Exercise developed and produced by:

Johns Hopkins Center for Civilian Biodefense Studies

National Memorial Institute for the Prevention of Terrorism

Office of Justice Programs, National Institutes of Justice, U.S. Department of Justice

The Alfred P. Sloan Foundation

The Frail and the Hardy Seniors of 9/11: The Needs of Older Americans

Transcript  [Listen to this talk]  [View the slides]

DR. SCHOCH-SPANA: So I want to turn the floor over to Myrna Lewis who is an accomplished scholar and practitioner in gerontology. She's an Assistant Clinical Professor in the Department of Community and Preventive Medicine at Mount Sinai School of Medicine. She's a member of the United Nations Committee on Aging, and is going to speak to us today about both the needs and the contributions of older Americans in emergencies. Thanks, Myrna.

DR. LEWIS: Good morning. It's an honor to be here with all of you. And it occurred to me that what I'm going to be talking about applies not just to older people, some of whom may be disabled, but it also applies to the disabled population of all ages, so if you will keep that in mind as we go along.

I'm going to be talking about the World Trade Center and its impact on the older population in that immediate area. There were two distinct impressions from those of us working during the World Trade Center period, that the majority of older New Yorkers held up extremely well in the chaos of September 11th and its aftermath. However, having said that, a significant group of frailer older people faced unique situations that compromised their ability to manage, and this was especially true for those living within that so-called frozen zone or red zone that surrounded the Trade Center area. And I should explain that this area was blocked off by police barricades for a number of weeks. And initially, only residents or people who could prove that they worked in the area, or people involved in rescue, recovery and cleanup were allowed access.

A little bit about the volunteer experience of many of us. Many New Yorkers, like myself, volunteered our services even though we had no formal training in disaster work. I came to it as a mental health professional, a gerontologist, a teacher, but not a trauma specialist. My experiences following 9/11 occurred first on the Missing Persons Hotline, then in the red zone surrounding Ground Zero, and the eventually work within Ground Zero itself. And finally, something that none of us I don't think have mentioned so far, and that was the air crash that we had about a month later, Flight 587 going to the Dominican Republic. There were also numbers of us involved in both the family work with that, and the neighboring community where the crash occurred.

I'll limit my remarks today to observations about older people as we encountered them in the red zone around Ground Zero, and the pertinent background information. The pertinent background information is that federal estimate was that about 6,300 people aged 65 and older were living in that area within a few blocks of Ground Zero, and maybe 18,000 older people in the effected areas below Canal Street, which is the location of the initial red zone barricade.

The communication breakdowns were the most immediate problem. Older people were very affected by this. The telephone and television cables were destroyed as the towers fell. Disruption of regular phone service was virtually universal. Very few older people had cell phones. Those who did found them unreliable the first few weeks. The phone lines were jammed, the electricity was out, the phone recharging was impossible. Events like the reopening of the Stock Market and Wall Street on day five began even further to overwhelm cell phone capacity. TVs, plug-in radios, computers were inoperable. Mail and newspaper delivery were discontinued for most of the red zone in the aftermath of the attacks, so the result was that many older people had enormous difficulty just finding out what was happening, and equal difficulty in calling their friends, their family, their health care providers.

And one example I'll give you is an older woman who I found clutching another older woman who was sobbing. She had run out of her prescription medication. All the local pharmacies had closed down. The women had no phone, no way to reach their doctor or the pharmacist, and so on impulse we took them a couple of blocks through police barricades, rescue vehicles, piles of relief supplies to an Army medical unit that was bivouacked in a tent. And there a very kindly Canadian male nurse gave the woman an emergency supply of medicine. And she gone in sobbing, and she came out smiling two minutes later, so that simple intervention put her back on track. And we heard her later regaling the rest of the people in her housing unit about where they could go and get their prescriptions refilled.

This was a week after the attack, I might add. Eventually, the Visiting Nurse Service and Red Cross nurses and others began providing emergency prescription service, but it took some time for all of this to be established.

Isolation was another issue. The majority of older people lived alone or with an older spouse, significant number of these, especially the emotionally and the mentally frail remained hidden behind the doors of their apartments and houses. They were located only after relief workers and volunteers began going door to door checking on every resident. This occurred, interestingly enough, only in the second week after the attacks. There was some initial work done, but solidly going through these buildings didn't really take place until the beginning of the second week.

