ORIGINAL ARTICLE
Perceptions of disaster preparedness among older people in South Korea Myoungran Yoo Professor, Korea Armed Forces Nursing Academy, Daejeon, Korea
Mijung Lee Assistant Professor, Korea Armed Forces Nursing Academy, Daejeon, Korea
Dorothy Tullmann Director, MSN and DNP Programs, Charlottesville, Virginia, University of Virginia School of Nursing, USA
Submitted for publication: 26 February 2014 Accepted for publication: 16 January 2015
Correspondence: Mijung Lee Nursing Department Korea Armed Forces Nursing Academy Daejeon Korea Telephone: 82-10-5089-0247 E-mail: [email protected]
YOO M., LEE M. & TULLMANN D. (2016) Perceptions of disaster preparedness among older people in South Korea. International Journal of Older People Nursing 11, 18–23. doi: 10.1111/opn.12084
Older people are a major vulnerable population. During disasters, given their physical frailty, lower social status, loss of medications and medical care, the vulnerability of older people increases. The purpose of this study was to examine the perceptions of older people in Korea on various aspects of disaster preparedness to better understand their special needs and to facilitate appropriate disaster planning. The study was qualitative and used focus group interviews with 12 older people in one major city and one rural area of South Korea. Four themes were identified by the analysis of the interviews: defenceless state, reality of accepting limitations, strong will to live, importance of disaster preparedness governmental efforts for the older people. Findings indicated that preparation of shelters and transportation was critical to help older people survive in times of disasters and suggested that there should be active involvement of the government in terms of disaster planning, managing and preparing older people for disasters. In addition, healthy older people can be assets to disaster relief efforts by providing practical and emotional support for the most fragile older people. Older people can also provide knowledge of their special needs to the government to improve their disaster response policy. Key words: interview, older people, disater preparedness, South Korea
18
© 2015 John Wiley & Sons Ltd
Perceptions of disaster preparedness
What does this research add to existing knowledge in gerontology?
• • •
During disasters, older people have a strong will to live despite their poor mobility and physical condition. Older people are aware of their defenceless state during disasters and realise the importance of disaster preparedness. Older people can assist the government by pointing out the essential aspects of disaster relief for themselves so that the government can develop a tailored disaster policy for them.
What are the implications of this new knowledge for nursing care with older people?
• •
Nurses should consider the decreased mobility, dependency on medicine and lack of knowledge about disaster responses when providing disaster relief care for older people. Nurses can utilise healthy older people as care givers who can give practical help and emotional support for more fragile older people in times of disaster.
How could the findings be used to influence policy or practice or research or education?
• •
Policymakers should be aware of the great risk of vulnerable older people during disasters. Older people should be included in planning for disaster response to better meet their special needs and decrease their vulnerability.
Introduction A disaster intensly disrupts the various level of systemic structural, institutional, and functional ability of individuals and communities (Freudenburg, 1997). Natural disasters such as floods, tsunamis, earthquakes and hurricanes are priority public health issues because of their catastrophic effects including tremendous damage, demolition and loss of human life on the physical and environment (Bethel et al., 2011). Along with natural disasters, man-made disasters caused by human error such as oil leaks, nuclear or chemical blasts, and occupational accidents have also led to many
© 2015 John Wiley & Sons Ltd
injuries and great socio-economic losses (Gill et al., 2010). The Center for Research on the Epidemiology of Disasters (CRED, 2014) reported that 315 natural disasters occurred in 2013 and, because of the disasters, 22 279 people died, and the total economic cost of the disasters was $116 billion (USD). The 2004 earthquake and tsunami in South Asia and the 2008 earthquake in Sichuan China claimed hundreds of thousands of lives (Lo et al., 2012). Even though it is considered a safe place to live, South Korea is not exempt from disasters. South Korea has experienced typhoons, floods, drought and landslides. In 2002, Typhoon No. 15 Rusa caused the collapse of 17,000 buildings and destruction of other property damage with a total cost of $6.6 billion (USD; Chae et al., 2005). Additionally, a department store in Seoul collapsed in mid-1990 causing 501 deaths and a subway train fire killed 186 people in 2003, both examples of man-made disasters (Back & Kim, 2010). Vulnerable populations include those with chronic disease, those who are physically handicapped, and those underserved by healthcare services are at greater risk of negative health outcomes derived from disasters (Bethel et al., 2011). Many older people (65 years and older) are physically frail with impaired sensory abilities and mobility restrictions which make them a major vulnerable population during a disaster (Loke et al., 2012). Most older people are dependent on medicine and medical care, so the loss of these necessities during disasters increases the frailty of older people and hinders their adaptability (Fernandez et al., 2002). Older people with lower social and financial status and personal support have even greater risks during a disaster (Jones, 2008). Due to Japan’s 2003 tsunami and earthquake, people over 60 years of age accounted for 65% of the 3,000 deaths (House of Japan, 2011). When Hurricane Katrina hit the United States in 2005, older people made up 12% of the New Orleans Parish population but resulted in nearly 50% of the deaths (Jones, 2008). Assessment of the existing preparedness of older people to sustain the impact of disaster is essential to improve their preparedness for such events (Bethel et al., 2011). In addition, understanding what older people perceive about disasters and disaster preparedness as well as their special needs will also help to facilitate the planning and implementation of interventions to improve their preparedness and thereby decrease their vulnerability. The purpose of the study therefore was to examine the perceptions of older people in Korea on various aspects of disaster preparedness to better understand their special needs and to facilitate appropriate disaster planning.
