A qualitative survey of household emergency preparedness for the elderly and the medically frail living in coastal urban communities


  • Tara N. Heagele, PhD, RN, PCCN, EMT




frail elderly, disabled persons, disasters, disaster planning, civil defense, hazard, emergency, preparedness, planning, readiness, kit, resilience, qualitative, situational analysis, emergency management, protective action decision model


Objective: To understand how elderly and medically frail adults have experienced disasters and how this experience impacts what they do now to prepare for disasters and to generate theory regarding the process through which community members prepare for disasters.

Design: This study employed a qualitative descriptive methodology, Situational Analysis (SA), to explore the social processes of disaster preparedness in vulnerable community members. The Protective Action Decision Model was used to inspire the interview guide and initial coding of the data. Discourse analysis was performed on noninterview data.

Setting: A coastal urban community heavily damaged by Hurricane Sandy in 2012.

Participants: Convenience sample of 33 elderly or medically frail community members.

Results: Based on the findings, it was theorized that these community members are unprepared for disasters. Their lack of preparedness is due in large part to a lack of education on how best to prepare. If these community members are incidentally prepared, it is largely due to their past experience with disaster or their professional experience. The preparedness discourse did not recognize the extent to which elderly and medically frail populations rely on institutions and social support networks to meet their disaster resilience antecedents.

Conclusions: Community interventions such as distributing disaster supply kits and offering evacuation assistance can help to overcome situational impediments to preparedness and provide the best chance for community members to survive disasters without becoming ill or injured. Study results can inform emergency plans and policy efforts to better meet the needs of these community members during disasters.

Author Biography

Tara N. Heagele, PhD, RN, PCCN, EMT

Assistant Professor, Hunter- Bellevue School of Nursing, Hunter College, The City University of New York, New York


Al-Rousan TM, Rubenstein LM, Wallace RB: Preparedness for natural disasters among older US adults: A nationwide survery. Am J Public Health. 2014; 104(3): 506-511.

Doran KM, McCormack RP, Johns EL, et al.: Emergency department visits for homelessness or inadequate housing in New York City before and after Hurricane Sandy. J Urban Health: Bull New York Acad Med. 2016; 93(2): 331-344.

Powell S, Plouffe L, Gorr P: When ageing and disasters collide: Lessons from 16 international case studies. Radiat Protect Dosimetry. 2009; 134(3-4): 202-206.

Tuohy R, Stephens C, Johnston D: Older adults? disaster preparedness in the context of the September 2010–December 2012 Canterbury earthquake sequence. Int J Disaster Risk Reduction. 2014; 9: 194-203.

Baker LR, Cormier LA: Disaster preparedness and families of children with special needs: A geographic comparison. J Commun Health. 2013; 38(1): 106-112.

True NA, Adedoyin JD, Shofer FS, et al.: Level of disaster preparedness in patients visiting the emergency department: Results of the civilian assessment of readiness for disaster (CARD) survey. Prehospital Disaster Med. 2013; 28(2): 127-131.

Heagele TN, Pacquiao D: Disaster vulnerability of elderly and medically populations. Health Emerg Disaster Nurs. 2019; 6:50-61.

Heagele TN: Lack of evidence supporting the effectiveness of disaster supply kits. Am J Public Health. 2016; 106(6):979-982.

Hoopes-Haplin S: The impact of superstorm Sandy on New Jersey towns and households. 2013. Available at https://doi.org/doi:10.7282/T36H4FTS. Accessed April 11, 2019.

Manuel J: The long road to recovery: Environmental health impacts of Hurricane Sandy. Environ Health Perspect. 2013; 121(5): 152-159.

Holloway I, Wheeler S: Qualitative research in nursing and healthcare. 3rd ed. Oxford, UK: Wiley-Blackwell; 2010.

IS-368: Including people with disabilities and others with access and functional needs in disaster operations. FEMA Emergency Management Institute Website. Available at https://training.fema.gov/is/courseoverview.aspx?code=is-368. Accessed October 14, 2016.

Clarke AE: Situational Analysis: Grounded Theory After the Postmodern Turn. Thousand Oaks, CA: Sage Publications; 2005.

Lindell MK, Perry RW: The protective action decision model: Theoretical modifications and additional evidence. Risk Analysis. 2012; 32(4): 616-632.

Miller KG, Kopp RE, Browning JV, et al.: Sea-level rise in New Jersey fact sheet. 2014. Available at http://geology.rutgers.edu/images/stories/faculty/miller_kenneth_g/Sealevelfactsheet7112014update.pdf. Accessed April 10, 2019.

Ready: Prepare. Plan. Stay informed. Federal Emergency Management Agency Website. Available at http://www.ready.gov. Accessed April 11, 2019.

Golden S: STORM Seniors Taking on Readiness Measures: Family disaster plan. Freehold, NJ: Monmouth County Sheriff’s Office; 2013.

