International Psychogeriatrics (2016), 28:1, 1120 

C International Psychogeriatric Association 2015

doi:10.1017/S1041610215001210

REVIEW
Mental health implications for older adults after natural
disasters a systematic review and meta-analysis
...........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

Georgina Parker,1 David Lie,2 Dan J. Siskind,2,3,4 Melinda Martin-Khan,3

Beverly Raphael,5,6 David Crompton2,4 and Steve Kisely2,3,4,7
1
Royal Brisbane and Womens Hospital, Brisbane, Queensland, Australia
2
Rehabilitation Academic Clinical Unit, Metro South Division of Mental Health Service, Brisbane, Queensland, Australia
3
School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
4
Centre for Neuroscience Recovery and Mental Health, Diamantina Health Partners, Brisbane, Queensland, Australia
5
School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
6
School of Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
7
Griffith Institute of Health, Griffith University, Brisbane, Queensland, Australia

ABSTRACT

Background: Natural disasters affect the health and well-being of adults throughout the world. There is some
debate in the literature as to whether older persons have increased risk of mental health outcomes after exposure
to natural disasters when compared with younger adults. To date, no systematic review has evaluated this.
We aimed to synthesize the available evidence on the impact of natural disasters on the mental health and
psychological distress experienced by older adults.
Design: A meta-analysis was conducted on papers identified through a systematic review. The primary
outcomes measured were post-traumatic stress disorder (PTSD), depression, anxiety disorders, adjustment
disorder, and psychological distress.
Results: We identified six papers with sufficient data for a random effects meta-analysis. Older adults were
2.11 times more likely to experience PTSD symptoms and 1.73 more likely to develop adjustment disorder
when exposed to natural disasters when compared with younger adults.
Conclusions: Given the global rise in the number of older adults affected by natural disasters, mental health
services need to be prepared to meet their needs following natural disasters, particularly around the early
detection and management of PTSD.

Key words: mental health, post-traumatic stress disorder, older persons, natural disaster, meta-analysis

