, Herbert K. Hosptials in Hurricane Katrina: Challenges Facing Custodial Institutions in a Disaster.; 2006:28.

17. Hoffman SM, Oliver-Smith A. The Angry Earth: Disaster in Anthropological Perspective. (Hoffman SM, Oliver-Smith A, eds.). New York: Routledge; 1999:350.

18. Hoffman SM, Anthony Oliver-Smith. Catastrophe & Culture: The Anthropology of Disaster. (Hoffman SM, Oliver-Smith A, eds.). Santa Fe, New Mexico: School for Advanced Research Press; 2002:316.

 

Aging in an Age of Climate Change: Part 2

On March 11, 2011, an unusually strong earthquake off the coast of northeastern Japan produced a tsunami that in some places reached as high as 40 meters. The massive wave crashed across the coastal towns, carrying massive boats and buildings before sweeping back out to sea, in an instance transforming the landscape into a wasteland. 15,884 people were confirmed dead as a direct result, and over 3000 more died in the aftermath. 2633 people are still considered missing, and over 260,000 were evacuated to temporary housing. A majority of those who died and almost half of those who were moved to temporary housing were adults over 60, often suffering from a combination of inadequate medical and caregiving assistance, emotional trauma and grief, and loneliness as a result of the displacement and the slow pace of recovery efforts. Suicides have been particularly high among older adults, and survivors’ risk of dementia is 1.3 times higher than the general population. Over 110,000 older adults in the areas most affected by the tsunami (including those evacuated from the area around the damaged Fukushima No. 1 Nuclear Power Plant) are certified as needing care. Fukushima, which has seen a 50% rise in seniors needing care since the disaster, just announced that it will be offering cash incentives of up to 450,000yen towards training and certification expenses to attract caregivers to the badly understaffed area. The last three years since the earthquake and tsunami have highlighted the larger issue of older adults’ vulnerability in the wake of natural disasters, many of which are now increasing in severity and impact as a result of climate change.

This past year in Japan has seen its share of climate related extremes, which, when combined with the changing demographic and residential trends, . Record snowfalls in northern Japan, for instance, resulted in hundreds of isolated villages, many of which, as a result of gradual depopulation over the last half century are mostly comprised of older adults. In early February, I joined a group of volunteers in Kyoto to shovel snow in one such community, located on the outer edge of the “city” limits, about an hour drive from downtown. According to the local community welfare director, of the 90 residents in this community, deep in the mountains, about 50 were over the age of 70, and while the plows had cleared many of the main roads, many could not leave their homes due to accumulated snowfall. Drifts blocked doorways, and ice covered the steps. “The snow is so frightening!” one long-time resident told me, “There are no young people to help us anymore. This place is going to disappear.”

After spending the morning shoveling we gathered in the senior community center, once the local elementary school to eat lunch and speak with some of the local residents. One of the organizers of the volunteer group spoke first: “Residents here pay into the same mandatory long-term health insurance plan as everyone else in the city, but don’t receive the services one has in the rest of the city! It is only one of many more communities where the insurance fees are just wasted. Volunteer groups like this one let them know that they are not abandoned, that there is still someone watching over them.”

At the bottom of the mountains, in the urbanized part of the city, the older adults are also the most keenly aware of global climate change, however, their main concern has been the increasing temperatures. “We used to get plenty of snow here in Kyoto,” my neighbor told me as the last remnants of the previous night’s snowfall melted off his gray shingled roof, “But these days we get one or two snowfalls and it melts right away.” Older Kyotoites notice these changes everywhere, from the water levels in the rivers to the timing of the peak of fall colors. The seasons that they grew up with are different than they remember them.

In 2013, Kyoto had its hottest summer on record (since 1946), with average temperatures 1.2 degrees (C) higher than average. By mid-August, a record 21,000 people had been hospitalized with heat stroke, about half of them over 65. The warming trend, beginning in 1930, is easily attributable to atmospheric Co2 and other greenhouse gases. The seas around Japan, which in the past had moderated these severe fluctuations in weather, are also warming, leading to more severe typhoons and even tornadoes, which were virtually unknown in Japan until about five years ago. At disaster prevention drills organized by local self-governing associations, those gathered are mostly older adults. “Things were a little different after 3.11,” one organizer told me at a recent drill, “But now the feeling has weakened; young people just think that they are going to live forever!” We were interrupted by a drill leader with a microphone who reminds us to remember things like medication and dentures when evacuating older people, and to clearly record how many adults will need diapers on our evacuation record paperwork.

The point I want to make here is not about the meteorological connections between snowstorms, typhoons, tornadoes, and climate change, but rather about the way that people interpret these uncertain weather changes to call attention to social, political, and demographic changes. How do people prepare for or prevent the uncertain? How do they assess their personal risk and the social effects climate change has on their future? As I informally polled snow shoveling volunteers and the those in attendance at disaster drills, it was clear that the consciousness of risk was not evenly distributed among generations. One result of this generational gap, in part structured by political systems of welfare, insurance, and community organizing, is an increased feeling among older adults that they are alone in their concern, that one cannot rely on the community or on formal assistance to fully prepare for the next disaster. Understanding aging in the age of climate change requires attention not only to the vulnerabilities in the wake of severe weather events, but also to the social and cultural environments in which relations of assistance and safety are created and the need for a global response that recognizes the complex dynamics of politics and population change.

 Jason Danely

Editor-in-Chief, Anthropology & Aging

Assistant Professor of Anthropology, Rhode Island College

Are you interested in contributing to this blog post series on aging in an age of climate change? write to journal@anthropologyandgerontology.com

“Aging in an Age of Climate Change” (Part 1)

Several of us have been involved in research around aging and climate change (enough for a special issue of Aging and Anthropology Perhaps? or a workshop?). When one considers the way aging is taking place around the world, and then looks at the effects of global climate change on the world`s populations, it is difficult to deny that we are at a crisis point. Natural disasters are not new, nor is the vulnerability of older people in the wake of these disasters. However, as older adults make up more of the population in areas prone to disaster, and as natural disasters become more fierce, frequent, and unpredictable, new challenges are being faced by disaster responders and by the communities afterward. An even greater challenge of halting detrimental human influence on climate change faces all of us as we consider the world we will live in 20, 30, or 40 years from now. If you live in India, the population change will look like this in about 36 years:

popindia2010

popindia2050

India is no exception to rapid population aging, and it is certainly no exception to the devastating effects of climate change.
Recent large-scale disasters in the Philippines and Japan have often highlighted the plight of older adults, especially those in need of medication, medical assistance and dietary needs, and the thousands who were unable to evacuate and have been lost. Almost two fifths of those killed in Typhoon Haiyan in the Philippines were over 60, and about 64% of those killed in the earthquake and tsunami in Japan were over 60.  After the Japanese earthquake and tsunami of 2011, suicides among older adults were not uncommon, and health of older adults spending prolonged periods in evacuee housing deteriorated at a much faster rate than in the general population. Older adults were also key to the recovery, comforting each other, becoming custodial grandparents for children who lost their parents. About two hundred older adults volunteered to help clean up the Fukushima nuclear power plant, some arguing that in contrast to younger people, they would be dying by the time the radioactivity would have serious effects.

In the following months, there will be regular posts from AAGE members on aging, climate change, and the role of anthropology within interdisciplinary efforts to improve research and policy from a global sociocultural perspective. Are younger generations looking to older generations for models of ecologically responsible lifestyles? How does climate change affect social and economic inequality in ways that impact inter-generational relationships? How will global climate change affect the older people who live in areas of the world you work in?

Jason Danely

Editor-in-Chief, Anthropology & Aging