19
M. Yoo et al.
Methods Design This descriptive qualitative study used focus group interviews to investigate perceptions of the older people on disaster preparedness in South Korea. The focus group interview was chosen to facilitate collection of diverse perspectives and stimulate interaction between participants through the generation of ideas as well as verbal reflections. This study was reviewed and approved by the Armed Forces Nursing Academy Review Board (Approved Number: MNRC-13IRB-27-01).
Sample and data collection To capture regional differences, this study was conducted in one major city and one rural area in South Korea in June, 2013. The participants were divided into two focus groups based on where they live: urban (n = 5) and rural (n = 7). To recruit participants, the primary investigator (PI) met the two mayors of the local areas to obtain permission to conduct the research. The two mayors of the local areas made an announcement of the research, and respondents were recruited at each area’s local senior centres. The PI then met the study participants, explained the study, provided copies of the consent form and encouraged them to ask questions about the study. All participants were informed that their responses would be anonymous and confidential. No names or personal information were written on any collected data. All participants signed an informed consent form and agreed to have their interview recorded. The participants’ (n = 12) ages were 60–80 (mean: 63) years, and they were divided into two groups: city and rural. Five (41.66%) participants lived in a major city, and seven (58.33%) lived in a rural area. Two semi-structured focus group interviews were conducted for each group, a total of four interviews. Each focus interview took about 40 minutes. The interviews were digitally audio-recorded, transcribed verbatim, and the accuracy of the transcripts was checked by re-reading the transcripts while the recording was played.
concluding question. The overriding research question was ‘What does disaster preparedness (preparation) mean to older people in South Korea?’
Data analysis The data were analysed according to Krueger (1998) qualitative content analysis of focus group interviews. Open coding was utilised to identify words, sentences or paragraphs. The PI examined the transcribed documents several times to deduct meaningful words, and based on the meaningful words, themes were generated. To avoid conveying different meanings due to varying translation processes, two authors (MY and ML) followed the World Health Organization (n.d.) guideline of process of translation and adaptation of instruments. One of the authors did forward translation from Korean to English, and one nursing faculty member, who is bilingual, examined the accuracy of forward translation and evaluated the cultural meanings of translation.
Results Four themes emerged from the analysis of the participants’ responses regarding disaster preparedness among older people in South Korea. These themes include defenceless state, reality of accepting limitations, strong will to live, importance of disaster preparedness governmental efforts for the older people. The themes were supported by the following paraphrased responses and quotes.
Defenceless state Some of the participants believe that the Korean government and its citizens do not give adequate thought and attention to disaster preparedness or know enough about how to respond disasters. There are not even shelters in which to live when a disaster strikes. We are not prepared at all. Because we haven’t experienced disasters like earthquakes we do not even think about disasters happening. I guess it is not just the older people but the majority of people who are at risk. If such a disaster happens and we lose our homes and do not
Materials The focus group interview questions were formulated by the PI and reviewed by two nursing faculty members who have knowledge of disaster preparedness. The questions were delivered in the following order: opening question, introductory question, transition question, major question, and
20
have shelters to which we can evacuate what would happen to us? There should be a place for us to go. In our village, there are no such locations (Respondent 1). During North Korean artillery attacks on Yeonpyeong Island, which is close to the North Korea coastline, I was surprised by the victim’s interview on TV. An anchor woman asked the victim in the shelter,
© 2015 John Wiley & Sons Ltd
Perceptions of disaster preparedness ‘How did you evacuate to the shelter?’ The victim replied ‘Is this place the shelter?’ Even people in Yeonpyeong Island, where a disaster had taken place, did not know where the shelter was. If an earthquake happens, to be honest, we would not know what we
Therefore, there should be some transportation vehicles available to move older people to safety. Helping them move out of the disaster area will increase their chances of survival. They should not be ignored or abandoned.
should do and how to respond. We would just run out of the building. Once we were out of the building, we would just frantically run about not knowing where to go. What can we possibly do?’ (Respondent 2).
Reality of accepting limitations The participants expressed that they cannot survive without help from others. They especially regretted their incapability to evacuate because of physical limitations. They said that when faced with catastrophic disasters, there was nothing more they could do. However, they also believe that rather than trying to overcome this reality, they should accept their disabilities. Furthermore, they also accept the brutal reality that younger people would likely not help them because they are more concerned about and focused on their own survival.