Disaster relief organizations that ordinarily would have been immediate responders were overwhelmed. Bridges, tunnels, airports were closed, so the logistical problems of setting up service was unprecedented. The Manhattan agencies that typically provide services to the frail and the disabled elderly were caught unaware. Many had no disaster plans for their staff or their clientele. And furthermore, personnel could not get through the police barricades, nor could they phone their clients.

The separation from home health aides, homemakers and home-bound services like Meals on Wheels was universal at first. Permits, special IDs and proof of residence or work in the red zone was necessary, so that it took a couple of weeks for many workers to begin acquiring these necessary documents, a very important point.

In addition, numbers of elder care workers were hesitant to enter what was possibly a contaminated area, and some were simply afraid to go anywhere near the Ground Zero zone. The results were that a number of older persons were found in deteriorated conditions with dwindling food, water, medical supplies. Some required immediate medical care, emergency medical care. The Visiting Nurse Service reported incidents of heart attacks and strokes that appeared to be directly related to 9/11. Some older people were emotionally traumatized by fear of not knowing what was happening. They had no access to information, or what would happen to them in the next days and weeks. Those who suffered from prior anxiety and depression were especially vulnerable to the exacerbation of the psychiatric symptoms.

Evacuation issues. A number of older people were evacuated because of suspected structural damage to their apartments or their homes, or dangerous breakdowns in the utilities. Some of their experiences were striking examples of survival. I met two women, for example, in their 80s who had been part of the larger exodus fleeing the Trade Center area on the first day. They described how they ran north to midtown in their slippers and their nightgowns, and a week later they were proudly telling us their stories of their ingenuity of how they stopped to buy shoes and clothing along the way. They borrowed cell phones to call their relatives, and they checked into a midtown hotel where they could have access to television and see what the mayor was saying.

There were also less inspiring stories. The New York Times reported instances of younger able-bodied folks commandeering the evacuation buses, leaving older people with canes and wheelchairs behind. Evacuated elders worried about their pets, their plants, their treasured possessions. It was some time before volunteers were able to respond to requests to feed or move stranded animals, but there's an interesting reversal here too, that some lucky animals were rescued within 24 hours, far before many of the frail elderly by volunteer animal lovers moving in very quickly.

We also located elders who had declined evacuation. One man refused to move his wife who had Alzheimer's Disease. He thought it was too big a stress for her. Another couple in their 80s chose the security of their apartment over the chaos in the streets outside, even when they had a full view of the smoking towers.

There were special problems for the hearing impaired. A number were evacuated without their hearing aide. Those around them were too preoccupied, too involved to notice that they had hearing difficulties, so they missed the emergency information usually relayed verbally. They had to rely on their own wits as they told us. Those with hearing impairments who were still in their homes reported that closed news captioning disappeared for a period of time on those few televisions that were still working. Once electricity was restored, a few of the fortunate elderly with computers were able to use e-mail and the Internet to find out what was happening. And that was one of the most reliable sources, as long as they had access.

Air and water quality was an issue. The alkaline air pollution from the explosions and the fires were a continuing concern, especially for older people with Emphysema or any other breathing difficulties. The New York physicians have reported an immediate marked increase in lung problems. A year later now, however the New York Academy of Medicine reports a surprisingly few long term problems for the general population. However, in my own institution, Mount Sinai, the clinic for Ground Zero workers themselves are finding some major and long-lasting serious consequences.

For a time, the drinking water wad also worrisome down in the red zone with concern that water was backing up from the sewers to some apartment buildings. Many elderly went for weeks with no hot water in certain apartment complexes.

Those older people who witnessed people jumping off of the Trade Center towers were especially traumatized, obviously. Some saw these incidents from the street, while other viewed the Trade Center from their apartment windows or balconies just a couple of blocks away. Sleep disturbances, anxiety, grief were especially common among this particular group.

The search for ongoing mental health services for these and other elderly affected by the attack revealed the scarcity of such services in New York City. The exception, of course, was the emergency counseling directly connected to the Trade Center attacks. However, these were often hastily put together services that were not designed with the special needs of the population in mind.

