Health Emergency and Disaster Nursing (2015) 2, 23–27

CASE REPORT

Adaptation of the elderly in shelters and temporary

housing after the Great East Japan Earthquake:
A focus on the interaction with their living environments
Ayumi HASHIMOTO, Misako MIYAZAKI and Mina ISHIMARU
Department of Community Health Nursing, Chiba University, Graduate School of Nursing, Chiba, Japan

Abstract
Aim: The aim of the study was to clarify the adaptation of the elderly in shelters and temporary housing
after the Great East Japan Earthquake, and provide new understanding about the elderly and their living
environments.
Methods: The study used a case study design. The participants were nine elderly people, survivors of the Great
East Japan Earthquake. They were residents of temporary housing with experiences of living in shelters. Semi-
structured interviews were conducted about living conditions, coping with difficulties, and enjoyable aspects of
life. The interview period was from April to August 2013. Data from the interviews were analyzed qualitatively
and inductively to describe the changes in the ideas and behavioral patterns of the elderly, and interactions with
their living environments.
Results: The ideas and behavioral patterns of the elderly changed through six phases; they were: “Recognize
the reality of being a survivor and living life in shelters”, “Try to recreate their way of life before the disaster”,
“Have difficulties living with the new environmental changes”, “Form a foundation for their new life”,
“Realize they can cope with environmental changes”, and “Be confident that they can manage their lives”.
Interactions with their living environments included interaction with family, evacuees, neighbors, and
adjustment to daily life.
Conclusions: The elderly have become more conscious of their way of life after the disaster through six
phases. Community health nurses need the ability to help isolated elderly people to have chances of meaningful
interaction with others, and to encourage the elderly to view their ability to cope with difficulties positively.
Key words: adaptation, elderly, environment, natural disasters, shelter

separates from the community (Kuroda & Kanzaki,

INTRODUCTION
The elderly have been thought to be vulnerable to
environmental changes after natural disasters. They are at
high risk of disaster-related death, a worsening of chronic
disease, and disuse syndrome (Kunii, 2012). Lower
quality of life associates with being temporarily housed
(Ardalan et al., 2011), which lacks life infrastructure like
transportation, shopping, amusement (Gotou, 2012), and
Correspondence: Ayumi Hashimoto, Kyoto City Nishikyo Public
Health Center, 1-2 Katsuraushitora-cho, Nishikyo-ku, Kyoto 615-
8083, Japan. Email: ahashimoto140@gmail.com
Received 28 March 2014; accepted 24 July 2014.
2012).
In contrast, the elderly contribute to reconstructing
networks within the population (Senda, 2012), and they
live independently after natural disasters. Family and
community support facilitate their posttraumatic growth
(Calhoun & Tedeschi, 1999) and resilience (Heppenstall,
Wilkinson, Hanger, Dhanak & Keeling, 2013), but few
studies have focused on the adaptation of the elderly,
including an interaction with their living environments.
In particular, not much attention has been paid to
physically healthy elderly people.
The aim of this study was to clarify the adaptation of
the elderly in shelters and temporary housing after the