Importance of disaster preparedness governmental efforts for the older people The participants consider preparedness as the most important factor to save them during a disaster. Older people prioritise public education first, and this should be taken into consideration when disaster relief policies are developed for this vulnerable population. Older people requested that the government educate them as to what classifies as a disaster and how to prepare and respond to each disaster. The participants want to learn about practical measures rather than theoretical explanations of disasters. They emphasise the importance of regularly repeated training to become familiar with action plans in times of disasters. Informing citizens about disasters is the first priority for policy
I don’t think I can survive. I cannot even go anywhere because of the
makers. Therefore politicians should consider how to deliver disaster
pain in my leg. Older people cannot do anything if they are
response education to older people. Personally, I hope that disaster
abandoned. We cannot ask for help. Everyone would only be
preparedness training be practical and want to learn the preparedness
concerned about their own survival. The young can easily receive
strategies not in the classrooms but in the field. In the past, we used to
necessary supplies when disaster relief teams provide supplies in
action based drills in case of North Korean attack; we actually
shelters or at the disaster site but the older people cannot. We cannot
gathered at certain evacuation place and stored emergency foods
expect the disaster relief teams to bring us supplies but it would be a
(Respondent 3).
great help if somebody would. We don’t like to ask others to do so but we desperately hope that somebody will do something for us (Respondent 8).
A strong will to live Even though they have physical and social limitations, older people have a strong will to live, and even if they have physical discomforts, they would do their best to evacuate during a disaster. However, they need transportation assistance and, in the long run, government assistance. Even though they may now be in good physical condition, they want policies for assisting others who have physical impairments. The participants acknowledged that they too will eventually experience physical difficulties as growing old is inevitable. They deeply understand the difficulties of more fragile older people and showed a willingness to help them in times of disasters. During earthquakes, we cannot sit still. I could run if I needed to evacuate in order to survive; my legs would not hurt and we would run as best we could. However, there will be some old people who cannot even walk. Some might crawl to safety; others would be unable to do even that (Respondent 6). © 2015 John Wiley & Sons Ltd
Places like Japan are said to have less impact from earthquakes since they are well prepared and the government educates the public based on previous cases of serious earthquakes. At home, there should be necessities ready for immediate use like those prepared in Japanese homes (Respondent 1). If we need to evacuate, we should pack necessary items to bring with us beforehand. We would like to know how much to bring; what important things to carry. We should prepare medications in advance since they are essential to our daily living (Respondent 12).
In addition, the participants said that there should be an official over-arching disaster relief department that focuses exclusively on older people. The designated government department should play a role in planning, managing and training personnel for older people’s disaster preparedness. The participants also suggested a practical way of education that uses a senior citizen centre or a local healthcare centre for education, given its accessibility and connectivity to older people. In addition, the participants showed eagerness to contribute to disaster policy and disaster preparedness plans, even for minute details. 21
M. Yoo et al. I suggest that we need to build shelters in every village and there should be an emergency transportation system for those who cannot move because of their disabilities. I think I am relatively healthy given my age, so I will help less healthy people. But we still need transportation and education on how to survive until the rescue squad arrives in case we are trapped. I also suggest the government use the senior center for disaster preparedness education since older people know the location and frequently gather there (Respondent 7). We will do whatever we can to contribute to disaster preparedness for ourselves. But more importantly, health care centres or local government offices should take responsibility. The designated department should show us how to deal with disasters rather than leave citizens to decide individually on response strategies. Civil servants should be more involved, developing and managing disaster plans. Based on the government instructions, we could help weak older people to store materials they should have, explain simple disaster preparedness strategies several times, and make them calm down by holding their hands. We are more than neighbours; we are family to each other (Respondent 12).
