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Japan's Lesson: Older People in United States May Be Vulnerable

The displaced need a place to go

When 80-year-old Sumi Abe and her grandson were pulled alive from the rubble in Japan more than a week after the earthquake and tsunami, it was cause for celebration — but also a reflection of the society that left the oldest and weakest most vulnerable to the disaster.

Just as in the United States, where young people are moving away from family and into cities, older people are increasingly left on their own in suburbs, small towns and villages in Japan. Japan's population is skewed older than the United States' — 23 percent of its citizens are over 65, compared with 13 percent here — but the problems of transportation and relocation of older residents are the same.

In Ishinomaki, Miyagi Prefecture, where Abe was miraculously found alive nine days after the quake, 20 percent of the population is over 65. And circumstances in which grandchildren live in close proximity to grandparents are becoming rarer.

"I'm all right," Abe told the rescue crew when she was lifted out of the rubble, the Associated Press reported. "I have a pain in my leg because something fell on it, but otherwise I have no complaints."

She was incredibly lucky, but the disaster points to the need to implement plans for helping older and infirm people in times of disaster. That point also was made in the aftermath of Katrina in New Orleans, and while state and local governments there have instituted plans, it's a little like shutting the barn door after the horse has escaped. In U.S. cities and towns untouched by disaster of such magnitude, planning has lagged.

'We're not keeping up'

The Japanese experience can be instructive, according to Richard Jackson, director and senior fellow of the Global Aging Initiative at the Center for Strategic and International Studies.

"Japan has long experience with earthquakes and tsunamis, and even so, the response has not been thoroughly effectual," he said, noting the large proportion of older people in that country, and especially in the rural provinces where the tsunami was the harshest. He said the percentage of older people in the United States is growing and moving toward a time in about 20 years when it will be what Japan's is today.

"I suspect we're not keeping up [with the need to plan for older victims]," he said, adding that he doesn't think many other countries have done so either. "We are headed where Japan is today. It's also the magnitude of the age wave, but also the ability to build consensus around shared national goals. Japan has a guiding aging doctrine. In the United States, we tend to approach it piecemeal — health care, long-term care, accessibility of transportation."

Ironically, just as the earthquake's consequences were being felt in Japan, a group of Japanese experts was presenting a paper at a conference in Cincinnati discussing how to use social welfare facilities devoted to older clients as evacuation centers and shelters.

According to the paper by Keiko Kitagawa, Tadashi Nagaie and Mika Tahara, older people tend not to evacuate when told to do so by authorities, making them more likely to become trapped like Abe, or to try to leave when it's too late.

According to a report in the New York Times, that's exactly what happened to many older residents of Natori, Japan. A 33-year-old taxi driver named Jun Kikuchi drove around after the earthquake asking a number of older residents whether they wanted a ride to a higher spot. They refused, and when the tsunami was over, their homes were all washed away, their fates unknown.

Next: Helping the displaced. >>

Helping the displaced

If the older residents do escape, the three Japanese experts said in their paper, their lives are often disproportionately affected by the aftermath of the disaster. They tend to be more disoriented, suffer more because of unfamiliar food or shelter, and may be in desperate need of medications they left behind. The experts recommended that long-term care facilities or adult day care centers be promoted as places where displaced older folks can go.

In a study in Japan, the experts found that 64.7 percent of long-term care facilities said they would accept evacuees from a disaster and 51 percent of facilities for the disabled would do so, but the population was not aware of that availability. A Centers for Disease Control and Prevention report for the United States discussed preparations for nursing home and long-term care facility residents in disasters, but did not suggest that outsiders go to those facilities in disaster situations.

Disaster experts also recommend that older people prepare disaster "go kits." Those kits should not only contain provisions such as high-nutrition canned or dried food and bottled water, but also names and numbers of relatives, a list of medications taken, dosages and doctors' names, a medical history with chronic conditions, extra batteries for hearing aids, and easily transported protective clothing like a hat or foldable poncho.

A report by Professor Thomas Glass of the Johns Hopkins University Population Center, published in the spring 2006 issue of Public Policy and Aging Report, called for:

  • Mapping of areas where older populations are high.

  • Enlisting volunteer organizations to name neighborhood captains to mobilize evacuations in cases of disaster.

  • Publicizing go kits so people know what they need.

  • Preemptively evacuating older people from an area when a full-scale evacuation might be premature.

Elaine S. Povich is a veteran Washington-based reporter.

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