Now I come to what I consider to be the sturdy majority, and I'll give you a few vignettes. I want to emphasize again, the majority of older New Yorkers whom I met showed remarkable resilience in the face of overwhelming circumstances. There was the older woman in the Red Cross in the red zone who put on her gold star mother pin. Some of you from World War II remember that. That's the pin that was given to mothers who lost a son in World War II. She walked with this pin on into the local fire station to hug the firefighters and to reassure them that she understood their losses, and she told them, "You'll survive."

There was also humor and humorous situations. There were three older friends we found sitting in a park in the midst of dump trucks, cranes, rescue vehicles, and they were busy planning their weekly bus trip to gamble in Atlantic City. And we said what are you guys doing, and they said, "Boy, do we need a break."

There was a 65 year old with a bad hip and a full-time job teaching school in Harlem. On the day the schools reopened I saw her limping her way to find an undamaged subway stop far from her house, and she was on time for school.

The older woman with eight cats and two dogs who lived alone, she had managed to make friends with the veterinarians who were taking care of the Ground Zero rescue dogs. These vets were inundated with dog food from all over the country, piles and piles of dog food, so she charmed them and she managed to connive and commandeer enough surplus dog food to take care of her animals for a year or more.

There was the Italian born widow who had been a little girl during the Nazi invasion of Italy. She hung a huge American flag from her balcony on the 30th floor facing Ground Zero. She said to me, "This isn't so bad. I've seen worse than this before". And finally, the 95 year old very tiny fragile looking African American women out on the street with her shopping cart after returning from a nine day evacuation, smoke was still pouring out of the buildings behind her. Meanwhile, she was busy buying her groceries for supper. When I asked how she was doing, she gave me a big smile and she said, "I'm just fine. Glad to be home again."

So what have we learned from these sturdy and frail elderly and does this apply to the threat of bioterrorism? Communication is critical. Older people need to know what is happening, and how to respond. Battery radios and cell phones work the best in New York. It's unclear that that will always be the case, particularly with cell phones if cell phone use continues to explode and increase. People need guidance on where to call for immediate information, or where to tune their battery radios for emergency instructions.

A recommended list of emergency supplies for the home would be useful. For example, battery radios, three day supplies of water, flashlights, a list of older people's prescriptions and their doctors, and a list of their relatives and their health care providers.

Organizations like FEMA, the Red Cross, the Salvation Army and local health and aging service organizations need to develop specific coordinated plans to locate and assist the older people and the disabled, rather than relying as we had to in New York on ad hoc systems. And when we interviewed some of the representatives of these organizations, we learned they had really no formal plans before 9/11 to reach these populations.

The coordination of volunteers, you've heard other speakers mention this, responding to the disaster is very necessary. Some community organizations for older people were flooded with surplus helpers. Others were begging and crying for more.

There's a need to find some way to identify the frail and the disabled, and the isolated elderly who are not connected to any service organizations and, therefore, especially vulnerable in an emergency. Prescription drugs are a special concern, since most people have at most a 30 day supply or less, many have less.

And finally, I want to emphasize once again that sturdy older population, particularly in view of our discussions of bioterrorism. They could be enlisted and trained as volunteers to serve as a resource in helping not only the frail and disabled, but other populations, as well.

There was an interesting article just yesterday in the Wall Street Journal that was talking about the granny patrol, the Florida cops recruiting elderly volunteers. One man had been volunteering for 15 years as a volunteer cop, cruising around in his cruiser looking for trouble. And now at 95 years of age, his police chief called him in and said he needed to have him another 10 years.

There's a senior corps, a federal service program that is now indicating that hundreds of police organizations around the country are beginning to enlist the elderly, and I think it's a long overlooked group of citizens who are well experienced, and very eager to serve and have the time to serve, so something that we should be seriously considering in looking at extra resources for bioterrorism protection.

Finally, I want to bring to your attention a brief which has been prepared out of our experiences with 9/11, some beginning thoughts on emergency preparedness for older people. I happen to have about 20 copies here if anybody is interested, but Monica told me they would be up on the website, so thank you very much.

DR. SCHOCH-SPANA: In this business sometimes I think the planets align and allow me to meet someone like a Myrna Lewis, who can speak to this type of issue. I met her at a wonderful conference at the International Longevity Center in New York, and she shared some of these anecdotes, and I thought we need to bring this type of information to this audience, so thank you, Myrna. That was wonderful.

[return to top]