Discussion This qualitative study revealed rich information about what older people in South Korea perceive about disaster preparedness. These insights may assist healthcare providers and governmental agencies in understanding what policies might be helpful to assist older people in disaster preparedness. Firstly, there is an urgent need of disaster preparedness for older people in South Korea. The older people interviewed in this study pointed out that South Korea does not have a strong awareness of and foundation for disaster preparedness. They specifically argued the need of shelter and transportation systems for them during disasters. This finding is in accordance with recommendations for disaster preparedness from previous disasters. Aldrich and Benson (2008) proposed that there should be a separate shelter for the older people and an evacuation system that includes transporting not only the older people but also their medications and supplies. Moreover, McGuire et al. (2007) argued that safe evacuation of and shelter for older people is essential for their survival. If older people’s needs are not met during disasters, their fears and concerns can increase resulting in more short- and long-term harm (Sugimoto et al., 2012). Secondly, the participants in this study insist that disaster preparedness for older people should be led by the government. The government should be more attentive to disaster preparedness policies and take leading roles to assist older people. Furthermore, there should be designated departments 22
which take care of vulnerable population groups such as older people and provide practical, appropriate, regular disaster preparedness education and training. Previous research addressed the importance of government’s role in disaster preparedness. Sugimoto et al. (2012) suggested that government leadership and accountability are crucial to mitigate the effects of disaster. Moreover, Barnes et al. (2008) argued that the disaster preparedness is mainly a social matter demanding governmental involvement and that it is not the individual but the government which holds the primary responsibility in the occurance of a disaster. Thirdly, older people can contribute to preparedness for disasters using their strong sense of community demonstrated by their willingness to be volunteers to provide practical and emotional support for fragile older people in disasters. Furthermore, older people can offer their strength and experience and be a model of resilience and resourcefulness to other members of community (Powell et al., 2009). Based on their strong sense of community, older people can organise self-help groups to identify their own needs in a detailed manner and propose their special needs to government or community to promote disaster relief policies (Burton & Breen, 2005). Government officials would benefit from examining current disaster preparedness policies and work with other groups with knowledge of the needs of older people to develop policies that would help protect older people when a disaster occurs. There were some limitations to this study. First of all, we examined two focus groups with a total of only 12 participants. Such a small number prevents generalisability to a larger population. Secondly, the authors did not include participants from the northern part of Korea where disasters have historically occurred more frequently. Therefore, the study might exclude a broader view of disaster perceptions of older people from that area. For these reasons, results may not be generalisable to the entire target population. The insights gained from this study provide a beginning to understanding about older people in South Korea and their lack of security regarding disaster preparedness. Future studies are needed with a larger sample size from a broader geographical area. The data from this study could also be used to develop a survey to quantify the findings. Such data could then be more generalisable and better guide disaster preparedness policies and education programmes to assist older people in preparing for disasters.
Conclusion This study examined the perceptions of older people in South Korea using focus group interviews. The study reveals that © 2015 John Wiley & Sons Ltd
Perceptions of disaster preparedness
the older people identified their current state as defenceless in the face of disasters and accepted the reality of their limitations. The study participants showed a strong will to live and stressed the importance of disaster preparedness lead by the government. Furthermore, the study participants suggested disaster preparedness interventions such as public education, action-based training and utilising local centres for disaster relief. Healthcare providers and policymakers should take into account older people’s limitations and special needs as part of disaster relief by preparing shelters and transportation systems, developing practical education programs and utilising older people as great resource in disaster response team.
Implications for practice Healthcare practitioners should be aware of that older people are at great risk during disasters due to their decreased mobility, dependence on medicine, and lack of knowledge about how to respond to disasters. However, at the same time, healthy older people can be valuable assets in disaster preparedness by not only providing physical and emotional support to more fragile older people but also communicating their special needs to their government and proposing ways to promote better disaster relief policies. The needs of older people in times of disaster, such as shelters and transportation, should be addressed urgently. The government should take a leading role in assisting older people by developing disaster preparedness policies and having designated departments to take care of this vulnerable population.
Contributions Study design MY; data collection and analysis: MY, ML, DT and manuscript preparation: ML, DT.
References Aldrich N. & Benson W.F. (2008) Disaster preparedness and the chronic disease needs of vulnerable older people. Preventing Chronic Disease Public Health Research, Practice, and Policy 5, A27. Back M. & Kim H. (2010) Analysis of hospital disaster in South Korea from 1990 to 2008. Yonsei Medicine Journal 51, 965– 970.