Parents and Friends of Pascack Valley Learning Center: Surviving Sandy: The Superstorm that Reshaped Our Lives. Airmont, NY: Ambient Funding Corporation; 2013.

Bergstrand K, Mayer B, Brumback B, et al.: Assessing the relationship between social vulnerability and community resilience to hazards. Soc Indic Res. 2015; 122(2): 391-409.

Houston JB, Spialek ML, Cox J, et al.: The centrality of communication and media in fostering community resilience: A framework for assessment and intervention. Am Behav Sci. 2015; 59(2): 270-283.

Kulig JC, Edge DS, Townshend I, et al.: Community resiliency: Emerging theoretical insights. J Commun Psychol. 2013; 41(6): 758-775.

Muller VM, Burke RV, Berg BM, et al.: A mixed-methods pilot study of disaster preparedness and resiliency among faith-based organizations. Prehospital Disaster Med. 2014; 29(2): 127-133.

Becker JS, Johnston DM, Paton D, et al.: Salient beliefs about earthquake hazards and household preparedness. Risk Anal. 2013; 33(9): 1710-1727.

Christensen JJ, Castaneda H: Danger and dementia: Caregiver experiences and shifting social roles during a highly active hurricane season. J Gerontol Soc Work. 2014; 57(8): 825-844.

de Boer J, Wouter Botzen WJ, Terpstra T, et al.: More than fear induction: Toward an understanding of people’s motivation to be well-prepared for emergencies in flood-prone areas. Risk Anal. 2015; 35(3): 518-535.

Terpstra T, Lindell MK: Citizens’ perceptions of flood hazard adjustments: An application of the protective action decision model. Environ Behav. 2013; 45(8): 993-1018.

Zakour MJ: Effects of support on evacuation preparedness of persons with disabilities. J Soc Work Disability Rehabil. 2015; 14(1): 1-22.

Trento L, Allen S: Hurricane Sandy: Nutrition support during disasters. Nutr Clin Pract. 2014; 29(5): 576-584.

Dostal PJ: Vulnerability of urban homebound older adults in disasters: A survey of evacuation preparedness. Disaster Med Public Health Preparedness. 2015; 9(3): 301-306.

Zidek C, West E, Holmes J, et al.: A survey comparison of rural versus urban residents and household preparedness. Home Healthcare Nurse. 2014; 32(7): 420-429.

Tuohy R, Johnston D, Stephens C: Disaster preparedness: Older adults’ perspectives. Int J Emerg Manage. 2015; 11(1): 46-61.

Bethel JW, Foreman AN, Burke SC. Disaster preparedness among medically vulnerable populations. Am J Prev Med. 2011; 40(2): 139-143.

Clay LA, Goetschius JB, Papas MA, et al.: Influence of mental health on disaster preparedness: Findings from the Behavioral Risk Factor Surveillance System, 2007-2009. Homeland Secur Emerg Manage. 2014; 11(3): 375-392.

Perman J, Shoaf K, Kourouyan A, et al.: Disaster kit contents: A comparison of published guidelines for household preparedness supplies. Int J Mass Emerg Disasters. 2011; 29(1): 1.

Tuohy R, Johnston D, Stephens C: Qualitative research can improve understandings about disaster preparedness for independent older adults in the community. Disaster Prev Manage. 2014; 23(3): 296-308.

Thompson K, Every D, Rainbird S, et al.: No pet or their person left behind: Increasing the disaster resilience of vulnerable groups through animal attachment, activities and networks. Animals. 2014; 4(2): 214-240.

Gershon RR, Portacolone E, Nwankwo EM, et al.: Psychosocial influences on disaster preparedness in San Francisco recipients of home care. J Urban Health. 2017; 2017(94): 606-618.

Eisenman DP, Glik D, Maranon R, et al.: Developing a disaster preparedness campaign targeting low-income Latino immigrants: Focus group results for Project PREP. J Health Care Poor Underserved. 2009; 20(2): 330-345.

Levac J, Toal-Sullivan D, O’Sullivan T: Household emergency preparedness: A literature review. J Commun Health. 2012; 37(3): 725-733; 729p.

Lindell M: North American cities at risk: Household responses to environmental hazards. In: Joffe H, Rossetto T, Adams J, eds. Cities at Risk: Living with Perils in the 21st Century. New York, NY: Springer; 2013: 109-130.

Christopher MA, Goldstein J: The visiting nurse service of New York’s response to Hurricane Sandy. Am J Nurs. 2014; 114(10): 55-62.

Heagele TN: A qualitative study of household emergency preparedness of the elderly and the medically frail living in coastal urban environments. [dissertation]. Newark, NJ: Rutgers University; 2018.



How to Cite

Heagele, PhD, RN, PCCN, EMT, T. N. “A Qualitative Survey of Household Emergency Preparedness for the Elderly and the Medically Frail Living in Coastal Urban Communities”. Journal of Emergency Management, vol. 19, no. 2, Mar. 2021, pp. 143-6, doi:10.5055/jem.0493.