Copyright © 2014 Disaster Nursing Global Leader Degree Program

A. Hashimoto et al.
Great East Japan Earthquake, and provide new under-
standing about the elderly and their living environments.
In this study, the definition of ‘adaptation’ is the
change in the ideas and behavioral patterns of the elderly
with regard to their way of life for self-realization,
resulting from interaction with their living environments.
And the definition of the ‘living environments’ is the
physical, economic, interpersonal and cultural living
conditions in shelters and temporary housing.
METHODS
Participants
This study used a case study design. The participants
were nine elderly people who were survivors of the Great
East Japan Earthquake. They were residents of temporary
housing with experiences of living in shelters. Demo-
graphic details are shown in Table 1. They did not
require long-term care. They lived in a rural area
damaged by a tsunami. Their houses were partially or
completely destroyed. They did not lose family members
in the disaster. The researchers asked public health
nurses, who worked in a city damaged by the earthquake,
to recommend participants.
Data collection
Semi-structured interviews were conducted to obtain
information about living conditions, aspects of coping
with difficulties, and enjoyable aspects of life experi-
enced over a period of 29 months from the time of the
earthquake. Interviews were conducted once or twice per
person in their houses or at a public health center. The
average time was 78 min (54–95 min). Interview content
was recorded on an IC recorder which was made by
olympus in China, and by field notes that were taken by
Table 1 Demographic details of participants (n = 9)
Demographic n
Gender
Male 3
Female 6
Age
60s 3
70s 3
80s 3
Household
Single 3
Couple 4
Two-generation 2
24
Health Emergency and Disaster Nursing (2015) 2, 23–27
the researchers, with the participants’ consent. The
interview period was from April to August 2013.
Data analysis
“The ideas and behavioral patterns of the elderly” and
“influential living conditions” were extracted from inter-
view transcriptions in each case. The way of life of the
elderly, which was detailed within the “The ideas and
behavioral patterns of the elderly” section of the inter-
view, was described clearly. The data were categorized
according to similarities, considering the passage of time.
To clarify the adaptation process of the elderly, the
categories were reviewed and integrated into phases. The
definition of a ‘phase’ is one of the stages of change in
the ideas and behavioral patterns for self-realization of
the elderly.
The experiences of the elderly with regard to
interaction with their living environments were described
in each phase. The contents of interaction were described
clearly.
The results of each case were integrated into phases,
and types of interactions with their living environments
were described.
Ethical consideration
This study was approved by the Ethical Review
Committee of the Graduate School of Nursing, Chiba
University. Informed consent, right to withdraw without
consequence, and anonymity were preserved.
RESULTS
The ideas and behavioral patterns of the elderly changed
through six phases. There were four types of interactions
with their living environments. Figure 1 shows the
adaptation of the elderly.
Phases of the ideas and behavioral patterns of the
elderly
Based on the results provided by the nine participants,
phase 1 and phase 2 occurred in shelters, and phase 3 to
phase 6 occurred in temporary housing. Regarding case E
and case F, phase 3 occurred in their families’ house.
All participants experienced “Phase 1. Recognize the
reality of being a survivor and living life in shelters”,
including “Be disconsolate about becoming a survivor at
the end of life” (Case H). Five participants experienced
“Phase 2. Try to recreate their way of life before the
disaster”, including “Keep in contact with fishing
companions by going to the beach from the shelter every
morning” (Case E). Seven participants experienced
Copyright © 2014 Disaster Nursing Global Leader Degree Program
Health Emergency and Disaster Nursing (2015) 2, 23–27
Figure 1 The Adaptation of the elderly in Shelters and Temporary Housing. Ideas and behavioral patterns of the elderly changed through six
phases; a result from four types of interactions with their living environments.
“Phase 3. Have difficulties living with the new environ-
mental changes”, including “Feel that trying to cope with
empty life in temporary housing is futile” (Case B). All
participants experienced “Phase 4. Form a foundation for
their new life”, including “Be encouraged to live with
local companions” (Case F). Eight participants experi-
enced “Phase 5. Realize they can cope with environ-
mental changes”, including “Find pleasure in the limited
environment in temporary housing” (Case B). Five
participants experienced “Phase 6. Be confident that they
can manage their lives”, including “Know what is
important for oneself and be satisfied with the present
life” (Case C).