© 2015 John Wiley & Sons Ltd
Barnes M.D., Hanson C.L., Novilla L.M.B., Meacham A.T., Mclntyre E. & Erickson B.C. (2008) Analysis of media agenda setting during and after hurricane Katrina: implications for emergency preparedness, disaster response, and disaster policy. American Journal of Public Health 98, 604–610. Bethel J.W., Foreman A.N. & Burke S.C. (2011) Disaster preparedness among medically vulnerable populations. American Journal of Preventive Medicine 40, 139–143. Burton A. & Breen C. (2005) Older refuges in humanitarian emergencies. The Lancet Supplement 360(Suppl.), s47–s48. Center for Research on the Epidemiology of Disasters (2014) 2013 Disasters in Numbers. Available at: http://www.cred.be/download/ download.php?file=sites/default/files/Disasters-in-numbers2013.pdf (accessed 14 August 2014). Chae E.H., Kim T.W., Rhee S.J. & Henderson T.D. (2005) The impact of flooding on the mental health of affected people in South Korea. Community Mental Health Journal 41, 633–645. Fernandez L., Byard D., Lin C., Benson S. & Barbera J.A. (2002) Frail elderly as disaster victims: emergency management strategies. Prehospital Disaster Medicine 17, 67–74. Freudenburg W.R. (1997) Contamination, corrosion, and the social order: an overview. Current Sociology 45, 19–40. Gill D.A., Picou J.S. & Ritchie L.A. (2010) Crime and Criminal Justice in Disaster. Carolina Academic Press, Durtham, NC. House of Japan (2011) Most Disaster Victims Elderly. Available at: http://www.houseofjapan.com/local/most-disaster-victims-elderly (accessed 13 August 2013). Jones J.C. (2008) Hurricane Katrina Death Tally 1000 – Half of Them Elderly. Available at: http://www.healthline.com/blogs/ headline_connects/2008/08/hurricanekatrina-death-tally (accessed 13 August 2013). Krueger R.A. (1998) Analyzing & Reporting Focus Group Results (Focus Group Kit 6). Sage, Thousand Oaks, CA. Lo H.A., Su C. & Chou F.H. (2012) Disaster psychiatry in Taiwan: a comprehensive review. Journal of Experimental and Clinical Medicine 4, 77–81. Loke A.Y., Lai C. & Fung O.W.M. (2012) At-home disaster preparedness of elderly people in Hong Kong. Geriatrics & Gerontology International 12, 524–531. McGuire L.S., Ford E.S. & Okoro C.A. (2007) Natural disasters and older US people with disabilities: implications for evacuation. Disasters 31, 49–56. Powell S., Plouffe L. & Gorr P. (2009) When aging and disasters collide: lessons from 16 interventional case studies. Radiation Protection Dosimetry 134, 202–206. Sugimoto A., Krull S., Nomura S., Morita T. & Tsubokura M. (2012) The voice of the most vulnerable: lessons from the nuclear crisis in Fukushima, Japan. Bulletin of the World Health Organization 90, 629–630. World Health Organization (n.d.) Process of Translation and Adaptation of Instruments. Available at: http://www.who.int/substance_abuse/ research_tools/translation/en/ (accessed 13 August 2013).
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Perceptions of disaster preparedness among older people in South Korea Myoungran Yoo Professor, Korea Armed Forces Nursing Academy, Daejeon, Korea
Mijung Lee Assistant Professor, Korea Armed Forces Nursing Academy, Daejeon, Korea
Dorothy Tullmann Director, MSN and DNP Programs, Charlottesville, Virginia, University of Virginia School of Nursing, USA
Submitted for publication: 26 February 2014 Accepted for publication: 16 January 2015
Correspondence: Mijung Lee Nursing Department Korea Armed Forces Nursing Academy Daejeon Korea Telephone: 82-10-5089-0247 E-mail: [email protected]
YOO M., LEE M. & TULLMANN D. (2016) Perceptions of disaster preparedness among older people in South Korea. International Journal of Older People Nursing 11, 18–23. doi: 10.1111/opn.12084
Older people are a major vulnerable population. During disasters, given their physical frailty, lower social status, loss of medications and medical care, the vulnerability of older people increases. The purpose of this study was to examine the perceptions of older people in Korea on various aspects of disaster preparedness to better understand their special needs and to facilitate appropriate disaster planning. The study was qualitative and used focus group interviews with 12 older people in one major city and one rural area of South Korea. Four themes were identified by the analysis of the interviews: defenceless state, reality of accepting limitations, strong will to live, importance of disaster preparedness governmental efforts for the older people. Findings indicated that preparation of shelters and transportation was critical to help older people survive in times of disasters and suggested that there should be active involvement of the government in terms of disaster planning, managing and preparing older people for disasters. In addition, healthy older people can be assets to disaster relief efforts by providing practical and emotional support for the most fragile older people. Older people can also provide knowledge of their special needs to the government to improve their disaster response policy. Key words: interview, older people, disater preparedness, South Korea
18
© 2015 John Wiley & Sons Ltd
Perceptions of disaster preparedness
What does this research add to existing knowledge in gerontology?
• • •
During disasters, older people have a strong will to live despite their poor mobility and physical condition. Older people are aware of their defenceless state during disasters and realise the importance of disaster preparedness. Older people can assist the government by pointing out the essential aspects of disaster relief for themselves so that the government can develop a tailored disaster policy for them.
What are the implications of this new knowledge for nursing care with older people?
• •
Nurses should consider the decreased mobility, dependency on medicine and lack of knowledge about disaster responses when providing disaster relief care for older people. Nurses can utilise healthy older people as care givers who can give practical help and emotional support for more fragile older people in times of disaster.
How could the findings be used to influence policy or practice or research or education?
• •
Policymakers should be aware of the great risk of vulnerable older people during disasters. Older people should be included in planning for disaster response to better meet their special needs and decrease their vulnerability.
