Caregivers are an invaluable resource: they are expected to provide care, support, facilitate navigation through health and social systems, and advocate for their loved ones. In 2018, approximately 8 million Canadians aged 15 and over, including 1.5 million adults aged 65 and over, provided unpaid care to a relative or friend. With the aging of the population, the declining birth rate and geographic remoteness, many older Canadians will have to assume a caregiving role despite their own health problems.
The role of caregivers is crucial, especially during disasters and as we have seen with the COVID-19 pandemic. Since Hurricane Katrina hit Louisiana in 2005 and caused a disproportionate number of deaths among adults aged 60 and over, there have been growing calls to adequately prepare caregivers to prepare for emergencies.
How do caregivers deal with disasters?
What research tells us
A recent systematic review identified 21 studies about caregiver experiences during disasters.(1) Five themes were identified:
1. A lack of education and training
Caregivers are often not prepared to deal with crises and emergency situations. It is important to set up training programs, but also community support to improve the resilience and autonomy of caregivers to face emergency situations, particularly among vulnerable populations.
2. Stressors related to medication and their supply
To prepare for disasters, caregivers should identify the medication and medical devices needed for their loved ones. Also, it would be advantageous to keep a certain amount of medication to avoid interrupting treatment in the event of an evacuation.
3. Factors influencing the decision-making process during disasters
Making decisions during emergencies places an emotional burden on caregivers. It seems to be all the more difficult for caregivers who are already uncomfortable making decisions on behalf of their loved one. Past and current social roles of the caregiver and care recipient have been highlighted as a strong indicator of the effectiveness of a caregiver's decision-making. Social roles refer to the status of the relationship between the care recipient and caregiver, such as mother and daughter, wife and husband, niece and grandfather, etc.
Other factors may influence decision-making: the health of the care recipient (for example, a degenerative disease or physical disability), if the caregiver lives far away, if there is no emergency plan already in place, having a lower socio-economic status (and thus having limited access to resources), having a limited or no social network, not sharing the same perceptions towards risks, being fearful, lacking trust in authorities and emergency shelters, etc.
4. Obstacles related to disasters
Lack of information and training is a major barrier to caregivers providing care in a disaster setting and needs to be addressed BEFORE a disaster strikes. Many people rely on emergency services, but these can be delayed, hence the importance of: knowing how to adapt care as needed, having a clear plan for when and how to evacuate, as well as an emergency kit (food, medication in original containers, non-perishable food, etc.). There are also social barriers, such as fear of stigma (for example, being perceived as vulnerable), lack of support in emergency shelters, and physical barriers to accessing these shelters.
5. Factors promoting resilience
Knowing what to do before, during and after a disaster, having a positive attitude, a high socio-economic status and having already experienced an emergency are elements that promote resilience according to studies. Life experiences and knowledge of caregivers can also help them deal with emergency situations.
What to do now?
Whether you are a caregiver or an older adult, you need to plan your response to disasters before they happen.
- Determine if you are at risk and learn what you can do to prepare for it.
- If you live in a high-risk area, check what options are available to you and correspond to your values: take permanent shelter by moving or stay put and plan an emergency plan that takes into account different scenarios.
- Health professionals are a reliable source of information and can help you prepare. Take advantage of a routine visit to broach the subject!
- Learn about resources for caregivers in the event of a disaster.
- Prepare an emergency kit and list the medications you need on a regular basis. If possible, try to have a small supply just in case.
