Psychological First Aid for Older Adults

The management of acute stress reactions following disasters and mass violence generally aims to foster resiliency, prevent chronic emotional problems, and minimize long-term deterioration in quality of life. Knowing who can benefit the most from acute postdisaster intervention involves having an understanding of risk and resilience factors for different groups. There are interesting discrepancies in the field of disaster research concerning these factors in older adults. On the one hand, there appears to be a certain level of resilience in older adults. A number of reviews of the disaster literature conclude that in postdisaster settings older adults tend to report lower levels of distress and fewer impairments in psychological functioning than do younger adults. It appears that when other factors (e.g., depression, anxiety) are controlled for, the maturity and experience that comes with age has a protective effect for older adults, particularly when there is little trauma (life threat, injury, bereavement, which are actually risk factors for postdisaster PTSD), as opposed to exposure to physical destruction and property loss. In actuality, the highest symptom levels postdisaster are often found among middle-aged adults (age 40 to 59) compared with young (19 to 39) and older adults (over age 60), suggesting a potential heightened burden because of caretaking responsibilities.

One the other hand, older adults who are frail or who have mobility issues, reduced social or economic resources, prior trauma, sensory or cognitive impairments, or mental or physical health issues have been shown to be vulnerable to the effects of disaster. For instance, elderly with mobility impairments often experience significant barriers to effective rescue and care. Additionally, elders may be vulnerable because they may be seen as expendable, are less likely to leave their homes for financial reasons, and are least likely to obtain financial help because of the stigma attached to accepting aid and the concern that aid will put them over the amount of money that they can collect from other sources under Social Security guidelines. They are more likely to accept assistance such as health care and transportation than income assistance because they see this as welfare. In shelter settings, they have been shown to request and receive little attention if there are no family or friends present. One hopes that further research will be able to identify the mediating and moderating factors that contribute to either resilient or vulnerable outcomes.

In the immediate phase following traumatic events, for those individuals reporting mild to moderate distress or functional impairments, psychological first aid (PFA) has been recommended by many reviews and consensus efforts as a first line of intervention considering more formal interventions. The goals of PFA are to promote safety, attend to practical needs, enhance coping and stability, and connect survivors with additional resources. One of the most operationalized and consensus-based PFA approaches is the Psychological First Aid Field Operations Guide (2nd edition), developed by the National Child Traumatic Stress Network (NCTSN) and the National Center for Posttraumatic Stress Disorder (NCPTSD). This model of PFA is based closely on the five empirically supported intervention principles for facilitating positive adaptation following traumatic events that were identified by Stevan Hobfoll and his colleagues in a review of the broad literature base applied to early and midterm interventions in disasters and mass violence situations. Those factors are (a) promoting sense of safety, (b) promoting calming, (c) promoting sense of self- and community-efficacy, (d) promoting connectedness, and (e) instilling hope. PFA is additionally intended to be flexible to the needs of the survivor, modularized depending on the context and needs, and sensitive to timing, context, age, culture, and preference of the survivor. The field guide includes particular guidelines for working with older adults, and a special version of the field guide for nursing homes has expanded those guidelines.

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