Interaction with family
The elderly shared problems concerning living conditions
with their family (Phase 1). They felt a responsibility to
protect the health of a family member who contracted
an illness in the shelter (Phase 2). In temporary housing,
they understood the situation, which was that family
members could not live as they did before the disaster.
Some family members living apart did not visit them
(Phase 3).
Copyright © 2014 Disaster Nursing Global Leader Degree Program
Adaptation of the elderly after disaster
“I am not a valuable person for my son because he
does not visit my temporary house even though he lives
nearby. I feel lonely.” (Case I)
They enjoyed time with their families, getting away
from life in temporary housing (Phase 4). They supported
family members to live life to the full (Phase 5).
“My mother’s only pleasure in temporary housing is
shopping after she sees the doctor. I am glad to see her
enjoyment, so I always accompany her.” (Case D)
Finally, they shared a vision of the future with their
families (Phase 6).
Interaction with evacuees
The elderly knew the living conditions of other evacuees
in shelters. The elderly spent time with evacuees who
sympathize with their sufferings (Phase 1). They helped
physically handicapped or isolated evacuees based on
their volunteerism (Phase 2). In temporary housing, they
had difficulties becoming familiar with residents or local
customs (Phase 3). Being considerate of other residents’
hardships (Phase 4) and communicating in an ordinary
manner (Phase 5) led them to have confidence in their
relationships with the residents. They supported the
25
A. Hashimoto et al.
residents who have difficulties in life (Phase 6).
“I told a single mother with growing children about
events held in the temporary housing. Especially, the
cooking events were very useful for her.” (Case G)
Interaction with neighbors
The elderly were generally shown little consideration
from local people who lived near shelters or temporary
housing. However, they were treated kindly by some
nearby friends such as hobby companions (Phase 1), who
contacted them frequently (Phase 2).
“I went to the beach from the shelter every morning to
meet my fishing companions who cared about me. I felt
relieved when I talked with them.” (Case E)
In temporary housing, the elderly lost contact with
neighbors that they had before the disaster. The elderly
who stayed in their families’ house did not have contact
with new neighbors (Phase 3). They were encouraged by
nearby friends (Phase 4), and resumed relationships with
neighbors from before the disaster as much as they could
(Phase 5). They came to communicate with the local
people not as an evacuee (Phase 6).
“Local people who did not suffer from the disaster
often consult with me about their worries. They rely on
me.” (Case G)
Adjustment to daily life
In shelters, the elderly felt themselves to be powerless
because they were supported by others with food and
money (Phase 1). They gave up the idea of rebuilding
their houses because of unstable economic conditions
(Phase 2). In temporary housing, they had patience with
inadequate housing conditions of soundproofing and
temperature. Routine became irregular, and the elderly
went out actively, trying to give themselves an aim to life
(Phase 3).
“Life in temporary housing is boring. I go out by
bicycle almost every day, but I am wasting my time.”
(Case B)
The elderly expected restrictions in temporary housing
to be solved when they moved to new houses. They felt
grateful that they could make decisions regarding food,
clothing and shelter themselves (Phase 4). They resumed
daily work relevant to their way of life, which was
interrupted by the disaster (Phase 5), and were content to
continue on with it (Phase 6).
“I resumed walking along the seaside 2 years after the
disaster. Familiar scenery of the local sea is always a
consolation to me.” (Case E)
26
Health Emergency and Disaster Nursing (2015) 2, 23–27
DISCUSSION
Characteristics of the adaptation of the elderly in
shelters and temporary housing
Six phases of the ideas and behavioral patterns of the
elderly suggest that the elderly have become more
conscious of their way of life after the disaster.
In “Phase 1. Recognize the reality of being a survivor
and living life in shelters”, the elderly are shocked about
life as a survivor, but they gradually feel comfortable
with the mutual support of evacuees. This phase overlaps
the “honeymoon phase”, to which group identification
contributes (Raphael,1986).
In “Phase 2. Try to recreate their way of life before the
disaster”, the elderly find people who remind them of
their lives before the disaster, like old friends or evacuees
who need their helps.
In “Phase 3. Have difficulties living with the new
environmental changes”, most of the elderly find it hard
to accept their life in a completely different environment
from the past. They face “a psychosocial theme in old
age, integrity versus despair” (Erik, Joan & Helen, 1994).
In “Phase 4. Form a foundation for their new life”,