Introduction A disaster intensly disrupts the various level of systemic structural, institutional, and functional ability of individuals and communities (Freudenburg, 1997). Natural disasters such as floods, tsunamis, earthquakes and hurricanes are priority public health issues because of their catastrophic effects including tremendous damage, demolition and loss of human life on the physical and environment (Bethel et al., 2011). Along with natural disasters, man-made disasters caused by human error such as oil leaks, nuclear or chemical blasts, and occupational accidents have also led to many
© 2015 John Wiley & Sons Ltd
injuries and great socio-economic losses (Gill et al., 2010). The Center for Research on the Epidemiology of Disasters (CRED, 2014) reported that 315 natural disasters occurred in 2013 and, because of the disasters, 22 279 people died, and the total economic cost of the disasters was $116 billion (USD). The 2004 earthquake and tsunami in South Asia and the 2008 earthquake in Sichuan China claimed hundreds of thousands of lives (Lo et al., 2012). Even though it is considered a safe place to live, South Korea is not exempt from disasters. South Korea has experienced typhoons, floods, drought and landslides. In 2002, Typhoon No. 15 Rusa caused the collapse of 17,000 buildings and destruction of other property damage with a total cost of $6.6 billion (USD; Chae et al., 2005). Additionally, a department store in Seoul collapsed in mid-1990 causing 501 deaths and a subway train fire killed 186 people in 2003, both examples of man-made disasters (Back & Kim, 2010). Vulnerable populations include those with chronic disease, those who are physically handicapped, and those underserved by healthcare services are at greater risk of negative health outcomes derived from disasters (Bethel et al., 2011). Many older people (65 years and older) are physically frail with impaired sensory abilities and mobility restrictions which make them a major vulnerable population during a disaster (Loke et al., 2012). Most older people are dependent on medicine and medical care, so the loss of these necessities during disasters increases the frailty of older people and hinders their adaptability (Fernandez et al., 2002). Older people with lower social and financial status and personal support have even greater risks during a disaster (Jones, 2008). Due to Japan’s 2003 tsunami and earthquake, people over 60 years of age accounted for 65% of the 3,000 deaths (House of Japan, 2011). When Hurricane Katrina hit the United States in 2005, older people made up 12% of the New Orleans Parish population but resulted in nearly 50% of the deaths (Jones, 2008). Assessment of the existing preparedness of older people to sustain the impact of disaster is essential to improve their preparedness for such events (Bethel et al., 2011). In addition, understanding what older people perceive about disasters and disaster preparedness as well as their special needs will also help to facilitate the planning and implementation of interventions to improve their preparedness and thereby decrease their vulnerability. The purpose of the study therefore was to examine the perceptions of older people in Korea on various aspects of disaster preparedness to better understand their special needs and to facilitate appropriate disaster planning.
19
M. Yoo et al.
Methods Design This descriptive qualitative study used focus group interviews to investigate perceptions of the older people on disaster preparedness in South Korea. The focus group interview was chosen to facilitate collection of diverse perspectives and stimulate interaction between participants through the generation of ideas as well as verbal reflections. This study was reviewed and approved by the Armed Forces Nursing Academy Review Board (Approved Number: MNRC-13IRB-27-01).
Sample and data collection To capture regional differences, this study was conducted in one major city and one rural area in South Korea in June, 2013. The participants were divided into two focus groups based on where they live: urban (n = 5) and rural (n = 7). To recruit participants, the primary investigator (PI) met the two mayors of the local areas to obtain permission to conduct the research. The two mayors of the local areas made an announcement of the research, and respondents were recruited at each area’s local senior centres. The PI then met the study participants, explained the study, provided copies of the consent form and encouraged them to ask questions about the study. All participants were informed that their responses would be anonymous and confidential. No names or personal information were written on any collected data. All participants signed an informed consent form and agreed to have their interview recorded. The participants’ (n = 12) ages were 60–80 (mean: 63) years, and they were divided into two groups: city and rural. Five (41.66%) participants lived in a major city, and seven (58.33%) lived in a rural area. Two semi-structured focus group interviews were conducted for each group, a total of four interviews. Each focus interview took about 40 minutes. The interviews were digitally audio-recorded, transcribed verbatim, and the accuracy of the transcripts was checked by re-reading the transcripts while the recording was played.
concluding question. The overriding research question was ‘What does disaster preparedness (preparation) mean to older people in South Korea?’
Data analysis The data were analysed according to Krueger (1998) qualitative content analysis of focus group interviews. Open coding was utilised to identify words, sentences or paragraphs. The PI examined the transcribed documents several times to deduct meaningful words, and based on the meaningful words, themes were generated. To avoid conveying different meanings due to varying translation processes, two authors (MY and ML) followed the World Health Organization (n.d.) guideline of process of translation and adaptation of instruments. One of the authors did forward translation from Korean to English, and one nursing faculty member, who is bilingual, examined the accuracy of forward translation and evaluated the cultural meanings of translation.
Results Four themes emerged from the analysis of the participants’ responses regarding disaster preparedness among older people in South Korea. These themes include defenceless state, reality of accepting limitations, strong will to live, importance of disaster preparedness governmental efforts for the older people. The themes were supported by the following paraphrased responses and quotes.