Introduction storms, and floods in the United States, China,

and Taiwan (Norris et al., 2002b, Jia et al.,
There is growing interest in the psychopathological 2010; Paranjothy et al., 2011). These events can
consequences of natural disasters for older adults in vary in suddenness, level of exposure to danger,
the context of worldwide aging (Cherniack, 2008). dislocation, or economic impact (Cherniack, 2008).
As older adults form an increasing proportion Cyclones, hurricanes, and floods are usually
of those exposed to natural disaster (Cherniack, associated with advance warning in contrast
2008), it is important to understand their needs at to earthquakes and tsunamis that result in
all phases of disaster response (Guha-Sapir et al., sudden impact. Older adults often form a
2011). disproportionately higher percentage of casualties
The research on disasters and older adults and have less ability to relocate at short notice with
primarily focuses on events such as earthquakes, potential consequences of psychological morbidity
post disaster (Kilijanek and Drabek, 1979).
Correspondence should be addressed to: Dr Dan J. Siskind, Associate Professor There is some debate in the literature on the
and Clinical Academic Psychiatrist, Mobile Intensive Rehabilitation Teams comparative risk of natural disasters on older adults
(MIRT), 519 Kessels Rd, MacGregor, Qld 4109, Australia. Phone: +61-7- when compared with younger adults. Some studies
3167-8430; Fax: +61-7-3167-8377. Email: d.siskind@uq.edu.au. Received 24
Feb 2015; revision requested 8 May 2015; revised version received 30 Jun 2015; have suggested that increasing age is associated with
accepted 1 Jul 2015. First published online 27 July 2015. an overall greater risk of mental health outcomes
12 G. Parker et al.
during a disaster (Yang et al., 2003; Jia et al., 2010).
This is possibly because older adults are often in
worse health before a disaster, and less able to
seek assistance after a natural disaster, with increase
in resulting morbidity and mortality (Ticehurst
et al., 1996; Jia et al., 2010). The older adults also
appear to have a greater sense of loss, with even
a minor injury provoking the fear of loss of self-
reliance (Goldstraw et al., 2012). By contrast, other
studies have reported no age-related differences
in mental health outcomes for older adults post
disaster (Knight et al., 2000).
There have been four hypotheses for older adults
varying psychological responses to natural disasters.
The inoculation hypothesis suggests that prior
experiences of disaster result in decreased emotional
reactivity to subsequent disaster exposure, placing
younger adults at high risk of adverse mental health
outcomes (Thompson et al., 1993). The maturation
hypothesis suggests that older adults develop an
adaptive coping style with greater resilience to
psychological distress than younger adults (Knight
et al., 2000). The burden hypothesis suggests that
it is the middle-aged adults, rather than the older
adults, who are at the highest risk of psychological
distress because of greater social and financial
responsibilities in the wake of a natural disaster
(Thompson et al., 1993; Cherry, 2009). Lastly,
the exposure hypothesis proposes that older adults
are at the greatest risk of mental health outcomes
because of a lower likelihood of receiving advanced
warnings, reluctance to evacuate, disruption to
accustomed patterns of life, and a sense of
deprivation resulting from their personal, physical,
and social losses post disaster (Ticehurst et al.,
1996; Yang et al., 2003; Jia et al., 2010).
Similarly, when attempting to define what
constitutes an older adult, no one clear definition
of older age is available. The most commonly cited
cut-off for older adults in the literature is the age
of 6065 years (Tinker, 1993). However, there
is variability within the literature. Cross-culturally,
there are differences in the cultural loading of age,
with frailty and disability contributing to whether an
individual is considered an older adult. For the
purpose of this study, we used the current United
Nations cut-off for older population, i.e. age more
than 60 years (WHO, 2014).
We undertook a systematic review and meta-
analysis to better determine the evidence of any of
the four competing hypotheses. In particular, we
examined whether older adults are at an increased
risk of adverse mental health outcomes, including
post-traumatic stress disorder (PTSD) symptoms,
psychological distress, and depressive symptoms
after exposure to a natural disaster compared with
younger adults. This information could help to
inform the planning of age-specific services and
resources from the context of disaster.
Methodology
Search and selection strategy
We conducted a systematic literature review of
the following databases from database inception
to 24 March 2014 to identify peer-reviewed
studies reporting on age cohort differences
for mental health outcomes in response to a
natural disaster: MEDLINE, CINAHL, PubMed,
PsycINFO, ANZRC, and Health Source Nursing
Academic Edition, Scopus, Embase, LILAC,
PILOTS, and Cochrane databases. The search used
the following key terms: natural disaster, aged,
mental Health, and well-being. The list of
comprehensive search terms is provided in Sup-
plementary Table S1 (available as supplementary
material attached to the electronic version of this
paper at www.journals.cambridge.org/jid_IPG).
Only publications in peer-reviewed journals and
English language were considered.
Inclusion and exclusion criteria
Inclusion and exclusion criteria were established
(Supplementary Table S1), and three authors
reviewed the papers (Georgina Parker, David Lie,
and Dan Siskind). Studies were included if they
presented a clear hypothesis, including comparison
of age cohorts as a factor for mental health outcomes
after natural disaster exposure. In addition, the
study had to clearly define age cohorts when assess-
ing the impact of a natural disaster. The literature
review included studies that used definition of age
as more than 60 to 65 years as the cut-off for
older adults. Studies were excluded if they had
insufficient data, either as published in the paper or
following attempts to contact the authors, or if they
were of insufficient quality (see section on Quality
Evaluation). As the study goal was to examine
impact of natural disasters on mental health, we
excluded subtypes of disasters that were secondary
to human error, terrorism, or technological failure.
Statistical analysis
The data from the included papers were extracted
by Georgina Parker, and validated by Steve Kisely
and Dan Siskind. Specific mental health outcomes
were included in the meta-analysis if they were
reported in at least two included studies. We
used Review Manager Version 5.3 to calculate a
pooled estimate of the association of age cohorts
and mental health outcomes reported post disaster.
Meta-analyses were undertaken for rates of PTSD,

