Katsutoshi Furukawa ^1,2* Aiko Ishiki ² Emiko Kurosawa ² Daiki Narai ² Yuta Sakai ² Youtaro Arima ² Akinobu Aihara ² Toshihiro Yamagata ² Yoshihisa Katsuta ² Shigeto Mashiko ² Tomoya Oizumi ²

• ¹ Tohoku University, Sendai, Japan
• ² Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan

Traditionally, New Year's Day is a joyous day for family gatherings for most Japanese.Many young workers and students usually head home from urban districts where they work to their rural homes during the new year break. On Monday, January 1, 2024, at approximately 1610 h, an earthquake with a magnitude of 7.6 and a tsunami hit the Noto Peninsula in Japan (1). More than 200 casualties were reported so far. Although the percentages of the population over 65 years are 9.3% and 28.6% worldwide and in Japan, respectively, the Ishikawa prefecture, where the Noto Peninsula is located, has a much higher aging rate of 30.1%, as well as the Suzu City at 51.4%. Sixty% were nursing care required in addition to that more than 80% were older people in the evacuees at the Ishikawa Sports Center in Kanazawa. This was the second earthquake and tsunami which hit a super-aged society since the East Great Earthquake in Japan on March 11, 2011 (2). Here, this narrative review described about disaster impact, preparedness, and response on older people.Disaster Responses:(A) Acute responses: Immediately after the earthquake and tsunami occurred, several disaster-relief teams, such as the Disaster Medical Assistance Team, responded to the area of the Noto Peninsula to rescue victims and to provide emergency medical care. Lives saved from a disaster must not be lost afterwards due to environmental problems, emphasizing that disaster-related secondary deaths should be prevented. It was reported that the majority of the disaster-related deaths included older people (3). (B) Health problems for the older people: Older people often have chronic illnesses that require them to take medication. They may also have a weak immune system and are at high risk of infection. They tend to develop or even die of stroke, heart failure, thrombosis, or infectious diseases due to their inability to obtain water and food of good quality and have to take shelter in cold facilities with poor hygiene during times of disaster (5). What we stated confirmed the extracts from literatures, such as older people have a significantly high risk to have pneumonia (6). (C) Prevention of disorders: To prevent the worsening of chronic diseases, hypothermia, infectious diseases, and other health conditions, the following measures are necessary: appropriate medications, hydration, nutritious foods, exercise, oral care, proper hygiene, and warm shelter (7). In different facilities, patients with respiratory infections, such as influenza and COVID-19, and gastrointestinal infections, such as norovirus, were also reported (8). Therefore, precautions also need to be put in place for people who are staying outside the evacuation shelters, such as at their homes or in their cars. Evacuation shelters are overcrowded; therefore, people may not be able to practice certain disease preventative measures, such as washing their hands or gargling with water (9). Their physical strength and immunity may continue to decline, especially as they sleep on mats on cold floors. In these situations, it is considered desirable to move the residents to secondary evacuation facilities, such as hotels, public housing, or rented housing as soon as possible (10). (D) Relocation stress:Many people may feel reluctant to move to a secondary evacuation site since this implies leaving behind their homes and properties. These result in a decline in physical strength, motivation, cognitive function, and an inability to perform daily activities, leading to further "relocation stress," observed as falling more easily, becoming more susceptible to pneumonia and infections, and experiencing mental health problems, which can lead to disaster-related deaths. Therefore, we must place ourselves in an environment where we can provide sufficient support, working with the residents in generating favorable plans (11). Quantitatively, older adults are significantly more likely to die in the aftermath of disasters. For example, studies have shown that older adults account for a disproportionate share of disaster-related fatalities. In Hurricane Katrina, older adults made up about 70% of the fatalities, despite being only a small percentage of the population (12). The 2011 Japan tsunami saw a higher incidence of hypothermia and dehydration among older survivors (2). Qualitatively, older adults are more likely to be displaced from their homes and face challenges in accessing medical care. Research has shown that after the 2010 Haiti earthquake, older adults faced significant barriers to accessing healthcare services, with only a fraction receiving the necessary follow-up care (13). For older people, changes in their living environment and relationships with the people around them can cause various harm to both their physical and mental functions, even if they were previously healthy (14)(15)(16). To prevent relocation stress, the responders must keep these risks in mind, encouraging family members and others from the community to talk and interact with older people. It may also help older people when they continue to move and exercise, as well as resuming their activities of daily living. It is important to take a steady approach, such as ensuring that patients are being treated properly and encouraging them to seek consultation with a medical professional promptly if there are any concerns, such as changes in their physical condition (17,18). We think that understanding of "relocation stress" is one of the biggest gaps in the disaster responses because some people including medical stuff have not fully understood the importance and risks of "relocation stress" yet. We believe that two research efforts are significantly important as follows, (i) very careful health checkups and (ii) to investigate which interventions would improve the health of elderly people most efficiently. Our conclusions were endorsed by the Japanese Geriatrics Society. We need to exert an effort to support the overall wellness of the individuals affected by the disaster, including their physical and mental health, and provide long-term support for reconstruction.