Defenceless state Some of the participants believe that the Korean government and its citizens do not give adequate thought and attention to disaster preparedness or know enough about how to respond disasters. There are not even shelters in which to live when a disaster strikes. We are not prepared at all. Because we haven’t experienced disasters like earthquakes we do not even think about disasters happening. I guess it is not just the older people but the majority of people who are at risk. If such a disaster happens and we lose our homes and do not
Materials The focus group interview questions were formulated by the PI and reviewed by two nursing faculty members who have knowledge of disaster preparedness. The questions were delivered in the following order: opening question, introductory question, transition question, major question, and
20
have shelters to which we can evacuate what would happen to us? There should be a place for us to go. In our village, there are no such locations (Respondent 1). During North Korean artillery attacks on Yeonpyeong Island, which is close to the North Korea coastline, I was surprised by the victim’s interview on TV. An anchor woman asked the victim in the shelter,
© 2015 John Wiley & Sons Ltd
Perceptions of disaster preparedness ‘How did you evacuate to the shelter?’ The victim replied ‘Is this place the shelter?’ Even people in Yeonpyeong Island, where a disaster had taken place, did not know where the shelter was. If an earthquake happens, to be honest, we would not know what we
Therefore, there should be some transportation vehicles available to move older people to safety. Helping them move out of the disaster area will increase their chances of survival. They should not be ignored or abandoned.
should do and how to respond. We would just run out of the building. Once we were out of the building, we would just frantically run about not knowing where to go. What can we possibly do?’ (Respondent 2).
Reality of accepting limitations The participants expressed that they cannot survive without help from others. They especially regretted their incapability to evacuate because of physical limitations. They said that when faced with catastrophic disasters, there was nothing more they could do. However, they also believe that rather than trying to overcome this reality, they should accept their disabilities. Furthermore, they also accept the brutal reality that younger people would likely not help them because they are more concerned about and focused on their own survival.
Importance of disaster preparedness governmental efforts for the older people The participants consider preparedness as the most important factor to save them during a disaster. Older people prioritise public education first, and this should be taken into consideration when disaster relief policies are developed for this vulnerable population. Older people requested that the government educate them as to what classifies as a disaster and how to prepare and respond to each disaster. The participants want to learn about practical measures rather than theoretical explanations of disasters. They emphasise the importance of regularly repeated training to become familiar with action plans in times of disasters. Informing citizens about disasters is the first priority for policy
I don’t think I can survive. I cannot even go anywhere because of the
makers. Therefore politicians should consider how to deliver disaster
pain in my leg. Older people cannot do anything if they are
response education to older people. Personally, I hope that disaster
abandoned. We cannot ask for help. Everyone would only be
preparedness training be practical and want to learn the preparedness
concerned about their own survival. The young can easily receive
strategies not in the classrooms but in the field. In the past, we used to
necessary supplies when disaster relief teams provide supplies in
action based drills in case of North Korean attack; we actually
shelters or at the disaster site but the older people cannot. We cannot
gathered at certain evacuation place and stored emergency foods
expect the disaster relief teams to bring us supplies but it would be a
(Respondent 3).
great help if somebody would. We don’t like to ask others to do so but we desperately hope that somebody will do something for us (Respondent 8).
A strong will to live Even though they have physical and social limitations, older people have a strong will to live, and even if they have physical discomforts, they would do their best to evacuate during a disaster. However, they need transportation assistance and, in the long run, government assistance. Even though they may now be in good physical condition, they want policies for assisting others who have physical impairments. The participants acknowledged that they too will eventually experience physical difficulties as growing old is inevitable. They deeply understand the difficulties of more fragile older people and showed a willingness to help them in times of disasters. During earthquakes, we cannot sit still. I could run if I needed to evacuate in order to survive; my legs would not hurt and we would run as best we could. However, there will be some old people who cannot even walk. Some might crawl to safety; others would be unable to do even that (Respondent 6). © 2015 John Wiley & Sons Ltd
Places like Japan are said to have less impact from earthquakes since they are well prepared and the government educates the public based on previous cases of serious earthquakes. At home, there should be necessities ready for immediate use like those prepared in Japanese homes (Respondent 1). If we need to evacuate, we should pack necessary items to bring with us beforehand. We would like to know how much to bring; what important things to carry. We should prepare medications in advance since they are essential to our daily living (Respondent 12).