Figure 1. Older adults mental health and natural disasters ow diagram.
depression, anxiety disorders, and adjustment dis-
orders. Further, sensitivity analyses were performed
to examine the effect of sudden impact (earthquakes
and tsunamis) versus advanced warning events (cyc-
lones, floods, and storms) and quality of research.
To check for heterogeneity between studies, both
the Q and I2 tests of heterogeneity were used as
well as visual inspection of forest plots. The Q and
I2 statistics provide an estimate of the percentage of
variability due to heterogeneity rather than chance
alone. We used the random effects model for all the
analyses given the heterogeneity of the data.
For any outcomes where there were at least
ten studies, we tested for publication bias using
funnel plot asymmetry where low p-values suggest
publication bias.
Quality evaluation
As there is no agreed quality assessment tool
for epidemiological prevalence studies, we adapted
a modified assessment tool based on published
STROBE and JHNEBP guidelines (von Elm et al.,
2008; Dearholt et al., 2013) provided in Sup-
plementary Table S2 (available as supplementary
material attached to the electronic version of this
paper at www.journals.cambridge.org/jid_IPG).
The evaluation conducted by Georgina Parker,
David Lie, and Dan Siskind allowed for an overall
rating of high, moderate, or low for each study based
on key objectives. These included design, sampling,
Mental health of older adults post natural disaster 13
bias control, methodology, data extraction, and
suitability of analysis.
Results
In the initial electronic searches, 1,216 citations
were identified, of which 92 papers were potentially
relevant and assessed for eligibility (Figure 1). We
excluded 80 papers that did not meet inclusion
criteria, leaving 12 papers for formal review. A
review of the reference lists of these 12 papers and
a hand search of additional papers identified no
additional papers. The 12 papers were reviewed
for quality. Six were appraised as high, one as
moderate, and five as of low quality. The six low
and moderate quality papers were excluded and
only the six studies assessed to be of high quality
were included in the meta-analysis. Consensus was
reached for all the ratings.
Studies included retrospective cohort, prospect-
ive cohort, and case-control designs. The samples
came from five countries, including two high-
income (Australia and Taiwan), one upper-middle
income (China), and two lower-middle income
(India and Indonesia) countries as defined by
the World Bank (2013). Four studies were on
earthquakes (Ticehurst et al., 1996; Yang et al.,
2003; Jia et al., 2010; Kun et al., 2013) and two
were on tsunami (Viswanath et al., 2012; Musa et al.,
2014).
14 G. Parker et al.

Table 1. Included studies

AGE
MEASURES COHORTS
(DISORDER: MONTHS N IN YEARS
STUDY DISASTER DESIGN SCALE) PD (% FEMALE) SAMPLING (%)
...........................................................................................................................................................................................................................................................................................................................

Jia et al., 2008 China, Cross- PTSD: 15 276 (46.4%) Random Young 1859
2010 Sichuan sectional PCL-C sampling (50%
earth- Distress: affected Old >60
quake GHQ-12 geographic (50%)
sub-districts
Kun et al., 2008 China, Cross- PTSD: HTQ 3 1,820 (48.1%) Random Young 1534
2013 Sichuan sectional and sampling (19.3%)
earth- DSM-IV affected Middle 3564
quake PTSD items geographic (58.4%)
sub-districts Old >65
(22.3%)
Musa et al., 2009 West Cross- MDD: >24 137 (69.5%) Stratified Young 1825
2014 Sumatra sectional DASS-21 cluster (26.5%)
and Aceh GAD: sampling Middle 2640
tsunami DASS-21 (27.9%)
Stress: and 4155;
DASS-21 (24.5%)
Old 5676
(21.1%)
Ticehurst 1989 Prospective PTSD: IES 624 3,007 (57.4%) Interview Young <65
et al. Australia, cohort Distress: personal (78.8%)
(1996) Newcastle GHQ-12 and neigh- Old >65
earth- borhood (22.2%)
quake damage,
#earth-
quakes
experienced
Viswanath 2004 India Cross- PTSD: >1 438 (NS) Geographic Young 1959
et al., tsunami sectional ICD-10; displace- (83%)
2012 MDD: ment Old >60
ICD-10; evacuee (17%)
GAD: shelter
ICD-10;
Adjustment
Dx
Yang et al., 1999 Cross- PTSD: 34 663 (58.4%) Case series Young <44
2003 Taiwan sectional PTSD-IV- exposed (32.4%)
earth- CL areas Middle 4565
quake Distress: (31.3%)
CHQ Old >65
(36.3%)