the elderly experience relief when they are able to share
their feelings with family, other evacuees or neighbors.
Accepting the limitations in their new life is a way that
the elderly are able to reduce their stress caused by the
unfamiliar living environments.
In “Phase 5. Realize they can cope with environmental
changes”, the elderly find positive aspects in their new
life, and make efforts to live in the best possible way
under the circumstances. Trauma survivors have the
strength of endurance, acceptance, expressiveness, and
support seeking (Calhoun & Tedeschi, 1999).
In “Phase 6. Be confident that they can manage their
lives”, the elderly strengthen their own identities. Elderly
survivors have the ability of self-determination, which
includes the management of living alone (Nakayama,
2002).
Community-care practices to promote adapta-
tion
Community health nurses can promote the adaptation of
the elderly in disaster-stricken areas by managing the
living environments.
In this study, the elderly are encouraged by people who
respect their way of life, including their family, evacuees
or neighbors. In addition, supporting others enables the
elderly to lead useful lives. Serving others helps survivors
to have a better understanding of the meaning and values
of life (Jang & Wang, 2009). Therefore, it is important for
Copyright © 2014 Disaster Nursing Global Leader Degree Program
Health Emergency and Disaster Nursing (2015) 2, 23–27
community health nurses to help isolated elderly people
to have chances of meaningful interaction with others.
Furthermore, it is found that the elderly try to adjust to
daily life through their own efforts, but sometimes they
feel that their efforts are in vain. The vulnerability of the
elderly to disasters is related to their impaired physical
mobility or social limitations (Lauren, Deana, Chien-
Chih, Samuel & Joseph, 2002). However, this study
suggests that the elderly are adaptable if they value their
own efforts. Therefore, community health nurses need the
ability to encourage the elderly to view their ability to
cope with difficulties positively.
Suggestions for further studies
The living environments include local cultures and
customs, which have effects on the adaptation of the
elderly. Further studies need to be conducted in areas
with different cultural characteristics. To improve the
quality of life of the elderly, we intend to clarify more
practical ways of facilitating interaction between the
elderly and the living environments after natural
disasters.
ACKNOWLEDGMENTS
The authors thank the participants who took part in this
study.
AUTHORS, CONTRIBUTIONS
A.H. contributed to the conception and design of this
study; A.H. performed the analysis and drafted the
manuscript; M.M. and M.I. critically reviewed the
manuscript and supervised the whole study process.
DISCLOSURE
The authors declare no conflict of interest.
Copyright © 2014 Disaster Nursing Global Leader Degree Program
Adaptation of the elderly after disaster
REFERENCES
Ardalan, A., Mazaheri, M., Vanrooyen, M., Mowafi, H., Nedjat, S.,
Holakouie Naieni, K. et al. (2011). Post-disaster quality of life
among older survivors five years after the Bam earthquake:
implications for recovery policy. Ageing and Society, 31(2),
179–196.
Calhoun, L. G. & Tedeschi, R. G. (1999). Facilitating post-
traumatic growth: A clinician’s guide. London: Lawrence
Erlbaum Associates.
Erik, H. E., Joan, M. E., & Helen, Q. K. (1994). Vital involvement
in old age. New York, London: W. W. Norton & Company.
Gotou, J. (2012). Construction of society where the elderly live
with ease. Health Care, 54 (1), 26–30. (in Japanese)
Heppenstall, C. P., Wilkinson, T. J., Hanger, H. C., Dhanak, M. R.,
& Keeling, S. (2013). Impacts of the emergency mass
evacuation of the elderly from residential care facilities after
the 2011 Christchurch earthquake. Disaster Medicine and
Public Health Preparedness,7 (4), 419–423.
Jang, L. J. & Wang, J. J. (2009). Disaster resilience in a Hakka
community in Taiwan. Journal of Pacific Rim Psychology, 3
(2), 55–65.
Kunii, O. (Ed.). (2012). Public health in time of disasters. Tokyo:
Nanzando. (in Japanese)
Kuroda, Y. & Kanzaki, H. (2012). Care in shelters and temporary
housing. Tokyo: Japanese Nursing Association Publishing
Company. (in Japanese)
Lauren, S. F., Deana, B., Chien-Chih, L., Samuel, B., & Joseph,
A. B. (2002). Frail elderly as disaster victims: Emergency
management strategies. Prehospital and Disaster Medicine, 17
(2), 67–74.
Nakayama, K. (2002). Research on the self determination of elderly
victims of the great Hanshin-Awaji Earthquake —Centered on
elderly citizens living alone in eternal apartment compleyes
after four and half years—. Journal of Japan Academy of
Community Health Nursing, 4 (1), 69–75. (in Japanese)
Raphael, B. (1986). When disaster strikes. How individuals and
communities cope with catastrophe. New York: Basic Books.
Senda, M. (2012). The eldery living in shelters and temporary
housing. Journal of the Japan Academy for the Prevention of
Elder Abuse, 8 (1), 20–22. (in Japanese)
27