In addition, the participants said that there should be an official over-arching disaster relief department that focuses exclusively on older people. The designated government department should play a role in planning, managing and training personnel for older people’s disaster preparedness. The participants also suggested a practical way of education that uses a senior citizen centre or a local healthcare centre for education, given its accessibility and connectivity to older people. In addition, the participants showed eagerness to contribute to disaster policy and disaster preparedness plans, even for minute details. 21
M. Yoo et al. I suggest that we need to build shelters in every village and there should be an emergency transportation system for those who cannot move because of their disabilities. I think I am relatively healthy given my age, so I will help less healthy people. But we still need transportation and education on how to survive until the rescue squad arrives in case we are trapped. I also suggest the government use the senior center for disaster preparedness education since older people know the location and frequently gather there (Respondent 7). We will do whatever we can to contribute to disaster preparedness for ourselves. But more importantly, health care centres or local government offices should take responsibility. The designated department should show us how to deal with disasters rather than leave citizens to decide individually on response strategies. Civil servants should be more involved, developing and managing disaster plans. Based on the government instructions, we could help weak older people to store materials they should have, explain simple disaster preparedness strategies several times, and make them calm down by holding their hands. We are more than neighbours; we are family to each other (Respondent 12).
Discussion This qualitative study revealed rich information about what older people in South Korea perceive about disaster preparedness. These insights may assist healthcare providers and governmental agencies in understanding what policies might be helpful to assist older people in disaster preparedness. Firstly, there is an urgent need of disaster preparedness for older people in South Korea. The older people interviewed in this study pointed out that South Korea does not have a strong awareness of and foundation for disaster preparedness. They specifically argued the need of shelter and transportation systems for them during disasters. This finding is in accordance with recommendations for disaster preparedness from previous disasters. Aldrich and Benson (2008) proposed that there should be a separate shelter for the older people and an evacuation system that includes transporting not only the older people but also their medications and supplies. Moreover, McGuire et al. (2007) argued that safe evacuation of and shelter for older people is essential for their survival. If older people’s needs are not met during disasters, their fears and concerns can increase resulting in more short- and long-term harm (Sugimoto et al., 2012). Secondly, the participants in this study insist that disaster preparedness for older people should be led by the government. The government should be more attentive to disaster preparedness policies and take leading roles to assist older people. Furthermore, there should be designated departments 22
which take care of vulnerable population groups such as older people and provide practical, appropriate, regular disaster preparedness education and training. Previous research addressed the importance of government’s role in disaster preparedness. Sugimoto et al. (2012) suggested that government leadership and accountability are crucial to mitigate the effects of disaster. Moreover, Barnes et al. (2008) argued that the disaster preparedness is mainly a social matter demanding governmental involvement and that it is not the individual but the government which holds the primary responsibility in the occurance of a disaster. Thirdly, older people can contribute to preparedness for disasters using their strong sense of community demonstrated by their willingness to be volunteers to provide practical and emotional support for fragile older people in disasters. Furthermore, older people can offer their strength and experience and be a model of resilience and resourcefulness to other members of community (Powell et al., 2009). Based on their strong sense of community, older people can organise self-help groups to identify their own needs in a detailed manner and propose their special needs to government or community to promote disaster relief policies (Burton & Breen, 2005). Government officials would benefit from examining current disaster preparedness policies and work with other groups with knowledge of the needs of older people to develop policies that would help protect older people when a disaster occurs. There were some limitations to this study. First of all, we examined two focus groups with a total of only 12 participants. Such a small number prevents generalisability to a larger population. Secondly, the authors did not include participants from the northern part of Korea where disasters have historically occurred more frequently. Therefore, the study might exclude a broader view of disaster perceptions of older people from that area. For these reasons, results may not be generalisable to the entire target population. The insights gained from this study provide a beginning to understanding about older people in South Korea and their lack of security regarding disaster preparedness. Future studies are needed with a larger sample size from a broader geographical area. The data from this study could also be used to develop a survey to quantify the findings. Such data could then be more generalisable and better guide disaster preparedness policies and education programmes to assist older people in preparing for disasters.
Conclusion This study examined the perceptions of older people in South Korea using focus group interviews. The study reveals that © 2015 John Wiley & Sons Ltd
Perceptions of disaster preparedness
the older people identified their current state as defenceless in the face of disasters and accepted the reality of their limitations. The study participants showed a strong will to live and stressed the importance of disaster preparedness lead by the government. Furthermore, the study participants suggested disaster preparedness interventions such as public education, action-based training and utilising local centres for disaster relief. Healthcare providers and policymakers should take into account older people’s limitations and special needs as part of disaster relief by preparing shelters and transportation systems, developing practical education programs and utilising older people as great resource in disaster response team.
Implications for practice Healthcare practitioners should be aware of that older people are at great risk during disasters due to their decreased mobility, dependence on medicine, and lack of knowledge about how to respond to disasters. However, at the same time, healthy older people can be valuable assets in disaster preparedness by not only providing physical and emotional support to more fragile older people but also communicating their special needs to their government and proposing ways to promote better disaster relief policies. The needs of older people in times of disaster, such as shelters and transportation, should be addressed urgently. The government should take a leading role in assisting older people by developing disaster preparedness policies and having designated departments to take care of this vulnerable population.
Contributions Study design MY; data collection and analysis: MY, ML, DT and manuscript preparation: ML, DT.
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