Notes: GAD = generalised anxiety disorder; PTSD = post-traumatic stress disorder; MDD = major depressive disorder; GHQ-12 =
General Health Questionnaire; CHQ = Chinese Health Questionnaire; PTSD-IV-CL = PTSD DSM-IV checklist; ICD-10 =
International Classification of Disease, version 10; DSM IV = Diagnostic and Statistical Manual, version IV; HTQ = Harvard Trauma
Questionnaire; IES Impact of Event Scale; PCL-C = PTSD Checklist, civilian version; DASS-21 = Depression, Anxiety and Stress
Scale 21; PD = post-disaster time between initial exposure and administration of questionnaires Where multiple times are provided, the
study administered questionnaires at those times; NS = not stated. All included studies were of high quality.

The available papers reported on disasters 12 was utilized in both validated English and
occurring between 1984 and 2009. Mental Chinese versions. Multiple measures of symptoms
health outcomes included PTSD, generalized of PTSD, and Major Depressive Disorder (MDD),
anxiety disorder (GAD), depressive symptoms, GAD were used, including both questionnaire and
and psychological distress as measured by the structured clinical interview diagnosis, as identified
General Health Questionnaire (GHQ). The GHQ- in Table 1. There was a mix of both structured

clinical interviews and self-report questionnaires
that have been validated and associated with PTSD,
MDD, and GAD. Details on study quality, type of
disaster, study design, measures used, sample size
and gender, time post disaster, and age cohorts used
are provided in Table 1.
Description of samples
All included studies used the age of 60 or 65 years as
the lower limit for an old or older adult. Some Data suitable for the meta-analysis of effects of
studies further stratified the population into young,
middle aged, older, and old-old adults (Table 1).
Description of exposure
There was variability in how each study measured
exposure to the disaster. Two studies used random
sampling of geographic regions known to be affected
or unaffected by the disaster to evaluate sample
population exposure (Jia et al., 2010; Kun et al.,
2013) (Table 1). Other studies used a self-report
questionnaire where individuals rated the degree of
exposure based on perceived life threat, experience
of loss of life, personal injury, and loss or damage to
property.
PTSD symptoms
Data suitable for the meta-analysis of the prevalence
of PTSD symptoms post disaster were available
for five studies, all of which examined sudden
impact disasters (Ticehurst et al., 1996; Yang et al.,
2003; Jia et al., 2010; Viswanath et al., 2012; Kun
et al., 2013). Random effects comparison identified
significant differences between older adults and
younger adults for PTSD symptoms. Older adults
(OR = 2.11, 95% CI = 1.403.17) were more likely
to experience PTSD symptoms after exposure to a
natural disaster than young adults (Figure 2).
Depressive symptoms
Data suitable for the meta-analysis of effects of
depressive symptoms were available from two
studies (Viswanath et al., 2012; Musa et al., 2014).
There were no significant differences in the risk
of depressive symptoms in older adults compared
with other age groups (OR = 0.71, 95% CI = 0.40,
1.25).
Anxiety symptoms
Data suitable for the meta-analysis of effects of
anxiety symptoms were available from two studies
(Viswanath et al., 2012; Musa et al., 2014). Meta-
analysis identified no difference between older and
younger adults for anxiety disorders (OR = 0.78,
95% CI = 0.47, 1.29).
Mental health of older adults post natural disaster 15
Adjustment disorder
Data were available on the effects of adjustment
disorder symptoms from a single tsunami study
(Viswanath et al., 2012). Older adults were more
likely to experience symptoms of adjustment
disorder after exposure to tsunami event than
younger adults (OR = 1.73, 95% CI = 1.05, 2.86).
Psychological well-being
natural disaster on psychological well-being as
rated by the GHQ were available for three studies
(Ticehurst et al., 1996; Yang et al., 2003; Jia
et al., 2010). No significant difference was identified
between older and younger age groups (OR = 1.41,
95% CI = 0.63, 3.16).
Publication bias
We were unable to test for publication bias, as there
were insufficient studies for any of the outcomes.
Discussion
The current review included studies published
between 1996 and 2014, comparing the mental
health outcomes after exposure to a natural disaster
among younger and older adults. Our results
identified that older adults had an increased risk
of PTSD following natural disasters. Older adults
were 2.11 times more likely to experience PTSD
symptoms and 1.73 times more likely to experience
adjustment disorder symptoms than younger
individuals when exposed to a natural disaster of
sudden onset. These findings are therefore most
consistent with the exposure hypothesis where
older adults are at the greatest risk of worse
outcomes because they are less likely to receive
advanced warnings or evacuate, and experience
greater disruption or perceived loss.
There are a number of well-documented risk
factors for PTSD that may particularly affect older
people. These include loss of livelihood, as older
people may have more difficulty with re-establishing
income and savings; prior exposure to trauma
from previous life events; lack of social support;
female gender; and trauma severity (Brewin et al.,
2000). Older persons have been noted to be over
represented in the casualties in sudden onset natural
disasters (Tanida, 1996; Nishikiori et al., 2006),
implying an increase in exposure to bereavement
(including traumatic bereavement) of peers and
spouses of older people. Older people may also
experience greater difficulty in escaping from
a sudden disaster because of limited mobility.
Women live longer than men, leading to a female
16 G. Parker et al.
Figure 2. (Colour online) Forest plot of mental health outcomes for young and old adults.
gender skew among older people, with female
gender a known risk factor for PTSD (Brewin et al.,
2000).
Further, the prevalence of PTSD most likely
differs from age cohort, country to country, and
region to region. Some research on the baseline
prevalence of PTSD in non-disaster community
samples has identified that as age increases beyond
55 years, the prevalence of PTSD reduces (Creamer
et al., 2001). This suggests that the higher rate
PTSD among older adults following a natural
disaster found in this review is due to the effects of
the natural disaster, and not due to a baseline higher
prevalence when compared with younger adults.
Our findings are at odds with a previous meta-
analysis, where younger age was associated with
greater PTSD symptoms (Brewin et al., 2000).
A possible explanation is that the review did not
directly compare age groups and was not restricted
to natural disasters, with the vast majority of papers
covering motor vehicle accidents, violent crime, or
war. This points to the need to consider each type
of disaster separately and is one of the reasons that
the present study was restricted to natural disasters.
Strengths and limitations
Given the aging of the population, it is increasingly
important to understand the effect of natural
disasters on older adults. To our knowledge, this
is the first published systematic review focusing on
the mental health sequelae for older adults exposed
to natural disaster. Although this result is obtained

from only small number of papers, the outcome
is from an accumulated sample size of over 5,700
participants.
There are several limitations to our study. First,
there are constraints common to epidemiological
studies of disasters in general. Disaster research is
a relatively new phenomenon with a relative lack
of standardized methodologies (Rodriguez et al.,
2006). This diversity in study design was reflected
in the studies we found in our search, particularly
in relation to differences in the type and severity of
disaster, level of dose exposure, intervals between
exposure and assessment, sampling methodology,
and outcome measures. The review identified a
need for standardized validated scales that can be
used not only cross culturally, such as the GHQ,
but have been also validated for older populations,
such as the Geriatric Anxiety Inventory (Pachana
et al., 2007).
This analysis chose to examine specifically the
relationship between older adults and natural
disasters. In the aftermath of 9/11 there have
been significant research investments examin-
ing the response of older adults to human-
made/technological disasters (Bonanno et al.,
2007). Promising results have emerged from this
research supportive of middle-age adult vulnerab-
ilities and older adult resilience. However, it has
been documented that human-made/technological
disasters may have different and more marked con-
sequences than natural disasters on mental health
outcomes (Norris et al., 2002a). For this reason, this
analysis excluded research from significant human-
made or technological disaster events in an attempt
to capture the differential vulnerability of older
adults with natural disasters alone. Our group is
currently undertaking a meta-analysis of the effects
of human-made disaster on older persons.
In common with gerontic research in general,
there was a lack of standardized age range and
common understanding of biological, social, and
psychological factors that contribute to the concept
of old age (Roebuck, 1979). It has been observed
that effects of age on post-disaster outcomes may
vary across cultures even for the same type of
disaster (Norris et al., 2002b), as what constitutes
midlife in one cultural settings may be old in
another. There is no one definition for older age
in some settings as it has been shown to be more
appropriate to use lower cut-off ranges for defining
an older adult to account for cultural variability,
frailty, cognitive, and physical disability differences
(WHO, 2014). Several studies were excluded due
to lower age cut-off for older adults ranging from
4555 years. This was done with the intention to
capture the response of older adults rather than
the adult population alone.
Mental health of older adults post natural disaster 17
A variety of measures were used for diagnostic
case finding. One study (Jia et al., 2010) used a
published symptom checklist, the PTSD Checklist
(Blanchard et al., 1996). Three studies used
unpublished checklists, with two (Yang et al., 2003;
Kun et al., 2013) based on Diagnostic and Statistical
Manual, 4th Edition (DSM-IV) (American
Psychiatric Association (APA), 2000) and one
(Viswanath et al., 2012) based on International
Classification of Diseases, version 10 (ICD-10)
(WHO, 2004). Another (Ticehurst et al., 1996)
used a self-report scale of distress (Horowitz et al.,
1979). There are psychometric issues to consider
when using symptom checklists as surrogates for
diagnostic case-finding, the gold standard being a
semi-structured diagnostic interview.
One study used ICD-10, while four others used
DSM-IV criteria. As these criteria are divergent,
there is a risk of discrepancies on case inclusion
between studies (Peters et al., 1999). The majority
of the scales used in the included studies were
not validated, which may increase the risk of false
positive or false negative cases of PTSD. Even for
validated scales, scales that have been validated in
working-age adults may not necessarily be suitable
for older individuals. This highlights the importance
of considering scales that have been validated not
only cross-culturally but also to account for age-
related variability, as has been done for the Geriatric
Anxiety Inventory (Pachana et al., 2007).
It is possible that the discrepancies between case
finding instruments may have contributed to the
heterogeneity we observed in the meta-analysis.
Although we attempted to take heterogeneity into
account using a random-effects model, our results
should be treated with caution.
Two studies reported a three to four months time
gap between the traumatic event and the screening
for PTSD (Yang et al., 2003; Viswanath et al.,
2012), while another reported a 15-month time
gap (Jia et al., 2010). The other three studies did
not report the time gap. DSM-IV criteria specify a
minimum six-month delay between the traumatic
event and a diagnosis of PTSD (APA, 2000). Any
diagnosis prior to this time would be an acute stress
reaction. Based on these diagnostic criteria, it is
possible that at least two studies were reporting
acute stress reaction rather than PTSD. For studies
with a longer time gap between traumatic event
and screening, there is the possibility that some
cases of PTSD may have spontaneously remitted
(Chapman et al., 2012). However, one study (Musa
et al., 2014) reported on rates of depression, anxiety,
and stress, but not PTSD, in two geographically
distinct regions that were exposed to separate
natural disasters five years apart from each other.
Rates of reported mental health disorders were not
18 G. Parker et al.
significantly different in the two regions. These
differences in time gap may have also contributed to
the heterogeneity of our results, which again should
be treated with caution, even with the use of a
random-effects model.
A final limitation is that we were only able to
identify a small number of studies, and these were
all of sudden impact disasters. This meant that
we were unable to examine whether other types of
natural disaster of slower impact, such as flooding,
had a different effect on mental health outcomes.
In addition, we were not able to assess the grade of
exposure to the traumatic event as only one study
(Kun et al., 2013) provided data on exposure by
age. We were unable to test for gender effects as no
studies reported data on age by gender. The small
number of studies also meant that we were unable
to test for publication bias.
Implications and further directions
Our findings suggest that there is a significant
vulnerability of older adults to experience PTSD
after exposure to natural disasters relative to the
younger adult population. However, these findings
also demonstrate that mental health outcomes such
as depression and anxiety are not automatically
worse for older adults. Indeed, the experience of
some communities is that older people may be an
under-recognized source of resilience and response
in time of crisis (Davey and Neale, 2013). Resources
targeted at personal preparation and mitigation of
impact should therefore be appropriate to all ages.
Appropriate planning could minimize disruption
to disability and health services on which older
people rely, potentially reducing consequent psy-
chiatric morbidity. Consideration should include
design of shelters that are accessible for older
persons, contact systems that enable checks on the
well-being of older adults, and triage systems that
allow rapid reconnection with their family and meet
their basic needs, including physical health.
Further studies on the impact of natural disasters
on older persons are needed. This research
should ideally include diagnosis through semi-
structured diagnostic interview. It should also
include improved standards for degree of exposure
to disaster and latency of investigation. Strategies
to improve comparison across studies in research
specific to understanding age as a risk factor could
be improved by reporting data in standardized age-
bands, controlling for age-relevant variables such
as measures of cognitive and physical performance,
health status, gender, and bereavement status,
and the use of measures validated among older
populations. There is also a need for standardized
validated scales that can be utilized cross-culturally
and have been validated for age-specific differences.
Given the potential confounding effects of gender,
disability, prior trauma, and bereavement, these
will need to be controlled for when analyzing the
contribution of older age to the epidemiology of
disaster-related PTSD.
Further research should aim to understand
that there may be age-specific differences in the
prevalence of PTSD and other target disorders
prior to exposure to natural disasters. Better studies
examining the impact of age among those exposed
to disasters could look to include a control sample
of non-exposed participants from the same country
of relevant ages or provide details of the known
prevalence data for that country. Studies could also
look to link some baseline data for participants in
each age cohort, i.e. those enrolled in other studies
prior to affect to assess post-disaster outcomes.
Conclusions
Recent decades have seen a global rise in the
number of older adults affected by natural disasters,
implying that an increasing number of the older
adults will find themselves in harms way
amid community disruption and distress. Service
providers need to be prepared to meet the mental
health needs of older persons, and be particularly
vigilant after natural disasters to ensure in particular
early detection and management of PTSD.
Conict of interest
None.
Description of authors roles
Authors G Parker, D Lie, and D Siskind designed
the study and developed the search protocol with
input from B Raphael and D Crompton. G Parker
conducted the systematic review with assistance
from D Siskind, D Lie, and M Martin-Khan. G
Parker extracted data with assistance from S Kisely
and D Siskind. G Parker and S Kisely analyzed the
data. D Lie, D Siskind, G Parker, and S Kisely
wrote the discussion with input from B Raphael and
D Crompton.
Supplementary Material
For supplementary material accompanying
this paper, visit http://dx.doi.org/10.1017/
S1041610215001210

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